1 - (SYM 98) Initial PTSD Symptom Severity and 20-year Course Following Index Trauma Among Veteran Women and Men with Black versus White Race Identities

Posttraumatic stress disorder (PTSD) is common among Veterans, especially for women and people of color. Trauma exposure types (e.g., combat vs. sexual trauma), frequency, and additive effects of bias-related trauma and discrimination may account for these disparities. However, little is currently known regarding initial PTSD severity and the longitudinal course of PTSD following index trauma among Black and white Veteran men and women

In this study, we examined the 20-year course of PTSD following index trauma exposure, separately among Black and white, men and women Veterans (n = 1,352; Mage = 37.49, SD = 9.88). Self-report surveys were administered at five time points spanning an average of seven years. We used latent growth curve modeling with time anchored to years since index trauma to estimate the 20-year course of PTSD symptoms separately by gender and race groups. We then examined exposure to other prior traumas as time-invariant predictors of PTSD over time.  

PTSD symptom severity in the first year following index trauma varied significantly between groups and was highest among Black women. For all groups, higher combat and combat aftermath exposure, childhood emotional abuse and physical neglect scores were positively associated with higher initial PTSD symptom severity; emotional abuse and physical neglect were additionally related to initial PTSD symptom severity among Black men. Black women and white men evidenced reliable symptom improvement 20 years following their index trauma and the symptom course was characterized by gradual symptom decrease over time. For white men, childhood sexual abuse predicted higher initial PTSD scores but steeper rate of improvement.  However, symptom course was stable/chronic for Black men and white women. White women who screened positive for PTSD, had greater combat aftermath exposure, and reported greater cumulative trauma exposure evidenced greater PTSD reduction over 20 years.

Our findings suggest important differences in trauma exposure types, initial PTSD symptom severity following index trauma exposure, and variable change over time at the intersection of Black versus white race men and women Veterans. The chronicity of PTSD, and predictors thereof, among white women and Black men represents an essential topic for future research. Encouragingly, the improvements noted for Black women and white men provide insight into possible treatment, resilience, community support, or other recovery capital (e.g., education; income) mechanisms of PTSD course.