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. Author manuscript; available in PMC: 2015 Mar 1.
Published in final edited form as: Soc Psychiatry Psychiatr Epidemiol. 2014 Mar;49(3):417–433. doi: 10.1007/s00127-013-0759-y

Table 2.

Single-population studies of PTSD among American Indians and Alaska Natives

Author-
Year
Time
Frame
Sample
Size
&
Population
Criteria &
Methods
Inciting
Events
Diagnostic
measure
Comorbidities
& Risk
Factors
Major Findings
Boyd-Ball
2006[17]
1997
-
2000
423
adolescents
and
young
adults
from a
Southwest
tribe
Enrolled
tribal
members in
SUPERPF
P dataset,
age 15-24
years.
Survey;
descriptive
statistics
and logistic
regression
Parental
alcohol
use
DSM-IV Risk factor:
Parental
alcohol use
Severe trauma increased
odds of alcohol use disorders
(direction of association
unclear).
Severe traumatic events
correlated with parental
alcohol use.
Severe IPV may have
stronger association with
alcohol use disorders than
severe non-interpersonal
trauma, witnessed trauma, or
traumatic news.
Brinker
2007[18]
255 male
AI/AN
and
Hispanic
veterans
with
lifetime
PTSD in
Southwest
and
North
Central
region
Community
-based sample
Descriptive
statistics
and logistic
regression
Combat
experience
PCL Veterans with combat-related
PTSD had more severe
symptoms, were less likely to
have remitted in the previous
year, and were less likely to
have sought mental health
treatment after military duty.
Csordas
2008[19]
84
Navajo
adults in
the
Southwest
Past
patients of
Navajo
Healing
Project (10-
year
ethnographic
study
of
therapeutic
process)
Ethnography
and
descriptive
statistical
analysis
of
interview
data
SCID Of 78 patients meeting DSM-
IV SCID criteria, 7.7% had
subthreshold lifetime MD,
29.5% had lifetime MD,
11.5% had subthreshold
lifetime PTSD, 23.1% had
lifetime PTSD, 5.1% had
current PTSD, 5.1% had
current other anxiety disorder,
20.5% had lifetime other anxiety disorder,
34.6% had
lifetime alcohol use
dependence, 9% had lifetime
alcohol use abuse.
Lifetime PTSD was 25% for
participants affiliated with
Native American Church,
19.3% for Traditional, and
25.9% for Christian.
23.1% were free from any
lifetime psychiatric stress.
16.1% of
men and 23.4% of
women reported full PTSD.
Lifetime PTSD was 23.5%
among married, 9.1% among
widowed/separated/divorced
(but 45.5% of this group
reported subthreshold PTSD),
and 31.3% among single.
Dickerson
2000[20]
1999
-
2001
480
AI/AN
male
veterans
from the
North
Central
region of
U.S.
AIAN male
veterans in
a
community-
based
sample
Cross-
tabulations
and odds
ratios,
logistic
regression
Quick-
Diagnostic
Interview
Schedule
to
determine
DSM-
III-R
diagnosis
Comorbidity:
Lifetime
nicotine
dependence
Risk factor:
Lifetime
nicotine
dependence
Lifetime prevalence of PTSD
was 11.9%
The highest prevalence of
lifetime nicotine dependence
was found in those with a
lifetime history of affective
disorders (61.9%), followed
by PTSD (52.6%)
Odds of lifetime PTSD were
higher among those with
lifetime nicotine dependence
than among those without.
Dillard
2007[21]
1993
-
1994
591 AI
male
veterans
in the
Southwest
AIAN male
Vietnam
veterans
identified
through
tribal rolls
(AIVVP
dataset)
Retrospective
analysis of survey
data using
descriptive
statistics
and linear
regression
Mississippi
Scale
for Combat-
Related
PTSD
and
DSM-III-R
CD not associated with
increased odds of high war
zone stress.
CD associated with higher
combat-related PTSD
symptoms among veterans
independent of war zone
stress level.
Ducci
2008[22]
291 AI
women
in the
Southwest
Recruited
from a
Southwest
tribe, age ≥
21.
Descriptive
statistics
and
frequencies
.
DSM-III-R Risk factor: Low activity
allele in the
MAOA locus; CSA
Women who had experienced
CSA and were homozygous
for the low activity allele in the
MAOA locus had higher
prevalence of alcoholism and
ASPD, and more ASPD
symptoms, than abused
women homozygous for the
high activity allele. No
relationship between
alcoholism and ASPD and
MAOA-LRP genotype in non-
abused women.
Duran
2004[23]
1999 234
AI/AN
women,
Albuquerque,
NM
Between 18
and 45
years,
received
medical
care from
IHS
facilities
Statistical
analysis of
interview
data
CIDI Risk factor: Child abuse
and neglect
76.5% reported some type of
CAN; more than 40%
reported severe CAN.
Severity of CAN was
associated with lifetime
diagnosis of psychiatric
disorders.
Severe CAN was most
strongly associated with
lifetime PTSD.
Lifetime PTSD prevalence
was 3.9.
Duran
2009[24]
1999 234 AI
women,
Albuquerque,
NM
Between 18
and 45
years,
received
medical
care from
IHS
facilities;
fluent in
English
Statistical
analysis of
interview
data
CIDI Comorbidities:
Severe
IPV, high
debt
Risk
factors:
Severe
IPV, high
debt, family
history of
alcohol use
Unadjusted prevalence ratios
for severe physical and
sexual abuse were significant
for anxiety, PTSD, mood,
and any mental disorder.
Women with severe IPV were
five times more likely to have
PTSD than women without
IPV .
Evans-
Campbell
2006[25]
2000
-
2003
112 adult
AI/AN
women,
New
York City
Enrolled
tribal
member
living in
NYC from
an AI/AN
community
center, then
random
sample.
Survey, descriptive
statistics and logistic regression
IPV Comorbidities:
Depression,
dysphoria,
risky sexual
behaviors
Risk
factors:
Interpersonal
violence
Over 65% experienced IPV
(28% childhood physical
abuse, 48% rape, 40%
domestic violence, 40%
multiple victimization).
History of IPV associated with
depression, dysphoria, help-
seeking, and high HIV risk
sexual behaviors.
Gnanade
sikan
2005[26]
1997
-
1999
349 young AI adults in
the
Northern
Plains
Ages 15-
24,
members of
a Northern
Plains tribe,
previous
participation
in a
community-
based
study
Logistic
regression
CIDI Risk factors: Sexual
trauma;
experiencing
6 or more
traumas
42 (12% of those who
experienced a traumatic
event) met criteria for lifetime
PTSD.
Kramer
2009[27]
2002
-
2003
Nationwide
sample:
4338
female
AI/AN
veterans;
1518
female
AI/AN
nonveterans
Women
among all
IHS
beneficiaries
who were
veterans or
used VHA
for health
care
Secondary
data
analysis;
descriptive
Combat
experience
Medical needs of female
AI/AN veterans were similar
to other veterans.
Most frequent diagnoses for
outpatient were similar to
general population of female
vets: hypertension,
depression, and PTSD.
82 of 804 veteran dual users
receiving attention for PTSD;
26 of 1518 nonveteran dual
users.
Laudenslager
2009[28]
66 AI/AN
men and
women
in the
Southwest
Drawn from
previous
large-scale
study
Descriptive
statistics
CIDI Comorbidity:
Higher
cortisol
levels
Women with lifetime PTSD
had sig higher mean cortisol
levels throughout the day
than women without PTSD.
No significant association in
men.
No influence from alcohol
use.
Manson
1996[29]
One 45-
year-old
AI man
in
Arizona
Case study Combat
experience,
bereavement
after
death of
father
Medical
diagnosis
Comorbidity: Alcohol
dependence
Risk factors: Perhaps
family
history of
alcoholism,
combat-
related
trauma,
alcohol
dependence,
history of
childhood
physical
abuse, and
bereavement.
In interviewee’s view, his
combat experience in
Vietnam and his failure to
participate in the cultural
grieving process after his
father’s death upset his
physical, mental, emotional,
and spiritual health.
Identifying with his culture
and participating in tribal
ceremonies and Native
veteran support group and
Native American Church
improved his outcome.
Robin
1997[30]
1991
-
1995
247
AI/AN
adults
Age ≥ 21
years,
eligible for
enrollment
in a
Southwestern
tribe
Descriptive
statistics
and logistic
regression
Physical
assault,
combat
experience,
multiple
traumatic
events
SCID
and
DSM-III-R
Risk factors:
For lifetime
PTSD,
women:
physical
assault;
men:
history of
combat,
more than
10
traumatic
events
Prevalence of lifetime PTSD
was 21.9%
81.4% had experienced at
least one traumatic event.
Prevalence of lifetime PTSD
and exposure to traumatic
events was higher than in
general U.S. population.
Robin
1998[31]
104 members
of a
Southwestern
tribe
Age ≥ 21
years,
eligible for
enrollment
in a
Southwestern tribe
Bivariate
analysis;
logistic
regression
For
women:
forced
sex
DSM-III-R Risk
factors: IPV
for both
genders
and forced
sex for
women
Men and women reported
high prevalence of lifetime
(91%) and recent (31%) IPV.
For women, forced sex was
only significant predictor of
lifetime affective disorders
and lifetime PTSD.
Saylors
2006[32]
1999
-2002
283
AI/AN
women
in
Oakland
and San
Francisco,
CA
Native
women
receiving
residential
and
outpatient
services for
substance
abuse and
mental
illness
Descriptive
analysis of
structured
interviews
in three
stages over
one year
Possibly
CSA
Comorbidities:
Perhaps
substance
abuse;
other
mental
health
disorders
Risk
factors: Perhaps
CSA;
physical
abuse,
sexual
abuse,
forced sex,
alcohol
abuse
89% had been emotionally
abused in their lifetime. 84%
had been physically abused
in lifetime. 67% had been
sexually abused in their
lifetime. 39% had
experienced forced sex.
96.7% who were sexually
abused were AIso physically
abused. 78.4% who were
physically abused reported
being AIso sexually abused.
94.7% of those who were
physically abused were AIso
emotionally abused. 95.8% of
those who were sexually
abused were AIso emotionally
abused.
55.6% reported CSA. 75%
reported adult violence.
84% of those who were
sexually abused sought
mental health services; 56%
sought substance abuse
services.
Any type of abuse, 40% had
dual mental health and
substance abuse diagnosis.
88.3% used alcohol to
intoxication during their
lifetime.
78% said Native identity was
important to them; 100% at
12-month follow-up.
Sawchuck
2005[33]
1414 AI
adults in
the
Northern
Plains
Northern
Plains AIs
living on or
within 20
miles of
their
reservation;
ages 18-57
years
Descriptive
statistics
and logistic
regression
Comorbidity:
CVD
Prevalence of lifetime PTSD
was 15%.
CVD was more commonly
reported by those with PTSD
than those without (12% v.
5%).
PTSD was significantly
associated with CVD after
controlling for traditional CVD
risk factors and MD.
Shore
2004[34]
One AI
man in
the
Southwest
Case study
Combat
experience
Medical
diagnosis
Comorbidities:
PTSD,
Alcohol
dependence
Drinking, contradictory views
about PTSD, stigma related
to PTSD, and limited access
to resources impeded
treatment.
Telehealth clinic helped
facilitate treatment, course,
and outcome.
Shore
2009[35]
1993
-
1994
305 male
Vietnam
veterans
from a
Northern
Plains
tribe
Population-
based
sample,
then clinical
interview of
subsample
from larger
survey
Chi-square
tests;
presentation
of
qualitative
materiAIs
Combat
experience
Mississippi
Scale
for Combat-
Related
PTSD
Comorbiditiy: Nightmares
Risk
factors:
Combat
experience
Combat-related PTSD group
had a mean PTSD symptom
count of 12.5, higher than the
mean symptom count for the
non-combat related PTSD
group (9.3), and higher than
the trauma/no PTSD group.
100% of those who reported
experiencing violence
reported experiencing
nightmares.
Villanueva
2003[36]
1994
-
1996
Nearly
70% of
Hopi
Vietnam
veterans
living on
the Hopi
reservation
during
study
period.
Vietnam
veteran
living on
Hopi
reservation
during
study
period
Ethnography
and
survey
Mississippi
Scale
for
Combat-
Related
PTSD;
Minnesot
a
Multiphasic
Personality
Inventory
-PK
Scale;
SCID
Hopi veterans had PTSD
prevalence nearly triple any
other tribal or ethnic group.
Hopi men who had been
initiated into the highest order
of Hopi secret religious
societies had the lowest
scores on any measure of
PTSD.
Suggests that variables such
as levels of spirituality may be
more important when
predicting PTSD than race or
ethnicity.
Westermeyer
2009[37]
1991
-
2001
Male and
female
AI/AN
veterans
in
Albuquerque,
NM,
and
Minneapolis,
MN
AI veterans
in Albuquerque
and
Minneapolis
using
1990
census.
Chi-squaretests
and
binary
logistic
regression.
Combat
experience
PCL;
DSM-III-R
Comorbidities:
Tobacco
dependence,
antisocial
personality
disorders,
pathological
gambling.
Risk factor:
Male
gender
Women were younger, had
more education, than men.
Men were more likely to be in
combat than women, but no
difference for lifetime
exposure to criterion A
trauma.
No difference between
genders in alcohol use. Men
more likely to use drugs (i.e.,
cannabis).
No gender differences for
comorbidities.
Men had more PTSD
symptoms than women.