Trauma and posttraumatic stress disorder symptoms among low income women of Mexican descent in the United States

A bright side of adversity? A systematic review on posttraumatic growth among refugees

Until the third trimester of 2022, 103 million people worldwide had been forced to leave their homes and become refugees. The traumatic experiences of refugees can lead not only to mental disorders but also to Posttraumatic Growth (PTG). (1) To find the variables positively and negatively associated with PTG in refugees. (2) To investigate the relationship between PTG and Posttraumatic Stress Disorder (PTSD) among refugees. We systematically searched Medline, Web of Knowledge, PsycInfo, Scopus, and PTSD Pubs for studies about PTG in refugees. Epidemiological studies using the Posttraumatic Growth Inventory. Grey literature, reviews, and meta-analysis. Risk of bias was assessed by the 'The Joanna Briggs Institute Prevalence Critical Appraisal Tool'. We included 24 studies investigating PTG and associated factors. The factors positively associated with PTG were social support, regular migration status, religiosity, satisfaction with life, time, and problem-focussed and emotion-focussed coping. The factors negatively associated with PTG were: irregular migration status, emotional suppression, and avoidance coping. Studies on PTG in refugees are essential to finding new ways to address mental health in this field. Few studies offered risk of bias, particularly regarding the sample selection. We conclude that PTG may be influenced by many factors and it would be of importance that the centres for support, as well as public policies, took that into account to foster the outcome and not only to focus on disease. This study was partially supported by CAPES and registered on PROSPERO (CRD42020215607).

Understanding the Relationship Between Social Stressors, Trauma, and Somatic Symptoms Among Latina Immigrant Women

BACKGROUND

Latina immigrant women are at increased risk for poor mental health. Little is known about factors associated with somatic symptoms, the physical manifestation of distress, in this population. This study examined associations between social stressors, trauma, and somatic symptoms.

METHODS

This study used survey data from a community-based sample of Latina immigrant women (n = 154). We determined the frequency of somatic symptoms and used linear regressions to estimate associations of stressors and trauma with physical symptoms.

RESULTS

Most participants reported mild or moderate levels of somatic symptom severity. In univariate models, all social stressors and trauma types were significantly associated with higher levels of somatic symptoms. A multivariate model suggested perceived stress was associated with increased somatic symptoms after accounting for other stressors and trauma.

DISCUSSION

Future research should examine whether stress and trauma lead to higher levels of somatic symptoms among Latina immigrants.

Experience of Sexual Violence Among Women of Mexican Heritage Raised in the United States

Sexual violence against women is a significant public health crisis that is understudied among Mexican American communities. Yet, there has been little attention directed to sociocultural factors that shape conceptualizations of and responses to sexual violence among Mexican American women. Guided by an integrative contextual framework, this qualitative study aimed to expand knowledge of how second generation Mexican American women conceptualize, experience, and respond to sexual violence. Semistructured interviews focused on conceptualizations of sexual violence, socialization concerning gender, sex, and sexual violence, experiences, and impact of sexual violence, coping, and help-seeking were conducted with 16 women between 20 and 38 years of age ( M = 27.13). The interview data, analyzed using qualitative conventional content analysis, revealed four broad domains: (a) implicit and explicit messages about sexuality and sexual violence, (b) psychological consequences of sexual violence, (c) barriers to disclosing violence and seeking help, and (d) sources of resilience and healing. Findings indicated that conceptualizations of sexual violence and coping were influenced by complex interactions among several sociocultural contexts, including families, religious and ethnic communities, and the mainstream U.S. context.

Communal mastery and associations with depressive and PTSD symptomatology among urban trauma-exposed women

Objective: Racial and ethnic minority women from low-resource urban communities experience disproportionately high rates of trauma exposure. Higher rates of lifetime trauma exposure are strongly associated with subsequent psychological sequela, specifically depression and posttraumatic stress disorder (PTSD). Communal mastery is the ability to cope with challenges and achieve goals by being closely interconnected with friends, family, and significant others. Yet, it is unknown if communal mastery is protective specifically against PTSD and depressive symptoms. Method: Participants (N = 131) were Black and Latina women (88.5% Black, mean monthly income: < $750) recruited from an urban outpatient obstetric-gynecological clinic at an academic medical center. Participants completed an online questionnaire that assessed trauma history, PTSD and depressive symptoms, types of individualistic coping, social support, and communal mastery. Results: Hierarchical multiple regression models demonstrated that communal mastery is uniquely associated with fewer PTSD symptoms (β = -.23, p = .003). More severe trauma history, more use of passive coping skills, and poorer social support were also significantly associated with PTSD symptoms, explaining over half of the variance in PTSD symptoms. Although significantly correlated, communal mastery was not uniquely associated with fewer depressive symptoms (β = -.13, p = .201). Conclusions: These findings suggest that connectedness as assessed through communal mastery serves as an important shield against the effects of traumatic stress for Black and Latina women. Future research would benefit by exploring interventions that aim to increase communal mastery in order to help highly trauma-exposed racial and ethnic minority women in low-resource environments. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Heart-Focused Anxiety Among Trauma-Exposed Latinx Young Adults: Relations to General Depression, Suicidality, Anxious Arousal, and Social Anxiety

Rates of traumatic event exposure, posttraumatic stress (PTS), and co-occurring mental health symptoms and disorders are conditionally higher among Latinx individuals compared to other racial/ethnic populations. Importantly, Latinx persons are a heterogeneous population, and certain subgroups endorse higher rates of negative mental health outcomes than others, including Latinx young adults born in the USA. Yet, there is little understanding of individual difference factors among trauma-exposed US born Latinx young adults that may be involved in mental health burden among this group. The present investigation sought to evaluate the potential explanatory relevance of heart-focused anxiety as an individual difference factor regarding some of the most common co-occurring mental health problems among trauma-exposed populations. Specifically, we tested whether heart-focused anxiety was related to increased co-occurring anxious arousal symptoms, depression, social anxiety, and suicidality among 169 (84% female, M_age=23.15 years, SD=6.07) trauma-exposed Latinx young adults. Results indicated that heart-focused anxiety was a statistically significant predictor of general depression (ΔR² = .02, F(1, 161) = 4.25, p = .041), suicidality (ΔR² = .10, F(1, 161) = 21.49, p < .001), anxious arousal (ΔR² = .11, F(1, 161) = 27.31, p < .001), and social anxiety (ΔR² = .03, F(1, 161) = 7.93, p = .005). Overall, this work offers empirical evidence that individual differences in heart-focused anxiety are related to more severe co-occurring anxiety and depressive symptomatology among a particularly at risk Latinx segment of the Latinx population (non-immigrant Latinx young adults s with previous trauma history).

Hate Crimes and Race-Based Trauma on Latinx Populations: A Critical Review of the Current Research

Traditionally, the literature has sought to understand the impact of racial minority status and trauma as it relates to interpersonal violence, domestic violence, and sexual assault. What has not been as extensively reviewed and summarized is how racially or ethnically motivated hate crimes impact the mental health of minorities-particularly Latinx/Hispanic groups. This review aims to summarize the current body of literature on the intersection of race-motivated hate crime and trauma responses within Latinx community. To do so, the theoretical foundation for this inquiry will build from a race-based trauma perspective. Specifically, this review connects existing frameworks for race and trauma and integrates literature that examines Latinx or Hispanic populations that have experienced discrimination, bias, or hate crime as a result of their identity or perceived identity. The importance of situating bias or hate events within the trauma literature stems from a lack of overall formal evaluation of these events, and how these occurrences are historically overlooked as a traumatic stressor. The findings of this review suggest that (1) experiencing racially motivated victimization can cause adverse mental and physical health outcomes in Latinxs and (2) currently, there is only one study that has examined the impact of hate crime on Latinxs in the United States. This leaves the field with unanswered questions about the impact of hate crime victimization among Latinxs, which is an ever-growing area in need of attention.

Violence, Place, and Strengthened Space: A Review of Immigration Stress, Violence Exposure, and Intervention for Immigrant Latinx Youth and Families

Latinx immigrant families are greatly impacted by US policies and practices that limit immigrant families' and children's rights. This article reviews the effects of such policies and the growing literature examining migration experiences. Latinx immigrant youth and parents may encounter multiple stressors across the stages of migration, including physical and structural violence, fear, poverty, and discrimination, which contribute to higher rates of mental health problems in this population. Despite significant trauma exposure, immigrants demonstrate incredible resilience within themselves, their families, and their communities and through movements and policies aimed at protecting their rights. Numerous culturally relevant universal, targeted, and intensive interventions were developed to magnify these protective factors to promote healing, advance immigration reform, and provide trauma-informed training and psychoeducation. Psychologistsplay a crucial role in implementing, evaluating, and advocating for accessible and collaborative approaches to care so that Latinx immigrant families have the resources to combat the harmful sequelae of immigration stress.

Deconstructing PTSD: Trauma and emotion among Mexican immigrant women

The symptomatology for Post-Traumatic Stress Disorder (PTSD) narrowly focuses on particular diagnostic frames and a single triggering event. Such narrow definitions of trauma and recovery have been heavily critiqued by anthropologists and cultural psychiatrists for overlooking cultural complexity as well as the effects of multiple and overlapping events that may cause someone to become "traumatized" and thereby affect recovery. This article investigates how subjective reporting of traumatic experience in life history narratives relates to depressive and PTSD symptomatology, cultural idioms, and repeated traumatic experiences among low-income Mexican immigrant women in Chicago. We interviewed 121 Mexican immigrant women and collected life history narratives and psychiatric scales for depression and PTSD. Most women spoke of the detrimental effects of repeated traumatic experiences, reported depressive (49%) and PTSD (38%) symptoms, and described these experiences through cultural idioms. These data complicate the PTSD diagnosis as a discrete entity that occurs in relation to a single acute event. Most importantly, these findings reveal the importance of cumulative trauma and cultural idioms for the recognition of suffering and the limitation of diagnostic categories for identifying the needs of those who experience multiple social and psychological stressors.

Participant Engagement in a Transmedia Storytelling Web-Based App Intervention for Mental Health of Latina Women: Qualitative Analysis

BACKGROUND

Stigma, fear, and lack of knowledge regarding treatment options or where to get help create delays for Latina women in accessing needed mental health help. Story-based media interventions hold appeal for Latina women. Thus, we drew upon the Social Cognitive Theory by Bandura to create an evidence-based, transmedia storytelling web-based app for mental health called Catalina: Confronting My Emotions to connect Latina women to a curated set of mental health resources. Understanding how Latina women perceive various aspects of the web-based app will help design future expansions.

OBJECTIVE

A previously published analysis led to the development of a category on how participants related to the lead character (Catalina) in the story line of the web-based app as a real person. However, the purpose of this analysis was to gain an understanding of participants' experiences with the extension of the dramatic story line of the web-based app beyond Catalina to a Latina nurse-therapist character named Veronica, who was featured prominently in the app's interactive content and bonus videos.

METHODS

Qualitative analyses were conducted with interview data from a community-based sample of 28 English-speaking Latina women aged between 21 and 50 years who scored above the threshold for anxiety (Generalized Anxiety Disorder-7) and/or depression (Patient Health Questionnaire-9) but were not suicidal at screening. Data were collected 72 hours after participants engaged with our transmedia storytelling web-based app for mental health. Grounded theory methodology guided the analysis and interpretation of data that had been collected telephonically, recorded, and transcribed with identifiers removed. Analyses included initial and focused coding using process codes (gerund form of verbs in codes focused on action), informed by symbolic interactionism, and the development of categories with properties through constant comparison, memo writing, and the use of charts and diagrams.

RESULTS

Our participants experienced a multiphase process that was most heavily related to Veronica, the Latina nurse-therapist character in our web-based app, who led them through a process to a place of action. We conceptualized this process as moving from passive viewer to active participant of a transmedia storytelling web-based app intervention. Overall, 3 new conceptual categories provided insight into women's experiences, including encountering a trustworthy nurse-therapist character, taking in messages that dispel old beliefs, and preparing when and how to take action. Each category has nuanced properties that reflect participants' experiences.

CONCLUSIONS

Active engagement with our web-based app led our sample to successfully transition from the viewpoint of the observer to the viewpoint of the experiencer, moving from a passive position of watching to active engagement that involved imagining, thinking, reflecting, and acting. Careful development of dramatic material for health-related web-based apps using transmedia story extension and bonus videos needs to be based on input from the target group from the start of development through evaluation and testing.

Experiences With Machismo and Pain: Latino Veterans

Physical and emotional pain from combat-related injuries and experiences are serious problems among Latino veterans. This study fleshes out existing cultural constructs and concepts (e.g., machismo and familism) from the participants' point of view and may serve as an important step in unraveling the influence of Latino culture on pain, providing a deeper and more critical theorization between masculinity, race/ethnicity, and the military. Using 26 interviews from U.S.-born Latino veterans, this study analyzes the meanings and experiences of pain from combat, masculinity, and how culture affects expressions of pain. The following themes emerged: (a) Latino culture and ethnicity, (b) machismo and pain, (c) the transforming self, and (d) feeling disconnected and dealing with pain. Overall, respondents were governed by strict gender standards influenced by their ethnic identity and exacerbated by military masculinity. Findings suggest that the study of race/ethnicity acts as a fundamental framework from which to understand the experiences and behaviors of pain.

Trauma and cultural values in the health of recently immigrated families

This study examined Ruiz et al.’s sociocultural model of Hispanic health resilience by assessing trauma exposure and symptoms and Hispanic cultural values in relation to the physical health of 97 Central American immigrant families, within 24 hours of arrival to the United States. Increased posttraumatic stress symptoms, but not exposure, were associated with increased physical health concerns for parents and children. Hispanic cultural values moderated trauma-health relations for adult health only. Identifying posttraumatic stress symptoms as a significant correlate of physical health in Latino immigrant parents and children is critical to identifying vulnerabilities in need of future research and interventions.

Vigilancia y análisis de zonas de frontera, puertos de entrada y de población inmigrante1

Objetivo Realizar una revisión de la literatura sobre los sistemas de información devigilancia sanitaria y epidemiológica en zonas de frontera y puntos de entrada enColombia.Materiales y Métodos Se desarrolló una revisión sistemática de literatura mediantela metodología Prisma, términos MeSH y DECS. Para ello, se consultaron, las basesde datos PubMed y BVS entre el 2000 y el 2014. Se incluyeron 51 documentos deacuerdo con los criterios de inclusión-exclusión, a partir de los cuales se discutieronlas categorías propuestas: servicios de salud, salud mental, estado de salud y determinantessociales.Resultados El análisis permite evidenciar que la vigilancia epidemiológica y sanitariade fronteras y puntos de entrada en el ámbito mundial, está enfocado principalmenteen ejes como salud mental, eventos transmisibles y eventos de condiciones no transmisibles.Adicionalmente, se da importancia a la atención integral en los servicios desalud y al análisis del estado de salud de la población inmigrante bajo el enfoquediferencial territorial, étnico y cultural. Sin embargo, hay pocas experiencias con unenfoque intersectorial, así como de determinantes sociales, en los territorios con condicionesde zonas de fronteras y/o puntos de entrada.Conclusiones Las diferencias de contexto, sistemas de salud, sistemas de informacióny prioridades de cada país, hacen que el intercambio y la cooperación entre lasfronteras tengan serios retos. Debido a esto, es necesario contar con instrumentos decooperación entre países limítrofes y análisis e información, con base en el modeloDeterminantes Sociales de la Salud.

Traumatic Events Associated With Posttraumatic Stress Disorder: The Role of Race/Ethnicity and Depression

This study sought to examine specific types of potentially traumatic experiences as predictors of posttraumatic stress disorder (PTSD) and the moderating effect of race/ethnicity and major depressive disorder (MDD) among non-Hispanic White, non-Hispanic Black, and Hispanic U.S. women. The study sample was drawn from two waves of the National Epidemiologic Surveys of Alcohol and Related Conditions. Sexual assault, intimate partner violence, and childhood trauma were the strongest predictors of PTSD compared with the reference group (indirect/witnessed trauma). Similar patterns were revealed across racial/ethnic groups, although the estimates were most robust among White women. Findings also suggest that MDD moderates the effect of traumatic experiences on PTSD.

Posttraumatic stress disorder and alcohol misuse among women: effects of ethnic minority stressors

PURPOSE

The aims of this study were to examine the relationship between adult-onset posttraumatic stress disorder (PTSD) and subsequent alcohol use outcomes (frequent heavy drinking, alcohol abuse, and alcohol dependence) in non-Hispanic white, non-Hispanic black, and Hispanic US women, and whether this relationship was moderated by ethnic minority stressors (discrimination and acculturation).

METHODS

The study sample was drawn from two waves of the National Epidemiologic Surveys of Alcohol and Related Conditions, employing time-dependent data to conduct multiple extended Cox regression.

RESULTS

Women with PTSD were over 50 % more likely than those without PTSD to develop alcohol dependence [adjusted hazards ratio (aHR) 1.55; 95 % confidence interval (CI) 1.15, 2.08]. Hispanic and black women were at lower risk of most alcohol outcomes than white women. In race-/ethnic-specific analyses, however, PTSD only predicted alcohol abuse among Hispanic women (aHR 3.02; CI 1.33, 6.84). Higher acculturation was positively associated with all alcohol outcomes among Hispanic women and discrimination was associated with AUD among Hispanic and black women. Acculturation and discrimination modified the effect of PTSD on AUD among Hispanic women: PTSD predicted alcohol dependence among those with low acculturation (aHR 10.2; CI 1.27, 81.80) and alcohol abuse among those without reported discrimination (aHR 6.39; CI 2.76, 16.49).

CONCLUSIONS

PTSD may influence the development of hazardous drinking, especially among Hispanic women. The influence of PTSD on alcohol outcomes is most apparent, however, when ethnic minority stressors are not present.

Painful Passages: Traumatic Experiences and Post-Traumatic Stress among Immigrant Latino Adolescents and their Primary Caregivers

Using data from a stratified random sample of 281 foreign-born adolescents and their parents, this study provides data on migration-related trauma exposures and examines how the migration process influences the risk of experiencing trauma and developing Post-Traumatic Stress Disorder (PTSD). We find that 29% of foreign-born adolescents and 34% of foreign-born parents experienced trauma during the migration process. Among those that experienced trauma, 9% of adolescents and 21% of their parents were at risk for PTSD. Pre-migration poverty combined with clandestine entry into the US increased the risk of trauma and the subsequent development of PTSD symptoms. Post-migration experiences of discrimination and neighborhood disorder further exacerbated this risk, while social support and familism mitigated it. Our results emphasize the importance of understanding how factors prior to, during, and after migration combine to influence the health of immigrants.

Conditional risk for PTSD among Latinos: a systematic review of racial/ethnic differences and sociocultural explanations

Conditional risk for Posttraumatic Stress Disorder (PTSD)--defined as prevalence, onset, persistence, or severity of PTSD after traumatic exposure--appears to be higher among Latinos relative to non-Latinos after accounting for sociodemographic factors. This systematic review focuses on differences in conditional risk for PTSD between Latinos and non-Latinos (White, Black, or combined) and across Latino subgroups in studies that adjust for trauma exposure. We discuss methodological characteristics of existing articles and sociocultural explanatory factors. Electronic bibliographic searches were conducted for English-language articles published in peer-reviewed journals between 1991 and 2012. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Twenty-eight articles met inclusion criteria. Consistent support was found for elevated rates of PTSD onset and PTSD severity among Latinos relative to non-Latino Whites. The evidence on racial/ethnic differences in conditional risk for PTSD prevalence and PTSD persistence is mixed. Twenty-four articles evaluated sociocultural explanations, with the strongest support found for racial/ethnic variation in peri-traumatic responses and structure of PTSD. There were also consistent main effects for social disadvantage in studies that simultaneously adjusted for effects of race/ethnicity. Future research should use theoretically-driven models to formally test for interactions between sociocultural factors, race/ethnicity, and PTSD probability.

Mental health needs and service utilization by Hispanic immigrants residing in mid-southern United States

PURPOSE

This study assessed mental health needs and service utilization patterns in a convenience sample of Hispanic immigrants.

DESIGN

A total of 84 adult Hispanic participants completed a structured diagnostic interview and a semistructured service utilization interview with trained bilingual research assistants.

RESULTS

In the sample, 36% met diagnostic criteria for at least one mental disorder. Although 42% of the sample saw a physician in the prior year, mental health services were being rendered primarily by religious leaders. The most common barriers to service utilization were cost (59%), lack of health insurance (35%), and language (31%). Although more women than men met criteria for a disorder, service utilization rates were comparable. Participants with a mental disorder were significantly more likely to have sought medical, but not psychiatric, services in the prior year and faced significantly more cost barriers than participants without a mental disorder.

CONCLUSIONS

Findings suggest that Hispanic immigrants, particularly those with a mental illness, need to access services but face numerous systemic barriers. The authors recommend specific ways to make services more affordable and linguistically accessible.

Interpersonal abuse and depression among mexican immigrant women with type 2 diabetes

Evidence for a bi-directional relationship of depression and type 2 diabetes suggests that social distress plays a role in depression among people with diabetes. In this study, we examine the relationship between subjective distress and depression in 121 first- and second-generation Mexican immigrant women seeking diabetes care at a safety-net hospital in Chicago. We used a mixed-methods approach including narrative interview, survey, and finger-stick blood HbA1c data. Using grounded theory analysis, we identified seven life stressors from narrative interviews: interpersonal abuse, stress related to health, family, neighborhood violence, immigration status, and work, and feeling socially detached. Women reported unusually high rates of interpersonal abuse (65%) and disaggregated physical abuse (54%) and sexual abuse (23%). We evaluated depression using CES-D cut-off points of 16 and 24 and assessed rates to be 49 and 34%, respectively. We found that interpersonal abuse was a significant predictor of depression (CESD ≥ 24) in bivariate (OR 3.97; 95% CI 1.58-10.0) and multivariate (OR 5.51; 95% CI 1.85, 16.4) logistic regression analyses. These findings suggest that interpersonal abuse functions as an important contributor to depression among low-income Mexican immigrant women and should be recognized and addressed in diabetes care.

Somali immigrant women and the American health care system: discordant beliefs, divergent expectations, and silent worries

The civil war in Somalia resulted in massive resettlement of Somali refugees. The largest diaspora of Somali refugees in the United States currently reside in Minnesota. Partnering with three community organizations in 2007-8, we implemented the Community Connections and Collaboration Project to address health disparities that Somali refugees experienced. Specifically, we examined factors that influenced Somali women's health experiences. Utilizing a socio-ecological perspective and a social action research design, we conducted six community-based focus groups with 57 Somali women and interviewed 11 key informants including Somali healthcare professionals. Inductively coding, sorting and reducing data into categories, we analyzed each category for specific patterns. The categorical findings on healthcare experiences are reported here. We found that Somali women's health beliefs related closely to situational factors and contrasted sharply with the biological model that drives Western medicine. These discordant health beliefs resulted in divergent expectations regarding treatment and healthcare interactions. Experiencing unmet expectations, Somali women and their healthcare providers reported multiple frustrations which often diminished perceived quality of health care. Moreover, silent worries about mental health and reproductive decision making surfaced. To provide high quality, transcultural health care, providers must encourage patients to voice their own health explanations, expectations, and worries.

From the margins to the center: ethnic minority women and the mental health effects of sexual assault

The trauma of sexual assault is heightened for many women by the interlocking experience of societal traumas such as racism, sexism, and poverty. The mental health effects of sexual assault are mediated by race and ethnicity. The investigators explore the experiences of African American, Asian American, Latina, and Native American female survivors of sexual assault. The sociohistorical context of intergenerational trauma in the lives of ethnic minorities is a part of the context for the contemporary experience of sexualized violence. Racial and ethnic dynamics related to sexual assault prevalence, mental health effects, and disclosure are examined. Literature related to cultural beliefs, community attitudes, and perceived social support in relation to sexualized violence are also reviewed. Finally, practice, research, and policy implications are discussed.

Health status of Mexican-origin persons: do proxy measures of acculturation advance our understanding of health disparities?

OBJECTIVES

This paper compares select health status indicators between the U.S. and Mexico, and within the Mexican-origin population using proxy measures of acculturation.

METHODS

Statistical data were abstracted and a Medline literature review conducted of English-language epidemiologic articles on Mexican-origin groups published during 1976-2005.

RESULTS

U.S.-born Mexican-Americans have higher morbidity and mortality compared to Mexico-born immigrants. Mexico has lower healthcare resources, life expectancy, and circulatory system and cancer mortality rates, but similar infant immunization rates compared to the U.S. Along the U.S.-Mexico border, the population on the U.S. side has better health status than the Mexican side. The longer in the U.S., the more likely Mexican-born immigrants engage in behaviors that are not health promoting. Conclusions Researchers should consider SEP, community norms, behavioral risk and protective factors when studying Mexican-origin groups. It is not spending-time in the U.S. that worsens health outcomes but rather changes in health promoting behaviors.

Social Context and the Psychobiology of Posttraumatic Stress

A growing body of research is identifying the molecular and genetic correlates of psychopathology and holds tremendous promise in suggesting the biologic mechanisms that may explain emergent posttraumatic stress disorder (PTSD) phenotypes. Another body of research has begun to consider how elements of the social context may influence the risk of PTSD. It is likely that the social context and molecular/genetic factors jointly determine the risk of PTSD and as such scientific inquiry that considers the interrelationship of these factors stands to advance the field. However, there are particular conceptual and methodologic challenges to conducting and designing studies that adequately assess both the social context and the biologic determinants of PTSD. Much of the current research exploring the biology of PTSD is conducted with highly selective samples that were recruited on the basis of strict phenotypic or medical history criteria. In contrast, population-based sampling represents an opportunity to obtain heterogeneous samples that better represent the population distribution of relevant molecular, genotypic, and phenotypic parameters of interest. These sampling strategies also allow researchers to consider the role of the social context and in turn, how the social context influences the molecular determinants of PTSD. An example of our own work illustrates the feasibility of the population-based sampling approach.