Racial Discrimination

Posttraumatic stress disorder (PTSD) is a debilitating response to trauma, marked by symptoms like intrusive thoughts, hypervigilance, and trauma avoidance. Diagnosis mandates that symptoms persist for at least one month after experiencing a criterion A trauma. Certain events, like sexual abuse, combat, and life-threatening assaults, qualify as criterion A traumas. Despite people of colour reporting heightened arousal, avoidance, cognitive decline, mood changes, distress, and impairment after exposure to racial discrimination, oppression, and vicarious racism, racism-related stressors are not considered criterion A events. The high prevalence of racial discrimination and clinically significant symptoms of PTSD resulting from these events has prompted the creation of several culturally relevant adaptations of evidence-based interventions for PTSD and treatments specific to racial traumatization. This study aims to review (1) the effectiveness of current cultural adaptations of PTSD interventions and racial trauma-specific treatments and (2) the components, delivery, and limits of existing race-based traumatic stress interventions. The methodology of this systematic review adheres to the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Thirteen selected studies will be included in the final analysis. 

The primary purpose of this study is to evaluate how repeated exposure to instances of racial discrimination (racism-related events) affects people of colour compared to exposure to criterion A events. The term trauma refers to one or a series of distressing or disturbing experiences that can harm a person's physical or emotional well-being. Posttraumatic stress disorder (PTSD) is a debilitating response to trauma characterized by intrusive thoughts, nightmares, avoidance of trauma reminders, hypervigilance, and sleep disturbances. To be diagnosed with PTSD, these symptoms must cause distress or impairment in daily functioning, persist for at least one month, and cannot be attributed to substance use or another medical condition. Additionally, PTSD symptoms must emerge after exposure to at least one dangerous or life-threatening event, known as criterion A events or criterion A stressors.

Racism, described as discriminatory, disparaging, or adverse events based on an individual's skin colour or ethnic group membership, is considered a traumatic stressor similar to other criterion A events like verbal and physical assaults. Previous research has reported significant posttraumatic stress symptoms, profound distress, and social and functional impairment in people of colour who experience racism. Trauma is cumulative. Repeated exposure to stressors and traumatic events, including through media and negative discussions about others' traumatic experiences, can increase the risk of developing PTSD over time. Repeated exposure to racism-related events can also increase the likelihood of people of colour developing clinically significant PTSD symptoms following a particularly distressing and impactful incident, known as an index event.

The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-V) identifies specific index events, such as natural disasters, physical assault, and transportation accidents, as criterion A events. Previous research has shown no significant differences in PTSD prevalence rates between individuals reporting index events meeting criterion A and those whose index event did not meet criterion A. Similarly, studies have indicated minimal disparities in the severity of posttraumatic stress symptoms between those reporting criterion A and non-criterion A events as index events. Even when researchers observed differences, they found that they were inconsequential. Moreover, there is evidence to suggest that exposure to discrimination may more strongly correlate with increased posttraumatic symptom severity in certain racial groups than cumulative exposure to conventionally recognized criterion A events. However, the current PTSD diagnostic criteria do not apply to those experiencing PTSD symptoms from non-criterion A events like racism-related incidents.

There is an ongoing debate about broadening criterion A in the current DSM to encompass experiences like racism-related events. This exclusion limits access to diagnosis and treatment for racial traumatization. This barrier to care is particularly concerning given the widespread prevalence of racial discrimination and the clinically significant symptoms that can result from exposure to racism-related events. The upcoming project will be a survey study exploring the correlations between racism-related events, PTSD symptoms, and functioning.