Frueh B C, Brady K L, de Arellano M A
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, USA.
Clin Psychol Rev. 1998 Apr;18(3):287-305. doi: 10.1016/s0272-7358(97)00087-1.
We critically review the empirical literature on racial differences in epidemiology, psychopathology, and treatment outcome in combat veterans with posttraumatic stress disorder (PTSD). Although there is a body of literature pertaining to various aspects of race and combat-related PTSD, much of the writing is conceptual in nature and based on single case or anecdotal reports, and there is a striking paucity of rigorous empirical findings. Furthermore, despite the prevailing zeitgeist and clinical lore, the limited extant empirical evidence suggests that veterans of different races are more similar to each other than they are different when it comes to the clinical manifestation and response to treatment of combat-related PTSD and associated features. The one area where clear differences exist is in epidemiological rates of PTSD, where minority combat veterans (i.e., Blacks and Hispanics) have been shown to have higher absolute rates of the disorder. However, secondary analyses within the existing epidemiological studies suggest that differential rates of PTSD between racial groups may be a function of differential rates of traumatic stressors and other pre-existing conditions. This finding, in combination with the general paucity of empirical data and certain methodological limitations, significantly moderates the conclusions that should be reached from this body of literature. Further research is needed before we can consider our knowledge in this area complete. A number of conceptual and methodological issues are discussed in order to highlight future research directions.
我们批判性地回顾了关于创伤后应激障碍（PTSD）退伍军人在流行病学、精神病理学及治疗结果方面种族差异的实证文献。尽管有一系列文献涉及种族与战斗相关PTSD的各个方面，但大部分论述本质上是概念性的，且基于单个案例或轶事报告，严格的实证研究结果极为匮乏。此外，尽管存在普遍的时代思潮和临床经验，但现有的有限实证证据表明，在与战斗相关的PTSD及相关特征的临床表现和治疗反应方面，不同种族的退伍军人彼此之间的相似性大于差异性。存在明显差异的一个领域是PTSD的流行病学发病率，少数族裔战斗退伍军人（即黑人和西班牙裔）的该疾病绝对发病率较高。然而，现有流行病学研究中的二次分析表明，种族群体之间PTSD发病率的差异可能是创伤应激源及其他既有状况发病率差异的一个函数。这一发现，再加上实证数据普遍匮乏以及某些方法学上的局限性，显著缓和了从这一系列文献中应得出的结论。在我们认为该领域的知识完备之前，还需要进一步研究。为突出未来研究方向，我们讨论了一些概念性和方法学问题。
