• Research Highlights
Mental health care after trauma is critical, especially for people from racial and ethnic minorities who are at higher risk of developing post-traumatic stress disorder (PTSD). PTSD can have a negative impact, leading to anxiety or fear in everyday situations that harm a person’s health and well-being. Finding effective care for PTSD is generally difficult, but systemic disparities and limited access make it even more difficult for people from racial and ethnic minorities.
A new study funded by the National Institute of Mental Health marks a step toward reducing disparities in mental health care. It found that a collaborative care intervention delivered in real-world settings significantly reduced PTSD symptoms among patients from minority racial and ethnic backgrounds.
How did researchers treat PTSD symptoms?
Collaborative care is a team-based, patient-centered approach to the treatment of mental disorders in acute and primary 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 “stepwise” approach, providers systematically and flexibly adjust the level of care based on the patient’s condition and response to treatment.
While previous studies have shown that collaborative care can reduce PTSD symptoms, few studies have examined its ability to address the unique mental health needs and disparities faced by racial and ethnic minorities. This study, which was supported by the NIH Common Fund Health Systems Research Collaborative is one of the first multisite studies to compare collaborative care between white and nonwhite trauma patients.
What did the researchers do in this study?
Douglas Zatzick, MD , senior investigator on the project, and Khadija Abu, BA, lead author of the paper, collaborated with colleagues at the University of Washington School of Medicine’s Harborview Trauma Center. They analyzed data from a large clinical trial of stepped collaborative care conducted at 25 trauma centers in the United States.
Individuals who were 18 years of age or older, seeking care for an injury, and experiencing a high level of distress based on a validated PTSD measure were eligible to participate. All participants reported their race and ethnicity. More than half (350 patients) identified as Hispanic or non-White (Asian, American Indian, Black, Hawaiian or Alaska Native, Pacific Islander, or other race), including those who claimed more than one race. The other 285 patients were identified as non-Hispanic White.
Patients were randomized to receive either enhanced usual care or stepped collaborative care.
- Enhanced usual care: Patients received care as usual at the trauma center, which included PTSD screening, baseline assessment, and follow-up interviews. The enhanced aspect was that nurses were alerted if a patient’s PTSD score was above a specified threshold.
- Stepwise collaborative care: The intervention consisted of enhanced usual care and additional monitoring, including preventive care management, cognitive behavioral therapy, and medication. Care was tailored to each patient’s specific post-injury needs and treatment preferences. Patients experiencing ongoing PTSD symptoms received increased care in the form of medication adjustments, additional therapy, or both.
Patients rated their PTSD symptoms at intake and 3, 6, and 12 months after their injury. They also completed measures of depressive symptoms, alcohol use problems, and physical functioning at intake at all three time points post-injury. For each racial and ethnic group, analyzes compared scores between patients who received enhanced usual care versus the stepped-up collaborative care intervention.
What did the researchers find in the study?
Six months after their injury, Hispanic or non-White patients who received collaborative care reported significantly lower PTSD symptoms compared to those who received usual care (no difference at 3 or 12 months postinjury). The researchers note that most post-injury care occurred within the first 6 months, possibly contributing to the lack of significant effects at 3 months and the decline in effects at 12 months.
In contrast, no significant group difference was found for non-Hispanic white patients. Those who received usual care or collaborative care showed similar change in PTSD symptoms at all time points, indicating that the intervention was no more effective than usual care for the White patents in this study.
There was no change in self-reported depressive symptoms, alcohol use problems, or physical functioning for either group, regardless of whether they received usual care or collaborative care. This suggests that the intervention specifically helps with PTSD but not with other common trauma-related symptoms.
What do the findings mean?
Findings from this large, randomized clinical trial support integrated care provided by clinicians as effective for the treatment of mental disorders, including PTSD. The study also suggests that this integrated form of care is beneficial for people from minority racial and ethnic backgrounds, who often face disparities in medical settings. Among the factors researchers attribute to the intervention’s success for a diverse group of trauma survivors are its patient-centeredness, flexible nature tailored to individual needs, and emphasis on shared decision-making.
This study is already having a real-world impact, informing trauma care guidelines in the United States. Researchers’ long-term 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 post-injury mental disorders as part of a new standard of care. The next step for researchers is to test this new model of care against the collaborative care intervention .
This study was limited by collapsing racial and ethnic groups into two categories, possibly masking differences in treatment responses. Replicating the study with larger samples would allow more comparisons to see which groups the intervention works best for. Additionally, many patients in the study had experienced prior traumatic events and had been treated for PTSD, which may have led to different results compared to other collaborative care studies. Researchers should continue to explore collaborative care with different patient groups in different health care settings and with other mental disorders to improve intervention and help make mental health care more equitable and effective.
Report
Abu, K., Bedard-Gilligan, M., Moodliar, R., Bulger, EM, Hernandez, A., Knutzen, T., Shoyer, J., Birk, N., Conde, C., Engstrom, A. , Ryan, P., Wang, J., Russo, J., & Zatzick, DF (2024). Can scaled collaborative care interventions improve posttraumatic stress disorder symptoms for racial and ethnic minority trauma survivors? Trauma & Acute Care Surgery Open, 9article e001232. https://doi.org/10.1136/tsaco-2023-001232
Grants
MH130460 , MH106338 , AT009676
