Trauma, Race, and PTSD: A Cross-Cultural Examination of Adult PTSD and Childhood Genocide Exposure

Background and Purpose: While the long-term psychological effects of exposure to complex trauma (acts of war, violence, terrorism, etc) have been documented in empirical studies (e.g., Hinton, D. E. & Jalal, B., 2014; Hinton, D. E. & Lewis-Fernandez, 2011; Kaplan, S., 2013; Kaplan, S., 2006; Kaplan, S., 2000; Mattsson, B., 2009; Shmotkin, D., Blumstein, T., & Modan, B., 2003), little research has been conducted on the moderating influence of culture in the expression of PTSD symptomatology. The present study aims to fill this gap in the literature by examining cultural differences in PTSD symptomatology among adult survivors of different genocides.

Methods: This study used secondary data from the University of Southern California’s Shoah Foundation. The sample comprised 47 previously video recorded interviews of adult survivors of genocide. Each adult survivor belonged to one of the following experience groups: Rwandan, Nanjing, Holocaust, and Armenian. The breakdown of interviews were as follows: 15 testimonies from the Armenian experience group, 14 testimonies from the Rwandan experience group, 12 testimonies from the Holocaust experience group, and 6 testimonies from the Nanjing experience group. Two independent raters used an adapted form of the Primary Care PTSD Screen (PC-PTSD) to assess PTSD symptomatology (Prins, Ouimette, & Kimberling, 2003). 

Results: Cohen’s kappa was calculated to determine interrater agreement on whether 47 individuals reported any PTSD symptoms and screen positive for PTSD (presence of 3 core symptoms). Findings reveal fair agreement between the two raters’ judgments, κ = .304, p< .0001; hence, the first rater’s ratings were used for the planned analysis. Overall, the findings show that none of the participants screened positive for PTSD. Additional analyses revealed that 17% of the Nanjing survivors, 40% of the Armenian survivors, 7% of the Rwandan survivors, and 92% of the Holocaust survivors reported at least 1 PTSD symptom. The combined results suggest that although adult survivors of various genocides fail to screen positive for PTSD, they still experience at least 1 PTSD symptom (e.g., nightmares) related to the traumatic event. The experience of PTSD seem to vary across cultures as well with a greater proportion of Holocaust survivors reporting at least 1 PTSD symptom compared to the Nanjing, Armenian, and Rwandan survivors.

Conclusions and Implications: Cultural competence is embedded in social work practice, particularly as vulnerable populations continue to emerge in modern practice. The prognosis of complex trauma survivors (adults and children alike) may improve with the incorporation of culturally attuned interventions. The implications of cross-cultural markers of complex trauma will be discussed.