Posttraumatic Stress Disorder and Sexual Orientation: An Examination of Life-Threatening and Non-Life-Threatening Events

Purpose: Previous studies (i.e., Cochran, Sullivan, & Mays, 2003; Gilman et al., 2001; Sandfort, de Graaf, Bijl, & Schnabel, 2001) have shown that lesbians, gays, and bisexuals (LGBs) have higher prevalence of mood and anxiety disorders than heterosexuals. However, most studies have not compared prevalence of posttraumatic stress disorder (PTSD) between the groups. To address this knowledge gap, the current study compared prevalence of PTSD between LGBs and heterosexuals. However, this study differed from the majority of PTSD research. Unlike DSM-IV criteria, non-life-threatening events qualified toward a diagnosis of PTSD. There is a lack of empirical evidence to explain why exposure to certain events other than those that involve actual or threatened death or serious injury should be excluded from the DSM definition of PTSD (Carlson & Dalenberg, 2000). By ignoring the effects of non-life-threatening events, researchers might overlook a population of individuals suffering from PTSD.

Method: Data was obtained from Project STRIDE, an NIMH-funded study that investigated associations among stress, identity, and mental health among minority groups in New York City (Meyer, Frost, Narvaez, & Dietrich, 2006). The current study used a cross-sectional research design consisting of 382 White, Black, and Latino LGBs and 126 White heterosexuals, ages 18-59. Stressful events were measured using the Life Events Questionnaire (Meyer et al., 2006), a semi-structured interview designed to elicit information about stressful events experienced throughout the life-span. Respondents reporting more than one stressful event were asked to identify the worst event, or the event that caused most distress. The worst event was used to formulate a DSM-IV PTSD diagnosis according to the World Mental Health Composite International Diagnostic Interview. A non-restrictive criterion A1 was used to assess for PTSD, that is, both life-threatening and non-life-threatening events qualified as potentially traumatic.

Results: Findings revealed that non-life-threatening events were more likely to be associated with PTSD than events qualifying as traumatic according to the DSM-IV. Non-life-threatening events associated with PTSD included: ending an intimate relationship, the expected death of a loved one, unemployment, separation from parents, and abortion. There was no difference in prevalence of PTSD between LGBs and heterosexuals, or between non-White LGBs and White LGBs. However, Latino LGBs were more likely than White LGBs [OR = 1.91, 95% CI = 1.06, 3.42] to have PTSD. Also, Latino gay/bisexual men were more likely than White gay/bisexual men to have PTSD [OR = 3.25, 95% CI = 1.32, 7.99].

Implications: The findings provide support for reconsidering diagnostic criteria for PTSD in the DSM-5. In addition, social workers should not overlook the possibility that individuals might suffer from PTSD following exposure to non-life-threatening events, and thus should conduct thorough diagnostic assessments regardless of whether an event is life-threatening or non-life-threatening. The ways in which individuals experience and cope with traumatic events should also be understood from a cultural context (Zayfert, 2008). The double minority status of LGB Latinos might increase their likelihood of developing of PTSD. Thus, prevention programs should be specifically tailored to meet the mental health needs of Latino LGBs.