Racial and ethnic disparities in clinical outcomes six months after receiving a PTSD diagnosis in Veterans Health Administration.

Abstract

Because the mental health burden of PTSD among many racial and ethnic minority veterans is greater than among non-Latinx Whites (NLW) and there are disparities in VHA mental health treatment, we evaluated variations in clinical outcomes across veteran racial and ethnic groups in a large national cohort diagnosed with PTSD in VHA. This was a planned secondary analysis of patient-reported outcomes from a large prospective cohort study of veterans with PTSD. Veterans were surveyed immediately following a PTSD diagnosis and again 6 months later. Changes in PTSD symptoms and mental health quality of life were modeled using initial measures of these factors and demographic characteristics. Primary analyses modeled outcomes constructed from a sample restricted to veterans who initiated some mental health care in the6-month follow-up period (n ϭ 2,992). Additionally, outcomes were modeled using the full cohort of treatment initiators and noninitiators (n ϭ 5,070). Sensitivity and post hoc analyses were used to examine robustness of our findings and to facilitate interpretability. Disparities in PTSD and mental health quality of life outcomes were observed for some racial and ethnic minority groups of veterans. Although improvements in PTSD symptoms and mental health quality of life have been highly associated in other studies, in this sample these outcomes were interrelated in complex ways across groups.

Assistance dogs for military veterans with PTSD: A systematic review, meta-analysis, and meta-synthesis

“…Although participants included in the United States studies appear somewhat representative of the population of United States veterans overall, they do not appear to be fully representative of the population of treatment-seeking veterans with PTSD more broadly, and PTSD is known to affect Black and Hispanic veterans at elevated rates [ 81 ]. White veterans are greatly overrepresented in the overall sample (78%, compared to 46% of treatment-seeking veterans with PTSD in the United States) while Black veterans in particular appear highly underrepresented (7%, compared to 20%) [ 82 ]. These could be indicators that research studies are recruiting veterans from different demographic characteristics disproportionately or may be a sign that the complementary intervention of a psychiatric assistance dog is not equally accessible to all veterans irrespective of demographic characteristics.…”

Sociocultural context and the posttraumatic psychological response: Considering culture, social support, and posttraumatic stress disorder.

“…Research has documented a reduced propensity to seek mental health treatment (Mojaverian & Kim, 2013), a lower likelihood of receiving quality health treatment, and poorer treatment outcomes for people from culturally diverse communities (Hwang, 2006). Further treatment outcome disparities have been reported across racial/ethnic cultural groups with Latinx and African American veterans less likely than European Americans to report reductions in PTSD symptoms (Spoont et al, 2020). Thus, it is critical for research to identify cultural factors that may impact on treatment retention and outcomes and provide clinicians with guidance on culturally tailoring evidence-based treatments (Hwang, 2006).…”

The Peritraumatic Distress Inventory: Factor structure and predictive validity in traumatically injured patients admitted through a Level I trauma center

“…However, the data used in this investigation were from a clinical sample of patients admitted to a Level I trauma center, where mental health screening and follow-up is rare (Love & Zatzick, 2014), and screening tools such as the PCL-5 are cost-effective and low-burden approaches to follow-up. Second, only one measure of PTSD was used in this study, whereas there are numerous measures available for use in clinical settings (see Spoont et al, 2013 for a review), limiting the generalizability of results. Despite this, the PCL-5 is a valid and widely-used measure of PTSD (Belvins et al, 2015; Weathers et al, 2013), thus, its use in this study also is a strength.…”