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Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States

  • A. L. Roberts (a1), S. E. Gilman (a1) (a2), J. Breslau (a3), N. Breslau (a4) and K. C. Koenen (a1) (a2) (a5)
  • DOI:
  • Published online: 29 March 2010

To identify sources of race/ethnic differences related to post-traumatic stress disorder (PTSD), we compared trauma exposure, risk for PTSD among those exposed to trauma, and treatment-seeking among Whites, Blacks, Hispanics and Asians in the US general population.


Data from structured diagnostic interviews with 34 653 adult respondents to the 2004–2005 wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were analysed.


The lifetime prevalence of PTSD was highest among Blacks (8.7%), intermediate among Hispanics and Whites (7.0% and 7.4%) and lowest among Asians (4.0%). Differences in risk for trauma varied by type of event. Whites were more likely than the other groups to have any trauma, to learn of a trauma to someone close, and to learn of an unexpected death, but Blacks and Hispanics had higher risk of child maltreatment, chiefly witnessing domestic violence, and Asians, Black men, and Hispanic women had higher risk of war-related events than Whites. Among those exposed to trauma, PTSD risk was slightly higher among Blacks [adjusted odds ratio (aOR) 1.22] and lower among Asians (aOR 0.67) compared with Whites, after adjustment for characteristics of trauma exposure. All minority groups were less likely to seek treatment for PTSD than Whites (aOR range: 0.39–0.61), and fewer than half of minorities with PTSD sought treatment (range: 32.7–42.0%).


When PTSD affects US race/ethnic minorities, it is usually untreated. Large disparities in treatment indicate a need for investment in accessible and culturally sensitive treatment options.

Corresponding author
*Address for correspondence: K. C. Koenen, Ph.D., Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Kresge Building, 7th Floor, Boston, MA02115, USA. (Email:
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

R Acierno , KJ Ruggiero , S Galea , HS Resnick , K Koenen , J Roitzsch , M de Arellano , J Boyle , DG Kilpatrick (2007). Psychological sequelae resulting from the 2004 Florida hurricanes: implications for postdisaster intervention. American Journal of Public Health 97 (Suppl. 1), S103S108.

RE Adams , JA Boscarino (2005). Differences in mental health outcomes among Whites, African Americans, and Hispanics following a community disaster. Psychiatry 68, 250265.

M Alegria , G Canino , PE Shrout , M Woo , N Duan , D Vila , M Torres , CN Chen , XL Meng (2008). Prevalence of mental illness in immigrant and non-immigrant U.S. Latino groups. American Journal of Psychiatry 165, 359369.

M Alegria , G Canino , FS Stinson , BF Grant (2006). Nativity and DSM-IV psychiatric disorders among Puerto Ricans, Cuban Americans, and non-Latino Whites in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry 67, 5665.

TN Alim , DS Charney , TA Mellman (2006). An overview of posttraumatic stress disorder in African Americans. Journal of Clinical Psychology 62, 801813.

J Beals , SM Manson , NR Whitesell , P Spicer , DK Novins , CM Mitchell (2005 a). Prevalence of DSM-IV disorders and attendant help-seeking in 2 American Indian reservation populations. Archives of General Psychiatry 62, 99–108.

J Beals , DK Novins , NR Whitesell , P Spicer , CM Mitchell , SM Manson (2005 b). Prevalence of mental disorders and utilization of mental health services in two American Indian reservation populations: mental health disparities in a national context. American Journal of Psychiatry 162, 17231732.

JA Boscarino , S Galea , RE Adams , J Ahern , H Resnick , D Vlahov (2004). Mental health service and medication use in New York City after the September 11, 2001, terrorist attack. Psychiatric Services 55, 274283.

J Breslau , DF Chang (2006). Psychiatric disorders among foreign-born and US-born Asian-Americans in a US national survey. Social Psychiatry and Psychiatric Epidemiology 41, 943950.

N Breslau , HD Chilcoat , RC Kessler , GC Davis (1999). Previous exposure to trauma and PTSD effects of subsequent trauma: results from the Detroit Area Survey of Trauma. American Journal of Psychiatry 156, 902907.

N Breslau , GC Davis , P Andreski , E Peterson (1991). Traumatic events and posttraumatic stress disorder in an urban population of young adults. Archives of General Psychiatry 48, 216222.

N Breslau , GC Davis , EL Peterson , L Schultz (1997). Psychiatric sequelae of posttraumatic stress disorder in women. Archives of General Psychiatry 54, 8187.

N Breslau , GC Davis , LR Schultz (2003). Posttraumatic stress disorder and the incidence of nicotine, alcohol, and other drug disorders in persons who have experienced trauma. Archives of General Psychiatry 60, 289294.

N Breslau , R Kessler , HD Chilcoat , LR Schultz , GC Davis , P Andreski (1998). Trauma and posttraumatic stress disorder in the community: The 1996 Detroit Area Survey of Trauma. Archives of General Psychiatry 55, 626632.

N Breslau , VC Lucia , GF Alvarado (2006 b). Intelligence and other predisposing factors in exposure to trauma and posttraumatic stress disorder: a follow-up study at age 17 years. Archives of General Psychiatry 63, 12381245.

N Breslau , HC Wilcox , CL Storr , VC Lucia , JC Anthony (2004 b). Trauma exposure and posttraumatic stress disorder: a study of youths in urban America. Journal of Urban Health 81, 530544.

CR Brewin , B Andrews , IH Gotlib (1993). Psychopathology and early experience: a reappraisal of retrospective reports. Psychological Bulletin 113, 8298.

CR Brewin , B Andrews , JD Valentine (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology 68, 748766.

E Bromet , A Sonnega , RC Kessler (1998). Risk factors for DSM-III-R posttraumatic stress disorder: findings from the National Comorbidity Survey. American Journal of Epidemiology 147, 353361.

JC Chow , K Jaffee , L Snowden (2003). Racial/ethnic disparities in the use of mental health services in poverty areas. American Journal of Public Health 93, 792797.

WE Copeland , G Keeler , A Angold , EJ Costello (2007). Traumatic events and posttraumatic stress in childhood. Archives of General Psychiatry 64, 577584.

DA Dawson (1998). Beyond black, white and Hispanic: race, ethnic origin and drinking patterns in the United States. Journal of Substance Abuse 10, 321339.

BP Dohrenwend , JB Turner , NA Turse , R Lewis-Fernandez , TJ Yager (2008). War-related posttraumatic stress disorder in Black, Hispanic, and majority White Vietnam veterans: the roles of exposure and vulnerability. Journal of Traumatic Stress 21, 133141.

BH Ellis , HZ MacDonald , AK Lincoln , HJ Cabral (2008). Mental health of Somali adolescent refugees: the role of trauma, stress, and perceived discrimination. Journal of Consulting and Clinical Psychology 76, 184193.

M Farley , BM Patsalides (2001). Physical symptoms, posttraumatic stress disorder and healthcare utilization of women with and without childhood physical and sexual abuse. Psychological Reports 89, 595606.

D Finkelhor , R Ormrod , H Turner , SL Hamby (2005). The victimization of children and youth: a comprehensive, national survey. Child Maltreatment 10, 5–25.

D Finkelhor , RK Ormrod , HA Turner (2007). Re-victimization patterns in a national longitudinal sample of children and youth. Child Abuse and Neglect 31, 479502.

JJ Gavrilovic , M Schutzwohl , M Fazel , S Priebe (2005). Who seeks treatment after a traumatic event and who does not? A review of findings on mental health service utilization. Journal of Traumatic Stress 18, 595605.

U Hapke , A Schumann , HJ Rumpf , U John , C Meyer (2006). Post-traumatic stress disorder – the role of trauma, pre-existing psychiatric disorders, and gender. European Archives of Psychiatry and Clinical Neuroscience 256, 299306.

KM Harris , MJ Edlund , S Larson (2005). Racial and ethnic differences in the mental health problems and use of mental health care. Medical Care 43, 775784.

M Hasselberg , L Laflamme , GR Weitoft (2001). Socioeconomic differences in road traffic injuries during childhood and youth: a closer look at different kinds of road user. Journal of Epidemiology and Community Health 55, 858862.

SL Hatch , BP Dohrenwend (2007). Distribution of traumatic and other stressful life events by race/ethnicity, gender, SES and age: a review of the research. American Journal of Community Psychology 40, 313332.

JA Himle , RE Baser , RJ Taylor , RD Campbell , JS Jackson (2009). Anxiety disorders among African Americans, blacks of Caribbean descent, and non-Hispanic whites in the United States. Journal of Anxiety Disorders 23, 578590.

ZJ Huang , FY Wong , CR Ronzio , SM Yu (2007). Depressive symptomatology and mental health help-seeking patterns of U.S.- and foreign-born mothers. Maternal and Child Health Journal 11, 257267.

R Jayakody , S Danziger , RC Kessler (1998). Early-onset psychiatric disorders and male socioeconomic status. Social Science Research 27, 371387.

LH Jaycox , GN Marshall , T Schell (2004). Use of mental health services by men injured through community violence. Psychiatric Services 55, 415420.

RL Johnson , S Saha , JJ Arbelaez , MC Beach , LA Cooper (2004). Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. Journal of General Internal Medicine 19, 101110.

RC Kessler , WT Chiu , O Demler , KR Merikangas , EE Walters (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617627.

RC Kessler , A Sonnega , E Bromet , M Hughes , CB Nelson (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry 52, 10481060.

DG Kilpatrick , R Acierno (2003). Mental health needs of crime victims: epidemiology and outcomes. Journal of Traumatic Stress 16, 119132.

KC Koenen , QJ Fu , MJ Lyons , R Toomey , J Goldberg , SA Eisen , W True , T Ming (2005). Juvenile conduct disorder as a risk factor for trauma exposure and posttraumatic stress disorder. Journal of Traumatic Stress 18, 2332.

KC Koenen , R Goodwin , E Struening , F Hellman , M Guardino (2003). Posttraumatic stress disorder and treatment seeking in a national screening sample. Journal of Traumatic Stress 16, 5–16.

KC Koenen , R Harley , MJ Lyons , J Wolfe , JC Simpson , J Goldberg , SA Eisen , M Tsuang (2002). A twin registry study of familial and individual risk factors for trauma exposure and posttraumatic stress disorder. Journal of Nervous and Mental Disease 190, 209218.

KC Koenen , SD Stellman , JF Sommer Jr, JM Stellman (2008). Persisting posttraumatic stress disorder symptoms and their relationship to functioning in Vietnam veterans: a 14-year follow-up. Journal of Traumatic Stress 21, 4957.

ME Kruijshaar , J Barendregt , T Vos , R de Graaf , J Spijker , G Andrews (2005). Lifetime prevalence estimates of major depression: an indirect estimation method and a quantification of recall bias. European Journal of Epidemiology 20, 103111.

LD Kubzansky , KC Koenen , C Jones , WW Eaton (2009). A prospective study of posttraumatic stress disorder symptoms and coronary heart disease in women. Health Psychology 28, 125130.

LD Kubzansky , KC Koenen , A Spiro 3rd, PS Vokonas , D Sparrow (2007). Prospective study of posttraumatic stress disorder symptoms and coronary heart disease in the Normative Aging Study. Archives of General Psychiatry 64, 109116.

SF Lewis , HS Resnick , KJ Ruggiero , DW Smith , DG Kilpatrick , CL Best , BE Saunders (2005). Assault, psychiatric diagnoses, and sociodemographic variables in relation to help-seeking behavior in a national sample of women. Journal of Traumatic Stress 18, 97–105.

CM Loo (1994). Race-related PTSD: the Asian American Vietnam veteran. Journal of Traumatic Stress 7, 637656.

CM Loo , JA Fairbank , CM Chemtob (2005). Adverse race-related events as a risk factor for posttraumatic stress disorder in Asian American Vietnam veterans. Journal of Nervous and Mental Disease 193, 455463.

CM Loo , SS Ueda , RK Morton (2007). Group treatment for race-related stresses among minority Vietnam veterans. Transcultural Psychiatry 44, 115135.

MC Lu , B Chen (2004). Racial and ethnic disparities in preterm birth: the role of stressful life events. American Journal of Obstetrics and Gynecology 191, 691699.

FH Norris (1992). Epidemiology of trauma: frequency and impact of different potentially traumatic events on different demographic groups. Journal of Consulting and Clinical Psychology 60, 409418.

AN Ortega , R Rosenheck , M Alegria , RA Desai (2000). Acculturation and the lifetime risk of psychiatric and substance use disorders among Hispanics. Journal of Nervous and Mental Disease 188, 728735.

A Perkonigg , H Pfister , MB Stein , M Hofler , R Lieb , A Maercker , HU Wittchen (2005). Longitudinal course of posttraumatic stress disorder and posttraumatic stress disorder symptoms in a community sample of adolescents and young adults. American Journal of Psychiatry 162, 13201327.

WJ Ruan , RB Goldstein , SP Chou , SM Smith , TD Saha , RP Pickering , DA Dawson , B Huang , FS Stinson , BF Grant (2008). The alcohol use disorder and associated disabilities interview schedule-IV (AUDADIS-IV): reliability of new psychiatric diagnostic modules and risk factors in a general population sample. Drug and Alcohol Dependence 92, 2736.

JT Sakai , PM Ho , JH Shore , NK Risk , RK Price (2005). Asians in the United States: substance dependence and use of substance-dependence treatment. Journal of Substance Abuse Treatment 29, 7584.

MR Santos , J Russo , G Aisenberg , E Uehara , A Ghesquiere , DF Zatzick (2008). Ethnic/racial diversity and posttraumatic distress in the acute care medical setting. Psychiatry 71, 234245.

TL Simpson (2002). Women's treatment utilization and its relationship to childhood sexual abuse history and lifetime PTSD. Substance Abuse 23, 1730.

CL Storr , NS Ialongo , JC Anthony , N Breslau (2007). Childhood antecedents of exposure to traumatic events and posttraumatic stress disorder. American Journal of Psychiatry 164, 119125.

VM Ta , HS Juon , AC Gielen , D Steinwachs , A Duggan (2008). Disparities in use of mental health and substance abuse services by Asian and Native Hawaiian/other Pacific Islander women. Journal of Behavioral Health Services and Research 35, 2036.

DT Takeuchi , N Zane , S Hong , DH Chae , F Gong , GC Gee , E Walton , S Sue , M Alegria (2007). Immigration-related factors and mental disorders among Asian Americans. American Journal of Public Health 97, 8490.

J Todd , C Armon , A Griggs , S Poole , S Berman (2006). Increased rates of morbidity, mortality, and charges for hospitalized children with public or no health insurance as compared with children with private insurance in Colorado and the United States. Pediatrics 118, 577585.

S Ullman , L Brecklin (2002). Sexual assault history, PTSD, and mental health service seeking in a national sample of women. Journal of Community Psychology 30, 261279.

LC Vogel , LL Marshall (2001). PTSD symptoms and partner abuse: low income women at risk. Journal of Traumatic Stress 14, 569584.

PS Wang , M Lane , M Olfson , HA Pincus , KB Wells , RC Kessler (2005). Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 629640.

DR Williams , PB Jackson (2005). Social sources of racial disparities in health. Health Affairs (Millwood) 24, 325334.

DR Williams , HW Neighbors , JS Jackson (2008). Racial/ethnic discrimination and health: findings from community studies. American Journal of Public Health 98, S29S37.

G Yamashiro , JK Matsuoka (1997). Help-seeking among Asian and Pacific Americans: a multiperspective analysis. Social Work 42, 176186.

C Zayfert , AR Dums , RJ Ferguson , MT Hegel (2002). Health functioning impairments associated with posttraumatic stress disorder, anxiety disorders, and depression. Journal of Nervous and Mental Disease 190, 233240.

F Zhai , Q Gao (2009). Child maltreatment among Asian Americans: characteristics and explanatory framework. Child Maltreatment 14, 207224.

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