We conducted a secondary data analysis to examine whether there were racial differences in adherence and treatment outcomes for participants with co-occurring full and subthreshold PTSD and alcohol/substance use disorders (A/SUD) who were treated with Seeking Safety (a cognitive-behavioral therapy) and sertraline (SS-S) or Seeking Safety and placebo (SS-P) as part of a clinical trial. Bivarate analyses examined the association between race and adherence and generalized estimating equations (GEE) assessed whether race moderated the effect of combination treatment on PTSD and alcohol use outcomes. Except for education, there were no statistically significant racial differences in baseline demographic and psychiatric characteristics. African Americans and Caucasians were equally adherent in number of psychotherapy and medication sessions attended and medication compliance. After controlling for baseline demographics and psychiatric symptoms, however, a race by treatment condition interaction emerged suggesting that African Americans who received the SS-S treatment had significantly lower PTSD symptom severity posttreatment and at 6-months follow-up compared to their counterparts who received SS-P. No differential effect of treatment condition was found for Caucasians. Moreover, results indicated that a diagnosis of Major Depressive Disorder (MDD) negatively impacted PTSD symptom recovery for African American participants but not for Caucasians. In conclusion, no differences emerged between African Americans and Caucasians in adherence to combination treatments for PTSD and A/SUD. Findings also suggest assessment and treatment of MDD among African Americans may improve treatment outcomes. More research is needed to determine whether the differential response to SS-S among African Americans compared to Caucasians can be replicated.

I n this issue of the Journal of Women's Health, Weitlauf et al. 1 present results from a survey examining the associations among sexual violence, posttraumatic stress disorder (PTSD), and women's reactions to the pelvic examination. In this study, 90 women veterans who had been scheduled for a pelvic examination in the past year answered questions about their emotions and pain level during their last examination and their beliefs about the safety, necessity, and utility of the pelvic examination. In contrast to women with a history of sexual violence but not PTSD and to those with no exposure to sexual violence at all, women with both a history of sexual violence and PTSD reported significantly higher levels of examination-related fear, embarrassment, and distress. Furthermore, these women were more likely to endorse beliefs that the examination was unnecessary or unsafe. Interestingly, neither women with sexual violence only (no PTSD) nor those with no history of sexual violence or PTSD reported high levels of negative reactions or maladaptive beliefs about the pelvic examination.This study adds to the growing literature about the effects of sexual trauma on women's experiences with the pelvic examination. In particular, this is the first published study to explore the specific role of sexual violence-related PTSD in predicting negative reactions to the pelvic examination. A limited prior literature suggests that women with a history of sexual violence have reduced adherence to cervical cancer screening, 2,3 and the current study lends support to the hypothesis that avoidance of screening may be due to negative reactions to the pelvic examination. This study also extends prior research by investigating maladaptive beliefs about pelvic examinations, further defining the psychological barriers women face in completing recommended screening examinations. 2,4 The findings that victims of sexual violence with PTSD are more likely to express hesitation about the safety and necessity of screenings than those without PTSD suggests avenues for educational interventions. Education on the utility of routine screening alone, however, may not address the complex emotions and cognitions underlying nonadherence. Improving the experience of the pelvic examination among women with sexual violence-related PTSD and, consequently, improving cervical cancer screening rates are critical to optimizing the gynecological care of this vulnerable population.

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