Am J Psychiatry Published November 17, 2008

Trauma, Resilience, and Recovery in a High-Risk African-American Population

Tanya N. Alim, M.D., Adriana Feder, M.D., Ruth Elaine Graves, Ph.D., Yanping Wang, Ph.D., James Weaver, B.A., Maren Westphal, Ph.D., Angelique Alonso, M.A., Notalelomwan U. Aigbogun, M.S., Bruce W. Smith, Ph.D., John T. Doucette, Ph.D., Thomas A. Mellman, M.D., William B. Lawson, M.D., Ph.D., and Dennis S. Charney, M.D.

Objective: Despite increased risk for psychiatric disorders after trauma exposure, many people are able to adapt with minimal life disruption, and others eventually recover after a symptomatic period. This study examined psychosocial factors associated with resilience and recovery from psychiatric disorders in a high-risk sample of African American adults exposed to a range of severe traumas, who participated in structured diagnostic interviews.

Method: The sample included 259 patients exposed to at least one severe traumatic event, recruited from primary care offices at Howard University and administered the Structured Clinical Interview for DSM-IV Axis I disorders. Multinomial logistic regression was used to identify potential psychosocial factors associated with resilience and recovery, including purpose in life, mastery, and coping strategies.

Results: Forty-seven patients had no lifetime psychiatric disorders (resilient), 85 met criteria for at least one past DSM-IV disorder but no current disorders (recovered), and 127 met criteria for at least one current DSM-IV disorder (currently ill). The resilient group was characterized by a significantly lower lifetime trauma load. Female gender was predictive of currently ill status. In the final model, purpose in life emerged as a key factor associated with both resilience and recovery, and mastery was also significantly associated with recovery.

 Conclusions: The identification of psychosocial factors associated with resistance to severe trauma can inform future studies of preventive and treatment interventions for high-risk populations. Further study is needed to determine which psychosocial factors are consistently associated with resilience and to what extent they can be modified through clinical intervention