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Context: Ethnoracial differences may exist in exposure to trauma and posttraumatic outcomes. However, Asian Americans and Native Hawaiians/other Pacific Islanders (NHOPIs) are vastly underrepresented in research pertaining to trauma and health status sequelae.
Objective: To determine whether there are ethnoracial disparities in sexual trauma exposure and its sequelae for health and functioning among Asian Americans and NHOPIs.
Method: We examined data on sexual assault exposure from the 2006-2007 Hawaii Behavioral Risk Factor Surveillance System (H-BRFSS), which yielded a cross-sectional, adult, community-based probability sample (N = 12,573). Data were collected via computer-assisted random-digit landline telephone survey. Survey response rate was found to be about 48% in 2006 and 52% in 2007. The main outcome measures were demographic information, the sexual violence module of the H-BRFSS regarding unwanted sexual experiences, and questions about health lifestyles, chronic diseases and disability, and health status and quality of life.
Results: Participants (N = 12,573) were 44.1% white, 15.0% NHOPI, and 40.9% Asian American. The NHOPIs had a higher 12-month period prevalence (2.24 per 100; 95% CI, 1.32-3.78) for any unwanted sexual experience but had a lower prevalence estimate and odds ratio for any lifetime unwanted sexual experience (prevalence: 9.38 per 100 [95% CI, 7.59-11.55]; odds ratio: 0.61 [95% CI, 0.47-0.81]) relative to whites, after adjusting for age, gender, income, and education level. Asian Americans had lower prevalence estimates for 12-month period prevalence (0.78 per 100; 95% CI, 0.44-1.39) and lower lifetime prevalence estimates and odds ratios (prevalence: 3.91 per 100 [95% CI, 3.23-4.72]; odds ratio: 0.27 [95% CI, 0.21-0.34]). The 12-month and lifetime prevalence estimates for any unwanted sexual experiences for whites were 0.71 per 100 (95% CI, 0.45-1.12) and 12.01 per 100 (95% CI, 10.96-13.14), respectively. Sexual assault experiences were highly associated with adverse health status sequelae (eg, disability, poor general health), but there were no significant ethnoracial disparities on self-reported health outcomes among those with a lifetime history of unwanted sexual experiences.
Conclusions: Data revealed significant ethnoracial differences between whites, Asian Americans, and NHOPIs on unwanted sexual experiences, with relative risk differing by time period. This pattern of disparity could represent early stages of a new trend in local assaultive behaviors toward NHOPIs and merits attention. Across all ethnoracial groups, a lifetime history of any unwanted sexual experience is associated with a wide range of adverse health status sequelae.
J Clin Psychiatry
Submitted: May 29, 2009; accepted November 10, 2009.
Online ahead of print: November 2, 2010 (doi:10.4088/JCP.09m05401blu).
Corresponding author: B. Christopher Frueh, PhD, Department of Psychology, University of Hawai' i at Hilo, 200 W. Kawili St, Hilo, HI 96720 (frueh@hawaii.edu).
The number of Hispanics serving in the US military is expected to grow substantially. Frequent deployments and combat assignments put significant stress on military families, increasing the risk of major depression. The family members of Hispanic military personnel may manifest depression differently than other ethnicities. Hispanics are also less likely to seek help, more likely to seek care from primary care physicians, and less likely to be appropriately diagnosed and treated. Thus, clinicians should be aware of the risk and presentation of major depressive disorder in family members of Hispanic US military veterans.
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About one-third of patients treated with antidepressants do not respond to initial treatment, and Spanish-speaking Hispanic patients with major depression may exhibit a worse response to initial medication than English-speaking patients. Patients and clinicians should be resolute and patient as different regimens are tried throughout the course of treatment. Other options include electroconvulsive therapy, vagus nerve stimulation, transcranial magnetic stimulation, and the medicinal food L-methylfolate.
Resolving acute bipolar mood episodes is only one part of an overall strategy for treating bipolar disorder. Successful prevention of mood episode relapse, particularly bipolar depressive episodes, through effective continuation and maintenance therapies can greatly improve patient functioning and outcomes. Little evidence is available to guide decisions on the treatment of bipolar depression, especially in the maintenance phase, and additional research into effective options is urgently needed. General strategies for treating patients with bipolar disorder include continuing the acute pharmacotherapeutic regimen into the maintenance phase and considering tolerability.
From our regular book review column.
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Because this piece has no abstract, we have provided for your benefit the first 3 sentences of the full text.
Kate Loewenthal, Professor of Psychology at RoyalHolloway, University of London, is the author of numerous articlesdealing with religion and mental health. In the presentwork, she brings credibility, balance, and clarity to the subject,anchored in genuine scholarship. The book's brevity (141 pagesof text) belies the richness of the source material, much of it recent,that she taps for her discussion.' ‹
A Clinical Manual of Cultural Psychiatry
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