Risk of Trauma Exposure and Posttraumatic Stress Disorder: An Examination of the Separate and Combined Effects of Race, Gender, and Social Context.

Posttraumatic Stress Disorder (PTSD) is a debilitating psychiatric disorder that affects approximately 7.7 million U.S. adults. A central criterion of a PTSD diagnosis is an exposure to an external traumatic stressor. Yet, surprisingly little research has focused on the role of the larger social context that shapes these exposures. Most PTSD research focuses on the separate effects of individual-level risk factors like gender and race, while the effects of macro-level factors like poverty are primarily used as control variables in regression models. Little is known about how the larger structural environment, and factors like racial residential and economic segregation impact PTSD risk, or whether examining the combined effects of risk factors like race, gender, and poverty might shift our understanding. The primary aims of this dissertation were two-fold: First, a stratified analysis was conducted to provide a fundamental understanding of race differences in trauma exposure/PTSD risk by examining within-group effects of gender, race, and poverty status, both alone and in combination, and testing for between-group differences in these effects. Second, discrete-time analysis and life-tables were used to examine the relationship between PTSD risk and incarceration, an exposure chosen to capture the effects of the U.S. macro-level social context due to its differential impact on the Black population. Study results showed the expected gender differences in PTSD risk. However, considerable variation in the pattern of risk was observed when the effects of race and gender were considered together, finding that African American females experienced greater disorder risk, and that non-Hispanic White males experienced greater risk when poverty status was considered. Prison exposure was found to be a significant predictor of lifetime PTSD, after accounting for the effects and timing of a comprehensive list of traumatic exposures. Race differences in the effect of incarceration exposure on PTSD risk were not found. These dissertation findings have implications for future PTSD research. Notably, these findings suggest that a better accounting of social contextual factors and the combined effects of sociodemographic and socioeconomic factors can improve our understanding of the disorder and those who are at most risk.PhDHealth Behavior & Health EducationUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/108839/1/lowallac_1.pd