More than 80 percent of patients surveyed at an Atlanta inner-city mental health clinic have experienced a severely traumatic event, mainly violence, during their lifetime, according to a study by researchers at the Atlanta-based Center for Behavioral Neuroscience (CBN), Emory University School of Medicine (SOM) and the University of Texas at Austin. Further, of those surveyed, 44 percent met the criteria for post-traumatic stress disorder (PTSD), but only 11 percent of those whose charts were reviewed had been diagnosed with this disabling anxiety disorder. The findings, published in the journal Psychiatric Services, suggest trauma is likely underrecognized and PTSD is an often undiagnosed among low-income, inner-city African-Americans in Atlanta.
PTSD affects an estimated 9 to 12 percent of the general population. The disorder, which results from a psychologically traumatic experience, is characterized by intense anxiety, insomnia, irritability, outbursts of anger, difficulty concentrating, hypervigilance and an exaggerated startle response.
For the study, researchers surveyed 184 African-Americans at Grady Hospital's outpatient mental health clinic about previous traumatic experiences. Most respondents earned less than $1,000 per month or were homeless. A total of 153 participants, or 83 percent reported having experienced at least one traumatic event in their lifetimes. More than half had been attacked with a knife, gun or other weapon. Forty-five percent of the females surveyed had experienced sexual assault. More than one-third of respondents had experienced childhood physical abuse, and a similar number had experienced childhood sexual abuse before the age of 13.
Forty-four percent of those surveyed met the criteria for PTSD. The researchers also found that many of those with PTSD suffered higher rates of major depression, suicide attempts and substance abuse compared to those who did not have PTSD. They also were more likely to have had an unstable childhood family environment.
"Despite the high rates of trauma and PTSD, our finding that only a small number of those surveyed had a PTSD diagnosis indicates this population is not currently identified as being in need of treatment," said study co-author Kerry Ressler, MD, PhD, of CBN and the Department of Psychiatry and Behavioral Sciences at Emory SOM. "We believe that the under diagnosis of PTSD is the case not only in our mental health center but also nationally."
In addition to Dr. Ressler, the study's authors include Ann Schwartz, MD, and Rebekah Bradley, PhD, of the Department of Psychiatry and Behavioral Sciences at Emory SOM, Melissa Sexton, MDiv, of the comparative literature program at Emory University, and Alissa Sherry, PhD, of the department of psychology at the University of Texas at Austin.
The study was funded by a grant from the National Institutes of Health, and by the Emory Medical Care Foundation and the Emory SOM.