title: Posttraumatic stress disorder and symptoms among American Indians and Alaska Natives: a review of the literature.
abstract: OBJECTIVE
  American Indians and Alaska Natives (AI/ANs) experience high rates of trauma and posttraumatic stress disorder (PTSD). We reviewed existing literature to address three interrelated questions: (1) What is the prevalence of PTSD and PTSD symptoms among AI/ANs? (2) What are the inciting events, risk factors, and co-morbidities in AI/ANs, and do they differ from those in the general U.S. population? (3) Are studies available to inform clinicians about the course and treatment of PTSD in this population?
  
  
  METHODS
  We searched the PubMed and Web of Science databases and a database on AI/AN health, capturing an initial sample of 77 original English-language articles published 1992–2010. After applying exclusion criteria, we retained 37 articles on prevalence of PTSD and related symptoms among AI/AN adults. We abstracted key information and organized it in tabular format.
  
  
  RESULTS
  AI/ANs experience a substantially greater burden of PTSD and related symptoms than U.S. Whites. Combat experience and interpersonal violence were consistently cited as leading causes of PTSD and related symptoms. PTSD was associated with bodily pain, lung disorders, general health problems, substance abuse, and pathological gambling. In general, inciting events, risk factors, and co-morbidities appear similar to those in the general U.S. population.
  
  
  CONCLUSIONS
  Substantial research indicates a strikingly high incidence of PTSD in AI/AN populations. However, inciting events, risk factors, and co-morbidities in AI/ANs, and how they may differ from those in the general population, are poorly understood. Very few studies are available on the clinical course and treatment of PTSD in this vulnerable population.
authors.forename: Deborah
authors.initials: D
authors.lastname: Bassett
authors.forename: Dedra
authors.initials: D
authors.lastname: Buchwald
authors.forename: Spero
authors.initials: S
authors.lastname: Manson
mesh_terms: D000413:Alaska / Q000453:epidemiology / Q000208:ethnology; D015897:Comorbidity; D006801:Humans; D007198:Indians, North American / Q000523:psychology* / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*
references.citation: J Head Trauma Rehabil. 2009 Sep-Oct;24(5):324-32
references.pmid: 19858966
references.citation: Psychiatry. 2008 Fall;71(3):234-45
references.pmid: 18834274
references.citation: Psychol Med. 2005 Mar;35(3):329-40
references.pmid: 15841869
references.citation: Pain Med. 2005 Jan-Feb;6(1):72-9
references.pmid: 15669952
references.citation: J Clin Psychiatry. 2005 Sep;66(9):1176-83
references.pmid: 16187777
references.citation: Am J Addict. 2009 Jan-Feb;18(1):87-92
references.pmid: 19219670
references.citation: J Anxiety Disord. 2011 Apr;25(3):456-65
references.pmid: 21168991
references.citation: Am Indian Alsk Native Ment Health Res. 2010;17(1):49-70
references.pmid: 20683823
references.citation: J Affect Disord. 2004 Jan;78(1):37-48
references.pmid: 14672795
references.citation: Transcult Psychiatry. 2005 Jun;42(2):242-71
references.pmid: 16114585
references.citation: Am J Prev Med. 1993 Nov-Dec;9(6):331-7
references.pmid: 8311982
references.citation: J Anxiety Disord. 2010 Oct;24(7):792-8
references.pmid: 20580527
references.citation: Community Ment Health J. 2006 Dec;42(6):537-53
references.pmid: 16897410
references.citation: Am J Psychiatry. 1997 Nov;154(11):1582-8
references.pmid: 9356568
references.citation: J Psychiatr Res. 2006 Feb;40(1):1-21
references.pmid: 16242154
references.citation: Acta Psychiatr Scand. 2000 Jan;101(1):46-59
references.pmid: 10674950
references.citation: Cult Med Psychiatry. 1996 Dec;20(4):489-98
references.pmid: 8989988
references.citation: Drug Alcohol Depend. 2009 Jan 1;99(1-3):169-75
references.pmid: 18845405
references.citation: Telemed J E Health. 2013 Apr;19(4):272-7
references.pmid: 23451811
references.citation: Am J Psychiatry. 2005 Sep;162(9):1713-22
references.pmid: 16135632
references.citation: Cult Med Psychiatry. 2004 Jun;28(2):231-43
references.pmid: 15470950
references.citation: Am Indian Alsk Native Ment Health Res. 2009;16(1):25-38
references.pmid: 19340764
references.citation: Braz J Psychiatry. 2009 Oct;31 Suppl 2:S66-76
references.pmid: 19967202
references.citation: Alcohol Clin Exp Res. 2003 Aug;27(8):1374-80
references.pmid: 12966343
references.citation: Psychol Med. 1999 Jul;29(4):813-21
references.pmid: 10473308
references.citation: J Trauma Stress. 2009 Oct;22(5):366-73
references.pmid: 19743480
references.citation: Psychiatry Res. 2002 Aug 30;111(2-3):199-213
references.pmid: 12374637
references.citation: J Prim Care Community Health. 2012 Apr 1;3(2):120-4
references.pmid: 23803455
references.citation: Annu Rev Clin Psychol. 2005;1:113-42
references.pmid: 17716084
references.citation: Am Indian Alsk Native Ment Health Res. 2009;16(2):11-27
references.pmid: 19639543
references.citation: J Nerv Ment Dis. 2008 Aug;196(8):585-96
references.pmid: 18974670
references.citation: Prehosp Disaster Med. 2004 Jan-Mar;19(1):102-12
references.pmid: 15453167
references.citation: J Trauma. 2010 Jul;69(1):231-7
references.pmid: 20622595
references.citation: J Trauma Stress. 2006 Dec;19(6):937-47
references.pmid: 17195969
references.citation: J Trauma Stress. 2013 Aug;26(4):512-20
references.pmid: 23900893
references.citation: Cultur Divers Ethnic Minor Psychol. 2007 Oct;13(4):356-63
references.pmid: 17967104
references.citation: J Stud Alcohol. 2004 Jul;65(4):419-27
references.pmid: 15376815
references.citation: Rehabil Psychol. 2010 Feb;55(1):1-11
references.pmid: 20175629
references.citation: Womens Health Issues. 2009 Mar-Apr;19(2):135-43
references.pmid: 19272564
references.citation: Psychiatr Serv. 2012 Feb 1;63(2):179-81
references.pmid: 22302338
references.citation: J Trauma Stress. 2002 Apr;15(2):89-97
references.pmid: 12013069
references.citation: Am J Psychiatry. 1993 Oct;150(10):1517-23
references.pmid: 8379557
references.citation: Cult Divers Ment Health. 1998;4(4):335-44
references.pmid: 9818522
references.citation: Child Abuse Negl. 2004 Feb;28(2):131-45
references.pmid: 15003398
references.citation: Public Health Rep. 1994 Mar-Apr;109(2):235-42
references.pmid: 8153275
references.citation: Am J Psychiatry. 2005 Sep;162(9):1723-32
references.pmid: 16135633
references.citation: Int J Circumpolar Health. 2007;66 Suppl 1:45-53
references.pmid: 18154232
references.citation: Arch Gen Psychiatry. 2005 Jan;62(1):99-108
references.pmid: 15630077
references.citation: Am Indian Alsk Native Ment Health Res. 2006;13(1):32-51
references.pmid: 17602396
references.citation: Am J Psychiatry. 1997 Aug;154(8):1114-9
references.pmid: 9247398
references.citation: Telemed J E Health. 2012 Mar;18(2):87-94
references.pmid: 22283396
references.citation: Curr Drug Abuse Rev. 2011 Dec;4(4):210-4
references.pmid: 21999696
references.citation: Br J Psychiatry. 2005 Jun;186:494-9
references.pmid: 15928360
references.citation: J Trauma Stress. 2010 Jun;23(3):384-92
references.pmid: 20564368
references.citation: Mol Psychiatry. 2008 Mar;13(3):334-47
references.pmid: 17592478
references.citation: Am J Public Health. 2006 Aug;96(8):1416-22
references.pmid: 16809604
references.citation: Am J Public Health. 2005 May;95(5):851-9
references.pmid: 15855465
references.citation: Biol Psychiatry. 2000 Nov 1;48(9):902-9
references.pmid: 11074228
references.citation: Cult Med Psychiatry. 2003 Sep;27(3):259-89
references.pmid: 14510095
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2013 Jun;48(6):895-905
references.pmid: 23135256
references.citation: J Trauma Stress. 2007 Feb;20(1):53-62
references.pmid: 17343265
references.citation: J Nerv Ment Dis. 2007 Aug;195(8):655-61
references.pmid: 17700297
references.citation: Brain Behav Immun. 2009 Jul;23(5):658-62
references.pmid: 19146946
references.citation: Subst Use Misuse. 2008;43(12-13):1927-49
references.pmid: 19016172
references.citation: Psychol Med. 2005 Dec;35(12):1785-94
references.pmid: 16300692
references.citation: Telemed J E Health. 2012 Jan-Feb;18(1):60-6
references.pmid: 22082106
references.citation: Ethn Health. 2010 Dec;15(6):569-79
references.pmid: 20721780
references.citation: Gen Hosp Psychiatry. 2010 May-Jun;32(3):262-7
references.pmid: 20430229