Oppressive Systems and Risk for PTSD in Minoritized Communities Open Access
Ravi, Meghna (Spring 2023)
Abstract
Black persons with few economic resources are disproportionately affected by PTSD, and pregnant Black persons may be particularly impacted. Environmental stressors like racism and biological factors like inflammation have been associated with greater PTSD symptoms, though little is known about how other environmental factors, like neighborhood poverty rates impact PTSD symptoms, or how these factors affect PTSD symptoms within pregnancy. In the current dissertation, I hypothesized that oppressive systems like racism and neighborhood poverty would be associated with greater PTSD symptoms in pregnant and non-pregnant persons, and that higher inflammation would relate to higher PTSD symptoms within pregnancy. I first determine the main and interactive effects of racial discrimination and neighborhood poverty on PTSD symptoms in a sample of non-pregnant Black women with few economic resources, and find that experiencing high amounts of racial discrimination or living in an area with a high rate of poverty are associated with high PTSD symptoms. I then follow up on this result and find that higher rates of neighborhood poverty predict greater PTSD symptoms six-months after experiencing a traumatic event in a non-pregnant sample of varied gender and socioeconomic status. Next, I focus on biological and environmental risk factors for PTSD within pregnant Black persons with few economic resources. I find that while neighborhood poverty is not associated with PTSD symptoms, higher amounts of racial stress (or stress caused by experiencing racism) are associated with more PTSD symptoms. I also find a trending positive association between systemic inflammation and PTSD symptoms. Lastly, I assess one mechanism by which racial stress can result in higher PTSD symptoms among pregnant Black persons, and find that racial stress is associated with more negative evaluations of therapy, which is in turn associated with greater PTSD symptoms. Overall, the results presented in this dissertation highlight that oppressive systems can exacerbate PTSD symptoms, and demonstrate the need for policies that promote racial and economic equity.
Table of Contents
Table of Contents
CHAPTER 1: INTRODUCTION: STRESS, SYSTEMIC INFLAMMATION, AND PSYCHOPATHOLOGY WITHIN AND OUTSIDE OF PREGNANCY
1.1 Context, Authors’ Contribution, And Acknowledgement Of Reproduction
1.2 Introduction.
1.3 Homeostatic regulation of immune activation in response to acute stress exposure.
1.4 Chronic stress-induced allostasis facilitates increased systemic inflammation.
1.5 Increased inflammation in individuals with stress-related psychopathology.
1.6 Mechanisms by which inflammation contributes to stress-related symptoms.
1.7 Clinical considerations and implications regarding the immunology of stress.
1.8 Psychoneuroimmunology of Pregnancy
1.9 Pregnancy and the Immune System
1.10 Stress/Trauma Impact Sympathetic, Neuroendocrine and Immune Interactions in Pregnancy
1.11 Inflammation and Stress/Trauma in Pregnancy
1.12 Inflammation and Stress-Related Psychopathology in Pregnancy
1.13 Implications and Future Directions
1.14 Overview of the Dissertation
CHAPTER 2: INTERSECTIONS OF OPPRESSION: EXAMINING THE INTERACTIVE EFFECT OF RACIAL DISCRIMINATION AND NEIGHBORHOOD POVERTY ON PTSD SYMPTOMS IN BLACK WOMEN
2.1 Context, Authors’ Contribution, And Acknowledgement Of Reproduction
2.2 Abstract
2.3 Introduction
2.4 Methods
2.4.1 Participants
2.4.2 Procedure
2.4.3 Measures
2.4.4 Data Analytic Plan
2.5 Results
2.5.1 Correlational and Regression Analyses
2.5.2 Overall PTSD Symptoms
2.5.3 Intrusive PTSD Symptoms
2.5.4 Avoidance and Numbing PTSD Symptoms
2.5.5 Hyperarousal PTSD Symptoms
2.6 Discussion
CHAPTER 3: NEIGHBORHOOD POVERTY PROSPECTIVELY PREDICTS PTSD SYMPTOMS SIX-MONTHS FOLLOWING TRAUMA EXPOSURE
3.1 Context, Authors’ Contribution, and Acknowledgement of Reproduction
3.2 Abstract
3.3 Introduction
3.4 Methods
3.4.1 Procedure
3.4.2 Measures
3.4.3 Data Analytic Plan
3.5 Results
3.5.1 Sample Demographics
3.5.2 Correlations
3.5.3 Regression Analyses
3.6 Discussion
CHAPTER 4: ENVIRONMENTAL AND BIOLOGICAL RISK FACTORS FOR PTSD IN PREGNANT BLACK PERSONS
4.1 Context and Authors’ Contribution
4.2 Abstract:
4.3 Introduction
4.4 Methods
4.4.1 Procedure
4.4.2 Measures
4.4.3 Fear Potentiated Startle (FPS)
4.4.4 CRP
4.4.5 Data Analytic Plan
4.5 Results
4.5.1 Participants
4.5.2 Neighborhood Poverty and PTSD
4.5.3 Racial Stress and PTSD Symptoms
4.4.4 FPS and PTSD Symptoms
4.5.5 CRP, PTSD Symptoms, Trauma History, and FPS
4.6 Discussion
CHAPTER 5: INDIRECT EFFECT OF NEGATIVE EVALUATIONS OF THERAPY ON THE ASSOCIATION BETWEEN RACIAL STRESS AND PTSD SYMPTOMS IN PREGNANT BLACK PERSONS
5.1 Context, Authors’ Contribution, And Acknowledgement Of Reproduction
5.2 Abstract
5.3 Introduction
5.4 Methods
5.4.1 Procedure
5.4.2 Measures
5.4.3 Data Analytic Plan
5.5 Results
5.5.1 Participants
5.5.2 Correlational Analyses
5.5.3 Mediation Model
5.6 Discussion
CHAPTER 6: CONCLUSIONS AND FUTURE DIRECTIONS
6.1 Summary of Findings
6.2 Contributions to the Field
6.3 Future Directions
REFERENCES
About this Dissertation
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