Cultural+&+Gender+considerations+in+prevalence+of+PTSD

**Discuss cultural and gender considerations in the prevalence of post-traumatic stress disorder. ** Research has found that there is a significant gender difference in the prevalence of PTSD. Community studies have consistently demonstrated a higher prevalence of posttraumatic stress disorder (PTSD) in females than in males. - Cohort study is a form of longitudinal observational study. It is an analysis of risk factors and follows a group of people who do not have the disorder and uses correlations to determine the absolute risk of subject contraction. The study groups follow a group of people who do not have the disease for a period of time and see who develops the disease (new incidence). Since the diagnosis of PTSD is dependent upon the presence of an adverse (traumatic) event, - Participants were randomly selected 1,007 young adult members between the ages 21-30 of a 400,000 member HMO(health-maintenance organization) in Detroit and surrounding suburban areas, who have been exposed to community violence - An initial interview was conducted - Subjects were re-evaluated at 3 and 5 years post-baseline interview - The prevalence of experience in trauma was 36% - Alcohol and drug dependence was found to be a risk factor for exposure to adverse events(such as automobile accidents), but was not a risk factor for the development of PTSD in exposed populations - A prior history of depression was not a risk factor for exposure to adverse events, but was a risk factor for PTSD in an exposed population - The evaluation of risk of exposure and risk of PTSD in exposed individuals demonstrated important sex differences. The conditional risk of PTSD associated with exposure to any trauma was 13% in females and 6.2% in males. Therefore, females did have a higher prevalence rate than males. - Females were somewhat less likely to be exposed to adverse traumatic events but were more likely to develop PTSD if exposed An overall increased prevalence of PTSD in females must be accounted for by a significantly greater vulnerability to develop PTSD after exposure.
 * __Post Traumatic Stress Disorder __**
 * __Gender Considerations: __**
 * __Breslau et al(1991): __**
 * <span style="font-family: 'Arial Narrow',sans-serif; font-size: 12pt;">Type: **<span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;"> Cohort study
 * <span style="font-family: 'Arial Narrow',sans-serif;">Aim: **<span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;"> To study both the risk for the occurrence of adverse events and the risk of developing the characteristic symptom profile among exposed individuals. They wanted to examine whether the different rates of PTSD could be due to differential exposure to events and not necessarily to differences in the development of PTSD.
 * <span style="font-family: 'Arial Narrow',sans-serif; font-size: 12pt;">Procedure: **
 * <span style="font-family: 'Arial Narrow',sans-serif; font-size: 12pt;">Results: **
 * <span style="font-family: 'Arial Narrow',sans-serif; font-size: 12pt;">Conclusions: **

- <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Large sample - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Participants include both females and males - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Supported by other studies (such as Horowitz(1995)) - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">It led to further research to examine the possible causes of sex differences in the prevalence rates - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Not cross-culturally valid - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Ignores biological factors - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Doesn’t take into account individual differences - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Could contain researcher bias <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">These results caused Breslau et al to conduct another study in 1996. - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">A random digit dialing method was used to collect the sample and a computer assisted telephone interview was used to obtain the data - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Participants consisted of 2181 persons aged 18-45 years in the Detroit primary metropolitan statistical area - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">DSM-IV PTSD was assessed with respect to a randomly selected trauma from the list of qualifying traumas reported by each respondent - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Adverse events were classified in to <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">-assaultive violence <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">- other injury/shocking event <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">- learning of traumas of others <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">- sudden unexpected death of relative/friend - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">The lifetime prevalence of exposure and the mean number of traumas were lower in females than in males - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">The overall conditional risk of PTSD(the probability of PTSD among those exposed to a trauma) was approximately twice higher in females than in males - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">The sex difference in conditional risk of PTSD was due primarily to females’ greater risk of PTSD following exposure to assaultive violence (36% in females versus 6% in males). There are no significant sex differences in other categories of traumatic events - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Within assaultive violence category, women had a higher risk of PTSD for every type of event <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Rape- 49% for females, 0% for males <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Sexual assault other than rape: 24% for females, 16% for males <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Held captive/tortured/kidnapped:78% in females, less than 1% in males <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Badly beaten up: 56% for females, 6% for males - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">The single most frequent cause of PTSD in both sexes is sudden unexpected death of loved one, but no significant sex difference was present(27% in female cases, 38% in male cases) - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">54% of female cases and only 15% of male cases were attributable to assaultive violence - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;"> There are also sex differences in the expression of PTSD. Women experienced certain symptoms more frequently than males, such as more intense psychological reactivity to stimuli that symbolizes the trauma, restricted effect and exaggerated startle response. <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;"> The estimates of the lifetime prevalence of PTSD are approximately twice as high for females as for males. While males experience somewhat more assaultive violence, females are at far greater risk for PTSD when exposed to such traumatic events. Sex differences with respect to other categories of traumatic events are small. Although females' higher vulnerability to PTSD effects of assaultive violence is, in part, attributable to the higher prevalence of rape, the sex difference persists when this particular event is taken into account. - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Large sample - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Participants include both females and males - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Takes into account social factors - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Supported by other studies (such as Horowitz(1995)) - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">It led to further research to examine the possible causes of sex differences in the prevalence rates - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Not cross-culturally valid - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Reductionist approach - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Ignores biological factors - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Doesn’t take into account individual differences - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Could contain researcher bias
 * <span style="font-family: 'Arial Narrow',sans-serif; font-size: 12pt;">Evaluation: **
 * <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Strengths: **
 * <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Weaknesses: **
 * __<span style="font-family: 'Arial Narrow',sans-serif; font-size: 14pt;">Breslau(1996): __**
 * <span style="font-family: 'Arial Narrow',sans-serif; font-size: 12pt;">Aim: **<span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;"> To examine potential sources of the sex differences in PTSD in the community
 * <span style="font-family: 'Arial Narrow',sans-serif; font-size: 12pt;">Procedure: **
 * <span style="font-family: 'Arial Narrow',sans-serif; font-size: 12pt;">Results: **
 * <span style="font-family: 'Arial Narrow',sans-serif; font-size: 12pt;">Conclusion: **
 * <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Strengths: **
 * <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Weaknesses: **
 * __<span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Empirical Study: __**
 * <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Horowitz et Al: **<span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;"> They conducted a statistical analysis on a number of studies and found that women have a risk of up to 5 times greater than males to develop PTSD after a violent or traumatic event.

<span style="font-family: 'Arial Narrow',sans-serif; font-size: 18pt;">The symptoms of PTSD also seem to differ in men and women. <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">- Men are more likely to suffer from irritability and impulsiveness, women are more likely to suffer from numbing and avoidance. <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">- Men with PTSD are more likely to suffer from substance abuse disorders whereas women are more likely to suffer from anxiety and affective disorders. <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Rape is experienced more often by women, which carries one of the highest risks for producing PTSD. It has been observed that PTSD occurs more often after sexual abuse and interpersonal violence than accidents or natural disasters. Therefore, the types of traumas carry different risks for the development of PTSD. Thus, the prevalence rates differ between the genders. <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">It appears that the incidence and prevalence of psychiatric disorders varies among people of different cultural backgrounds due to an interplay of biological, psychological and social factors. ** Role of Social and institutional support: ** - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Social support and family functioning is a well established protective factor for traumatic stress reactions. The level of support at an institutional level has also been shown to influence the prevalence of PTSD. - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">They propose that the social, political, and cultural realities structure the context in which violence was experienced and determine the subjective meaning given to the violence, the way in which distress associated with the violence is experienced, the type of support available to the individual, and the therapy which will be appropriate. - <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Community cohesiveness plays a significant role in how trauma is experienced.
 * __<span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Nolen-Hoeksema(1994): __**<span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;"> Also, socialization differences that occur in society may lead girls to internalize their problems and boys to externalize them.
 * __<span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Achenbach(1991): __**<span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;"> There are gender differences in symptoms. Males are more likely to externalize symptoms (delinquency, aggression) and girls are more likely to internalize symptoms(depression, anxiety).
 * __<span style="font-family: 'Arial Narrow',sans-serif; font-size: 14pt;">Cultural Considerations: __**
 * <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Kleinman(1987): **<span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;"> category fallacy - It is when one presumes that what the mental health constructs will translate and be evident in other cultures. It is irrational and ethnocentric to assume that non-western forms of the disorder are atypical- the form commonly seen in the West being assumed the norm. Often, non-western survivors exhibit body memory symptoms.
 * <span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Hanscom( 2001): **<span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;"> One example is the dizziness experienced by a woman, which was found to be a body memory of her repeated experience of being forced to drink large amounts of alcohol and then being raped.
 * __ Wang et al(2000): __**<span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Nine months after an earthquake in China in north Hebei province, one village that had suffered less damage but had received less reconstruction support had significantly greater PTSD rates than a comparable village that suffered more seriously and had received substantially more reconstruction support.
 * __<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Bracken et al. (1995): __**

<span style="font-family: 'Arial Narrow',sans-serif; font-size: 10pt;">Case Study: A 45 year old man who was tortured during counter-insurgency operations in Luwero (Uganda) had both hands cut off by soldiers and was separated from his wife whom he has never seen or heard of since. A remarkable operation, performed by a surgeon in a rural mission hospital, in which the bones and muscles of his forearm were divided had given him some use in one of the stumps, but apart from this he was totally dependent on his neighbors. He was referred to us a victim of torture but when they interviewed him in his home four years after his traumatic experience he reported no symptoms of PTSD or any other psychiatric syndrome. He remarked that the support and solidarity shown to him by his neighbors had allowed him to return to a fairly normal life. His current difficulties were all of a practical nature.