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. 2024 Jan 24;9(1):e001232.
doi: 10.1136/tsaco-2023-001232. eCollection 2024.

Can stepped collaborative care interventions improve post-traumatic stress disorder symptoms for racial and ethnic minority injury survivors?

Khadija Abu  1 , Michelle Bedard-Gilligan  1 , Rddhi Moodliar  2 , Eileen M Bulger  3 , Alexandra Hernandez  3 , Tanya Knutzen  1 , Jake Shoyer  1 , Navneet Birk  1 , Cristina Conde  1 , Allison Engstrom  1 , Paige Ryan  1 , Jin Wang  1 , Joan Russo  1 , Douglas F Zatzick  1
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Can stepped collaborative care interventions improve post-traumatic stress disorder symptoms for racial and ethnic minority injury survivors?

Khadija Abu et al. Trauma Surg Acute Care Open. .

Abstract

Objectives: No large-scale randomized clinical trial investigations have evaluated the potential differential effectiveness of early interventions for post-traumatic stress disorder (PTSD) among injured patients from racial and ethnic minority backgrounds. The current investigation assessed whether a stepped collaborative care intervention trial conducted at 25 level I trauma centers differentially improved PTSD symptoms for racial and ethnic minority injury survivors.

Methods: The investigation was a secondary analysis of a stepped wedge cluster randomized clinical trial. Patients endorsing high levels of distress on the PTSD Checklist (PCL-C) were randomized to enhanced usual care control or intervention conditions. Three hundred and fifty patients of the 635 randomized (55%) were from non-white and/or Hispanic backgrounds. The intervention included care management, cognitive behavioral therapy elements and, psychopharmacology addressing PTSD symptoms. The primary study outcome was PTSD symptoms assessed with the PCL-C at 3, 6, and 12 months postinjury. Mixed model regression analyses compared treatment effects for intervention and control group patients from non-white/Hispanic versus white/non-Hispanic backgrounds.

Results: The investigation attained between 75% and 80% 3-month to 12-month follow-up. The intervention, on average, required 122 min (SD=132 min). Mixed model regression analyses revealed significant changes in PCL-C scores for non-white/Hispanic intervention patients at 6 months (adjusted difference -3.72 (95% CI -7.33 to -0.10) Effect Size =0.25, p<0.05) after the injury event. No significant differences were observed for white/non-Hispanic patients at the 6-month time point (adjusted difference -1.29 (95% CI -4.89 to 2.31) ES=0.10, p=ns).

Conclusion: In this secondary analysis, a brief stepped collaborative care intervention was associated with greater 6-month reductions in PTSD symptoms for non-white/Hispanic patients when compared with white/non-Hispanic patients. If replicated, these findings could serve to inform future American College of Surgeon Committee on Trauma requirements for screening, intervention, and referral for PTSD and comorbidities.

Level of evidence: Level II, secondary analysis of randomized clinical trial data reporting a significant difference.

Trial registration number: NCT02655354.

Keywords: healthcare disparities; race factors; randomized controlled trial; stress disorders, post-traumatic.

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Conflict of interest statement

Competing interests: DFZ has provided forensic expert consultation/testimony related to post-traumatic stress disorder for the Washington State Attorney General, the City of Seattle, and other agencies/firms.

Figures

Figure 1
Figure 1
PTSD Checklist (PCL-C) symptom levels over time for non-white/Hispanic patients (n=350). *Analyses are adjusted for age, gender, prior PTSD diagnosis, pre-injury opioid use, baseline Medical Outcome Study 12-item Mental Health Summary Scale Score, Patient Health Questionnaire 9-item Depression score. PTSD, post-traumatic stress disorder.
Figure 2
Figure 2
PTSD Checklist (PCL-C) symptom levels over time for white/non-Hispanic patients (n=285). *Analyses are adjusted for age, gender, prior PTSD diagnosis, intensive care unit admission, prior inpatient hospitalization, and tobacco use. PTSD, post-traumatic stress disorder.
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