(The Dallas Examiner) –Trama-related psychiatric disorders such as posttraumatic stress disorder and depression affect more than twice as many women as men. Women are also more likely to experience a chronic illness that persists for over a year. Despite the evidence of sex differences in the epidemiology of trauma-related disorders, little research has outlined a clear risk pathway in women.
Recently, the Office of Disparities Research and Workforce Diversity for the National Institute of Mental Health held a webinar, Addressing the Risk for Persistent Effects of Trauma in the Mental Health of Women Across the Lifecourse, that spotlighted recent scientific advances in translational, social, behavioral and intervention research to understand better the sex and gender influences underlying the neurobiology of and advancing improved mental health outcomes of PTSD, depression and suicidal thoughts and behaviors in women. Program Director Tamara Lewis, MPH, MBA, facilitated the event, which featured the research of Dr. Jennifer Stevens and Dr. Bernadine Waller, who were speakers at the webinar.
Stress, trauma, and mental health in women
“PTSD is, of course, not only a veteran’s issue, and there are many traumas that particularly influence women,” Stevens explained, “A third of women experience childhood sexual abuse. A quarter of women experience adult sexual assault. And we know that these types of interpersonal traumas, and sexual traumas in particular, can be particularly impactful on mental health.”
Traumas occurring in childhood and sexual trauma show the most significant risk for the development of PTSD. The types of traumas women experience are important, just as the unique context in which women can experience trauma also has the potential to influence a woman’s mental health following a traumatic or majorly stressful event.
Gender-marginalized groups face heightened violence exposure and greater risk for PTSD and depression.
“The prevalence of PTSD is up to 48% among transgender individuals,” Stevens stated.
Posttraumatic stress disorder
PTSD is unique relative to other psychiatric conditions in that it begins with a traumatic exposure and is followed by an unfolding timeline of symptoms. To be diagnosed with PTSD, symptoms must last for more than one month.
PTSD symptoms include re-experiencing symptoms, such as nightmares, flashbacks, hyperarousal, sweaty palms or racing, alterations in thought or mood, feeling guilt or blame for yourself, or feeling that the world is a harmful place.
Treatment for PTSD
Stevens stated that there are currently effective treatments for PTSD.
The first line of treatment is trauma-focused therapy. This includes prolonged exposure therapy, cognitive processing therapy and written exposure therapy.
“These therapies all involve a component of thinking about the trauma and discussing it in a therapeutic context until the emotions invoked by the trauma become more bearable or less distressing,” Stevens explained.
A second option is pharmacological therapies which primarily include selective serotonin reuptake inhibitors.
“Boosting patient awareness that symptoms can increase or start during these phases of lifespan could be helpful. Social support is the most important resilience factor. And then also care providers can highlight that exercise and healthy sleep habits, healthy balanced diet and writing or artistic outlets or religious connection can all be important ways to heal and increase resilience in women who have experienced trauma,” Stevens expressed.
Sex differences in trauma-related symptoms
PTSD is more prevalent in women than it is in men.
“We know that some of this comes from the fact that women are more likely to experience more impactful forms of traumatic events such as childhood sexual abuse or adult sexual assault. Of course, men experience these things too, but the rates of exposure are over twice as high for childhood abuse in women and six times as high as for adult assaults,” Stevens said.
She added that women’s increased risk for PTSD and depression following trauma is also related to women’s long, protracted developmental timeline of hormonal changes over the life cycle.
Intimate partner violence
DIVAA is an acronym for Divinely Interrupting Victimization and Abuse and Waller shared her research from the DIVAA project; specifically, intimate partner violence victimization.
Intimate partner violence is any physical, sexual, psychological, or financial abuse, as well as stalking and controlling behaviors.
“Forty-five percent of Black women are abused by their intimate partner but know that intimate partner violence victimization is not specific to this population of women. It happens across all races, all ethnicities as well as across SES,” Waller stated, “The challenge is, is that Black women are killed at a rate on average that of White women, three times more. And unfortunately, 91% of women are killed by people who they knew.
Waller explained that Black women are frequently left asking where they can, as Black women, get the services and support they need.
“We found that this population of women are oftentimes marginalized. And when they do engage the police, they find the police very unhelpful. This population of women is also socially stigmatized. And when they are relegated to and referred to shelters, the shelters that they’re relegated to are oftentimes dilapidated,” Waller said.
It was also found that Black women forgo treatment at emergency rooms, are untrusting of mental health providers, and primarily rely on people not trained to assist them, like family and friends or the Black church.
Theories that identify Black women’s IPV-help-seeking process
Through her research, Waller developed three theories that identify U.S. Black women’s IPV-help-seeking process: Help-Seeking Behavior, Constructed Agency, and Sarah Waller’s Help-Seeking Model.
The Theory of Help-Seeking Behavior includes three constructs – social context, beliefs, and individual agency. Constructed Agency has four phases – resistance, persistence, rejection, and resignation.
In the first three phases of Sarah Waller’s Help-Seeking Model, women become aware of what’s going on, acknowledge the abuse they are experiencing, and assess why they are in that situation and the resources available to them. In the subsequent three phases of the model, women decide ‘enough is enough’ and begin to create boundaries, enlist assistance, and engage trained providers. In the subsequent three phases, women start to reject formal support systems, secure alternative interventions and reclaim their sense of self.
“We know that depression is very disabling for IPV survivors. And those women who have experienced a trauma, if you have trauma exposure, it increases the likelihood that they will indeed experience depression. Depression delays help-seeking efforts, and they have greater difficulty securing safety as a result of experiencing depression,” Waller explained.
PTSD evidence-based interventions for Black women survivors
Waller’s research found that Black women prefer brief sessions, meaning fewer than six sessions of treatment; faith and spirituality infused into the intervention; other Black women are the facilitators in community-based settings; and there’s an account for women’s social determinants of health, such as, including or providing child care, transportation or housing.
Waller commented that this was an opportunity for the Black church to expand its impact in the community.
“It is so important that we’re bridging and making connections between clinicians that are culturally responsive and out Black churches,” Waller stated.