Study Shows Racial/Ethnic Disparities in Treatment Retention for Veterans with PTSD
Recommended first-line interventions for PTSD include both psychotherapy and pharmacotherapy. However, many Veterans with PTSD do not receive sufficient treatment to clinically benefit. This prospective, national cohort study of 6,788 Veterans (44% White, 20% Hispanic or Latino, and 19% African-American) recently diagnosed with PTSD sought to determine whether the odds of premature mental health treatment termination varied by patient race/ethnicity and, if so, whether such variation is due to differential access to services or beliefs about mental health treatment, or whether there is a disparity in the provision of treatment. Using VA data, investigators identified Veterans who had been recently diagnosed with PTSD during an outpatient visit at any VA facility from 6/08 to 7/09 and sent them a survey within two weeks of that diagnosis. The survey assessed barriers, treatment need, and treatment beliefs. VA data were used to assess mental health treatment across racial/ethnic groups in the six months following diagnosis. Outcome measures reflecting treatment retention included 1) psychotherapy only: at least eight therapy sessions, 2) pharmacotherapy only: at least four 30-day supplies of antidepressants, or 3) either eight therapy sessions or four 30-day supplies of medication.
- Compared to White Veterans, African-American and Latino Veterans were less likely to receive a minimal trial of pharmacotherapy and, overall, African-Americans were less likely to receive a minimal trial of any treatment in the six months after being diagnosed with PTSD.
- Controlling for beliefs about mental health treatments diminished the lower odds of pharmacotherapy retention among Latino Veterans but not African-American Veterans.
- As expected, positive beliefs about psychotherapy or pharmacotherapy facilitated treatment retention.
- Access barriers did not contribute to treatment retention disparities. They significantly impacted psychotherapy participation, but equally across the entire sample.
- Overall, 1,246 Veterans (18%) received at least four months of antidepressant medication, only 567 Veterans (8%) had at least eight psychotherapy sessions, and 1,626 Veterans (24%) were retained in at least one of these treatments during the six-month period following PTSD diagnosis.
- Investigators did not have information about treatments Veterans may have received outside VA.
- Investigators did not know about the quality of treatment received.
- This study relied on patient self-report for symptoms and belief measures.
- Retention in PTSD treatment was suboptimal across the overall sample
- To improve treatment equity, clinicians may need to directly address patients' treatment beliefs and preferences.
This study was funded by HSR&D (IAC 06-266). All authors are part of HSR&D's Center for Chronic Disease Outcomes Research in Minneapolis, MN.
Spoont M, Nelson D, Murdoch M, et al. Are There Racial/Ethnic Disparities in VA PTSD Treatment Retention? Depression and Anxiety. November 24, 2014;e-pub ahead of print.