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June 26, 2012

Post-traumatic Stress Disorder in Vulnerable Populations

by Lisa S. Meredith

Post-traumatic stress disorder (PTSD) is a common condition associated with consequences including increased risk for medical conditions, poor physical health, and poor quality of life. Large epidemiological studies have shown that, in the United States, up to 10% of people who experience a traumatic event will go on to develop PTSD—a rate similar to depression, another common emotional condition. PTSD is also associated with risks including marital instability, teenage childbearing, lower educational attainment, and unemployment. Moreover, the disorder is expensive, contributing to an estimated $3 billion or more in annual productivity losses.

The good news is that our understanding of PTSD is improving. Treatments are becoming more effective, and researchers are finding more creative ways to get treatments to those who need it. June is National PTSD Awareness Month and tomorrow June 27th is PTSD Awareness Day, providing an opportunity to recognize the challenges faced by survivors of trauma who live with PTSD symptoms—which include re-experiencing, avoidance/numbing, and hyperarousal—and recommit to efforts to help ensure that all of those in need receive effective treatment.

RAND research is helping increase awareness about the disorder and inform policy about how to prevent and address it. We hear a good deal about PTSD as a consequence of war-related trauma among military personnel. RAND has contributed extensively to enhancing the system of care available to the many service members and veterans who may experience delayed onset of PTSD.

However, far less media attention has been paid to civilians with PTSD as a consequence of traumatic events unrelated to war. These underserved civilian populations include poor and uninsured racial/ethnic minorities, refugees, homeless persons, and children.

Some RAND research led by Lisa Meredith has aimed to reduce the risk of PTSD in poor uninsured Latino patients. For example, one study identified the importance that both patient and clinician/system factors play in managing PTSD. Making mental health services better integrated with medical services, creating better links with other community services that patients might need (such as legal and shelter services), and considering whether reports of feeling sad, anxious, nervous, or fearful might be related to PTSD when doctors inquire about it in Latino patients are of particular importance.

A related ongoing study is testing a program to improve PTSD care compared to routine care for patients seeking care from their medical doctors at Community Health Centers in New York and New Jersey. The patients in this study are mostly uninsured Latinos who suffer multiple forms of interpersonal and community violence. This is the first study to examine practice-based quality improvement in such underserved community health settings.

Another ongoing study led by Grant Marshall involves a household survey of Cambodian refugees residing in the United States. This will constitute the first-ever community-based, epidemiologic study to understand the prevalence and mental health correlates of exposure to pre-migration trauma and post-migration community violence.

Other RAND work led by Lisa Jaycox has developed an intervention and toolkit for schools to use to help children recover from traumatic experiences, and another study led by Suzanne Wenzel has identified groups of homeless women who may benefit most from trauma screening and treatment interventions.

All of this work has potential to make a large impact on practice and policy around PTSD among these vulnerable groups. For example, based on RAND research we can already recommend educating and training primary care providers to recognize and manage PTSD and deploying evidence-based programs for children through schools. As more is learned from these studies, RAND research will be poised to provide answers to questions about how to improve the quality of care and quality of life for those who are exposed to trauma and faced with this debilitating condition, so that they may live happy, healthy, and productive lives.


Lisa Meredith is a senior behavioral scientist at RAND.

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