Experiencing racial discrimination increases vulnerability to PTSD after trauma via peritraumatic dissociation

Higher lifetime trauma exposure and increased peritraumatic dissociation (PD) are well-known predictors of Post-Traumatic Stress Disorder (PTSD) symptoms following new trauma (prospective PTSD symptoms). The interplay between those factors, however, is not well established. In this study, we aimed to assess whether PD mediates the influence of lifetime trauma exposure on prospective PTSD symptoms. A total of 387 adults visiting five emergency departments who had experienced a traumatic event within 72 hours completed baseline assessments on lifetime trauma exposure count and PD. PTSD symptoms were assessed 1 month later. Structural equation modeling was used to examine the mediation effect of PD in the relationship between lifetime trauma exposure count and 1-month PTSD symptoms. We found that PD mediated the association between lifetime trauma exposure count and 1-month PTSD symptoms, even after accounting for some confounders. However, the mediation was partial, accounting for 17.9% of the lifetime trauma exposure count’s total effect. While this finding is significant, it also suggests that additional mechanisms beyond PD play a role in explaining the influence of higher lifetime trauma exposure on prospective PTSD symptoms. These findings provide valuable insights into the complex dynamics of PTSD development and call for further research to explore complementary factors and preventive strategies.

In this study, we evaluated whether peritraumatic dissociation (PD) was associated with symptoms of depression and posttraumatic stress disorder (PTSD), and whether this association was modified by trauma prior to police work. Symptoms of depression, PTSD, peritraumatic dissociative experience (PDE), and trauma prior to police work were measured using the Center for Epidemiologic Studies Depression scale, PTSD Checklist-Civilian, PDE questionnaire, and the Brief Trauma questionnaire, respectively, in 328 police officers. Separate regression models were used to assess if either symptoms of depression or PTSD were associated with PD stratified by prior trauma. Means were adjusted for race, number of drinks per week, and smoking. PD was associated with symptoms of PTSD and depression (β = 0.65, p < .001 and β = 0.27, p < .001, respectively). PD was positively associated with symptoms of PTSD regardless of prior trauma (β = 0.61, p < .001(without prior trauma), 0.75, p < .001 (with prior trauma). In contrast to PTSD, depression symptoms were significantly associated with PD scores in individuals with prior trauma (β = 0.47, p < .001), but not in individuals without prior trauma (β = 0.13, p = .165). This is a cross-sectional study. Outcomes were obtained via self-report and were not clinically diagnosed. Aspects of both the trauma event as well as the symptoms and severity of PD may have introduced recall bias. These results add to the literature indicating that PD plays a role in symptoms of PTSD and depression and how prior trauma may modify this relationship. (PsycINFO Database Record

ObjectivesOur objective was to determine if symptoms of depression and posttraumatic stress disorder (PTSD) are associated with peritraumatic dissociation, and if this association is modified by trauma prior to police...

Back to table of contents Previous article Next article LetterFull AccessLetterPhilippe J. Birmes M.D., Ph.D.Laetitia Daubisse M.D.Alain Brunet Ph.D.Philippe J. Birmes M.D., Ph.D.Search for more papers by this authorLaetitia Daubisse M.D.Search for more papers by this authorAlain Brunet Ph.D.Search for more papers by this authorPublished Online:1 Jan 2008https://doi.org/10.1176/ps.2008.59.1.116AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Predictors of Enduring PTSD After an Industrial DisasterTo the Editor: Only a few studies have examined the long-term effects (more than one year) of mass trauma on victimized communities ( 1 , 2 ). On September 21, 2001, a petrochemical plant exploded in the city of Toulouse, France. Victims were surveyed by using self-report questionnaires that assessed peritraumatic distress and dissociation and acute stress. A hierarchical multiple regression conducted with survey data gathered six months after the explosion indicated that all three constructs explained unique variance, accounting for 62% of the variance in symptoms of posttraumatic stress disorder (PTSD) ( 3 ). Here we report the results of a follow-up survey conducted 15 months after the explosion. The survey used the same predictors plus a measure of depression. Five to ten weeks after the explosion, 892 potential study participants were sent self-report questionnaires to assess symptoms of acute stress (Stanford Acute Stress Reaction Questionnaire) and depression (Beck Depression Inventory). The 391 persons who responded were sent another self-report questionnaire six months after the explosion. The second survey retrospectively assessed peritraumatic dissociation (Peritraumatic Dissociative Experiences Questionnaire) and distress (Peritraumatic Distress Inventory) as well as current PTSD symptoms (Posttraumatic Stress Disorder Checklist). Fifteen months after the explosion, the 200 participants who responded to the second survey were sent the same questionnaire assessing PTSD symptoms, and 129 persons responded to this third survey.To analyze the relationship between predictors and PTSD symptoms at 15 months, we computed Pearson correlations. Strong correlations with PTSD symptoms were found for peritraumatic dissociation (r=.50, p<.01), peritraumatic distress (r=.58, p<.01), acute stress symptoms (r=.71, p<.01), and depression symptoms (r=.61, p<.01). We computed a hierarchical multiple linear regression with PTSD symptom score as the dependent variable. Peritraumatic dissociation was entered first, followed by peritraumatic distress in the second step, symptoms of acute stress in the third step, and symptoms of depression in the fourth step. The model accounted for 59% of the variance in PTSD symptoms. All of our predictors were strongly correlated with persistent PTSD symptoms 15 months after exposure. The number of dropouts and retrospective ratings of the peritraumatic responses should be acknowledged as potentially limiting the generalizability of these results. However, the study found that peritraumatic dissociation and distress, acute stress, and depression were related to the development and persistence of PTSD symptoms after an industrial disaster. Loss of control and helplessness-anger, measured with the Peritraumatic Distress Inventory, were strong predictors of posttraumatic stress one year after the World Trade Center disaster ( 4 ). Acknowledgments and disclosuresThe authors report no competing interests.Dr. Birmes is affiliated with the Traumatic Stress Laboratory, Young Unit 2511, Toulouse III University, and the University Hospital of Toulouse, Toulouse, France. Dr. Daubisse is with Mixed Research Unit S558, National Institute of Health and Medical Research (INSERM), and Toulouse III University. Dr. Brunet is with Douglas Hospital Research Center and McGill University, Montreal.

Racial discrimination has a clear impact on health-related outcomes, but little is known about how discriminatory experiences are associated with neural response patterns to emotionally salient cues, which likely mediates these outcomes. To examine associations of discriminatory experiences with brainwide response to threat-relevant cues in trauma-exposed US Black women as they engage in an attentionally demanding task. A cross-sectional study was conducted from May 1, 2014, to July 1, 2019, among 55 trauma-exposed US Black women to examine associations of racial discrimination experiences with patterns of neural response and behavior to trauma-relevant images in an affective attentional control task. Posttraumatic stress disorder (PTSD) symptoms and trauma exposure were entered as covariates to isolate variance associated with experiences of racial discrimination. Varying levels of trauma, PTSD symptoms, and experiences of racial discrimination. Experiences of Discrimination Questionnaire (EOD) (range, 0-9) for count of the number of situations for which each participant reported having unfair treatment for a racial reason. Experiences of trauma and PTSD symptoms were assessed with the Traumatic Events Inventory (TEI) (number of times the person was exposed to trauma; score range, 0-112) and PTSD Symptom Scale (PSS) (score range, 0-51). Response to trauma-relevant vs neutral distractor cues were assessed via functional magnetic resonance imaging during performance of an affective Stroop (attentional control) task. Statistical analyses were conducted at a whole-brain, voxelwise level with familywise error correction. In this study of 55 Black women in the US (mean [SD] age, 37.7 [10.7] years; range, 21-61 years), participants reported a mean (SD) TEI frequency of 33.0 (18.8) and showed moderate levels of current PTSD symptoms (mean [SD] PSS score, 15.4 [12.9]). Mean (SD) EOD scores were 2.35 (2.44) and were moderately correlated with current PTSD symptoms (PSS total: r = 0.36; P=.009) but not with age (r = 0.20; P = .15) or TEI frequency (r = -0.02; P = .89). During attention to trauma-relevant vs neutral images, more experiences of racial discrimination were associated with significantly greater response in nodes of emotion regulation and fear inhibition (ventromedial prefrontal cortex) and visual attention (middle occipital cortex) networks, even after accounting for trauma and severity of PTSD symptoms (brainwide familywise error corrected; r = 0.33 for ventromedial prefrontal cortex; P = .02). Racial discrimination was also associated with affective Stroop task performance; errors on trials with threat-relevant stimuli were negatively correlated with experiences of racial discrimination (r = -0.41; P = .003). These findings suggest that experiences of racial discrimination associate with disproportionately greater response in brain regions associated with emotion regulation and fear inhibition and visual attention. Frequent racism experienced by Black individuals may potentiate attentional and regulatory responses to trauma-relevant stressors and lead to heightened modulation of regulatory resources. This may represent an important neurobiological pathway for race-related health disparities.

Altered functioning of the bed nucleus of the stria terminalis (BNST) may play a critical role in the etiology of posttraumatic stress disorder (PTSD). Chronic stressors such as racial discrimination and lifetime trauma are associated with an increased risk for PTSD, but it is unknown whether they influence the relationship between BNST functioning and PTSD. We investigated acute post-trauma BNST resting-state functional connectivity (rsFC) as a predictor of future PTSD symptoms in Black trauma survivors. We also examined whether racial discrimination and lifetime trauma moderated the relationship between BNST rsFC and PTSD symptoms. Black adults (N = 95; 54.7% female; mean age = 34.04) were recruited from an emergency department after experiencing a traumatic injury (72.6% were motor vehicle accidents). Two-weeks post-injury, participants underwent a resting-state fMRI scan and completed questionnaires evaluating their PTSD symptoms as well as lifetime exposure to racial discrimination and trauma. Six-months post-injury, PTSD symptoms were reassessed. Whole brain seed-to-voxel analyses were conducted to examine BNST rsFC patterns. Greater rsFC between the BNST and the posterior cingulate cortex, precuneus, left angular gyrus, and hippocampus prospectively predicted six-month PTSD symptoms after adjusting for sex, age, education, and baseline PTSD symptoms. Acute BNST rsFC was a stronger predictor of PTSD symptoms in individuals who experienced more racial discrimination and lifetime trauma. Thus, in the acute aftermath of a traumatic event, the BNST could be a key biomarker of risk for PTSD in Black Americans, particularly for individuals with a greater history of racial discrimination or previous trauma exposure.

This study examined the relationship between peritraumatic reactions, posttraumatic stress disorder (PTSD) symptoms, somatic complaints, and quality of life in Tunisians exposed to the events of the Arab Spring. Participants (n = 60) completed an online survey 1 year after the events, assessing peritraumatic distress, peritraumatic dissociation, PTSD symptoms, somatic complaints, and physical and mental quality of life. Results showed that peritraumatic dissociation was independently associated with increased PTSD symptoms and somatic complaints 12 months after the events. Multiple mediator mediation analyses revealed that somatic complaints (not PTSD symptoms) were the only independent mediators of the relationships between peritraumatic dissociation and both physical and mental quality of life. Assessing peritraumatic dissociation soon after trauma exposure among the North African population might help identify individuals at risk for PTSD. Furthermore, the impact of trauma on quality of life may be better explained by somatic complaints than PTSD symptoms among North Africans.

Endocannabinoids Mediate Racial/Ethnic Discrimination Prediction of Posttraumatic Stress Disorder Symptoms Moderated by Resting-State Functional Connectivity in Black and African American Individuals.

Toward the Predeployment Detection of Risk for PTSD

The roles of peritraumatic dissociation, child physical abuse, and child sexual abuse in the development of posttraumatic stress disorder and adult victimization

ObjectiveMetacognitive models posit that beliefs about thoughts and memories influence the development of posttraumatic stress disorder (PTSD) symptoms following traumatic events. This study examined the relationship of beliefs about memory with peritraumatic experiences in the development of PTSD symptoms following the Canterbury earthquakes and Queensland floods.MethodA convenience sample of individuals affected by these disasters (N = 662) was given questionnaires measuring peritraumatic distress and dissociation, beliefs about memory, and PTSD symptoms.ResultsThe results showed that individuals with a high level of peritraumatic distress and dissociation or high level of positive or negative beliefs about memory reported increased PTSD symptoms compared to those with a low level of the respective variable. Furthermore, peritraumatic distress and dissociation interacted with negative beliefs about memory. The difference in PTSD symptoms for those with a high compared to low level of peritraumatic distress and dissociation was elevated when individuals also reported a high level of negative beliefs about memory. This difference was diminished for individuals who reported a low level of negative beliefs about memory.ConclusionsThese findings suggest that beliefs about memory may moderate the effects of peritraumatic distress and dissociation on PTSD symptoms following a natural disaster. Given that metacognitive beliefs are a modifiable risk factor, future research is warranted to consider their potential causal effects on PTSD outcomes, particularly for individuals with severe peritraumatic experiences.

Motor vehicle accidents (MVAs) are the main cause of Posttraumatic stress disorder (PTSD) in industrialized countries. This includes the frequently occurring but understudied situation of parents learning that their children were injured. However, unlike in other types of trauma survivors, little is known about the predictors of PTSD symptoms in mothers whose child has suffered an MVA. A group of 72 mothers and 28 fathers were prospectively assessed for peritraumatic distress, peritraumatic dissociation, and PTSD symptoms 1 and 5 weeks after their child had suffered an MVA. Levels of peritraumatic distress and dissociation were comparable to other trauma victims, 18% of the mothers were considered to be suffering from probable PTSD. In mothers, significant positive correlations were found between PTSD symptoms and peritraumatic distress (r=.34) and dissociation (r=.37), whereas mothers' PTSD symptoms were associated with decreased peritraumatic dissociation in fathers (r=-.37). Even after controlling for covictim/witness status, peritraumatic distress was a predictor of mothers' PTSD symptoms, explaining 14% of the variance. Peritraumatic response and PTSD symptoms should be routinely assessed among parents whose child has experienced a traumatic event.

Peritraumatic dissociation, a term used to describe a complex array of reactions to trauma, including depersonalization, derealization, and emotional numbness, has been associated with posttraumatic stress disorder (PTSD) symptoms across a number of studies. Cognitive theory suggests that interpretations of traumatic events and reactions underlie the persistence of PTSD. The present study examined the associations among peritraumatic dissociation, posttraumatic cognitions, and PTSD symptoms in a group of trauma-exposed adults (N = 169). Results indicated that, after accounting for overall symptom severity and current dissociative tendencies, peritraumatic dissociation was significantly predictive of negative beliefs about the self (R2 = .06, p < .001). Other categories of maladaptive posttraumatic cognitions did not show a similar relationship (R2 = .01 to .02, nonsignificant). Negative thoughts about the self partially mediated the association between peritraumatic dissociation and PTSD severity (completely standardized indirect effect = .25). These findings lend support to cognitive theories of PTSD and point to an important area for clinical intervention.

ObjectiveThis study analyzed predictors of post-traumatic stress disorder (PTSD) in civilian trauma victims to assess how peritraumatic dissociation (PD) relates to PTSD symptom development. We examined PD and PTSD symptoms from a prior trauma simultaneously to better understand the extent to which past and current reactions to a trauma can predict the development of PTSD for a current trauma.MethodsParticipants (N=48) were recruited from the emergency department (ED) of a large, southeastern hospital and assessed immediately after a trauma and again at 4 weeks and 12 weeks post-trauma. We used both self-report and interviewer-based questionnaires to assess PD and PTSD symptoms for prior and current trauma.ResultsA hierarchical linear regression revealed that at 4-week follow up, when controlling for several demographic variables and trauma type, a model including both PD and PTSD symptoms from a prior trauma significantly predicted PTSD outcome (F(47)= 3.70, p=0.00), with PD and prior PTSD symptoms significantly contributing 17% and 9% of variance respectively. At 12 weeks, PTSD symptoms from prior trauma (β=0.094, p=0.538) and PD (β=−0.017, p=0.909) did not account for a significant proportion of the variance in PTSD for the enrolling trauma.ConclusionPrior and current reactions to trauma are both important factors in predicting the development of PTSD symptoms to a current trauma. The more immediate measurement of PD during presentation to the ED may explain the strength of its relationship to PTSD symptom development. Furthermore, our findings support the use of PTSD symptoms of a past trauma, as opposed to trauma frequency, as a predictor of PTSD from a subsequent trauma. Methodological limitations and future directions are discussed.

Women have higher rates of posttraumatic stress disorder (PTSD) than men. The authors examined prior trauma, PTSD, major depression, anxiety disorder not including PTSD, and peritraumatic dissociation; current peritraumatic dissociation; and passenger injury as possible explanations for the different rates of acute PTSD in women and men after a serious motor vehicle accident. Subjects age 18-65 years who had been in a serious motor vehicle accident (N=122) were assessed with the Structured Clinical Interview for DSM-III-R and the Peritraumatic Dissociative Experiences Questionnaire-Rater Version 1 month after the accident. Women did not differ from men in meeting the overall reexperiencing criterion for a diagnosis of PTSD (criterion B), but women were at greater risk for the specific reexperiencing symptoms of intense feelings of distress in situations similar to the motor vehicle accident and physical reactivity to memories of the motor vehicle accident. Women were 4.7 times more likely than men to meet the overall avoidance/numbing criterion (criterion C) and 3.8 times more likely to meet the overall arousal criterion (criterion D). Women were more likely than men to report the criterion C symptoms of avoiding thoughts and situations associated with the accident, loss of interest in significant activities, and a sense of foreshortened future and the criterion D symptoms of trouble sleeping, difficulty concentrating, and exaggerated startle response. Multiple logistic regression analysis indicated that the gender differences in acute PTSD were not associated with prior trauma, PTSD, peritraumatic dissociation, major depression, or anxiety disorder not including PTSD or with passenger injury. However, peritraumatic dissociative symptoms at the time of the accident were associated with a significantly higher risk for acute PTSD in women than in men. Gender differences in peritraumatic dissociation may help explain differences in risk for PTSD and for some PTSD symptoms in women and men.