Treating Posttraumatic Stress Disorder in Urban African American Mental Health Patients

African American individuals in the urban community are at high risk for experiencing or witnessing violence and traumatic events, and therefore are at high risk for the development of Posttraumatic Stress Disorder (PTSD). Despite this high risk, we have found that PTSD tends to be under-diagnosed and therefore undertreated in this population. This study aims to define the prevalence and comorbidity of PTSD at the outpatient mental health service of a large inner-city hospital in Atlanta, Georgia.

We have screened approximately two hundred patients at random. We find that urban African American mental health patients have been extremely traumatized, with a remarkably high prevalence of PTSD (∼80% experienced severe trauma). Further, PTSD is grossly under-diagnosed in this population (the prevalence is 35-40%, compared to chart diagnosis of 5-10%). Compared with other mental health patients, those with PTSD are significantly more likely to have a history of suicide attempts or substance abuse and to be homeless. Based on the Structured Clinical Interview for DSM-IV (SCID-I) data, those with PTSD are also more likely to have multiple comorbidities, primarily substance abuse and affective disorders, than those without PTSD. Finally, our findings that the majority of these patients have multiple traumatic experiences and are more likely to report an unstable early family life suggest that “Complex PTSD” may be highly prevalent. In summary, our data suggest that untreated PTSD may be a significant and often unrecognized source of morbidity within this population.

A Newly Constructed Intervention

In an attempt to optimize existing interventions, we have created a time-limited, manualized, culturally competent group therapy that integrates cognitive/behavioral and interpersonal approaches for use with a low-income, inner-city African American population. This trauma-focused group incorporates components of established treatment