As health systems pay more attention to the effects of social determinants of health, a pair of studies presented at the 175th Annual Meeting of the American Psychiatric Association (APA), in San Francisco, California, shed light on a group for whom daily life itself can present ongoing stress: minority urban women.
APA’s scientific briefing Sunday highlighted findings from Jennifer Trinh, MD, of the Department of Psychiatry at Temple University Hospital, whose study of midlife minority women in North Philadelphia revealed isolation and loneliness, fueled by strained relationships, past trauma, and an abundance of responsibilities.1
A separate study presented Saturday by medical students from Rutgers New Jersey Medical School found that 30% of a small sample of Newark, New Jersey, residents met the criteria for posttraumatic stress disorder (PTSD), and women were 3 times more likely to screen positive.2
Authors of both studies suggest that more work needs to be done to find the best possible interventions, but that community support efforts to help women deal with the effects of chronic stress and trauma are in order. Trinh said that the women who took part in the Temple study told researchers they enjoyed taking part in the interviews, even though the survey took place because women at midlife weren’t accessing the healthcare system.
Temple Health included an initial survey in its 2016 community needs assessment because minority women in their midlife years were likely to bring children or elderly relatives for care, but they didn’t seek care themselves until they landed in the emergency department. Urban women “are the backbone of the families we treat,” she said. “We need to better understand what they are dealing with all day long.”
More Attention to Loneliness
Health systems in the United States and abroad are paying attention to the effects of loneliness on health. Trinh mentioned the appointment of United Kingdom’s first Minister for Loneliness
, Tracey Couch, a former member of parliament who admits past struggles with depression and is tasked with bringing down the $3.5 billion cost that loneliness adds to the nation’s healthcare tab.
Closer to home, CareMore Health has made news by creating the first Togetherness Program
, which is focused largely on seniors who not only have no one to talk to all day, but also have no one to drive them to the doctor or pick up a prescription, or to intercede when their oxygen tank never shows up. It’s not just seniors, however. Former US Surgeon General Vivek Murthy, MD, said in 2017 that the nation suffers from an “epidemic
” of loneliness; at its worst, extreme isolation is as bad for our cardiovascular health as smoking 15 cigarettes a day.
Trinh explained the difference between social isolation and loneliness: social isolation refers to a lack of relationships, while loneliness refers to a perceived lack of meaningful
relationships and a sense of disconnectedness.
Loneliness is associated with functional decline, and among midlife women it is associated with a higher incidence of coronary artery disease, Trinh said. Among low-income populations, it is linked to chronic problems with anxiety and depression, she said.
The community needs assessment identified loneliness as a mental health priority—7% of older adults reported speaking with family or friends less than once a week. Then, 50 women who were 35 to 60 years of age (mean age, 50.3 years) from North Philadelphia took part in individual interviews, and a subgroup of 21 participants also attended focus groups. Nearly three-fourths of the women (72%) were African-American, and 20% self-reported being Hispanic. Most women completed high school (88%) and 6% completed college.
The study found the following:
- Focus groups revealed that the sources of loneliness were the burdens of responsibility, trauma, and unhealthy relationships.
- Supportive relationships could prevent loneliness, when they were positive.
- More than 1 in 5 women (22%) said they “always” felt there is no one they can turn to for help.
- Another 20% said they “sometimes” feel there is no one they can turn to.
- 14% said they “rarely” felt close to others, while 10% said they “never” feel close to others.
Even if the women were in relationships, “the poor quality of these relationships,” often contributed to feelings of loneliness, rather than offering support.
Trinh shared some the statements from focus group meetings, where a participant said, “Mentally, I grew up alone, even though I was in a house, a family, and people around me, mentally, I grew up alone. Mentally, I was broken.… It’s a sadness, and the darkness that I’ve experienced as a child never allowed me mentally to have a life.”
High Rate of PTSD Seen in Newark Cohort
Authors of the abstract, “A
Community Study: Violence, PTSD, Hopelessness, Substance Use, and Perpetuation of Violence in Newark, NJ,” acknowledged that their sample was small—just 153 participants—and they used a convenience sample from churches and community centers near the medical school in New Jersey’s largest city.
But in their effort to investigate “the relationships among chronic exposure to violence, PTSD symptomatology, hopelessness, substance use, and the further perpetuation of violence,” the early findings were alarming. Being female, having heavy alcohol use, and feeling hopelessness were significantly linked with high levels of PTSD symptoms.
The medical students collected anonymous, self-reports of the following measures:
- PTSD checklist, civilian version
- Beck’s Hopelessness Scale
- The CAGE screen (acronym of alcohol-related questions)
- CDC Health Behavior Scale, to assess drinking frequency, drug use, and fights.
Results showed that 30% (95% CI [22.7, 37.4]) of the participants screened positive for PTSD, compared with 7% to 8% who develop the condition at some point
in their lives.
Excessive use of alcohol, drug use, fighting, carrying weapons, problematic drinking (CAGE score), and hopelessness were highly related to degree of PTSD symptomatology (P
Women at higher risk.
Females had 3 times greater odds times greater odds of screening positive for PTSD compared with males (P
< .05). The authors concluded, “While the sample is small and cross-sectional, these data suggest that PTSD rates are extra high in parts of the Newark community.”
- Trinh J, Devlin A, Fisher S, Morrison M. All the lonely people: a qualitative and quantitative study of factors influencing perceived social isolation in urban minority women in midlife. Presented at: 175th Annual Meeting of the American Psychiatric Association, San Francisco, California; May 18-22, 2019; P2-158.
- Sachdev D, Bonanno PA, Raman U, et al. A community study: violence, PTSD, hopelessness, substance use, and perpetuation of violence in Newark, NJ. Presented at: 175th Annual Meeting of the American Psychiatric Association, San Francisco, California; May 18-22, 2019; P1-120.