The topic of "culture, race, ethnicity and PTSD" is a complicated subject, with great potential to offend, so it has to be covered delicately, and slowly, over time.
There is a concern that ethnic minorities or non-white populations experience PTSD at greater rates than whites, but this concept is not without its detractors, who frankly disagree.
It would be interesting to learn more about this phenomenon, and learn if the data really supports it, or if it's just an assumption. If it turns out to be true, then it might be useful to map it against the prevalence of ethnic minorities who serve in the armed forces, in order to guesstimate more accurately future numbers of veterans who are likely to be affected by PTSD, and predict the resources that will be needed for their effective care in their home communities. On the one hand, you would hope that these estimates were already being made; on the other hand, it doesn't seem that they are. Consequently, in this post we're unfortunately raising more questions than answers.
To narrow the focus here enough for discussion, let's take a look at just one ethnicity among many from which we could choose -- one that's on the rise in the United States (and in the U.S. military) -- Hispanics (aka Latinos). Observe how cultural issues may come into play with their incidence of PTSD, as the study indicates. (The same questions that are raised here could apply, in turn, to other ethnic minorities, and ideally, all should be studied.)
Re: Hispanics/Latinos:
"Several studies have found that Hispanic Americans have higher rates of post-traumatic stress disorder (PTSD) than non-Hispanic Caucasian and Black Americans. The authors identified predictors of PTSD symptom severity that distinguished Hispanic police officers (n=189) from their non-Hispanic Caucasian (n=317) and Black (n=162) counterparts and modeled them to explain the elevated Hispanic risk for PTSD. The authors found that greater peri-traumatic dissociation, greater wishful thinking and self-blame coping, lower social support, and greater perceived racism were important variables in explaining the elevated PTSD symptoms among Hispanics. Results are discussed in the context of Hispanic culture and may be important for prevention of mental illness in the fastest growing ethnic group in the United States." (Source.)
Hispanics/Latinos in the military. Do figures exist for how many Hispanics/Latinos are currently serving in the military; and/or are veterans of the Vietnam war, the Gulf war, the Iraq war, or Afghanistan? Are more Hispanics/Latinos joining the military?
I've seen a copy of a report that the state of Massachusetts has for number of veterans by zip code across the state. Not surprisingly, a quick glance through that report impresses the casual reader that numbers of veterans are highest in poorer communities than wealthier communities. (You'd have to know Massachusetts for the examples to make sense, but say, the difference between Brockton or Fall River, MA and Wellesley or Osterville, MA.) A similar trend may also exist for communities with higher concentrations of ethnic minorities.
Hispanic/Latinos military suicides. Similarly, do figures exist that break out the ethnicity of active duty servicemembers or veterans who have committed suicide? Seemingly, the data to this point has not been this specific, but it needs to be.
Ironically, an unrelated study (circa 2002) done at the VA showed that with regard to being misdiagnosed with a particular mental illness (in this case, schizophrenia), you were more likely to be misdiagnosed if you were black or Hispanic than if you were white. Also, if you were single, male, and lived in a rural area.
A study published in the American Journal of Public Health, Dec. 2007, Vol. 97, No. 12 offered some conflicting findings. Their study, done with the VA system in the Ann Arbor, Michigan area, suggested that suicide rates for Hispanic veterans were actually LOWER than those of whites. According to the study's authors:
"When the researchers calculated suicide rates over the entire 5.5 year study period, they were much higher for men (89.5 per 100,000 person-years) than for women (28.9), and higher for whites (95 per 100,000 PY) than for African Americans (27) and veterans of other races (56.1). Veterans of Hispanic origin had a lower rate (46.28 per 100,000 PY) of suicide than those not of Hispanic origin (86.8)."
The study had other unusual findings, including that vets with service-connected disabilities committed suicide less frequently than those without, and, most interestingly, that veterans with PTSD diagnoses committed suicide less frequently than those without such diagnoses(!).
However, the study's methodology was such that "the researchers analyzed comprehensive data from 807,694 veterans of all ages diagnosed with depression and treated at any Veterans Affairs facility nationwide between 1999 and 2004." In other words, before any significant number of OEF/OIF vets could be included in the study, a group whose rate of suicide is markedly higher than expected. In fact, during the course of the study, only "1,683 of the [over 800,000] depressed veterans committed suicide," a figure which represents "0.21 percent of the depressed veterans studied." Clearly, suicide figures among veterans today are higher than this study indicated, and it would be worthwhile redoing the study with a more current population of veterans.
