(PS11-B38) Can Psychosocial Interventions That Include Behavioral Therapy Elements Improve Posttraumatic Stress Disorder (PTSD) Symptoms for Racial and Ethnic Minority Injury Survivors?

No large scale randomized clinical trials have previously evaluated the potential differential effectiveness of early interventions for posttraumatic stress disorder (PTSD) among injured patients from racial and ethnic minority backgrounds. The current study assessed whether a level I trauma center stepped collaborative care intervention trial (25 sites across the US) differentially improved PTSD for racial and ethnic minority injury survivors. This investigation was a secondary analysis of a stepped wedge cluster randomized clinical trial. Patients who endorsed high levels of distress on the PTSD Checklist – Civilian Version (PCL-C) were randomized to enhanced usual care control or stepped care intervention. Of the 635 randomized patients, 350 (55%) were from Non-White/Hispanic backgrounds. The collaborative care intervention included embedded cognitive behavioral therapy (CBT) elements and psychopharmacologic intervention addressing PTSD symptoms. The primary study outcome was PTSD symptoms assessed with the PCL-C at 3-, 6- and 12-months post-injury. Mixed model regression analyses compared treatment effects for intervention and control group patients from Non-White/Hispanic versus White/Non-Hispanic backgrounds. The investigation attained between 3- to 12-month follow-up. Mixed model regression analyses revealed clinically and statistically significant changes in PCL-C scores for Non-White/Hispanic intervention patients at 6-month follow-up (difference, -3.69 [95% CI, -7.30, -0.08] Effect Size = 0.25, P < 0.05). No significant differences were observed for White/Non-Hispanic intervention patients (difference, -0.89 [95% CI, -4.53, 2.75] Effect Size = 0.07, P = ns). Results suggest that a CBT and pharmacotherapy stepped care intervention delivered soon after traumatic injury particularly benefits patients with non-White and Hispanic racial and ethnic identities. If replicated, these findings could influence American College of Surgeon Committee on Trauma requirements for the inclusion of trauma center PTSD focused behavioral interventions.