Trauma, psychiatric disorders, and treatment history among pregnant African American women
Open accessAbstract
OBJECTIVE: Pregnant African American women living in low-income urban communities have high rates of trauma exposure and elevated risk for the development of trauma-related disorders, including posttraumatic stress disorder (PTSD) and depression. Yet, engagement in behavioral health services is lower for African American women than Caucasian women. Limited attention has been given to identifying trauma exposure and PTSD, especially within at-risk communities. The present study examined rates of trauma exposure, PTSD, depression, and behavioral health treatment engagement in an obstetrics/gynecology (OB/GYN) clinic within an urban hospital. METHOD: The study included 633 pregnant African American women screened within the OB/GYN clinic waiting room; 55 of the women also participated in a subsequent detailed clinical assessment based on eligibility for a separate study of intergenerational risk for trauma and PTSD in African American mother-child dyads. RESULTS: = 358), 15% endorsed a past psychiatric diagnosis but none shared their PTSD diagnosis with their OB/GYN provider. CONCLUSION: Results of the current study highlight elevated levels of trauma exposure, PTSD, and depression in low-income, African American pregnant women served by this urban clinic, and demonstrate the need for better identification of trauma-related disorders and appropriate linkage to culturally responsive care especially for PTSD. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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PTSD affects up to 30% of pregnant individuals seen in low-resource settings.
“PTSD affects up to 30% of pregnant individuals seen in low-resource settings [2]”
From Written exposure therapy for treatment of perinatal PTSD among women with comorbid PTSD and SUD: A pilot study examining feasibility, acceptability, and preliminary effectiveness (2023) · cites this paper as [2]
The Results (page unavailable) report that approximately 30% of women in the study met criteria for probable current PTSD. The study sampled pregnant African American women at one urban clinic serving a primarily low-income population; it does not establish that rate for pregnant individuals across low-resource settings. (LLM, conf=0.87)
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“Compared to their white counterparts, Black women are less likely to receive appropriate mental health referrals, trauma-informed care, or consistent follow-up services [26].”
Stanhope, K. K., Suglia, S. F., Boulet, S. L., Powers, A. D., & Michopoulos, V. (2022) · Annals of Epidemiology · doi:10.1016/j.annepidem.2022.09.007 · Cited by 4 · see citing works
Self-citationStanhope, K. K., Galatan, J., Umerani, A., Islam, R., Powers, A. D., Michopoulos, V., Lawley, M. E., Leslie, S., & Suglia, S. F. (2025) · Midwifery · doi:10.1016/j.midw.2025.104530 · Cited by 4 · see citing works
Self-citationRocha, M., Lipschutz, R. S., Ravi, M., Nugent, N. R., Lathan, E. C., Wallace, S., Arthur, M., Karra, S., Hinrichs, R. C., Stevens, J. S., et al. (2025) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2025.107619 · Cited by 3 · see citing works
“This health disparity is especially pronounced in under-resourced pregnant Black females from urban areas (Powers et al., 2020) who are also at heightened risk of pregnancy-related morbidity and mortality (Callaghan, 2012).”
Self-citationRacial Discrimination–Related Interoceptive Network Disruptions: A Pathway to Disconnection
Elbasheir, A., Bond, R., Harnett, N. G., Guelfo, A., Karkare, M. C., Fulton, T. M., Ely, T. D., McDermott, T. J., Lanius, R. A., Ahluwalia, V., et al. (2024) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2024.12.011 · Cited by 3 · see citing works
Self-citationRavi, M., Lathan, E. C., Wallace, S., Hinojosa, C. A., Jones, D., Villalobos, J., Karra, S., Powers, A. D., & Michopoulos, V. (2023) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0001593 · Cited by 3 · see citing works
Self-citationPonting, C., Bond, M. J., Rogowski, B., Chu, A. T., & Lieberman, A. F. (2023) · Journal of Traumatic Stress · doi:10.1002/jts.22989 · Cited by 3 · see citing works
“Over 75% of women experience at least one traumatic event by the time they become pregnant (e.g., Powers et al., 2020; Seng et al., 2009).”
Herbst, K., Malmin, N. P., Paul, S., Williamson, T., Sugg, M. M., Schreck, C. J., & Runkle, J. D. (2024) · PLOS mental health. · doi:10.1371/journal.pmen.0000040 · Cited by 3 · see citing works
A Preliminary Scoping Review of Trauma Recovery Pathways among Refugees in the United States
Mbamba, C. R., Asare, J. L., & Gyimah, C. (2022) · Trauma Care · doi:10.3390/traumacare2040048 · Cited by 3 · see citing works
“Oftentimes, wrong interventions are offered to immigrants [27].”
BackgroundMethodInfluentialLathan, E. C., Davydenko, I., Hosking, C., Rodriguez, D. C., Haynes, T., & Powers, A. D. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-12662-4 · Cited by 2 · see citing works
“Routine medical care settings, like primary care and gynecology and obstetrics clinics, are additional spaces where patients seek medical care for chronic trauma-related symptoms (e.g., chronic pain, depression) [11, 17].”
Self-citationPowers, A. D., Lipschutz, R. S., McAfee, E. E., Abrams, C., O’Banion, D., Michopoulos, V., Brennan, P. A., & Stevens, J. S. (2025) · Psychological Medicine · doi:10.1017/s0033291725102432 · Cited by 2 · see citing works
“Efforts are needed at system levels (e.g., obstetrics clinics) to increase access to PTSS screening and referral processes (Powers et al., 2020) and expand evidence-based treatment options to address the large gaps in available care for PTSS among postpartum women (Yildiz, Ayers, & Phillips, 2017).”
Self-citationA Trauma-informed Care Curriculum for Perinatal Providers, Staff, and Learners
Chin, J., Sheth, M., Britz, S., Owens, L. E., & Zhang, Y. (2025) · MedEdPORTAL · doi:10.15766/mep_2374-8265.11563 · Cited by 2 · see citing works
Determinantes Sociais de Saúde e vulnerabilização de populações negras: uma revisão sistemática
Furlan, L. V., Cezar, M. M., & Pizzinato, A. (2023) · Revista Psicologia em Pesquisa · doi:10.34019/1982-1247.2024.v1.35653 · Cited by 3 · see citing works
Huibregtse, M. E., Wallace, S., Ravi, M., Karra, S., McAfee, E. E., Hinojosa, C. A., Mekawi, Y., Powers, A. D., Michopoulos, V., & Lathan, E. C. (2024) · Journal of Interpersonal Violence · doi:10.1177/08862605241245386 · Cited by 2 · see citing works
“…rooms of medical clinics at the same public hospital in which the current study was conducted; 14.4%-18.0% of participants had ever been attacked by a partner with a weapon, and 32.8%-37.5% had ever been attacked by an intimate partner without a weapon (Gluck et al., 2021; Powers et al., 2020).”
InfluentialSelf-citationCumulative maternal lifetime stress & child asthma: effect modification by BMI
Ramsey, N., Chiu, Y.-H. M., Hsu, H. L., Enlow, M. B., Coull, B. A., Wright, R. J., & Carroll, K. N. (2024) · Stress · doi:10.1080/10253890.2024.2435262 · Cited by 2 · see citing works
“…interpersonal racism, lower-income, BilPOc (Black, indigenous, latinX, People of color) women may disproportionately experience traumatic events (Powers et al., 2020; cheng & lo, 2016) or live in historically segregated communities shaped by discriminatory practices, such as redlining and…”
Kornfield, S. L., Johnson, R. L., Hantsoo, L. V., Kaminsky, R. B., Waller, R. E., Sammel, M. D., & Epperson, C. N. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.882429 · Cited by 2 · see citing works
“However, given high levels of trauma and poor access to mental health services in low-income, majority Black communities (8, 9, 90) the findings may be generalizable to pregnant women in other similar communities outside of Philadelphia and St.”
BackgroundValentine, S. E., Alshabani, N., Godfrey, L. B., Paul, E., Clark, C., Giovannini, K., & Nillni, Y. I. (2023) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2023.05.013 · Cited by 2 · see citing works
Access to Mental Healthcare Services for Black Women during Perinatal Period – A Scoping Review
Kemei, J., Asirifi, M. A., Nelson, J., Khalema, E. M., Adekoya, A. T., & Satimehin, O. O. (2024) · Global Journal of Health Science · doi:10.5539/gjhs.v16n4p43 · Cited by 1 · see citing works
“Powers et al. (2020) and Sroka et al. (2023) suggest improved screening processes that evaluate past traumatic experiences and thoroughly assess risks to determine the need for interventions and support, considering that treatment relies heavily on self-reported information.”
BackgroundInfluentialDepression and Suicide in the “World’s Happiest Countries”
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.003.0013 · Cited by 1 · see citing works
A Feasibility and Acceptability Trial of Narrative Exposure Therapy During Pregnancy
Padin, A. C., Miller, M. L., Perera, M. J., Addante, S., Scharff, A., Meyer, D. J., Shalowitz, M. U., & Stevens, N. R. (2025) · Behavior Therapy · doi:10.1016/j.beth.2025.08.005 · Cited by 1 · see citing works
Britt, A. J., Carlson, N. S., Dunn‐Amore, A., Houser, M. C., Smith, A., Lott, A. P., Merrill, N. A., & Michopoulos, V. (2026) · Research in Nursing & Health · doi:10.1002/nur.70073 · Cited by 1 · see citing works
Self-citationReducing the Risk of Maternal Morbidity and Mortality for Underserved Women
Olabode, S., & Grasser, L. R. (2024) · Journal of Science Policy & Governance · doi:10.38126/jspg240112 · Cited by 1 · see citing works
Paltell, K. C., Duffecy, J. L., Maki, P. M., Zakeri, S. E., Vujanovic, A. A., & Berenz, E. C. (2024) · JMIR Formative Research · doi:10.2196/53744
List of Abbreviations and Acronyms
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.002.0009
Dimensions and Implications of Cultural Identity
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.003.0004
Seeing Depression Through A Cultural Lens
Fogel, B. S., & Jiang, X. (2025) · doi:10.1093/med/9780190850074.001.0001
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.002.0006
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.003.0002
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.003.0006
Ancient Wisdom Meets Modern Science: Depression in Traditional Medicine
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.003.0009
South Korea: Han and Passionate Intensity
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.003.0012
Picturing Depression: Faces, Backgrounds, and Foregrounds
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.003.0001
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.002.0003
Cultural Identity and Personal Biography
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.003.0005
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.003.0018
Cultural Correlates and Clinical Consequences
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.003.0008
Depression and Social Class: A Four-Dimensional View
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.003.0007
Japan: Invisible Double-Edged Swords
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.003.0011
China: Confucian Harmony and Dissonance
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.003.0010 · Cited by 1 · see citing works
Beyond Shades of Gray: Depression and the Bipolar Spectrum
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.003.0003
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.002.0007
Flying High, Feeling Low: Depression in Airline Pilots
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.003.0017
American Regional Cultures and Geography of Mood
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.003.0014
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.002.0004
The Dark Side of Creative Talent
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.003.0015
Physicians in Pain: Depression in the Medical Profession
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.003.0016
Lipschutz, R. S., Ravi, M., Lathan, E. C., Duan, M., Karra, S., Wallace, S., Arthur, M., Britt, A. J., Powers, A. D., & Michopoulos, V. (2025) · Journal of Mood and Anxiety Disorders · doi:10.1016/j.xjmad.2025.100111
“However, because trauma exposure and subsequent mental health symptoms disproportionately impact Black pregnant people [12], understanding the functional outcomes is critical for addressing the long term implications in high-risk populations.”
Self-citationLong, A. M., Thompson, A. L., Bentley, M. E., Skinner, H. G., Barr, A. W., Nicholas, K., Headley, I., & Wasser, H. (2025) · SSM - Mental Health · doi:10.1016/j.ssmmh.2025.100463
“Previous work among pregnant Non-Hispanic Black women has suggested that lifetime trauma exposure may play a role, which has been associated with depressive symptoms, anxiety, and generalized stress (Dailey et al., 2011; Powers et al., 2020).”
Britt, A. J., Higgins, M. K., Dunlop, A. L., Michopoulos, V., & Carlson, N. S. (2025) · Journal of Midwifery & Women s Health · doi:10.1111/jmwh.13762
Self-citationPrevalent Forms of Mental Health Issues and Coping Strategies Amongst Black Women
Abdalla, N. (2025) · Advances in medical diagnosis, treatment, and care (AMDTC) book series · doi:10.4018/979-8-3693-4272-5.ch003
Longitudinal Changes in Fear Learning across Pregnancy: Moderation by Sexual Trauma
Rocha, M., Karra, S., Ravi, M., Minton, S. T., Merrill, N. A., Hinrichs, R. C., Nugent, N. R., Lathan, E. C., Wallace, S., Chandrasekaran, S., et al. (2026) · Women s Health Reports · doi:10.1177/26884844261446169
Self-citationGligorovic, S., & Drwecki, B. B. (2026) · Research Square · doi:10.21203/rs.3.rs-9683890/v1
Carroll, K. N., Lesseur, C., Brunst, K., Colicino, E., Chiu, Y., Hartman, T. J., Coull, B., & Wright, R. J. (2026) · Placenta · doi:10.1016/j.placenta.2026.06.013
“Importantly, women in racial and minoritized groups and of lower socioeconomic status are at greater risk of obesity [76], as they are disproportionately exposed to psychosocial stress, traumatic experiences [17], and obesogenic factors [77,78].”
Powers, A. D., & Woods-Jaeger, B. A. (2026) · Pregnancy · doi:10.1002/pmf2.70351
“%) was present, PTSD diagnoses were absent from patients’ medical records [3].”
InfluentialSelf-citationPsychometric properties of the City Birth Trauma Scale in Black trauma-exposed women
Lipschutz, R. S., Karra, S., Stanhope, K. K., Nugent, N. R., Arthur, M., Wallace, S., McAfee, E. E., Ravi, M., Lathan, E. C., Britt, A. J., et al. (2026) · European Journal of Psychotraumatology · doi:10.1080/20008066.2026.2690729
Self-citationStroink, L., Huijbregts, K., Rakic, A., de Vries, M. R., Rijkeboer, M. M., & Bekker, M. H. J. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1788675
Williams, T. R., Scifres, C., & Haas, D. M. (2026) · Maternal Health Neonatology and Perinatology · doi:10.1186/s40748-026-00289-0
Post-traumatic stress disorder and adverse pregnancy and birth outcomes: a population-based study
Huang, Y.-C., Kao, S., Yang, H.-W., Zhong, P.-X., To, S.-Y., & Kao, L. (2026) · European Journal of Psychotraumatology · doi:10.1080/20008066.2026.2717827
“…protective factor promoting resilience among high-risk women, pregnancy-specific stressors, labor-related anxiety, and total lifetime PTSD load may exacerbate symptoms (Muzik et al., 2016), highlighting the need for culturally responsive trauma screening in obstetric settings (Powers et al., 2020).”
- Authors
- Powers, A., Woods-Jaeger, B., Stevens, J. S., Bradley, B., Patel, M. B., Joyner, A., Smith, A. K., Jamieson, D. J., Kaslow, N., & Michopoulos, V.
- Affiliations
- Atlanta VA Medical Center (US)
- ORCID
- Venue
- Psychological Trauma: Theory, Research, Practice, and Policy
- Published
- 2020-02
- Volume
- 12
- Issue
- 2
- Pages
- 138-146
- ISSN
- 1942-9681 (ISSN-L)
- 1942-969X
- PMC
- PMC6986992
- OpenAlex
- W2970630564
- Cited by
- 73
- References
- 50
- Citations by year
- 2026: 9 · 2025: 37 · 2024: 12 · 2023: 7 · 2022: 6 · 2021: 2
- FWCI
- 1.84
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Psychological Trauma Theory Research Practice and Policy (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (MH115174, K23AT009713, HD085850, HD071982)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Keywords
- trauma exposure, post-traumatic stress disorder, depression, mental illness, pregnant women, African American women, low-income urban communities, culturally responsive care, intergenerational trauma, maternal mental health
- MeSH terms
- Psychological Trauma, Adolescent, Adult, Black or African American, Depressive Disorder, Female, Hospitals, Urban, Humans, Mental Health Services, Patient Acceptance of Health Care, Pregnancy, Prenatal Care, Stress Disorders, Post-Traumatic, Urban Population, Young Adult
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