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. Author manuscript; available in PMC: 2024 Jul 1.
Published in final edited form as: Cogn Behav Ther. 2023 Feb 14;52(4):317–330. doi: 10.1080/16506073.2023.2176783

Posttraumatic Stress among Trauma-Exposed Hispanic/Latinx Adults: Relations to Mental Health

Nubia A Mayorga 1, Justin M Shepherd 1, Cameron T Matoska 1, Katherine E Kabel 1, Anka A Vujanovic 1, Andres G Viana 1, Michael Zvolensky 1,2,3
PMCID: PMC10247488  NIHMSID: NIHMS1871993  PMID: 36786315

Abstract

Latinx persons are exposed to higher rates of traumatic events and conditional risks for developing posttraumatic stress disorder (PTSD) symptoms and comorbid mental health symptoms compared to other minority groups. The study evaluated PTSD symptom severity for global and specific cluster severity relating to co-occurring anxiety, social anxiety, depression, and suicidal ideation among 326 Latinx adults who endorsed trauma exposure. Results indicated that global PTSD symptom severity was significantly related to greater social anxiety, anxious arousal, depression, and suicidal ideation symptoms. PTSD arousal and reactivity symptom cluster had the strongest relation to r anxious arousal, social anxiety, and depression, whereas negative alterations in cognitions and mood symptoms had the strongest association with social anxiety, depression, and suicidal ideation. The findings suggest that global PTSD symptom severity, alongside arousal and reactivity and negative alterations in cognitions and mood, are related to a range of concurrent negative mental health symptoms among trauma exposed Latinx young adults.

Keywords: Latinx, Posttraumatic Stress Disorder, Anxious Arousal, Depression, Social Anxiety, Comorbidity

Introduction

The Latinx population experiences several trauma and posttraumatic stress disparities (Sibrava et al., 2019), including intergenerational and community transferred trauma (e.g., immigration raids, undocumented status, incarceration of loved ones; (Stucchi-Duran, 2011) at higher rates than non-Latinx White persons ( López et al., 2017). The United States (U.S.) Latinx population evinces a higher conditional risk for posttraumatic stress disorder (PTSD) compared to other racial groups (McKnight-Eily et al., 2021) and when diagnosed with PTSD, Latinx persons showcase a more chronic course (McKnight-Eily et al., 2021; Ortega & Rosenheck, 2000).

Both diagnostic and subclinical PTSD are associated with higher rates of co-occurring mental health problems (Keane et al., 2007). Even subthreshold levels of PTSD can be a risk factor for developing mental health symptoms and disorders (e.g., depression; Yarvis & Schiess, 2008). Regarding the Latinx population, specifically, diagnostic and subclinical PTSD are associated with greater severity of anxiety and social anxiety symptoms (Mayorga et al., 2021; Pérez Benítez et al., 2014). Elevated symptoms may be further influenced by sociocultural issues such as mental health stigma and racial/ethnic discrimination that impede PSTD assessment and treatment (Pérez Benítez et al., 2014). Moreover, PTSD is related to prior suicide attempts and ideation as well as ideation (Krysinska & Lester, 2010), and increased risk for suicidal ideation, attempts, and having a plan (Tarrier & Gregg, 2004). Research that evaluates the relationship between suicide risk and PTSD among Latinx persons is limited; more work is needed to identify specific risk factors that are associated with suicide risk among this minoritized group.

Although research has established global PTSD symptoms as an important factor for mental health comorbidity among trauma exposed Latinx adults (Eisenman et al., 2008), limited work has explored its symptom cluster dimensions. By identifying the symptoms of PTSD that engender worse psychological functioning above the others, clinical treatments can provide more nuanced screening and targeted therapeutic techniques for trauma exposed populations (Asnaani et al., 2014). Research among non-Latinx White samples has found PTSD-related avoidance shares stronger associations with impaired functioning compared to hyperarousal and intrusion symptoms (North et al., 1999; Rona et al., 2009). Other studies have found PTSD-related numbing symptoms are associated with lower life satisfaction and greater impairment in role functioning (Lunney & Schnurr, 2007). These investigations have started documenting which PTSD cluster symptoms are more reliable predictors of psychological wellbeing, such as avoidance and hyperarousal symptoms being related to achievement, and numbing symptoms being associated with changes in personal relationships. However, overall results remain inconsistent and limited work has focused on Latinx persons.

Of relevant work among Latinx populations, one study focused on Latinx firefighters reported that PTSD-related symptom clusters of arousal and reactivity, avoidance, and re-experiencing (intrusion symptoms) were related to greater depression (Arbona & Schwartz, 2016). Further, cross sectional and longitudinal work has found a higher frequency of trauma-related intrusion symptoms among Latinx persons compared to non-Latinx White or Black persons (Perilla et al., 2002). Trauma categories such as exposure type (e.g., war related, childhood maltreatment) have been identified as viable predictors of suicide risk among racial and ethnic minorities, but these data have yet to extend into specific PTSD symptom clusters (Beristianos et al., 2016). No work has explored whether the PTSD symptom cluster of intrusion is associated with worse depression or anxiety symptoms among trauma exposed Latinx persons. Broadening scientific understanding of PTSD symptom clusters regarding co-occurring mental health problems is needed to aid the development of culturally informed interventions for trauma exposed Latinx persons.

The current work aimed to evaluate associations between PTSD symptom severity and co-occurring anxiety, social anxiety, depression, and suicidal ideation among trauma exposed Latinx adults. Global PTSD symptom severity was predicted to be associated with more severe co-occurring mental health symptoms. It was hypothesized that trauma-related intrusion, negative alterations in cognitions and mood, and arousal and reactivity symptom clusters severity would be most strongly related to depression and anxious arousal (Arbona & Schwartz, 2016) and negative alterations in cognitions and mood would predict social anxiety and suicidal ideation. Across models, PTSD-related effects were expected to be evident over and above the variance accounted for by factors that have been associated with somatic disturbances and psychopathology in the Latinx population. Specifically, older age (Beutel et al., 2019), being female (Seedat et al., 2009), lower education (Bjelland et al., 2008), lower income (Sareen et al., 2011), national origin (Preciado & D’Anna-Hernandez, 2017), higher levels of neuroticism (Mostafaei et al., 2019), and a greater number of lifetime traumatic event types experienced (Elhai et al., 2012).

Methods

Participants

Participants included Latinx trauma-exposed adults recruited form a large, urban southwestern University (N = 326; Mage = 22.40 years; SD = 5.79; age range: 18-59 years; 85.3% female) who participated between September 2019 through April 2021. Participants received extra credit towards their psychology course of choice as compensation and were recruited via postings on the online Sona Systems website, a secure cloud-based participant software tool for universities. Inclusion criteria for the current study included identifying as Latinx, being between ages 18 and 64, reporting exposure to a DSM-5 PTSD Criterion A traumatic event, and proficiency in English.

Measures

Demographic Questionnaire.

A demographic questionnaire was used to collect sociodemographic information; age, sex, education history, income, and national origin were included as covariates.

Big Five Inventory-10 (BFI-10).

The BFI-10 (Rammstedt & John, 2007) is a 10-item self-report measure that assesses five key dimensions of an individual’s personality (i.e., extraversion, agreeableness, conscientiousness, neuroticism, and openness to experiences). Each item is scored on a 5-point Likert-type scale ranging from 1 (disagree strongly) to 5 (agree strongly). The BFI-10 has demonstrated strong psychometric properties in prior work (Rammstedt & John, 2007). In the current study, the two-item neuroticism subscale was used as a covariate as prior work has noted persons with higher levels of neuroticism have endorsed worse somatic disturbances following a traumatic event, and worse mental health severity (Mostafaei et al , 2019).

Posttraumatic Diagnostic Scale (PDS-5).

The PDS-5 (Foa et al., 2016) is a 24-item self-report measure designed to assess traumatic event exposure history and index (i.e., most distressing) trauma. The measure yields a total symptom severity score (range = 0-80) as well as four subscale scores: intrusion, avoidance, negative alterations in cognitions and mood, and arousal and reactivity. The PDS-5 has demonstrated strong internal consistency (Foa et al., 2016). In the current study, the PDS-5 total score (α = .96) and subscales (α’s range = .78 - .91) demonstrated good to excellent internal consistency and were used as predictor variables.

Inventory of Depression and Anxiety Symptoms (IDAS).

The IDAS (Watson et al., 2007) is a 64-item self-report measure that assesses distinct affective symptom clusters. The IDAS consists of 10 specific subscales. In the current study, four subscales were used as criterion variables: anxious arousal, social anxiety, general depression, and suicidal ideation. Respondents rate the degree to which they experience symptoms within the past two weeks on a 5-point Likert-type scale from 1 (not at all) to 5 (extremely). Further, cut-off scores were used to assess symptom severity (i.e., mild, moderate, and severe), among subscales, (Stasik-O’Brien et al., 2019). The IDAS subscales show strong psychometric properties with both community and psychiatric patient samples (Watson et al., 2008; Watson et al., 2007). In the present work, the four subscales demonstrated good to excellent internal consistency (anxious arousal α = .89; social anxiety = .88; general depression α = .93; suicidal ideation = .87).

Procedure

Participants were recruited from a large, urban southwestern university campus and through Sona Systems. Individuals who met eligibility criteria completed several self-report measures via Qualtrics. All participants provided informed consent, prior to proceeding to the Qualtrics survey and were compensated with extra course credit for their psychology course of choice. Additionally, several quality assurance safeguards were included to ensure the validity of the data such as collection of IP addresses and checks for inattention. This study protocol was approved by the Institutional Review Board at the university wherein the study took place and was performed in line with the principles of the Declaration of Helsinki.

Analytic Strategy

Analyses were conducted using SPSS version 28. Sample descriptive statistics and zero-order correlations among study variables were examined. Two-step hierarchical regressions were conducted for each of the criterion variables: (1) anxious arousal, (2) social anxiety, (3) general depression, and (4) suicidal ideation. For all analyses, step one covariates included age (Beutel et al., 2019), sex (Seedat, 2009), education (Bjelland et al., 2008), income (Sareen et al., 2011), national origin (Preciado & D’Anna-Hernandez, 2017), neuroticism (Mostafaei, 2019) and number of traumatic event types experienced (Elhai & Palmieri, 2011). Step two included PTSD symptom severity. In separate models, the four PTSD symptom clusters were entered simultaneously at step two. Model fit for each of the steps was evaluated with the F statistic and an increase in variance accounted for as evidenced by a change in R2. Change in R2 and squared semi-partial correlations (sr2) were used as indices of effect size.

Results

Bivariate Relations and Frequencies

Bivariate correlations and descriptive statistics are presented in Table 1. PTSD symptom severity was positively correlated with anxious arousal (r = .53), social anxiety (r = .47), general depression (r = .64), and suicidal ideation (r = .53). Additionally, PTSD-related intrusion, avoidance, negative alterations in cognitions and mood, and arousal and reactivity symptoms were positively correlated with anxious arousal (r’s range = .43-.52), social anxiety (r’s range = .35-.47), general depression (r’s range = .51-.64), and suicidal ideation (r’s range = .40-.53). Additionally, 23.7% of the sample met the clinical cut-off score for probable PTSD (>28) (Foa et al., 2016).

Table 1.

Descriptive Statistics and Bivariate Correlations between Study Variables (N = 326)

Variable 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1. Age --
2. Sex −.08 --
3. Education .36** .02 --
4. Income .55** −.05 .31** --
5. National Origin .07 −.05 .06 −.06 --
6. Neuroticism −.19** .22** −.10 −.15** .08 --
7. # Traumatic Events .09 .02 .13* .09 −.04 −.06 --
8. Posttraumatic Stress Symptom Severity −.06 .12* .06 −.08 −.02 .32** .35** --
9. Intrusion −.04 .16** .07 −.06 −.03 .26** .36** .90** --
10. Avoidance −.05 .16** .05 −.08 −.005 .24** .30** .86** .82** --
11. Negative Alterations in Cognition and Mood −.09 .06 .06 −.11* −.03 .32** .34** .95** .79** .79** --
12. Arousal and Reactivity −.03 .10 .03 −.04 −.01 .32** .28** .93** .76** .71** .84** --
13. Anxious Arousal −.14* .18** −.07 −.15** −.005 .37** .10 .53** .48** .43** .50** .52** --
14. Social Anxiety −.15** .12* −.11 −.13* .03 .48** .06 .47** .35** .36** .47** .47** .60** --
15. Depression −.13* .15** −.01 −.14* .01 .52** .22** .64** .51** .52** .64** .63** .66** .62** --
16. Suicidal ideation −.08 .02 .05 −.12* −.003 .25** .17** .53** .46** .40** .53** .50** .57** .45** .62** --
Mean/n 22.40 278 4.19 1.93 53 6.76 2.02 17.20 3.90 2.10 5.87 5.34 13.26 11.10 50.60 8.46
SD/% 5.79 85.3% 0.84 1.59 16.3% 2.02 1.16 17.25 4.17 2.22 6.59 5.72 6.22 5.26 16.18 4.10
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Note.

**

p < .01,

*

p < .05.

Sex: % listed as females (Coded: 0 = male and 1 = female); Place of Birth: % listed as other country (Coded: 0 = United States and 1 = other country); Neuroticism = Big Five Inventory-10 (Rammstedt & John, 2007); # Traumatic Events = Total number of traumatic events from the Posttraumatic Diagnostic Scale-5 (Foa et al., 2016); Posttraumatic Stress Symptom Severity = Posttraumatic Diagnostic Scale-5 Total Severity Score (Foa et al., 2016); Intrusion, Avoidance, Negative Alterations in Cognition and Mood, and Arousal and Reactivity = Subscales from Posttraumatic Diagnostic Scale-5 (Foa et al., 2016); Anxious Arousal = Inventory of Depression and Anxiety Symptoms-Anxious Arousal subscale (Watson et al., 2007); Social Anxiety = Inventory of Depression and Anxiety Symptoms-Social Anxiety subscale (Watson et al., 2007); Depression = Inventory of Depression and Anxiety Symptoms-General Depression subscale (Watson et al., 2007); Suicidal ideation = Inventory of Depression and Anxiety Symptoms-Suicidal ideation subscale (Watson et al., 2007).

Regarding mental health variables, 14.7% of the sample met the cut-off score for mild severity anxious arousal severity, 8.0% for moderate, and 2.5% for severe anxious arousal. Further, 16.0% met the clinical cut-off for mild social anxiety, followed by 10.7% for moderate, and 1.2% for severe. In addition, 35.0% evinced (probable) mild depression, 5.2% with moderate depression, and 2.8% met the severe clinical cut-off. Lastly, 16.6% of participants met the recommended cut-off score of mild suicidal ideation,7.7% evinced moderate suicidal ideation, and 0.6% for severe suicidal ideation.

Regarding the number of traumatic event types experienced, 42.6% reported exposure to one traumatic event type, whereas 57.4% reported experiencing two or more trauma types. The most common traumatic event types experienced by the current sample included: natural disaster (69.6%), accident (e.g., serious injury or death from a car; 35.3%), sexual assault (25.5%), childhood physical or sexual abuse (20.2%), physical assault (19.0%), serious life-threatening illness (14.1%), and military combat or lived in a war zone (2.5%).

Regression Analyses

Regression results are presented in Table 2. For anxious arousal, step one of the model was statistically significant (R2 = .18, F(7, 318) = 9.77, p < .001); neuroticism and number of traumatic event types were statistically significant correlates. In step two, the model with PTSD symptom severity was statistically significant (ΔR2 = .17, F(1, 317) = 21.20, p < .001). Regarding the symptom cluster analyses, PTSD-related intrusion (b = .28, SE = .14, p = .043, sr2 =.009) and AR (b = .27, SE = .10, p = .006, sr2 =.016) symptom severity were statistically significant, incremental correlates of anxious arousal severity.

Table 2.

Hierarchical Linear Regression Results

Anxious Arousal
Step ΔR2 b SE t p CI (l) CI (u) sr2
1 Age .18*** −0.03 0.07 −0.40 .691 −0.16 0.11 .0004
Sex 1.62 0.92 1.76 .079 −0.19 3.43 .008
Education −0.14 0.41 −0.34 .732 −0.95 0.67 .0003
Income −0.34 0.24 −1.39 .164 −0.82 0.14 .005
National Origin −0.38 0.87 −0.44 .660 −2.10 1.33 .001
Neuroticism 1.06 0.16 6.47 <.001 0.74 1.38 .108
# Traumatic Events 0.71 0.28 2.58 .010 0.17 1.25 .017
2a Posttraumatic Stress Symptom Severity .17*** 0.17 0.02 9.14 <.001 0.14 0.21 .172
2b Intrusion .18*** 0.28 0.14 2.03 .043 0.01 0.54 .009
Avoidance −0.16 0.25 −0.66 .508 −0.65 0.32 .001
Negative Alterations in Cognition and Mood 0.13 0.10 1.34 .183 −0.06 0.32 .004
Arousal and Reactivity 0.27 0.10 2.79 .006 0.08 0.46 .016
Social Anxiety
Step ΔR2 b SE t p CI (l) CI (u) sr2
1 Age .25*** −0.03 0.06 −0.47 .635 −0.14 0.08 .001
Sex 0.25 0.74 0.34 .736 −1.21 1.71 .0003
Education −0.30 0.33 −0.91 .364 −0.95 0.35 .002
Income −0.14 0.20 −0.72 .474 −0.53 0.25 .001
National Origin 0.05 0.71 0.07 .947 −1.34 1.43 <.0001
Neuroticism 1.21 0.13 9.12 <.001 0.95 1.47 .197
# Traumatic Events 0.46 0.22 2.08 .038 0.02 0.90 .010
2a Posttraumatic Stress Symptom Severity .10*** 0.11 0.02 7.07 <.001 0.08 0.14 .103
2b Intrusion .12*** −0.16 0.11 −1.37 .173 −0.38 0.07 .004
Avoidance 0.03 0.21 0.16 .873 −0.37 0.44 .0001
Negative Alterations in Cognition and Mood 0.19 0.08 2.35 .019 0.03 0.35 .011
Arousal and Reactivity 0.23 0.08 2.87 .004 0.07 0.39 .017
General Depression
Step ΔR2 b SE t p CI (l) CI (u) sr2
1 Age .34*** −0.06 0.16 −0.37 .710 −0.37 0.25 .0003
Sex 0.96 2.14 0.45 .653 −3.24 5.16 .0004
Education 0.91 0.95 0.96 .339 −0.96 2.79 .002
Income −0.89 0.57 −1.57 .117 −2.01 0.22 .005
National Origin −1.08 2.03 −0.53 .595 −5.06 2.91 .001
Neuroticism 4.16 0.38 10.91 <.001 3.41 4.91 .246
# Traumatic Events 3.59 0.64 5.60 <.001 2.33 4.85 .065
2a Posttraumatic Stress Symptom Severity .18*** 0.46 0.04 11.05 <.001 0.38 0.55 .183
2b Intrusion .20*** −0.43 0.30 −1.44 .151 −1.01 0.16 .003
Avoidance 0.44 0.54 0.82 .412 −0.62 1.50 .001
Negative Alterations in Cognition and Mood 0.69 0.21 3.24 .001 0.27 1.12 .015
Arousal and Reactivity 0.81 0.21 3.83 <.001 0.40 1.23 .021
Suicidal ideation
Step ΔR2 b SE t p CI (l) CI (u) sr2
1 Age .12*** −0.01 0.05 −0.27 .788 −0.10 .08 .0002
Sex −0.60 0.63 −0.96 .338 −1.84 0.63 .003
Education 0.51 0.28 1.80 .072 −0.05 1.06 .009
Income −0.33 0.17 −1.97 .049 −0.66 −.001 .011
National Origin −0.33 0.60 −0.55 .584 −1.50 0.84 .001
Neuroticism 0.53 0.11 4.77 <.001 0.31 0.75 .063
# Traumatic Events 0.66 0.19 3.52 .001 0.29 1.03 .034
2a Posttraumatic Stress Symptom Severity .18* 0.12 0.01 9.05 <.001 0.09 0.14 .181
2b Intrusion .19** 0.15 0.09 1.64 .102 −0.03 0.33 .006
Avoidance −0.26 0.17 −1.52 .129 −0.59 0.07 .005
Negative Alterations in Cognition and Mood 0.23 0.07 3.45 .001 0.10 0.36 .026
Arousal and Reactivity 0.10 0.07 1.48 .140 −0.03 0.23 .005
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Note. N for analyses is 326 cases.

*

= p <.05;

**

= p <.01;

***

= p <.001.

Neuroticism = Big Five Inventory-10 (Rammstedt & John, 2007); # Traumatic Events = Total number of traumatic events from the Posttraumatic Diagnostic Scale-5 (Foa et al., 2016); Posttraumatic Stress Symptom Severity = Posttraumatic Diagnostic Scale-5 Total Severity Score (Foa et al., 2016); Intrusion, Avoidance, Negative Alterations in Cognition and Mood, and Arousal and Reactivity = Subscales from Posttraumatic Diagnostic Scale-5 (Foa et al., 2016); Anxious Arousal = Inventory of Depression and Anxiety Symptoms-Anxious Arousal subscale (Watson et al., 2007); Social Anxiety = Inventory of Depression and Anxiety Symptoms-Social Anxiety subscale (Watson et al., 2007); General Depression = Inventory of Depression and Anxiety Symptoms-General Depression subscale (Watson et al., 2007); Suicidal ideation = Inventory of Depression and Anxiety Symptoms-Suicidal ideation subscale (Watson et al., 2007).

For social anxiety, the overall model was statistically significant (R2 = .23, F(7, 318) = 14.86, p < .001); neuroticism and number of traumatic event types experienced were statistically significant correlates. PTSD symptom severity was a statistically significant correlate at step two (ΔR2 = .10, F(1, 317) = 21.25, p < .001). Regarding the PTSD symptom clusters, negative alterations in cognitions and mood (b = .19, SE = .08, p = .019, sr2 = .011) and arousal and reactivity (b = .23, SE = .08, p = .004, sr2 = .017) were statistically significant correlates of social anxiety severity.

Regarding general depression, step one was statistically significant (R2 = .34, F(7, 318) = 23.76, p < .001), with neuroticism and number of traumatic event types as statistically significant correlates. In step two, PTSD symptom severity was a statistically significant correlate (ΔR2 = .18, F(1, 317) = 43.96, p < .001). In terms of the PTSD symptom clusters, negative alterations in cognitions and mood (b = .69, SE = .21, p = .001, sr2 = .015) and arousal and reactivity (b = .81, SE = .21, p < .001, sr2 = .021) were statistically significant correlates of general depression severity.

In regard to suicidal ideation, the model was statistically significant (R2 = .12, F(7, 318) = 6.13, p < .001). Specifically, income, neuroticism, and number of traumatic event types were statistically significantly related to suicidal ideation. In step two, PTSD symptom severity was a statistically significant correlate (ΔR2 = .18, F(1, 317) = 16.95, p < .001). For the PTSD symptom clusters, only negative alterations in cognitions and mood (b = .23, SE = .07, p = .001, sr2 = .026) was a statistically significant correlated of suicidal ideation severity.

Discussion

The current study sought to investigate relations of PTSD symptom severity and specific symptom cluster severity with co-occurring mental health problems in trauma exposed Latinx adults. Regarding global PTSD symptom severity, results were in line with hypotheses. Global PTSD symptom severity was significantly and incrementally related to more severe co-occurring mental health symptoms, including anxious arousal, social anxiety, depression, and suicidal ideation. Effect size evaluation indicated global PTSD symptom severity accounted for a range of incremental variance from 10% for social anxiety to 18% for depression and suicidal ideation. These data collectively suggest that greater global levels of PTSD symptomatology among trauma exposed Latinx adults are related to elevated co-occurring mental health symptoms. These effects are not explained by the variance accounted for by a range of theoretically relevant covariates.

For PTSD symptom clusters, results partially lined with expectation. Negative alterations in cognitions and mood and arousal and reactivity symptom severity were the most consistent incremental correlates of mental health symptoms across the studied criterion variables. Arousal and reactivity symptom severity was significantly associated with greater anxious arousal, social anxiety, and depression, but not suicidal ideation; moderate to strong effects were evident for the significant models (b = .23-81; Acock, 2008). These findings align with past work which found PTSD-related arousal and reactivity and intrusion (i.e., “re-experiencing”) were related to risk of depression among Latinx firefighters whereas other symptom clusters related to general distress (Arbona & Schwartz, 2016). This study provides support for the association between PTSD-related arousal and reactivity and intrusion symptoms in terms of negative affect among trauma-exposed Latinx adults. Clinically, it may prove beneficial to assess and provide psychoeducation and cognitive-behavioral skill training for elevation in specific PTSD symptom clusters to offset mental health problems among trauma exposed Latinx persons.

In other work, negative alterations in cognitions and mood symptom severity emerged as a significant correlate of social anxiety, depression, and suicidal ideation, but not anxious arousal. The effect for depression was particularly robust (b = .69; Acock, 2008). These data highlight the prominent role of negative alterations in cognitions and mood symptoms for depression related factors, suicidal ideation, and social anxiety, which tends to frequently co-occur with depressed affect (Connor & Davidson, 2003; Mather et al., 2010; Ohayon & Schatzberg, 2010). These results suggest importance of utilizing therapies that tap into trauma-related cognitions to reduce risk for common mental health comorbidities among trauma exposed Latinx individuals (Cognitive processing therapy; (Holliday et al., 2018). The overlap between PTSD-related negative alterations in cognitions and mood and depression may be due to the overlapping nature of symptomatology (e.g., negative beliefs about self, others, or the world). PTSD-related intrusion symptoms were incrementally related to anxious arousal only.

The present data implicate global PTSD symptom severity as a relevant mental health phenotype for better understanding co-occurring anxious arousal, social anxiety, depression, and suicidal ideation among trauma exposed Latinx adults. Theory and research, largely conducted among non-Latinx White samples, have consistently found evidence that a greater tendency to experience PTSD symptomatology is associated with expression, onset, and maintenance of negative mood states and life impairment (Green et al., 2006; Rona et al., 2009). Theoretical perspectives posit that PTSD symptomatology can be associated with co-occurring psychological symptoms through the mechanisms of avoidance, negative alterations in cognitions and mood, and arousal and reactivity (Campbell et al., 2007; Kashdan et al., 2009). The current investigation found some support for this perspective in that evaluation of symptom dimensions revealed consistent relations of arousal and reactivity with anxious arousal, social anxiety, and depression and negative alterations in cognitions and mood with social anxiety, depression, and suicidal ideation. Data suggest that, among trauma exposed Latinx adults with varying PTSD symptoms, these two PTSD symptom clusters may play an important role in the expression of many common forms of mental health symptoms for this population.

Results fall largely in line with what has been found among non-Latinx White samples (e.g., arousal and reactivity and negative alterations in cognitions and mood strongly related to anxiety and depression; Contractor et al., 2014, 2016; Hurlocker et al., 2018). For the Latinx population specifically, future work could usefully evaluate the cultural components that influence PTSD symptom clusters and mental health comorbidity (e.g., cultural values such as stoicism, mental health stigma). Future research also is needed to explicate the mechanisms underlying the observed relations.

Clinically, the present findings suggest that diagnostic or subclinical PTSD symptomatology may represent an important psychological construct in the expression of co-occurring mental health problems among trauma exposed Latinx adults. The extension of present results using alternative research designs and clinical samples would be useful. For example, there may be benefit to screen and focus intervention development efforts on reducing PTSD symptomatology and specific PTSD symptom clusters (i.e., arousal and reactivity, negative alterations in cognitions and mood) among trauma exposed Latinx adults to offset mental health burden among this health disparities group (De Arellano et al., 2018). Moreover, considering cultural factors relevant to the Latinx population is important in efforts to offer a more comprehensive understanding of complex mental health issues among trauma exposed Latinx adults. For example, stoicism has been related to poorer psychological wellbeing and may be linked to avoidance among trauma exposed Latinx persons (Phinney et al., 2000). Therefore, future work might focus on adapting extant evidence-based interventions for PTSD for Latinx adults (Epelbaum et al., 2010) to form culturally relevant approaches to address trauma-related Latinx mental health disparities.

There are several study limitations. First, the sample limits the generalizability of the results among the Latinx population in terms of other age groups, education levels, or English language proficiency levels. All materials were included in English therefore excluding non-English speaking Latinx persons whom make up 28.4% of the U.S population (“Facts on Latinos in America,” 2020). Studies regarding PTSD mental health comorbidity should consider including Spanish speaking Latinx individuals. Second, the current work utilized self-report measures to assess PTSD symptom severity. Future research could increase validity of responses via structured clinical interviews. Third, index trauma (i.e., most distressing traumatic event experienced) was not gathered. Future work would benefit from incorporating this information to further characterize the sample. Fourth, it is important to contextualize the findings among the relatively low level of symptomology observed within the sample. Research should aim to include samples that higher rates of PTSD symptomatology. Fifth, due to the cross-seectional design, subsequent research could employ experimental or longitudinal methodologies to evaluate causal and/or temporal relations between studied variables. Lastly, no corrections were conducted for multiple testing in the current models; although it should be noted that if an alpha correction was employed, most of the statistically significant results would have still been evident at the p < .001 level (i.e., using an alpha correction). Nonetheless, future work could benefit by replicating and extending the current findings using an alpha correction.

Overall, the current study empirically examined global PTSD symptom severity and PTSD symptom clusters in terms of the severity of co-occurring mental health problems among trauma exposed Latinx adults. The results suggest that posttraumatic stress generally, and certain symptom clusters (i.e., arousal and reactivity and negative alterations in cognitions and mood) are associated with a wide range of concurrent negative mental health symptoms among trauma exposed Latinx adults.

Acknowledgements

Research reported in this publication was supported by the National Institute on Minority Health and Health Disparities (NIMHD) of the National Institutes of Health (NIH) to the University of Houston under Award Number U54MD015946. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

Disclosure Statement: The authors report there are no competing interest to declare.

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