title: Racial differences in adherence and response to combined treatment for full and subthreshold post-traumatic stress disorder and alcohol use disorders: A secondary analysis.
abstract: 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 post-traumatic stress disorder (PTSD) and alcohol/substance use disorders (A/SUD) who were treated with Seeking Safety (a cognitive-behavioral therapy) and sertraline or Seeking Safety and placebo as part of a clinical trial. Bivarate analyses examined the association between race and adherence, and generalized estimating equations 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 Seeking Safety and sertraline treatment had significantly lower PTSD symptom severity posttreatment and at six months follow-up compared to their counterparts who received Seeking Safety and placebo. No differential effect of treatment condition was found for Caucasians. Moreover, results indicated that a diagnosis of major depressive disorder 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 Seeking Safety and sertraline among African Americans compared to Caucasians can be replicated.
authors.affiliation: a Department of Psychology , City College of New York of CUNY , New York , NY.
authors.forename: Lesia M
authors.initials: LM
authors.lastname: Ruglass
authors.affiliation: a Department of Psychology , City College of New York of CUNY , New York , NY.
authors.forename: Annelisa
authors.initials: A
authors.lastname: Pedersen
authors.affiliation: b Department of Psychology , University of Houston , Houston , TX.
authors.forename: Soumia
authors.initials: S
authors.lastname: Cheref
authors.affiliation: c Department of Psychiatry , Columbia University College of Physicians and Surgeons , New York , NY.
authors.forename: Mei-Chen
authors.initials: MC
authors.lastname: Hu
authors.affiliation: d Gordon F. Derner Institute for Advanced Psychological Studies, Adelphi University and Department of Psychiatry , Columbia University College of Physicians and Surgeons , New York , NY.
authors.forename: Denise A
authors.initials: DA
authors.lastname: Hien
mesh_terms: D000328:Adult; D001741:Black or African American / Q000208:ethnology*; D019973:Alcohol-Related Disorders / Q000188:drug therapy / Q000208:ethnology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000208:ethnology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance / Q000208:ethnology*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D020280:Sertraline / Q000627:therapeutic use; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy / Q000208:ethnology* / Q000628:therapy*; D044465:White People / Q000208:ethnology*
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline
keywords: Alcohol use disorders; PTSD; racial differences; seeking safety; sertraline; substance use disorders