Research has demonstrated that individuals who are female and/or from diverse backgrounds are subject to higher rates of Post-Traumatic Stress Disorder (PTSD) than their majority counterparts. The rates of PTSD in the general population are 8% for males and 20% for females (Kessler, 2000). Individuals with disabilities, particularly women, experience higher rates of trauma and PTSD (33.4%) compared to non-disabled individuals (18.4%; Powers, Curry, Oschwald, Maley, Saxton, & Eckels, 2002). The risk of developing PTSD in lesbian, gay, bisexual, transgender (LGBT) persons is higher (22.3%) than heterosexuals (12.5%; Roberts, Austin, Corliss, Vandermorris, Koenen, 2010). In Veterans, the prevalence of PTSD is 15% in males and 25% in females (Kessler, Chiu, Demler, & Walters, 2005), though males experience a higher number of traumatic events. Finally, the highest rates of PTSD in male Veterans are found in African Americans (20%) and Hispanics (29%), compared to 15% in general (Dohrenwend, Turner, Turse, Lewis-Fernandez, & Yager, 2008). These findings suggest minorities and women are particularly vulnerable to developing PTSD and, as such, need special attention in assessment and treatment.
The assessment and treatment of PTSD has received much attention since the identification of the disorder by the Diagnostic and Statistical Manual of Mental Disorders-III (American Psychiatric Association, 1980) and evidence-based guidelines have been developed for both. However, little focus has been on the assessment of trauma events, essential to the diagnosis of PTSD. Assessment of traumatic events has relied upon either self-report scales, such as the Life Events Checklist (LEC; Gray, Litz, Hsu, & Lombardo, 2004), or more commonly, open-ended, unstructured questions posed by the clinician. Neither of these methods provide guidance to the clinician in asking questions about trauma events in general, nor importantly to the unique trauma experiences of diverse populations and particularly highly vulnerable populations such as ethnic minorities, LGBT individuals, women, and disabled persons.
This project represents an attempt to address this gap in training of the non-trauma clinician and to create an educational tool for psychologist clinicians and other therapists to identify nuances specific to high-risk trauma clients (HRTC) in the assessment of trauma events in these individuals. Such guidance to the clinician is important for several reasons. First, avoidance is a key symptom of PTSD in individuals diagnosed with PTSD, which is displayed in guarding and withholding trauma information. Next, avoidance is compounded in HRTC population’s mistrust toward clinicians representing the dominant culture and may withhold more information. Finally, trauma events may and often occur within the context of discrimination (e.g., interactions with the police) and are likely difficult for the client to discuss with a therapist of another race who does not face such discrimination. A clinician lacking direction could prevent the accurate assessment of traumatic events, leading to poorer PTSD diagnostic assessment and/or impeding progress in treatment. Non-trauma clinicians and early career therapists are at a disadvantage with little guidance. While experienced trauma clinicians may have developed the skills in eliciting trauma information, they too may benefit from an assessment video that provides direction with HRTC populations.
In order to address these issues, Division 56 President Dr. Diane Castillo, and Division 56 Social Media Chair, Dr. Bryann DeBeer, applied for a Council on Division/APA Relations grant to create innovative educational videos on how to assess trauma in HRTCs. These videos will be targeted towards psychology students, and early career psychologists to be used as a tool to further education regarding HRTCs. The goals of this CODAPAR grant are to:
1) increase the knowledge of general practice psychologists in the assessment of trauma in high-risk, trauma-vulnerable populations, specifically in women, LGBT persons, individuals with disabilities, and ethnically diverse Veterans in a culturally sensitive/responsive manner; 2) develop and create training videos of assessment interviews with above populations, identifying and noting pertinent details in each interview; 3) provide incentives to complete clinician training with free CEUs. We have partnered with several other APA Divisions: Division 17 – Counseling Psychology (Dr. Ruth Fassinger), Division 22 – Rehabilitation Psychology (Dr. Sarah-Rae Andreski, & Dr. Michelle Meade), Division 35 – Psychology of Women (Dr. Thema Bryant, & Dr. Khan Dinh), Division 44 – Society for the Psychology of Sexual Orientation and Gender Diversity (Dr. Gary Howell, Dr. David Pantalone, & Dr. Shay Caramiello). With Division 22, we are developing a video which focuses on a client with multiple sclerosis. In partnership with Division 35, we are developing a video which focuses on a black female who has experienced sexual assault. With Division 44, we are developing a video which focuses on a trans woman. Finally, the Division 56 video will focus on a male Hispanic combat veteran. The videos will be completed at the end of 2018, and will be disseminated through the Division 56 listserve and website, among other dissemination tools.
American Psychiatric Association (1980). Diagnostic and statistical manual of mental disorders (3rded.). Washington, DC: Author.
Dobie, D. J., Kivlahan, D. R., Maynard, C., Bush, K.R., Davis, T. M., & Bradley, K. A. (2004). PTSD in female veterans: association with self-reported health problems and functional impairment. Archives of Internal Medicine, 164, 394-400.
Dohrenwend, B. P., Turner, J. B., Turse, N. A., Lewis-Fernandez, R., & Yager, T. J. (2008). War-related posttraumatic stress disorder in Black, Hispanic, and majority White Vietnam veterans: The roles of exposure and vulnerability. Journal of Traumatic Stress, 21, 133–141.
Gray, M. J., Litz, B. T., Hsu, J. L., & Lombardo, T. W. (2004). Psychometric properties of the life events checklist. Assessment,11, 330-341.
Kessler, R. C., (2000). Posttraumatic Stress Disorder: The Burden to the Individual and to Society. Journal of Clinical Psychiatry, 61(suppl 5), 4-12.
Kessler, R.C., Chiu, W.T, Demler, O., & Walters, E.E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617-627.
Powers, L. E., Curry, M. A., Oschwald, M., Maley, S., Saxton, M., & Eckels, K. (2002). Barriers and strategies in addressing abuse: A survey of disabled women’s experiences. Journal of Rehabilitation, 68, 4–13.
Roberts, A. L., Austin, S. B., Corliss, H. L., Vandermorris, A. K., & Koenen, K. C. (2010). Pervasive trauma exposure among US sexual orientation minority adults and risk of posttraumatic stress disorder. American Journal of Public Health, 100, 2433- 2441.
Bryann DeBeer, Ph.D., is the Director of the VA Patient Safety Center of Inquiry for Suicide Prevention and a Clinical Research Psychologist at the VISN 17 Center of Excellence for Research on Returning War Veterans within the U.S. Department of Veterans Affairs. Dr. DeBeer is also an Assistant Professor in the Department of Psychiatry & Behavioral Sciences at the Texas A&M College of Medicine, as well as the Program Chair and Social Media Committee Chair of Division 56 (Trauma) of the American Psychological Association. Dr. DeBeer’s research interests include trauma exposure and suicide risk in Veteran populations.