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OBJECTIVE: Trauma exposure is high in African Americans who live in stressful urban environments. Posttraumatic stress disorder (PTSD) and depression are common outcomes of trauma exposure and are understudied in African Americans. African Americans are more likely to seek treatment for psychiatric disorders in a primary care setting. Our study evaluated trauma exposure, PTSD and major depression in African Americans attending primary care offices. METHOD: Six-hundred-seventeen patients (96% African Americans) were surveyed for trauma exposure in the waiting rooms of four primary care offices. Those patients reporting significant traumatic events were invited to a research interview. Of the 403 patients with trauma exposure, 279 participated. RESULTS: Of the 617 participants, 65% reported > or = 1 clearly traumatic event. The most common exposures were transportation accidents (42%), sudden unexpected death of a loved one (39%), physical assault (30%), assault with a weapon (29%) and sexual assault (25%). Lifetime prevalence of PTSD and a major depressive episode (MDE) among those with trauma exposure (n=279) was 51% and 35%, respectively. The percent of lifetime PTSD cases (n=142) with comorbid MDE was 46%. Lifetime PTSD and MDE in the trauma-exposed population were approximately twice as common in females than males, whereas current PTSD rates were similar. CONCLUSIONS: Our rate of PTSD (approximately 33% of those screened) exceeds estimates for the general population. Rates of MDE comorbid with PTSD were comparable to other studies. These findings suggest the importance of screening African Americans for PTSD, in addition to depression, in the primary care setting.