• Research Highlights
Mental health care after trauma is critical, especially for people belonging to racial and ethnic minorities who are at higher risk for developing Post-traumatic stress disorder (PTSD). PTSD can be disruptive, causing stress or fear in everyday situations that harm a person’s health and well-being. Finding effective care for PTSD is challenging in general, but systemic disparities and limited access make it even more difficult for people from racial and ethnic minority groups.
A new study funded by the National Institute of Mental Health marks a step toward reducing disparities in mental health care. A collaborative care intervention delivered in real-world settings was found to significantly reduce PTSD symptoms among patients from racial and ethnic minorities.
How did researchers treat PTSD symptoms?
Collaborative care is a team-based, patient-centered approach to treating mental disorders in primary and acute care settings. Health care providers work as a team and with the patient to provide comprehensive care tailored to the patient’s needs and preferences. In a “stepped” method, providers systematically and flexibly adjust the level of care based on the patient’s condition and response to treatment.
While previous studies Although collaborative care has been shown to reduce PTSD symptoms, few studies have examined its ability to address the unique mental health needs and disparities experienced by racial and ethnic minority groups. This study, which was supported by the NIH Common Fund Health Care Systems Research Collaboratory It is one of the first multicenter studies to compare collaborative care between white and nonwhite trauma patients.
What did the researchers in this study do?
Dr. Douglas Zatzick principal investigator on the project, and Khadija Abu, BA, senior author on the paper, collaborated with colleagues at the Harborview Trauma Center at Washington University School of Medicine. They analyzed data from a large clinical trial of collaborative stepped care conducted at 25 trauma centers across the United States.
Individuals aged 18 years or older who were seeking medical care for an injury and who were experiencing a high level of distress based on a validated measure of PTSD were eligible to participate. All participants reported their race and ethnicity. More than half (350 patients) identified as Hispanic or nonwhite (Asian, American Indian, Black, Native Hawaiian or Alaskan, Pacific Islander, or other race), including those who identified with more than one race. The other 285 patients identified as non-Hispanic white.
Patients were randomly assigned to receive enhanced usual care or stepped collaborative care.
- Enhanced routine carePatients received care as usual at the trauma center, which included PTSD screening, an initial assessment, and follow-up interviews. The improved aspect was that nurses were notified if a patient’s PTSD score exceeded a specific threshold.
- Collaborative tiered careThe intervention consisted of an enhancement of usual care plus additional follow-up, including proactive care management, cognitive behavioral therapy, and medication. Care was tailored to each patient’s specific post-injury needs and treatment preferences. Patients who showed persistent PTSD symptoms received intensified care in the form of medication adjustments, additional therapy, or both.
Patients rated their PTSD symptoms at admission and at 3, 6, and 12 months postinjury. They also completed measures of depression symptoms, alcohol use problems, and physical function at admission and at three postinjury time points. For each racial and ethnic group, analyses compared scores between patients who received enhanced usual care versus the stepped collaborative care intervention.
What did the researchers find in the study?
Six months after injury, Hispanic/nonwhite patients who received collaborative care reported significantly fewer PTSD symptoms compared with those who received usual care (with no differences at 3 or 12 months postinjury). The researchers note that most postinjury care occurred within the first 6 months, possibly contributing to the lack of significant effects at 3 months and diminishing effects at 12 months.
In contrast, no significant differences were found between the non-Hispanic white patient groups. Those who received usual care or collaborative care showed similar change in PTSD symptoms across all time points, indicating that the intervention was no more effective than usual care for white patients in this study.
No changes were seen in self-reported symptoms of depression, alcohol use problems, or physical function in either group, regardless of whether they received usual care or collaborative care. This suggests that the intervention specifically helps with PTSD, but not other common trauma-related symptoms.
What do the findings mean?
The results of this large, randomized clinical trial support the effectiveness of comprehensive care delivered by clinicians for treating mental disorders, including PTSD. The study also suggests that this comprehensive form of care is beneficial for people from racial and ethnic minority backgrounds, who often face disparities in medical settings. Among the factors that researchers attribute to the intervention’s success for a diverse group of trauma survivors are its patient-centered approach, flexible nature tailored to individual needs, and emphasis on shared decision-making.
This study is already having a real-world impact by informing trauma care guidelines in the United States. The researchers’ long-standing work with this population has helped establish best practices for screening and treating mental health and substance use disorders among trauma survivors. Based on the results of this study, trauma centers are now implementing a screening and referral process for patients at high risk for mental disorders after injury as part of a new standard of care. The next step for the researchers is to Testing this new standard of care against collaborative care intervention .
This study was limited by the division of racial and ethnic groups into two categories, potentially masking differences in treatment responses. Replicating the study with larger samples would allow for more nuanced comparisons to see which groups the intervention works best for. Additionally, many patients in the study had experienced prior traumatic events and had been hospitalized for PTSD, which may have led to different outcomes compared to other collaborative care studies. Researchers should continue to explore collaborative care with diverse patient groups in different health care settings and with other mental disorders to refine the intervention and help make mental health care more equitable and effective.
Reference
Abu, K., Bedard-Gilligan, M., Moodliar, R., Bulger, E.M., Hernandez, A., Knutzen, T., Shoyer, J., Birk, N., Conde, C., Engstrom, A., Ryan, P., Wang, J., Russo, J., & Zatzick, D.F. (2024). Can stepped collaborative care interventions improve posttraumatic stress disorder symptoms in racial and ethnic minority injury survivors? Trauma surgery and open acute care, 9Article e001232. https://doi.org/10.1136/tsaco-2023-001232
Subsidies
MH130460 , MH106338 , AT009676
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