Impact of race on early treatment termination and outcomes in posttraumatic stress disorder treatment.
OBJECTIVE
The present study investigated the influence of race on posttraumatic stress disorder (PTSD) treatment among 94 African American and 214 Caucasian female victims of interpersonal violence participating in 2 studies of cognitive-behavioral treatment for PTSD that were conducted sequentially and continuously.


METHODS
In each study, participants were randomized into 1 of 3 conditions. The first study compared cognitive processing therapy with prolonged exposure and a delayed treatment condition. In the second study, cognitive processing therapy was compared with its constituent components: cognitive therapy only and written accounts. Participants were assessed with the Clinician Administered PTSD Scale and the Structured Clinical Interview for DSM-IV, as well as through self-report measures of PTSD.


RESULTS
Analyses revealed that African Americans were significantly less likely to complete treatment compared with Caucasians (45% vs. 73%, respectively, p < .001) and that the differences held even after controlling for education and income. Despite racial differences in treatment completion status, analyses with the intent-to-treat sample indicated no racial differences in outcomes on PTSD measures.


CONCLUSIONS
The lack of difference in treatment outcomes despite racial differences in dropout may be explained by greater symptom improvement of African Americans who dropped out compared with Caucasians who dropped out. Implications of these findings and practical approaches to addressing sociocultural barriers to care are explored.
Lester
Kristin
K
Women's Health Sciences Division, National Center for PTSD, Veterans Affairs Boston Healthcare System, Boston, MA, USA. kristin.lester@va.gov
Resick
Patricia A
PA
Young-Xu
Yinong
Y
Artz
Caroline
C
D000328:Adult; D001741:Black or African American / Q000523:psychology*; D002648:Child; D002649:Child Abuse / Q000208:ethnology* / Q000628:therapy*; D002650:Child Abuse, Sexual / Q000208:ethnology*; D015928:Cognitive Behavioral Therapy; D004522:Educational Status; D005260:Female; D006801:Humans; D007171:Implosive Therapy; D008875:Middle Aged; D010352:Patient Dropouts / Q000523:psychology / Q000706:statistics & numerical data; D010552:Personality Assessment; D012959:Socioeconomic Factors; D013179:Spouse Abuse / Q000208:ethnology* / Q000523:psychology / Q000628:therapy*; D013313:Stress Disorders, Post-Traumatic / Q000208:ethnology* / Q000628:therapy*; D016896:Treatment Outcome; D044465:White People / Q000523:psychology*