Racial differences in combat-related PTSD: empirical findings and conceptual issues

We critically review the empirical literature on racial differences in epidemiology, psychopathology, and treatment outcome in combat veterans with posttraumatic stress disorder (PTSD). Although there is a body of literature pertaining to various aspects of race and combat-related PTSD, much of the writing is conceptual in nature and based on single case or anecdotal reports, and there is a striking paucity of rigorous empirical findings. Furthermore, despite the prevailing zeitgeist and clinical lore, the limited extant empirical evidence suggests that veterans of different races are more similar to each other than they are different when it comes to the clinical manifestation and response to treatment of combat-related PTSD and associated features. The one area where clear differences exist is in epidemiological rates of PTSD, where minority combat veterans (i.e., Blacks and Hispanics) have been shown to have higher absolute rates of the disorder. However, secondary analyses within the existing epidemiological studies suggest that differential rates of PTSD between racial groups may be a function of differential rates of traumatic stressors and other pre-existing conditions. This finding, in combination with the general paucity of empirical data and certain methodological limitations, significantly moderates the conclusions that should be reached from this body of literature. Further research is needed before we can consider our knowledge in this area complete. A number of conceptual and methodological issues are discussed in order to highlight future research directions.