ABSTRACT

Given the diversity of military veterans and growing evidence of ethnoracial disparities in posttraumatic stress disorder (PTSD) within this population, elucidating the role of discrimination-related stress in contributing to these disparities is crucial. We examined the relative impact of discriminatory stress (i.e., due to race/ethnicity, religion, nationality, gender, sexual orientation, or physical appearance) on 6-month changes in PTSD symptom severity among trauma-exposed White (74%), Black (11%) and Hispanic/Latino/a/x (15%) veterans (17% female). PTSD symptoms were measured with the 8-item PTSD Checklist for DSM-5. A measure of the extent to which discrimination has caused stress for the respondent assessed discriminatory stress. Hierarchical regression analyses examined interactions among race/ethnicity, gender and discriminatory stress in predicting six-month changes in PTSD severity. Black and Hispanic/Latino/a/x veterans reported higher baseline PTSD severity and discriminatory stress than White veterans, with some variation by gender. Three-way interactions of race/ethnicity by discriminatory stress by gender were significant, controlling for income, education and age. The relationship between discriminatory stress and increases in PTSD severity was significantly stronger for Black women compared with Black men and did not differ between White men and women. There was also a stronger relationship between discriminatory stress and increases in PTSD severity for Hispanic/Latino/x men as compared to Black men. These findings suggest that discriminatory stress impacts PTSD severity differentially for various ethnoracial/gender groups and highlight the value of applying an intersectional framework that accounts for the synergistic connections among multiple identities to future screening, intervention, and research efforts.

摘要

鉴于退伍军人的多样性以及该人群中创伤后应激障碍（PTSD）中种族差异的证据不断增多，阐明与歧视有关的压力在造成这些差异中的作用至关重要。我们研究了歧视性压力（即由于种族/民族，宗教，国籍，性别，性取向或外貌）导致的创伤暴露的白人（74％），黑人中PTSD症状严重程度的6个月变化的相对影响（11％）和西班牙裔/拉丁美洲裔/ a / x（15％）退伍军人（17％女性）。PTSD症状使用DSM-5的8项PTSD检查表进行测量。衡量歧视对受访者造成压力的程度的一种评估歧视性压力。分层回归分析考察了种族/民族之间的相互作用，性别和歧视性压力预测PTSD严重性的六个月变化。黑人和西班牙裔/拉丁美洲人/ a / x退伍军人报告的基线PTSD严重程度和歧视性压力高于白人退伍军人，但性别有所不同。种族/族裔在性别歧视压力下的三重互动非常重要，并控制了收入，教育程度和年龄。与黑人相比，黑人女性的歧视性压力与PTSD严重性增加之间的关系明显更强，白人与女性之间没有区别。与黑人相比，西班牙裔/拉丁美洲裔/ x男性的歧视性压力与PTSD严重性增加之间也存在更强的关系。