Trauma, Psychiatric Disorders, and Treatment History Among Pregnant African American Women

• Authors: Abigail Powers, Emory University; Briana Woods-Jaeger, Emory University; Jennifer Stevens, Emory University; B Bradley, Emory University; MB Patel, Emory University; Andrea Joyner, Emory University; Alicia Smith, Emory University; DJ Jamieson, Emory University; Nadine Kaslow, Emory University; Vasiliki Michopoulos, Emory University
• Journal Title: Psychological Trauma: Theory, Research, Practice, Policy
• Volume: Volume 12, Number 2
• Publisher: Educational Publishing Foundation - American Psychological Association (APA) | 2020-02-01, Pages 138-146
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1037/tra0000507
• Subjects: Psychology, Behavioral; Psychology, Cognitive; Health Sciences, Obstetrics and Gynecology; Health Sciences, Health Care Management; Health Sciences, Mental Health
• Keywords: Social Sciences; Science & Technology; Life Sciences & Biomedicine; Psychology, Clinical; Psychiatry; Psychology; pregnancy; depression; posttraumatic stress disorder; trauma; underserved population; Posttraumatic stress disorder; Perinatal depression; Symptom profile; Low-income; Health; Risk; Care; Exposure; PTSD; Prevalence

Abstract

Objective: Pregnant African American women living in low-income urban communities have high rates of trauma exposure and elevated risk for the development of trauma-related disorders, including posttraumatic stress disorder (PTSD) and depression. Yet, engagement in behavioral health services is lower for African American women than Caucasian women. Limited attention has been given to identifying trauma exposure and PTSD, especially within at-risk communities. The present study examined rates of trauma exposure, PTSD, depression, and behavioral health treatment engagement in an obstetrics/gynecology (OB/GYN) clinic within an urban hospital. Method: The study included 633 pregnant African American women screened within the OB/GYN clinic waiting room; 55 of the women also participated in a subsequent detailed clinical assessment based on eligibility for a separate study of intergenerational risk for trauma and PTSD in African American mother–child dyads. Results: Overall, 98% reported trauma exposure, approximately one third met criteria for probable current PTSD, and one third endorsed moderate-or-severe depression based on self-report measures. Similar levels were found based on clinical assessments in the subsample. While 18% endorsed depression treatment, only 6% received treatment for PTSD. In a subsample of women with whom chart reviews were conducted (n = 358), 15% endorsed a past psychiatric diagnosis but none shared their PTSD diagnosis with their OB/GYN provider. Conclusion: Results of the current study highlight elevated levels of trauma exposure, PTSD, and depression in low-income, African American pregnant women served by this urban clinic, and demonstrate the need for better identification of trauma-related disorders and appropriate linkage to culturally responsive care especially for PTSD.