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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. Can stepped collaborative care interventions improve post-traumatic stress disorder symptoms for racial and ethnic minority injury survivors? Trauma Surg Acute Care Open 2024; 9:e001232. [PMID: 38287923 PMCID: PMC10824071 DOI: 10.1136/tsaco-2023-001232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/07/2024] [Indexed: 01/31/2024] 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.
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Affiliation(s)
- Khadija Abu
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Michelle Bedard-Gilligan
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Rddhi Moodliar
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Eileen M Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Alexandra Hernandez
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Tanya Knutzen
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jake Shoyer
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Navneet Birk
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Cristina Conde
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Allison Engstrom
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Paige Ryan
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jin Wang
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Joan Russo
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Douglas F Zatzick
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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