title: Intervention Efficacy in Engaging Black and White Veterans with Post-traumatic Stress Disorder into Treatment.
abstract: This study examined racial differences among Black and White Veterans who screened positive for post-traumatic stress disorder (PTSD) but were not in PTSD treatment and were participating in an intervention trial. Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans with PTSD but not yet engaged in treatment were recruited and randomly assigned to control or intervention conditions. Intervention participants received a cognitive-behavioral engagement intervention by phone. All participants received follow-up calls to assess symptoms and utilization of treatment. Black and White participants were compared to assess differences in treatment utilization. Intervention session notes were analyzed qualitatively for explanatory themes. Participants of both races who received the intervention had higher PTSD treatment initiation than their respective control groups (Blacks: 85% vs. 58% and Whites: 53% vs. 45%, respectively). However, Blacks completed fewer PTSD treatment sessions compared to Whites overall (M = 2.06 [SD = 2.3] vs. M = 3.77 [SD = 9.9]; p < .05). Within the intervention condition, Blacks were significantly more likely to initiate treatment (odds ratio = 2.3, p < .04), and had a greater reduction in PTSD symptom compared to Whites (PTSD Checklist - Military Version [PCL] scores: 12.75 vs. 9.68). Based on qualitative analysis of intervention session notes, themes emerged that may suggest cultural differences involving social connection, attitudes towards treatment, and the desire to appear "okay." Blacks had a higher initiation rate and greater reduction in PTSD severity but completed fewer treatment sessions than Whites. These are promising results with respect to other studies which demonstrate that Black Veterans are less likely to seek treatment for PTSD.
authors.affiliation: a Psychiatric Research Center, The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA.|b VA Health Services Research and Development, White River Junction Veterans Administration , White River Junction , Vermont , USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Stecker
authors.affiliation: a Psychiatric Research Center, The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Adams
authors.affiliation: a Psychiatric Research Center, The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Carpenter-Song
authors.affiliation: a Psychiatric Research Center, The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Nicholson
authors.affiliation: a Psychiatric Research Center, The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Streltzov
authors.affiliation: a Psychiatric Research Center, The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA.
authors.forename: Haiyi
authors.initials: H
authors.lastname: Xie
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001741:Black or African American / Q000523:psychology*; D057189:Checklist; D015928:Cognitive Behavioral Therapy / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008889:Military Personnel / Q000523:psychology; D010342:Patient Acceptance of Health Care; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D014728:Veterans / Q000523:psychology*; D044465:White People / Q000523:psychology*
keywords: OEF/OIF Veterans; PTSD; Treatment seeking; health disparities; treatment engagement