Exploring Racial Disparity in Posttraumatic Stress Disorder Diagnosis: Implications for Care of African American Women

Abstract

To explore factors contributing to disparities in posttraumatic stress disorder (PTSD) diagnosis between African Americans and White Americans, while controlling for gender and class by using a data set limited to poor women. A cross-sectional epidemiological secondary analysis. Michigan Medicaid fee-for-service claims data from 1994 through 1997. A total of 20,298 African American and White American adolescents and adult women, including 2,996 with PTSD diagnosis. Victimization, PTSD diagnosis, psychiatric and somatic comorbidities, and PTSD treatment. African American women were under-represented in the group diagnosed with PTSD (12% versus 31% in the comparison group), despite having equal rates of hospitalization for rape and battering. They were less likely to be diagnosed with comorbidities associated with complex PTSD, such as dissociative disorder (OR = 0.259, p < .001) or borderline personality disorder (OR = 0.178, p < .001), but were equally likely to be diagnosed with conduct disorder, schizophrenia, or substance abuse. African American women were 40% less likely to have continuous insurance coverage. Patient, provider, and system factors appear to interact to create disparities in PTSD diagnosis and treatment. Attention to case finding and provider or system bias may help reduce disparities.