Posttraumatic Stress Disorder and Minority Status as a Risk Factor

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Friedman, M.J., Schnurr, P.P., Sengupta, A., Holmes, T., & Ashcraft, M. (2004). The Hawaii Vietnam veterans project: Is minority status a risk factor for posttraumatic stress disorder? The Journal of Nervous and Mental Disease, 192(1), 42-49.

Ethnic minority status has been associated with greater risk of developing posttraumatic stress disorder (PTSD) and other psychological problems (Brewin, Andrews & Valentine, 2000; Norris, Friedman, Watson, Byrne, Diaz & Kaniasty, 2002). Researchers have compared ethnic minority veterans to Caucasian veterans and found ethnic minority veterans were more likely to develop PTSD than Caucasian veterans who have endured the same experiences. Two recent studies that support these findings are the National Vietnam Veterans Readjustment Study (NVVRS) (Kulka, Schlenger, Fairbank, Hough, Jordan, Marmar & Weiss, 1990), and the American Indian Vietnam Veterans Project (AIVVP) (Beals, Manson, Shore, Friedman, Ashcraft, Fairbank & Schlenger, 2002). Both studies found significantly lower prevalence of PTSD among Caucasian veterans than among African-American, Hispanic, and American Indian veterans. Congress mandated the Hawaii Vietnam Veterans Project (HVVP), in which Friedman, Schnurr, Sengupta, Holmes and Ashcraft (2004) attempted to ascertain whether similar findings of the NVVRS and AIVVP apply to Native Hawaiian and Americans of Japanese ancestry Vietnam veterans. The authors were interested in previous findings that found the prevalence of PTSD among veterans from ethnic minority groups became non-significant when war zone exposure was taken into account. Furthermore, they were interested in replicating the finding that racism has also been found to contribute to PTSD severity and distress among ethnic minority veterans.

Friedman et al. highlight cultural factors among both Americans of Japanese ancestry and Native Hawaiian veterans that may influence the prevalence of PTSD. The authors suggest that cultural pressures to suppress emotional reactions or psychological distress may result in significantly lower prevalence of PTSD in Americans of Japanese ancestry. Conversely, Native Hawaiian veterans may be expected to exhibit relatively high prevalence of PTSD based on current experiences of cultural disintegration pressures and sociocultural transformations such as eradication of customs, traditions, and values; and a breakdown of social, political, economic, and religious systems (Crabbe, 1998). Friedmen et al. make a significant contribution to cross-cultural research in suggesting that experiences within a socio-cultural context may have negatively affected mental health.

The HVVP closely resembled the NVVRS in design, instrumentation, and objectives, with two exceptions: comparison groups were omitted due to practical constraints and the span between the end of the military service in Vietnam and the survey of combatants was 8 years longer for the HVVP than the NVVRS. Minority groups from both studies were compared with each other rather than simply comparing each minority group with Caucasian veterans. The eight-year span provides opportunity to examine the current and lifetime prevalence of full and partial PTSD using a greater time span than the NVVRS, and enhances current research in understanding the longterm impacts of PTSD (over a span of 30-40 years).

In order to assess current and lifetime prevalence of full and partial PTSD among the veterans, 700 participants were recruited. Of these, 302 Native Hawaiians and 302 Americans of Japanese ancestry completed the lay interview. The lay interview questionnaire collected data from various areas, including: marital history and adjustment, educational history, occupational history and work role adjustment, military service history, and the Composite International Diagnostic Interview (CIDI). The CIDI was utilized rather than the Diagnostic Interview Schedule (DIS) used in the NVVRS because of known reliability and validity of the CIDI, and its tailored design for cross-cultural use. …

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