Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-10T08:50:00.279Z Has data issue: false hasContentIssue false
  • English
  • Français

Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States

Published online by Cambridge University Press:  29 March 2010

A. L. Roberts ,
S. E. Gilman ,
J. Breslau ,
N. Breslau  and
K. C. Koenen
A. L. Roberts
Affiliation:
Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
S. E. Gilman
Affiliation:
Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
J. Breslau
Affiliation:
Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
N. Breslau
Affiliation:
Department of Epidemiology, Michigan State University, East Lansing, MI, USA
K. C. Koenen*
Affiliation:
Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA Harvard Center on the Developing Child, Cambridge, MA, USA
*
*Address for correspondence: K. C. Koenen, Ph.D., Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Kresge Building, 7th Floor, Boston, MA 02115, USA. (Email: kkoenen@hsph.harvard.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

To identify sources of race/ethnic differences related to post-traumatic stress disorder (PTSD), we compared trauma exposure, risk for PTSD among those exposed to trauma, and treatment-seeking among Whites, Blacks, Hispanics and Asians in the US general population.

Method

Data from structured diagnostic interviews with 34 653 adult respondents to the 2004–2005 wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were analysed.

Results

The lifetime prevalence of PTSD was highest among Blacks (8.7%), intermediate among Hispanics and Whites (7.0% and 7.4%) and lowest among Asians (4.0%). Differences in risk for trauma varied by type of event. Whites were more likely than the other groups to have any trauma, to learn of a trauma to someone close, and to learn of an unexpected death, but Blacks and Hispanics had higher risk of child maltreatment, chiefly witnessing domestic violence, and Asians, Black men, and Hispanic women had higher risk of war-related events than Whites. Among those exposed to trauma, PTSD risk was slightly higher among Blacks [adjusted odds ratio (aOR) 1.22] and lower among Asians (aOR 0.67) compared with Whites, after adjustment for characteristics of trauma exposure. All minority groups were less likely to seek treatment for PTSD than Whites (aOR range: 0.39–0.61), and fewer than half of minorities with PTSD sought treatment (range: 32.7–42.0%).

Conclusions

When PTSD affects US race/ethnic minorities, it is usually untreated. Large disparities in treatment indicate a need for investment in accessible and culturally sensitive treatment options.

Keywords

Ethnic groupspost-traumatic stress disorderracetraumatic eventstreatment-seeking
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 1 , January 2011 , pp. 71 - 83
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Acierno, R, Ruggiero, KJ, Galea, S, Resnick, HS, Koenen, K, Roitzsch, J, de Arellano, M, Boyle, J, Kilpatrick, DG (2007). Psychological sequelae resulting from the 2004 Florida hurricanes: implications for postdisaster intervention. American Journal of Public Health 97 (Suppl. 1), S103–S108.CrossRefGoogle ScholarPubMed
Adams, RE, Boscarino, JA (2005). Differences in mental health outcomes among Whites, African Americans, and Hispanics following a community disaster. Psychiatry 68, 250–265.CrossRefGoogle ScholarPubMed
Alegria, M, Canino, G, Shrout, PE, Woo, M, Duan, N, Vila, D, Torres, M, Chen, CN, Meng, XL (2008). Prevalence of mental illness in immigrant and non-immigrant U.S. Latino groups. American Journal of Psychiatry 165, 359–369.CrossRefGoogle ScholarPubMed
Alegria, M, Canino, G, Stinson, FS, Grant, BF (2006). Nativity and DSM-IV psychiatric disorders among Puerto Ricans, Cuban Americans, and non-Latino Whites in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry 67, 56–65.CrossRefGoogle ScholarPubMed
Alim, TN, Charney, DS, Mellman, TA (2006). An overview of posttraumatic stress disorder in African Americans. Journal of Clinical Psychology 62, 801–813.CrossRefGoogle ScholarPubMed
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. APA: Washington, DC.Google Scholar
Beals, J, Manson, SM, Whitesell, NR, Spicer, P, Novins, DK, Mitchell, CM (2005 a). Prevalence of DSM-IV disorders and attendant help-seeking in 2 American Indian reservation populations. Archives of General Psychiatry 62, 99–108.CrossRefGoogle ScholarPubMed
Beals, J, Novins, DK, Whitesell, NR, Spicer, P, Mitchell, CM, Manson, SM (2005 b). Prevalence of mental disorders and utilization of mental health services in two American Indian reservation populations: mental health disparities in a national context. American Journal of Psychiatry 162, 1723–1732.CrossRefGoogle Scholar
Boscarino, JA, Galea, S, Adams, RE, Ahern, J, Resnick, H, Vlahov, D (2004). Mental health service and medication use in New York City after the September 11, 2001, terrorist attack. Psychiatric Services 55, 274–283.CrossRefGoogle ScholarPubMed
Breslau, J, Aguilar-Gaxiola, S, Kendler, KS, Su, M, Williams, D, Kessler, RC (2006 a). Specifying race-ethnic differences in risk for psychiatric disorder in a USA national sample. Psychological Medicine 36, 57–68.CrossRefGoogle Scholar
Breslau, J, Chang, DF (2006). Psychiatric disorders among foreign-born and US-born Asian-Americans in a US national survey. Social Psychiatry and Psychiatric Epidemiology 41, 943–950.CrossRefGoogle Scholar
Breslau, N (2002). Epidemiologic studies of trauma, posttraumatic stress disorder, and other psychiatric disorders. Canadian Journal of Psychiatry 47, 923–929.CrossRefGoogle ScholarPubMed
Breslau, N, Chilcoat, HD, Kessler, RC, Davis, GC (1999). Previous exposure to trauma and PTSD effects of subsequent trauma: results from the Detroit Area Survey of Trauma. American Journal of Psychiatry 156, 902–907.CrossRefGoogle ScholarPubMed
Breslau, N, Davis, GC, Andreski, P (1995). Risk factors for PTSD-related traumatic events: a prospective analysis. American Journal of Psychiatry 152, 529–535.Google ScholarPubMed
Breslau, N, Davis, GC, Andreski, P, Peterson, E (1991). Traumatic events and posttraumatic stress disorder in an urban population of young adults. Archives of General Psychiatry 48, 216–222.CrossRefGoogle Scholar
Breslau, N, Davis, GC, Peterson, EL, Schultz, L (1997). Psychiatric sequelae of posttraumatic stress disorder in women. Archives of General Psychiatry 54, 81–87.CrossRefGoogle ScholarPubMed
Breslau, N, Davis, GC, Schultz, LR (2003). Posttraumatic stress disorder and the incidence of nicotine, alcohol, and other drug disorders in persons who have experienced trauma. Archives of General Psychiatry 60, 289–294.CrossRefGoogle ScholarPubMed
Breslau, N, Kessler, R, Chilcoat, HD, Schultz, LR, Davis, GC, Andreski, P (1998). Trauma and posttraumatic stress disorder in the community: The 1996 Detroit Area Survey of Trauma. Archives of General Psychiatry 55, 626–632.CrossRefGoogle ScholarPubMed
Breslau, N, Lucia, VC, Alvarado, GF (2006 b). Intelligence and other predisposing factors in exposure to trauma and posttraumatic stress disorder: a follow-up study at age 17 years. Archives of General Psychiatry 63, 1238–1245.CrossRefGoogle ScholarPubMed
Breslau, N, Peterson, EL, Poisson, LM, Schultz, LR, Lucia, VC (2004 a). Estimating post-traumatic stress disorder in the community: lifetime perspective and the impact of typical traumatic events. Psychological Medicine 34, 889–898.CrossRefGoogle ScholarPubMed
Breslau, N, Wilcox, HC, Storr, CL, Lucia, VC, Anthony, JC (2004 b). Trauma exposure and posttraumatic stress disorder: a study of youths in urban America. Journal of Urban Health 81, 530–544.CrossRefGoogle ScholarPubMed
Brewin, CR, Andrews, B, Gotlib, IH (1993). Psychopathology and early experience: a reappraisal of retrospective reports. Psychological Bulletin 113, 82–98.CrossRefGoogle ScholarPubMed
Brewin, CR, Andrews, B, Valentine, JD (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology 68, 748–766.CrossRefGoogle ScholarPubMed
Bromet, E, Sonnega, A, Kessler, RC (1998). Risk factors for DSM-III-R posttraumatic stress disorder: findings from the National Comorbidity Survey. American Journal of Epidemiology 147, 353–361.CrossRefGoogle ScholarPubMed
Chow, JC, Jaffee, K, Snowden, L (2003). Racial/ethnic disparities in the use of mental health services in poverty areas. American Journal of Public Health 93, 792–797.CrossRefGoogle ScholarPubMed
Copeland, WE, Keeler, G, Angold, A, Costello, EJ (2007). Traumatic events and posttraumatic stress in childhood. Archives of General Psychiatry 64, 577–584.CrossRefGoogle ScholarPubMed
Cox, D (1972). Regression models and life-tables. Journal of the Royal Statistical Society, Series B (Methodological) 34, 187–220.CrossRefGoogle Scholar
Dawson, DA (1998). Beyond black, white and Hispanic: race, ethnic origin and drinking patterns in the United States. Journal of Substance Abuse 10, 321–339.CrossRefGoogle ScholarPubMed
DeNavas-Walt, C, Proctor, BD, Smith, JC (2008). Income, poverty, and health insurance coverage in the United States: 2007. In Current Population Reports: Consumer Income, pp. 1–71. United States Census Bureau and United States Department of Commerce: Washington, DC.Google Scholar
Dohrenwend, BP, Turner, JB, Turse, NA, Lewis-Fernandez, R, Yager, TJ (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.CrossRefGoogle ScholarPubMed
Ellis, BH, MacDonald, HZ, Lincoln, AK, Cabral, HJ (2008). Mental health of Somali adolescent refugees: the role of trauma, stress, and perceived discrimination. Journal of Consulting and Clinical Psychology 76, 184–193.CrossRefGoogle ScholarPubMed
Farley, M, Patsalides, BM (2001). Physical symptoms, posttraumatic stress disorder and healthcare utilization of women with and without childhood physical and sexual abuse. Psychological Reports 89, 595–606.CrossRefGoogle ScholarPubMed
Finkelhor, D, Ormrod, R, Turner, H, Hamby, SL (2005). The victimization of children and youth: a comprehensive, national survey. Child Maltreatment 10, 5–25.CrossRefGoogle ScholarPubMed
Finkelhor, D, Ormrod, RK, Turner, HA (2007). Re-victimization patterns in a national longitudinal sample of children and youth. Child Abuse and Neglect 31, 479–502.CrossRefGoogle Scholar
Gavrilovic, JJ, Schutzwohl, M, Fazel, M, Priebe, S (2005). Who seeks treatment after a traumatic event and who does not? A review of findings on mental health service utilization. Journal of Traumatic Stress 18, 595–605.CrossRefGoogle Scholar
Grant, B, Dawson, D, Hasin, D (2001). The Alcohol Use Disorder and Associated Disabilities Interview Schedule – DSM-IV Version. National Institute on Alcohol Abuse and Alcoholism: Bethesda, MD.Google Scholar
Grant, B, Kaplan, K (2005). Source and Accuracy Statement for the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). National Institute on Alcohol Abuse and Alcoholism: Rockville, MD.Google Scholar
Hapke, U, Schumann, A, Rumpf, HJ, John, U, Meyer, C (2006). Post-traumatic stress disorder – the role of trauma, pre-existing psychiatric disorders, and gender. European Archives of Psychiatry and Clinical Neuroscience 256, 299–306.CrossRefGoogle ScholarPubMed
Harrell, E (2007). Black victims of violent crime. In Bureau of Justice Statistics Special Report, pp. 1–12. United States Department of Justice, Office of Justice Programs: Washington, DC.Google Scholar
Harrell, E (2009). Asian, Native Hawaiian, and Pacific Islander victims of crime, pp. 1–8. In Bureau of Justice Statistics Special Report. United States Department of Justice, Office of Justice Programs: Washington, DC.Google Scholar
Harris, KM, Edlund, MJ, Larson, S (2005). Racial and ethnic differences in the mental health problems and use of mental health care. Medical Care 43, 775–784.CrossRefGoogle ScholarPubMed
Hasselberg, M, Laflamme, L, Weitoft, GR (2001). Socioeconomic differences in road traffic injuries during childhood and youth: a closer look at different kinds of road user. Journal of Epidemiology and Community Health 55, 858–862.CrossRefGoogle Scholar
Hatch, SL, Dohrenwend, BP (2007). Distribution of traumatic and other stressful life events by race/ethnicity, gender, SES and age: a review of the research. American Journal of Community Psychology 40, 313–332.CrossRefGoogle Scholar
Himle, JA, Baser, RE, Taylor, RJ, Campbell, RD, Jackson, JS (2009). Anxiety disorders among African Americans, blacks of Caribbean descent, and non-Hispanic whites in the United States. Journal of Anxiety Disorders 23, 578–590.CrossRefGoogle ScholarPubMed
Huang, ZJ, Wong, FY, Ronzio, CR, Yu, SM (2007). Depressive symptomatology and mental health help-seeking patterns of U.S.- and foreign-born mothers. Maternal and Child Health Journal 11, 257–267.CrossRefGoogle ScholarPubMed
Jayakody, R, Danziger, S, Kessler, RC (1998). Early-onset psychiatric disorders and male socioeconomic status. Social Science Research 27, 371–387.CrossRefGoogle Scholar
Jaycox, LH, Marshall, GN, Schell, T (2004). Use of mental health services by men injured through community violence. Psychiatric Services 55, 415–420.CrossRefGoogle ScholarPubMed
Johnson, RL, Saha, S, Arbelaez, JJ, Beach, MC, Cooper, LA (2004). Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. Journal of General Internal Medicine 19, 101–110.CrossRefGoogle ScholarPubMed
Kessler, RC (2000). Posttraumatic stress disorder: the burden to the individual and to society. Journal of Clinical Psychiatry 61, 4–12.Google Scholar
Kessler, RC, Chiu, WT, Demler, O, Merikangas, KR, Walters, EE (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617–627.CrossRefGoogle ScholarPubMed
Kessler, RC, Sonnega, A, Bromet, E, Hughes, M, Nelson, CB (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry 52, 1048–1060.CrossRefGoogle ScholarPubMed
Kilpatrick, DG, Acierno, R (2003). Mental health needs of crime victims: epidemiology and outcomes. Journal of Traumatic Stress 16, 119–132.CrossRefGoogle ScholarPubMed
Koenen, KC, Fu, QJ, Lyons, MJ, Toomey, R, Goldberg, J, Eisen, SA, True, W, Ming, T (2005). Juvenile conduct disorder as a risk factor for trauma exposure and posttraumatic stress disorder. Journal of Traumatic Stress 18, 23–32.CrossRefGoogle ScholarPubMed
Koenen, KC, Goodwin, R, Struening, E, Hellman, F, Guardino, M (2003). Posttraumatic stress disorder and treatment seeking in a national screening sample. Journal of Traumatic Stress 16, 5–16.CrossRefGoogle Scholar
Koenen, KC, Harley, R, Lyons, MJ, Wolfe, J, Simpson, JC, Goldberg, J, Eisen, SA, Tsuang, M (2002). A twin registry study of familial and individual risk factors for trauma exposure and posttraumatic stress disorder. Journal of Nervous and Mental Disease 190, 209–218.CrossRefGoogle ScholarPubMed
Koenen, KC, Moffitt, TE, Poulton, R, Martin, J, Caspi, A (2007). Early childhood factors associated with the development of post-traumatic stress disorder: results from a longitudinal birth cohort. Psychological Medicine 37, 181–192.CrossRefGoogle ScholarPubMed
Koenen, KC, Stellman, SD, Sommer, JF Jr, Stellman, JM (2008). Persisting posttraumatic stress disorder symptoms and their relationship to functioning in Vietnam veterans: a 14-year follow-up. Journal of Traumatic Stress 21, 49–57.CrossRefGoogle ScholarPubMed
Kruijshaar, ME, Barendregt, J, Vos, T, de Graaf, R, Spijker, J, Andrews, G (2005). Lifetime prevalence estimates of major depression: an indirect estimation method and a quantification of recall bias. European Journal of Epidemiology 20, 103–111.CrossRefGoogle Scholar
Kubzansky, LD, Koenen, KC, Jones, C, Eaton, WW (2009). A prospective study of posttraumatic stress disorder symptoms and coronary heart disease in women. Health Psychology 28, 125–130.CrossRefGoogle ScholarPubMed
Kubzansky, LD, Koenen, KC, Spiro, A 3rd, Vokonas, PS, Sparrow, D (2007). Prospective study of posttraumatic stress disorder symptoms and coronary heart disease in the Normative Aging Study. Archives of General Psychiatry 64, 109–116.CrossRefGoogle ScholarPubMed
Lewis, SF, Resnick, HS, Ruggiero, KJ, Smith, DW, Kilpatrick, DG, Best, CL, Saunders, BE (2005). Assault, psychiatric diagnoses, and sociodemographic variables in relation to help-seeking behavior in a national sample of women. Journal of Traumatic Stress 18, 97–105.CrossRefGoogle Scholar
Libby, AM, Orton, HD, Novins, DK, Beals, J, Manson, SM (2005). Childhood physical and sexual abuse and subsequent depressive and anxiety disorders for two American Indian tribes. Psychological Medicine 35, 329–340.CrossRefGoogle ScholarPubMed
Loo, CM (1994). Race-related PTSD: the Asian American Vietnam veteran. Journal of Traumatic Stress 7, 637–656.Google ScholarPubMed
Loo, CM, Fairbank, JA, Chemtob, CM (2005). Adverse race-related events as a risk factor for posttraumatic stress disorder in Asian American Vietnam veterans. Journal of Nervous and Mental Disease 193, 455–463.CrossRefGoogle ScholarPubMed
Loo, CM, Ueda, SS, Morton, RK (2007). Group treatment for race-related stresses among minority Vietnam veterans. Transcultural Psychiatry 44, 115–135.CrossRefGoogle ScholarPubMed
Lu, MC, Chen, B (2004). Racial and ethnic disparities in preterm birth: the role of stressful life events. American Journal of Obstetrics and Gynecology 191, 691–699.CrossRefGoogle ScholarPubMed
Moffitt, TE, Caspi, A, Taylor, A, Kokaua, J, Milne, BJ, Polanczyk, G, Poulton, R (2009). How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Psychological Medicine. Published online 1 September 2009. doi: 10.1017/S0033291709991036.Google ScholarPubMed
National Epidemiologic Survey on Alcohol and Related Conditions (2004). Wave 1 NESARC Data Notes. US government, National Institute on Alcohol Abuse and Alcoholism (http://niaaa.census.gov). Accessed 27 February 2008.Google Scholar
Norris, FH (1992). Epidemiology of trauma: frequency and impact of different potentially traumatic events on different demographic groups. Journal of Consulting and Clinical Psychology 60, 409–418.CrossRefGoogle ScholarPubMed
Ortega, AN, Rosenheck, R, Alegria, M, Desai, RA (2000). Acculturation and the lifetime risk of psychiatric and substance use disorders among Hispanics. Journal of Nervous and Mental Disease 188, 728–735.CrossRefGoogle ScholarPubMed
Perkonigg, A, Pfister, H, Stein, MB, Hofler, M, Lieb, R, Maercker, A, Wittchen, HU (2005). Longitudinal course of posttraumatic stress disorder and posttraumatic stress disorder symptoms in a community sample of adolescents and young adults. American Journal of Psychiatry 162, 1320–1327.CrossRefGoogle Scholar
Rand, MR (2008). National crime victimization survey: criminal victimization, 2007, pp. 1–12. In Bureau of Justice Statistics Bulletin. United States Department of Justice, Office of Justice Programs: Washington, DC.Google Scholar
Roberts, AL, Austin, SB, Corliss, HL, Vandermorris, AK, Koenen, KC (in press). Pervasive trauma exposure among US sexual orientation minority adults linked to posttraumatic stress disorder risk. American Journal of Public Health.Google Scholar
Ruan, WJ, Goldstein, RB, Chou, SP, Smith, SM, Saha, TD, Pickering, RP, Dawson, DA, Huang, B, Stinson, FS, Grant, BF (2008). The alcohol use disorder and associated disabilities interview schedule-IV (AUDADIS-IV): reliability of new psychiatric diagnostic modules and risk factors in a general population sample. Drug and Alcohol Dependence 92, 27–36.CrossRefGoogle Scholar
Sakai, JT, Ho, PM, Shore, JH, Risk, NK, Price, RK (2005). Asians in the United States: substance dependence and use of substance-dependence treatment. Journal of Substance Abuse Treatment 29, 75–84.CrossRefGoogle ScholarPubMed
Sakai, JT, Risk, NK, Tanaka, CA, Price, RK (2008). Conduct disorder among Asians and Native Hawaiian/Pacific Islanders in the USA. Psychological Medicine 38, 1013–1025.CrossRefGoogle ScholarPubMed
Santos, MR, Russo, J, Aisenberg, G, Uehara, E, Ghesquiere, A, Zatzick, DF (2008). Ethnic/racial diversity and posttraumatic distress in the acute care medical setting. Psychiatry 71, 234–245.CrossRefGoogle ScholarPubMed
Sawchuk, CN, Roy-Byrne, P, Goldberg, J, Manson, S, Noonan, C, Beals, J, Buchwald, D (2005). The relationship between post-traumatic stress disorder, depression and cardiovascular disease in an American Indian tribe. Psychological Medicine 35, 1785–1794.CrossRefGoogle Scholar
Simpson, TL (2002). Women's treatment utilization and its relationship to childhood sexual abuse history and lifetime PTSD. Substance Abuse 23, 17–30.CrossRefGoogle ScholarPubMed
Stoops, N (2004). Educational Attainment in The United States: 2003 Population Characteristics, pp. 1–10. United States Census Bureau and United States Department of Commerce: Washington, DC.Google Scholar
Storr, CL, Ialongo, NS, Anthony, JC, Breslau, N (2007). Childhood antecedents of exposure to traumatic events and posttraumatic stress disorder. American Journal of Psychiatry 164, 119–125.CrossRefGoogle ScholarPubMed
Ta, VM, Juon, HS, Gielen, AC, Steinwachs, D, Duggan, A (2008). Disparities in use of mental health and substance abuse services by Asian and Native Hawaiian/other Pacific Islander women. Journal of Behavioral Health Services and Research 35, 20–36.CrossRefGoogle ScholarPubMed
Takeuchi, DT, Zane, N, Hong, S, Chae, DH, Gong, F, Gee, GC, Walton, E, Sue, S, Alegria, M (2007). Immigration-related factors and mental disorders among Asian Americans. American Journal of Public Health 97, 84–90.CrossRefGoogle ScholarPubMed
Todd, J, Armon, C, Griggs, A, Poole, S, Berman, S (2006). Increased rates of morbidity, mortality, and charges for hospitalized children with public or no health insurance as compared with children with private insurance in Colorado and the United States. Pediatrics 118, 577–585.CrossRefGoogle ScholarPubMed
Ullman, S, Brecklin, L (2002). Sexual assault history, PTSD, and mental health service seeking in a national sample of women. Journal of Community Psychology 30, 261–279.CrossRefGoogle Scholar
Vogel, LC, Marshall, LL (2001). PTSD symptoms and partner abuse: low income women at risk. Journal of Traumatic Stress 14, 569–584.CrossRefGoogle ScholarPubMed
Wang, PS, Lane, M, Olfson, M, Pincus, HA, Wells, KB, Kessler, RC (2005). Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 629–640.CrossRefGoogle ScholarPubMed
Williams, DR, Jackson, PB (2005). Social sources of racial disparities in health. Health Affairs (Millwood) 24, 325–334.CrossRefGoogle ScholarPubMed
Williams, DR, Neighbors, HW, Jackson, JS (2008). Racial/ethnic discrimination and health: findings from community studies. American Journal of Public Health 98, S29–S37.CrossRefGoogle ScholarPubMed
Yamashiro, G, Matsuoka, JK (1997). Help-seeking among Asian and Pacific Americans: a multiperspective analysis. Social Work 42, 176–186.CrossRefGoogle ScholarPubMed
Zayfert, C, Dums, AR, Ferguson, RJ, Hegel, MT (2002). Health functioning impairments associated with posttraumatic stress disorder, anxiety disorders, and depression. Journal of Nervous and Mental Disease 190, 233–240.CrossRefGoogle ScholarPubMed
Zhai, F, Gao, Q (2009). Child maltreatment among Asian Americans: characteristics and explanatory framework. Child Maltreatment 14, 207–224.CrossRefGoogle Scholar