Using a Continuous Traumatic Stress Framework to Examine Ongoing Adversity Among Indian Women from Slums: A Mixed-Methods Exploration

Gender-based violence (GBV) is pervasive among Indian women. Although posttraumatic stress disorder (PTSD) is a psychological outcome of GBV, it might not accurately capture the experiences of Indian women from slums, who face continued stressors (i.e., ongoing adversity). Continuous traumatic stress (CTS) is a framework used to characterize experiences of ongoing adversity. This mixed-method study investigated the applicability of the CTS framework for characterizing ongoing adversity and the psychological impacts of ongoing adversity among GBV-exposed Indian women from slums. Indian women from slums (N = 100) completed all study measures; a subset (n = 47) completed qualitative interviews analyzed using deductive coding and thematic analysis to identify core CTS characteristics. To examine the impact of ongoing adversity on participants' psychological symptom severity in the full sample, we performed an ANCOVA on PTSD symptom severity and an ANOVA on anxiety and depression symptom severity. Interviewed participants described the context of stressor conditions as pervasive, reported stressor conditions existed in the present or future rather than the past, had difficulty discriminating between real versus imagined threat, and demonstrated absent external protective systems. Results indicated that ongoing adversity was associated with significantly more severe PTSD, F(1, 96) = 9.86, p < .001; anxiety, F(1, 98) = 20.31, p < .001; and depression, F(1, 98) = 25.24, p < .001. The CTS framework is valuable for characterizing ongoing adversity and its related mental health impacts among GBV-exposed Indian women from slums. Assessment and intervention in slum communities must account for ongoing adversity.