Content uploaded by Michelle Sotero
Author content
All content in this area was uploaded by Michelle Sotero on Jun 06, 2016
Content may be subject to copyright.
Content uploaded by Michelle Sotero
Author content
All content in this area was uploaded by Michelle Sotero on Jun 06, 2016
Content may be subject to copyright.
Electronic copy available at: http://ssrn.com/abstract=1350062Electronic copy available at: http://ssrn.com/abstract=1350062
Journal of Health Disparities Research and Practice
Volume 1, Number 1, Fall 2006
©2006 Center for Health Disparities Research
School of Public Health
University of Nevada Las Vegas
93
HD
R
P
JOURNAL OF
A Conceptual Model of Historical Trauma:
Implications for Public Health Practice and Research
Michelle M. Sotero, University of Nevada, Las Vegas
Abstract
Historical trauma theory is a relatively new concept in public
health. The premise of this theory is that populations historically sub-
jected to long-term, mass trauma—colonialism, slavery, war, genocide—
exhibit a higher prevalence of disease even several generations a er the
original trauma occurred. Understanding how historical trauma might
infl uence the current health status of racial/ethnic populations in the
U.S. may provide new directions and insights for eliminating health
disparities. This article off ers an analysis of the theoretical framework of
historical trauma theory and provides a general review of the literature.
A conceptual model is introduced illustrating how historical trauma
might play a role in disease prevalence and health disparities. Finally,
implications for public health practice and research are discussed.
Key Words: historical trauma theory, racial/ethnic health disparities,
minority health, American Indian/Alaskan Native, public health, social
epidemiology
Introduction
Eliminating racial/ethnic health disparities is a key objective in
public health. To that end, modern epidemiology relies primarily on
the biomedical model for understanding the determinants of popula-
tion health. The approach is constrained, however, as McMichael1 has
pointed out, by a preoccupation with proximate risk factors and a focus
on the health of individuals rather than of particular populations. One of
the contributions of social epidemiology has been to expand the search
for causal infl uences on health to social pathways, social transitions and
their institutional contexts.2, 3 As Elder3 has eloquently stated, “lives are
lived in specifi c historical times and places…if historical times and places
change, they change the way people live their lives.”
, pp. 93–108
Electronic copy available at: http://ssrn.com/abstract=1350062Electronic copy available at: http://ssrn.com/abstract=1350062
94 Journal of Health Disparities Research and Practice • Vol. 1, No. 1 • Fall 2006
Historical trauma theory is the embodiment of this sentiment. The
premise is that populations historically subjected to long-term, mass
trauma exhibit a higher prevalence of disease even several generations
a er the original trauma occurred.4–7 Historical trauma theory is a
relatively new concept in public health; thus, empirical evidence
presently off ers weak support for the validity of the theory and its
connection to contemporary health disparities. Yet, for many, the concept
makes intuitive sense. In fact, a large body of interdisciplinary research
seemingly lends support to the theory, making it deserving of further
empirical research.
Understanding how historical trauma infl uences the current
health status of racial/ethnic populations in the U.S. may provide new
directions and insights for eliminating health disparities. This article
off ers an analysis of the theoretical framework of historical trauma
theory and provides a general review of the literature. A conceptual
model is introduced illustrating how historical trauma might play a role
in disease prevalence and health disparities. Finally, implications for
public health practice and research will be discussed.
Historical Trauma Theory
Historical trauma theory incorporates and builds upon three
theoretical frameworks in social epidemiology.2 The fi rst is psychosocial
theory, which links disease to both physical and psychological stress
stemming from the social environment. In this framework, psychosocial
stressors not only create susceptibility to disease, but act as a direct
pathogenic mechanism aff ecting biological systems in the body. The
second theoretical framework is political/economic theory, which
addresses the political, economic and structural determinants of health
and disease such as unjust power relations and class inequality. The
third is social/ecological systems theory, which recognizes the multilevel
dynamics and interdependencies of present/past, proximate/distal, and
life course factors in disease causation.1, 2
In understanding how and why certain populations have a higher
burden of disease than others, historical trauma theory provides a
macro-level, temporal framework for examining how the “life course” of
a population exposed to trauma at a particular point in time compares
with that of unexposed populations. Based on a review of the literature,
at least four distinct assumptions underpin this theory: (1) mass trauma
is deliberately and systematically infl icted upon a target population
by a subjugating, dominant population; (2) trauma is not limited to
a single catastrophic event, but continues over an extended period
95
of time; (3) traumatic events reverberate throughout the population,
creating a universal experience of trauma; and (4) the magnitude of the
trauma experience derails the population from its natural, projected
historical course resulting in a legacy of physical, psychological, social
and economic disparities that persists across generations. The three
basic constructs of the theory are the historical trauma experience, the
historical trauma response, and the intergenerational transmission of
historical trauma.4, 8
A Review of the Literature
All trauma experiences are technically historical in nature. Most of
the body of work on psychic trauma has focused on the psychological
eff ects of individuals’ rather than populations’ exposure to traumatic
events.9-11 In 1980, Post-Traumatic Stress Disorder (PTSD) was formally
accepted by the American Psychiatric Association as a diagnosis
describing the severe and long-term eff ects of exposure to traumatic
stressors like combat, sexual assault, child abuse, motor vehicle accidents
or natural disasters.12 Research indicates that individuals diagnosed
with PTSD have elevated odds of behavioral health risks and social
dysfunction.9, 12 Another study found that experiences of chronic trauma
created deep emotional scars aff ecting life-long pa erns of interpersonal
relationships, the ability to master life-skills and role performance.9 More
recently, clinical studies have linked chronic stress associated with PTSD
to physical health. Chronic stress has been linked to impairment of the
nervous system, the hypothalamic–pituitary–adrenal (HPA) axis, and
cardiovascular, metabolic, and immune systems. These impairments
contribute to chronic diseases such as diabetes, hypertension, and
cardiovascular disease.9, 10, 12, 15, 16 The literature also reveals that responses
to deliberate perpetration of mass trauma are very diff erent from those
caused by accident or forces of nature. Trauma as the result of deliberate
intent produces a profound sense of dismay and alienation. Intentional
violence threatens basic assumptions about an orderly, just world and
the intrinsic invulnerability and worthiness of the individual.13, 14
A key feature of historical trauma theory is that the psychological
and emotional consequences of the trauma experience are transmi ed to
subsequent generations through physiological, environmental and social
pathways resulting in an intergenerational cycle of trauma
response.4, 6–8, 17–21
Historical trauma transmission was fi rst conceptualized in the 1960s,
based on studies of persistent trauma among Holocaust survivors and
their families a er World War II.4, 17 Since then, a number of studies
A Conceptual Model of Historical Trauma • Sotero
96 Journal of Health Disparities Research and Practice • Vol. 1, No. 1 • Fall 2006
have found that off spring of Holocaust survivors manifested an array of
trauma response pathology and experienced themselves as “diff erent or
damaged” by their parents’ experiences.4, 15, 17, 21 Though these fi ndings
are not without controversy, disagreement centers primarily around
inadequacies in methodological complexity and study design.4, 17, 22 More
recently, studies in other populations—Palestinian, Russian, Cambodian,
African American and American Indian—have documented that
off spring of parents aff ected by trauma also exhibited various symptoms
of PTSD or “historical trauma response.” These symptoms included
an array of psychological problems such as denial, depersonalization,
isolation, memory loss, nightmares, psychic numbing, hypervigilance,
substance abuse, fi xation on trauma, identifi cation with death, survivor
guilt and unresolved grief.4-8, 17, 20, 23–29
In the last decade, the majority of historical trauma research has
been with American Indian/Alaskan Native (AIAN) populations.
Brave Heart and DeBruyn5 fi rst published on the concept of historical
trauma in the AIAN population in the mid 1990s. Brave Heart8 defi ned
historical trauma as “the cumulative and collective psychological and
emotional injury sustained over a lifetime and across generations
resulting from massive group trauma experiences.” Faimon30 described
historical trauma experienced by the (American Indian) Dakota nation
as an “indescribable terror and the legacy of terror that remains a er
140 years, as evidenced by repression, dissociation, denial, alcoholism,
depression, doubt, helplessness and devaluation of self and culture.”
She also elaborated on the intergenerational legacy of shame, guilt, and
distrust embedded in collective memory and passed down through
seven generations. The Aboriginal Healing Foundation18 describes
historical trauma as a cluster of traumatic events and as a disease itself.
The symptoms of historical trauma as a disease are the maladaptive
social and behavioral pa erns that were created in response to the
trauma experience, absorbed into the culture and transmi ed as learned
behavior from generation to generation.18
Recently, researchers have begun to identify historical trauma as
a precipitating condition infl uencing racial/ethnic health disparities.
Williams, Neighbors and Jackson31 identifi ed race-related historical
trauma as a large-scale, systems-related macro-stressor that adversely
impacts both the physical and mental health of the aff ected racial/
ethnic group. Walters and Simoni32 described historical trauma from
an indigenous fourth-world context, in which a minority indigenous
population exists in a nation where a colonizing, subordinating majority
holds institutionalized power and privilege. The subordination of
97
indigenous populations and the cumulative eff ects of injustice and
discrimination are characterized as a “soul wound” that impacts
health outcomes for Native people. Duran and Walters33 suggested that
temporal pa erns of exposure to cultural and historical trauma may act
as covariates in HIV/AIDS behavior among AIAN populations. Finally,
Leary7 and Reid, Mims and Higginbo om20 assert that African Americans
have sustained traumatic psychological and emotional injury as a direct
result of slavery, perpetuated by social/institutional inequality, racism
and oppression.
The literature on historical trauma is largely theoretical and
qualitative in nature. More quantitative studies are needed to build
on existing work and to connect historical trauma with public health
and disease outcomes. Whitbeck et al.,17 for example, developed a
Historical Loss Scale and a Historical Loss Associated Symptoms Scale
as a measure of historical trauma in American Indian elders. Baker and
Gippenreiter34 conducted a study designed to measure the physical and
mental health eff ects of historical trauma in the grandchildren of victims
of the Stalin Purge of 1937–39.
In addition, the literature on trauma (psychic and historical)
primarily focuses on the psychosocial/psychobiological sequelae of the
trauma experience. Li le is wri en about the physical eff ects resulting
from exposure to mass trauma—injuries, infectious and chronic diseases,
malnutrition—and whether they persist through future generations.
However, a large body of empirical research on the Dutch Famine of
1944 (see the works of M. Susser; A. Ravelli; L. Lumey; and J. McClellan)
and a growing body of research on the fetal origins of disease (see D.
Barker and D. Benyshek) indicate that physical ramifi cations of trauma
exposure can carry over to subsequent generations via genetic mutation,
impairments in gene expression and physiological adaptations.
One of the challenges to quantitative research may be
conceptualizing how events that took place in the distant past aff ect
the present. The literature review did not produce a general conceptual
model illustrating how all of the described elements of historical trauma
interact in a manner that infl uences contemporary health disparities.
A Conceptual Model of Historical Trauma
The conceptual model of historical trauma introduced here a empts
to synthesize the literature and delineate physical, psychological and
social pathways linking historical trauma to disease prevalence and
health disparities (Figure 1).
A Conceptual Model of Historical Trauma • Sotero
98 Journal of Health Disparities Research and Practice • Vol. 1, No. 1 • Fall 2006
Figure 1. Conceptual Model of Historical Trauma
Dominant
Group
Subjugation of
a Population
Segregation/Displacement
(plantation, reservation,
refugee camp, etc.)
Physical/Psychological
Violence
(acute and chronic)
Economic Destruction
(loss of resources,
legal rights)
Cultural Dispossession
(loss of cultural roles,
language, religion, etc.)
First Generation or Primary Generations
Secondary and Subsequent Generations
Trauma Response
Physical Response
> Nutritional stress
> Compromised immune system
> Biochemical abnormalities
> Endocrine impairment
> Adrenal maladaptation
> Gene impairment/expression
Resulting in: malnutrition, diabetes,
hyperglycemia, infectious disease,
heart disease, hypertension, cancer
Psychological Response
> Post-Traumatic Stress Disorder
> Depression
> Panic/Anxiety Disorders
Resulting in:
anger/aggression terror/fear
social isolation grief
shame withdrawal
loss of self-worth numbness
> Increased suicide rate
> Domestic violence
> Unemployment
Resulting in:
breakdown of community/family structures and social
networks, loss of resources, separation from loved ones
> Substance abuse
> Child maltreatment
> Poverty
Resilience
Protective
Factors
Social Response
MASS
TRAUMA
EXPERIENCE
Modes of Intergenerational Transmission
> Physiological
> Genetic
> Environmental
> Psychosocial
> Social/Economic/Political Systems
> Legal and Social Discrimination
Present
Proximate
Individual
Population
Distal Life stage
Life course
Past
influences on
Health Disparities
INTERGENERATI ONAL
TRANSMISSION
99
The model posits that historical trauma originates with the
subjugation of a population by a dominant group. Successful subjugation
requires at least four elements: 18 (1) overwhelming physical and
psychological violence, (2) segregation and/or displacement, (3)
economic deprivation, and (4) cultural dispossession.
The dominant group enforces subjugation through various means
including military force, bio-warfare, national policies of genocide, ethnic
cleansing, incarceration, enslavement, and/or laws that prohibit freedom
of movement, economic development, and cultural expression.4, 5, 18, 19,
24, 32, 35–41 Though overt legitimization of subjugation may be rescinded
over time, its legacy remains in the form of racism, discrimination and
social and economic disadvantage.6, ,7, 20, 31, 32, 42 The universal experience of
subjugation constitutes signifi cant physical and psychological trauma for
the aff ected population.
As the model illustrates, primary generations are the direct victims
of subjugation and loss, which threaten their population and economic
and cultural survival. Having witnessed great loss of life and endured
brutality, starvation, and disease, many survivors are plagued with
physical injuries, malnutrition, and high rates of infectious and chronic
diseases.5, 18, 30, 43 Their psychological and emotional responses stem from
experiencing violence, severe stress, pervasive hardship and <relentless>
unremi ing grief at the loss of kin, land, and way of life.5, 13, 18, 37, 39–41, 44
Trauma response in primary generations may include PTSD, depression,
self-destructive behaviors, severe anxiety, guilt, hostility, and chronic
bereavement.9–11, 13 Psychological and emotional disorders may well
translate into physical disease, and vice versa.9, 12
Secondary and subsequent generations are aff ected by the original
trauma through various means. Extreme trauma may lead to subsequent
impairments in the capacity for parenting.4 Physical and emotional
trauma can impair genetic function and expression, which may in turn
aff ect off spring genetically, through in utero biological adaptations,
or environmentally. 4, 11, 18, 45, 46–49 Evidence suggests that disorders such
as mental illness, depression and PTSD can be genetically transmi ed
to secondary and subsequent generations.1, 45, 50 Maternal malnutrition
contributes to poor-quality breast milk and low-birth-weight babies.51
Some studies indicate that maternal care and depressive state are
also major determinants of endocrine and behavioral stress responses
in off spring.50, 52 Further, some evidence suggests that physiological
adaptations made by a fetus in response to in utero stressors are
correlated with a number negative health outcomes throughout life.49
According to Benyshek,46 research shows that Type 2 diabetes in adults
A Conceptual Model of Historical Trauma • Sotero
100 Journal of Health Disparities Research and Practice • Vol. 1, No. 1 • Fall 2006
may be caused by metabolic adaptations of the fetus in response to
maternal malnutrition. The disorder is then propagated throughout
subsequent generations via hyperglycemic pregnancies.46
Maladaptive behaviors and related social problems such as
substance abuse, physical/sexual abuse, and suicide directly traumatize
off spring and are indirectly transmi ed through learned behavior
perpetuating the intergenerational cycle of trauma.4, 53–56 Secondary and
subsequent generations also experience “vicarious traumatization”
through the collective memory, storytelling and oral traditions of the
population. Traumatic events become embedded in the collective,
social memories of the population. Off spring are taught to share
in the ancestral pain of their people and may have strong feelings
of unresolved grief, persecution and distrust.18, 24, 30 They may also
experience original trauma through loss of culture and language, as well
as through proximate, fi rst-hand experiences of discrimination, injustice,
poverty, and social inequality. Such experiences validate their ancestral
knowledge of historical trauma and reinforce the historical trauma
experience and response.24, 31
Finally, the cumulative eff ects of historical trauma on the population,
mitigated to some degree by the existence of resiliency and protective
factors, result in a surfeit of social and physical ills that ultimately lead to
population-specifi c health disparities. Historical trauma has been called
a “disease of time.”18 From this perspective, the poor health status of
aff ected populations can be argued as the result of the accumulation of
disease and social distress across each succeeding generation.
Case Study: Historical Trauma and Health Disparities in the
AIAN Population
Descriptions and details of the subjugation of AIAN people through
colonization, war and genocide have been provided by many authors
and will not be repeated here. (See Stannard, 1992; Thornton, 1987;
Aboriginal Healing Foundation, 2004; and Brave Heart & DeBruyn,
1998). However, to illustrate how historical trauma might infl uence
health disparities, one pertinent historical event will be recounted and
associated with the current health status of the AIAN population.
The introduction of infectious diseases was the single most
devastating impact of the European colonization of the Americas. Known
as virgin soil epidemics, measles and small pox alone decimated over
90% of the indigenous population by some estimates.18 Until the early
1900s, measles and small pox epidemics struck every seven to eleven
101
years, resulting in great loss of life, habitual food scarcity, starvation and
chronic illness.18
Recurrent epidemics meant that the population had li le time to
reproduce fully immune off spring.18 Exposure to infectious disease
compromised cellular immunity, facilitated the spread of viruses and
created susceptibility to other diseases such as tuberculosis, hepatitis and
infl uenza.18, 51, 57 Food scarcity and starvation, a by-product not only of
the epidemics but of government policies, may also have led to metabolic
and behavior adaptations. In a paper titled “Diseases Among Indians,”
published in 1892 in the Weekly Journal of Medicine and Surgery, Dr.
A.B. Holder57 writes, “The buff alo is gone and Government rations or
scant subsistence by their own labor, is the Indians’ present diet. In this
change is found a factor in the causation of consumption and scrofula.”
He further states that food rations furnished by the government were
inconsistent and insuffi cient to maintain health. A er a period of fasting,
the next supply of food rations would arrive and there would be a feast
in which most of the food was consumed. This resulted in a regular
succession of fasts and feasts that “deranges digestion and assimilation
and fi ts the constitution for the invasion of tuberculosis.”57
Though it was only one of many historical tragedies, 6, 18, 58, 59
infectious disease had a devastating impact on the health of American
Indians and Alaskan Natives. One could argue that the population
health of contemporary AIANs never recovered from the extensive
physical, psychological, social and cultural trauma of European
colonization.42 Today, this population has the poorest health status
of any racial/ethnic population in the United States.42 Compared to
the U.S. average, American Indians are 770% more likely to die from
alcoholism, 650% more likely to die from tuberculosis, 420% more likely
to die from diabetes, 280% more likely to die from accidents, 190% more
likely to commit suicide and 52% more likely to die from pneumonia or
infl uenza.42 For some Native populations in the U.S., life expectancy is
lower than every country in the Western Hemisphere, with the exception
of Haiti.60
Implications for Public Health Practice and Research
Pearce61 states that modern epidemiology embraces a paradigm
that “focuses on the individual, blames the victim, and produces
interventions that can be harmful.” Many Native and non-Native allied
public health professionals have begun to change this by developing
intervention programs that integrate theories of historical trauma,
community capacity and community empowerment. 8, 23–25, 33, 55, 62–64
A Conceptual Model of Historical Trauma • Sotero
102 Journal of Health Disparities Research and Practice • Vol. 1, No. 1 • Fall 2006
These programs are designed to be holistic, culturally relevant, and
respectful of indigenous self-understanding of historical trauma and
its impact on community health. Symptoms of historical trauma—like
diabetes, suicide, and domestic violence—are addressed from a diff erent
perspective and through a new paradigm diff erent from traditional
health programs that subscribe to Western belief systems and inherent
dominant culture biases.55, 62 The work pioneered in AIAN communities
provides a model for addressing health disparities in other minority
populations.
Connecting the past with the present is inherent in many cultural
traditions. Historical trauma theory contextualizes “time and place.” It
validates and aligns itself with the experiences and explanatory models
of aff ected populations and recognizes issues of accountability and
agency. It creates an emotional and psychological release from blame
and guilt about health status, empowers individuals and communities to
address the root causes of poor health and allows for capacity building
unique to culture, community and social structure.62
Historical trauma theory is a rich-in-variables framework whose
application to public health is invaluable. More empirical research
is necessary to fully understand, operationalize and validate the
theoretical constructs of historical trauma. More work is also needed
to link measures of historical trauma to health outcomes. The majority
of research on historical trauma has been conducted with American
Indian populations and is largely qualitative. More evaluative research
is needed on the eff ectiveness of intervention programs. More empirical
research is needed to gain a be er understanding of the manifestations
and prevalence of historical trauma among indigenous populations,
as well as the specifi c mechanisms of intergenerational transmission.
Research needs to be conducted in other minority populations in the
U.S. to determine the existence of historical trauma or if there are trauma
response variations dependent on intensity, length and context of
exposure, time passed since exposure, resiliency, protective or cultural
factors. The conceptual model of historical trauma introduced here
is intended to help public health practitioners and researchers gain a
broader perspective of health disparities and aid in the development
of new approaches for improving the health status of racial/ethnic
populations in the United States.
Acknowledgments
Many thanks to Michelle Chino, Ph.D., for making this paper
possible. Her expertise, support and mentorship were invaluable. Special
103
thanks to Roland Sotero for his insightful comments and contributions
and to an anonymous reviewer who took the time to provide an in-depth
critique.
References
1. McMichael, A. 1999. Prisoners of the Proximate: Loosening the Constraints
on Epidemiology in an Age of Change. American Journal of Epidemiology
149(10):887–897.
2. Krieger, N. 2001. Theories for Social Epidemiology in the 21st Century: An
Ecosocial Perspective. International Journal of Epidemiology 30:668–677.
3. Elder, G. 2001. The Life Course in Time and Place. Presentation to the Interna-
tional Symposium on Institution, Interrelations, Sequences: The Bremen Life-Course
Approach. Breman, Germany. Accessed 09/14/2006 at h p://www.unc.edu/
~elder/presentations/Life_course_in_time.html
4. Danieli, Y. (Ed.) 1998. International Handbook of Multigenerational Legacies of
Trauma. New York: Plenum Press.
5. Brave Heart, M.,& DeBruyn, L. 1998. The American Indian Holocaust:
Healing Historical Unresolved Grief. Am Indian Alk Nat Mental Health Res
8(2):56–78.
6. Duran, E., & Duran, B. 1995. Native American Postcolonial Psychology. Albany:
State University of New York Press.
7. Leary, Degruy, L. 2005. Post Traumatic Slave Syndrome: America’s Legacy of
Enduring Injury and Healing. Uptone Press.
8. Brave Heart, M. 2003. The Historical Trauma Response Among Natives and
its Relationship with Substance Abuse: A Lakota Illustration. Journal of Psy-
choactive Drugs 35(1):7–13.
9. Brunello, N.; Davidson, J.; Deahl, M.; et al. 2001. Postraumatic Stress Disor-
der: Diagnostic and Epidemiology, Comorbidity and Social Consequences,
Biology and Treatment. Neuropsychobiology 43:150–162.
10. Jankowsi, K. National Center for Post Traumatic Stress – PTSD and Physical
Health. Accessed 10/11/05. Available at h p://www.ncptsd.va.gov/facts/spe-
cifi c/fs_physical_health.html
11. Feli i, V.; Anda, R.; Nordenberg, D.; et al. 1998. Relationship of Childhood
Abuse and Household Dysfunction to Many of the Leading Causes of Death
in Adults. The Adverse Childhood Experiences (ACE) Study. American Jour-
nal of Preventative Medicine 14(4):245–258.
12. Schnurr, P., & Green, B. (Eds.) 2004. Trauma and Health: Physical Health Conse-
quences of Exposure to Extreme Stress. Washington, DC: American Psychologi-
cal Association.
13. Webb, Boyd, N. (Ed.) 2004. Mass Trauma and Violence: Helping Families and
Children Cope. New York: The Guilford Press.
14. Brenner, I. (Ed.) Psychic Trauma: Dynamics, Symptoms and Treatment. Lanham,
MD: Rowman & Li lefi eld Publishers, Inc.
A Conceptual Model of Historical Trauma • Sotero
104 Journal of Health Disparities Research and Practice • Vol. 1, No. 1 • Fall 2006
15. Lloyd, C.; Smith, J.; and Weinger, K. 2005. Stress and Diabetes: A Review of
the Links. Diabetes Spectrum 18(2):121–127.
16. Cardeña, E., & Croyle, K. (Eds.) 2005. Acute Reactions to Trauma and Psycho-
therapy. Binghamton, NY: The Haworth Medical Press.
17. Whitbeck, L.; Adams, G.; Hoyt, D.; and Chen, X. 2004. Conceptualizing and
Measuring Historical Trauma among American Indian People. Journal of
Community Psychology 33(3/4):119–130.
18. The Aboriginal Healing Foundation. 2004. Historic Trauma and Aboriginal
Healing. O awa, Ontario: Anishinabe Printing. Accessed 09/30/05. Available
at h p://www.ahf.ca
19. Kellerman, N. 2001. Transmission of Holocaust Trauma: An Integrative
View. Psychiatry: Interpersonal & Biological Processes 64(3):256–268.
20. Reid, O.; Mims, S.; and Higginbo om, L. 2004. Post Traumatic Slavery Disor-
der: Defi nition, Diagnosis and Treatment. Philadelphia: Xlibris Corporation.
21. Abrams, M. 1999. Intergenerational Transmission of Trauma: Recent Con-
tributions from the Literature of Family Systems Approaches to Treatment.
American Journal of Psychotherapy 53(2):225–232.
22. Denham, A. Rethinking Historical Trauma: Narratives of Resilience. Unpublished
Manuscipt. Accessed 09/11/06. Available at h p://www.webpages.uidaho.
edu/~rfrey/PDF/Rethinking%20Historical%20Trauma%20Revised.pdf#search
=%22Rethinking%20Historical%20Trauma%22
23. Brave Heart, M. 1999. Oyate Ptayela: Rebuilding the Lakota Nation through
Addressing Historical Trauma among Lakota Parents. Journal of Human Be-
havior in the Social Environment 2(1/2):109–126.
24. Brave Heart, M. 1999. Gender Diff erences in the Historical Trauma Response
among the Lakota. Journal of Health and Social Policy 10(4):1–21.
25. Struthers, R., & Lowe, J. 2003. Nursing in the Native American Culture and
Historic Trauma. Issues in Mental Health Nursing 24:257–272.
26. Punamaki, R.; Qouta, S.; and El-Sarraj, E. 2001. Resiliency Factors Predicting
Psychological Adjustment a er Political Violence among Palestinian Chil-
dren. International Journal of Behavioral Development 25(3):256–267.
27. Quota, S.; Punamaki, R.; and El-Sarraj, E. 2003. Prevalence and Determinants
of PTSD among Palestinian Children Exposed to Military Violence. European
Child & Adolescent Psychiatry 12(6):265–272.
28. Rubin, A., & Rhodes, L. 2005. Telling “Ten Percent of the Story” Narrative
and the Intergenerational Transmission of Trauma among Cambodian Refu-
gees. In Cross-Cultural Psychiatry, A. Georgiopoulos and R. Rosenbaum, eds.,
pp. 157–178. Philadelphia: Lippinco Williams & Wilkins.
29. Daud, A.; Skoglund, E.; and Rydelius, P. 2005. Children in Families of Tor-
ture Victims: Transgenerational Transmission of Parents’ Traumatic Experi-
ences to their Children. International Journal of Social Welfare 14(1):23–32.
30. Faimon, M. 2004. Ties that Bind. American Indian Quarterly 28(1/2):238–250.
31. Williams, D.; Neighbors, H.; and Jackson, J. 2003. Racial/Ethnic Discrimi-
105
nation and Health: Findings from Community Studies. American Journal of
Public Health 93(2):200–208.
32. Walters, K., & Simoni, J. 2002. Reconceptualizing Native Women’s Health:
An “Indigenist” Stress-Coping Model. American Journal of Public Health
93(4):520–524.
33. Duran, B., & Walters, K. 2004. HIV/AIDS Prevention in “Indian Country:”
Current Practice, Indigenist Etiology Models, and Postcolonial Approaches to
Change. AIDS Education and Prevention 16(3):187–201.
34. Baker, K., & Gippenreiter, J. 1998. Stalin’s Purge and its Impact on Russian
Families: A Pilot Study. In International Handbook of Multigenerational Legacies
of Trauma, Y. Danieli, ed., pp. 403–434. New York: Plenum Press.
35. Weaver, H. 1998. Indigenous People in a Multicultural Society: Unique Is-
sues for Human Services. Social Work 43(3):203–211.
36. Dodgson, J., & Struthers, R. 2005. Indigenous Women’s Voices: Marginaliza-
tion and Health. Journal of Transcultural Nursing 16(4):339–346.
37. Easley, C., & Charles, G. 2004. Qualitative Report - Conference of Alaska Native
Elders: Our View of Dignifi ed Aging. National Resource Center for American
Indian, Alaska Native, and Native Hawaiian Elders: University of Alaska
Anchorage. Accessed 09/30/05. Available at h p://elders.uaa.alaska.edu
38. Hallaq, Eyad. 2003. An Epidemic of Violence. Palestine–Israel Journal of Poli-
tics, Economics & Culture 10(4):37–42.
39. Punamaki, R. 1986. Stress among Palestinian Women under Military Oc-
cupation: Women’s Appraisal of Stressors, their Coping Modes, and their
Mental Health. International Journal of Psychology 21(4/5):445–463.
40. Thabet, A.; Abed, Y.; and Vostanis, P. 2004. Comorbidity of PTSD and
Depression among Refugee Children during War Confl ict. Journal of Child
Psychology & Psychiatry & Allied Disciplines 45(3):533–542.
41. Thabet, A.; Abed, Y.; and Vostanis, P. 2002. Emotional Problems in Pales-
tinian Children Living in a War Zone: A Cross-sectional Study. The Lancet
359(9320):1801–1804.
42. U.S. Commission on Civil Rights. 2004. Broken Promises: Evaluating the Na-
tive American Health Care System. Washington, DC: U.S. Commission on Civil
Rights. Accessed 11/28/05. Available at h p://www.usccr.gov
43. Brundtland, G. 2002. Health Situation of Palestinian People Living in the Oc-
cupied Palestinian Territory. Statement by Director-General, World Health
Organization. September 27, 2002. Accessed 10/01/2005. Available at www.
who.int/mediacentre/news/statements/statements04/en/print.html
44. Zakrison, T.; Shahen, A.; Mortaja, S.; and Hamel, P. 2004. The Prevalence of
Psychological Morbidity in West Bank Palestinian Children. Canadian Journal
of Psychiatry 49(1):60–63.
45. McClellen, J.; Susser, E.; and King, M. 2006. Maternal Famine, De Novo Mu-
tations, and Schizophrenia. JAMA 296(5):582–584.
A Conceptual Model of Historical Trauma • Sotero
106 Journal of Health Disparities Research and Practice • Vol. 1, No. 1 • Fall 2006
46. Benyshek, Daniel. 2005. Type 2 Diabetes and Fetal Origins: The Promise of
Prevention Programs Focusing on Prenatal Health in High Prevalence Native
American Communities. Human Organization 64(2):192–200.
47. Ravelli, G.; Stein, Z.; and Susser, M. 1976. Obesity in Young Men a er
Famine Exposure In-Utero and Early Infancy. New England Journal of Medicine
295(7):349–353.
48. Emanuel, I.; Filakti, H.; Alberman, E.; and Evans, S. 1992. Intergenerational
Studies of Human Birthweight from the 1958 Birth Cohort: Evidence for a
Multigenerational Eff ect. British Journal of Obstetrics and Gynaecology 99(1):67–
74.
49. Barker, D. (Ed.). 1992. Fetal and Infant Origins of Adult Disease. London: BMJ
Books.
50. Eisenb, L. 2001. From Molecules to Mind. Eastern Mediterranean Health
Journal 7(3):363–366. Accessed 10/2/05. Available at h p://www.emro.who.
int/Publications/EMHJ/0703/5Molecules.htm
51. Tulchinsky, T., & Varavikova, E. 2000. Nutrition in a Global Context and
Nutrition and Infections. In The New Public Health: An Introduction for the 31st
Century, pp. 403–405. San Diego: Academic Press.
52. Lupien, S.; King, S.; Meaney, M.; and McEwen, B. 2000. Child’s Stress Hor-
mone Levels Correlate with Mother’s Socioeconomic Status and Depressive
State. Biological Psychiatry 48(10):976–980.
53. Manson, S.; Beals, J.; Klein, S.; and Croy, C. 2005. Social Epidemiology of
Trauma among 2 American Indian Reservation Populations. American Journal
of Public Health 95(5):851–859.
54. Koss, M.; Yuan, N.; Dightman, D.; Prince, R.; et al. 2003. Adverse Childhood
Exposures and Alcohol Dependence among Seven Native American Tribes.
American Journal of Preventative Medicine 25(3):238–244.
55. DeBruyn, L.; Chino, M.; Serna, P.; and Fullerton-Gleason, L. 2001. Child Mal-
treatment in American Indian and Alaska Native Communities: Integrating
Culture, History, and Public Health for Intervention and Prevention. Child
Maltreatment 6(2):89–102.
56. Ehrensa , M.; Cohen, P.; Brown, J.; Smailes, E.; et al. 2003. Intergenerational
Transmission of Partner Violence: A 20-Year Prospective Study. Journal of
Consulting and Clinical Psychology 71(4):741–753.
57. Holder, A.B. 1892. Papers on Diseases among Indians. Medical Record: A
Weekly Journal of Medicine and Surgery 42(7):177–182. Accessed 3/10/06 at Na-
tive Health Databases h p://hsc.unm.edu/library/nhd/
58. Stannard, D. 1992. American Holocaust: Columbus and the Conquest of the New
World. New York: Oxford University Press.
59. Thornton, R. 1987. American Indian Holocaust and Survival: A Population His-
tory since 1492. Norman: University of Oklahoma.
60. Senate Democratic Native American Leadership Forum. Health Care. Ac-
cessed 11/28/05. Available at: h p://democrats.senate.gov/steering/ images/
na-forum/health-care.pdf
107
61. Pearce, N. 1996. Traditional Epidemiology, Modern Epidemiology, and Pub-
lic Health. American Journal of Public Health 86(5):678–683.
62. Chino, M., & DeBruyn, L. 2006. Building True Capacity: Indigenous Models
for Indigenous Communities. American Journal of Public Health 96(4):596–599.
63. Melton, A.; Chino, M.; May, P.; and Gossage, J. 2000. Promising Practices and
Strategies to Reduce Alcohol and Substance Abuse among American Indians and
Alaska Natives. An OJP Issues and Practices Report. Accessed 9/14/2006.
Available at h p://www.ojp.usdoj.gov/americannative/promise.pdf
64. May, P.; Serna, P.; Hurt, L.; and DeBruyn, L. 2005. Outcome Evaluation of a
Public Health Approach to Suicide Prevention in an American Indian Tribal
Nation. American Journal of Public Health 95(7):1238–1244.
Michelle M. Sotero, B.A., is a MPH candidate at the University of Nevada, Las
Vegas and a research assistant at the Center for Health Disparities Research,
University of Nevada, Las Vegas.
A Conceptual Model of Historical Trauma • Sotero
