Psychological Medicine

Original Articles

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

A. L. Robertsa1, S. E. Gilmana1a2, J. Breslaua3, N. Breslaua4 and K. C. Koenena1a2a5 c1

a1 Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA

a2 Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

a3 Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA

a4 Department of Epidemiology, Michigan State University, East Lansing, MI, USA

a5 Harvard Center on the Developing Child, Cambridge, MA, USA


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.

(Received October 27 2009)

(Revised February 05 2010)

(Accepted February 13 2010)

(Online publication March 29 2010)


c1 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: