Objectives: To estimate the association of lifetime post-traumatic stress disorder (PTSD) and pain in American Indians, and determine if tribe, sex, cultural and psychosocial factors, or major depression influence the magnitude of this association.
Design: A cross-sectional probability sample survey completed between 1997 and 2000. A structured interview was conducted by trained, tribal members to gather information on demographic and cultural features, physical health status, psychiatric disorders, and functional status.
Setting: General community.
Participants: A total of 3,084 individuals randomly selected from the tribal rolls of a Southwestern (N = 1,446) and a Northern Plains (N = 1,638) tribal group who were 15-54 years of age and lived on or within 20 miles of their reservations.
Outcome measures: Bodily pain subscale of the Short Form-36. Linear regression models were fit to examine the association between lifetime PTSD and pain, adjusting for demographic, cultural, psychosocial features, painful medical conditions, and major depression.
Results: The prevalence of lifetime PTSD was 16% in the Southwestern and 14% in the Northern Plains; women were nearly twice as likely as men to have lifetime PTSD in both tribes. The final adjusted model demonstrated that mean Short Form-36 bodily pain subscale scores were lower (indicating more pain) among individuals with lifetime PTSD than those without lifetime PTSD. Effect modification by tribe, sex, and depression was not observed.
Conclusions: Lifetime PTSD was strongly associated with bodily pain in this rural sample of American Indians. Clinicians should be aware of, and address, the link between physical pain syndromes and PTSD.