Demographic and Clinical Characteristics Associated with Trauma Exposure Among Latina Immigrants at an Urban Primary Care Clinic (WITHDRAWN)

Background/Purpose: Latina immigrants are an underserved population with complex mental health needs. Evidence suggests that this population may experience high rates of trauma exposure, compounding their mental health issues. However, due to systemic barriers restricting access to quality mental healthcare for immigrants, little is known about the characteristics of trauma-exposed Latina immigrants. A growing body of research demonstrates support for community healthcare clinics with co-located mental and physical health services as efficacious in increasing access to mental health treatment for undocumented immigrants. In order to design and implement trauma-sensitive healthcare programs for Latina immigrants, more information must be obtained about their clinical presentation and trauma-specific needs. The current study sought to identify clinical characteristics, as well as types and rates of trauma exposure among Latina women who received services at an urban community healthcare clinic.

Methods: This study is a secondary analysis. The sample consists of 189 consecutively-referred Latina (91%) women who received co-located healthcare services between December 2014 and February 2016 at a primary care outpatient clinic located in a predominately Latino community in Chicago. Each service-user had been screened for psychiatric disorders and associated symptomatology upon initial assessment. Additionally, women were screened for exposure to specific types of trauma: physical abuse; sexual abuse; exploitation; community violence; domestic violence; emotional abuse; and other. Service-users were classified according to trauma severity, operationalized by number of different trauma types to which they had been exposed (no trauma, single trauma, multiple trauma) and compared on key demographic and clinical characteristics. Primary analytic techniques included Pearson chi-square tests to determine associations between variables and binomial and multinomial logistic regression to determine which clinical and demographic characteristics were most associated with trauma exposure.

Results: Of the 189 women, most were Spanish-speaking (56%), unemployed (65%), and currently married or coupled (49%). Women most commonly presented with Major Depressive Disorder (44%), Generalized Anxiety Disorder (27%), and Post-Traumatic Stress Disorder (19%). Most women (75%) reported exposure to at least one type of trauma. Notably, domestic violence (43%) was the most prevalent trauma type experienced. Women who experienced physical abuse, sexual abuse, emotional abuse, and domestic violence were more likely to have been exposed to multiple (versus single) types of trauma. Among the psychiatric symptoms assessed, “feelings of anger” was found to most strongly and significantly differentiate women who experienced multiple versus single trauma.  Latina women who exclusively spoke Spanish (RRR=5.54, p=.01) and those with more than one Axis I psychiatric diagnosis (RRR=9.69, p <.05) were found to have greater relative risk of experiencing multiple trauma types.

Implications: Latina women receiving healthcare in primary care clinics appear to have exceptionally high rates of trauma exposure with the majority undiagnosed and having no prior trauma-related treatment. These women are psychiatrically complex with multiple co-occurring diagnoses of anxiety, depressive disorders, and PTSD, and most speak Spanish exclusively.