Impact of Posttraumatic Stress Disorder (PTSD) on diabetes in low-income minority patients

Objectives. Major disparities in the prevalence and outcomes of diabetes persist among racial and ethnic minorities. Although the negative impact of depression in these populations has been established, other mental health conditions have received less attention. There is building evidence that Posttraumatic Stress Disorder (PTSD) is prevalent in poor communities, is associated with negative health behaviors, and may contribute to poorer health. However PTSD is often unrecognized in the primary care setting. The primary aim of this study was to measure the prevalence of PTSD among low-income minorities with diabetes, and to measure the association between PTSD and Hemoglobin A1C (HgbA1C) in this group. The impact of PTSD on diabetes complications and diabetes-related health attitudes was also assessed.;Methods. A cross-sectional study of adults over 18 years with type 1 or type 2 diabetes was conducted at medical clinics in Harlem. Standardized interviews were completed in-person during a regularly scheduled medical visit. Trauma and PTSD were assessed with the Structured Clinical Interview for DSM-IV - PTSD Module. Other variables included demographics, clinical profile (i.e., diabetes duration, body mass index, Charlson Comorbidity Index score, depressive symptoms, psychiatric medication use), smoking, alcohol and illicit drug use history, food insecurity and social support. HgbA 1C was obtained from chart review. Other measured outcomes included diabetes complication rates, diabetes-related self-efficacy, and perception of risk from diabetes. Associations between PTSD and these outcomes were assessed after adjusting for potential confounders on multivariate analysis.;Results. Of 110 participants, 92% were Black and 68% were female. The mean age was 60 +/- 12 years and 85% earned less than ;Conclusions. PTSD was prevalent in this population, and as the duration of diabetes increased, patients with PTSD symptoms were significantly less likely to have a HgbA1C level ≤7% compared to patients without symptoms. Increased perception of disease-risk was also associated with PTSD symptoms as age increased. Additional studies are needed to determine whether PTSD-targeted interventions may have a role in eliminating health disparities among low-income minorities with diabetes.