Collaborative Care Can Help Reduce Mental Health Treatment Disparities
• Research Highlights
Mental health care after trauma is important, especially for people from racial and ethnic minorities who are at high risk for post-traumatic stress disorder (PTSD). ). PTSD can be debilitating, leading to daily stress or fear that harms a person’s health and well-being. Finding effective PTSD care is a challenge in general, but system disparities and limited experience make it even more difficult for people from racial and ethnic minorities.
A new study funded by the National Institute of Mental Health marks a step toward reducing disparities in mental health care. It found that collaborative care provided in real-world settings significantly reduced PTSD symptoms among racial and ethnic minority patients.
How did researchers treat PTSD symptoms?
Shared care is a team-based, patient-centered approach to treating mental illness in both acute and primary settings. Health care providers work as a team with the patient to provide comprehensive care tailored to the patient’s needs and preferences. In the “step” approach, providers systematically and flexibly adjust the level of care based on the patient’s condition and response to treatment.
Although previous studies have shown that collaborative care can reduce PTSD symptoms, few studies have examined its ability to address the unique mental health needs and disparities experienced by racial and ethnic minorities. This study, which was supported by the NIH Common Fund’s Health Care Systems Research Collaboratory is one of the first multisite studies to compare collaborative care among active White and non-White patients.
What did the researchers do in this study?
Douglas Zatzick, MD , the project’s principal investigator, and Khadija Abu, BA, lead author on the paper, in collaboration with colleagues at Harborview Trauma Center at the University of Washington School of Medicine. They analyzed data from a large clinical trial of collaborative care conducted at 25 trauma centers across the United States.
Individuals who were 18 years of age or older, seeking trauma care, and with a high level of distress based on a validated PTSD scale were eligible to participate. All participants self-reported their race and ethnicity. More than half (350 patients) identified as Hispanic or non-White (Asian, American Indian, Black, Hawaiian or Alaskan Native, Pacific Islander, or other race), including who support more than one race. An additional 285 patients were identified as non-Hispanic White.
Patients were given the opportunity to receive improved standard care or collaborative care.
- Improved routine maintenance: Patients received standard care at a trauma center, which included a PTSD diagnosis, baseline assessment, and follow-up interviews. An improved feature was that nurses were notified if a patient’s PTSD score was above a specified threshold.
- Collaborative care stepped on: This process included improved routine care as well as additional follow-up, including urgent care management, cognitive behavioral therapy, and medication. Care was tailored to the patient’s specific post-injury needs and treatment options. Patients who showed persistent PTSD symptoms received additional care in the form of medication modification, additional treatment, or both.
Patients rated their PTSD symptoms at intake and 3, 6, and 12 months after their injury. They also completed measures of depressive symptoms, alcohol use problems, and physical activity during drinking and at three post-injury time points. For each racial and ethnic group, analyzes compared scores between patients who received improved standard care versus integrated care.
What did the researchers find in the study?
Six months after their injury, Hispanic or non-White patients who received collaborative care reported significantly less PTSD symptoms compared to those who received standard care (no the difference between 3- or 12 months after the injury). The researchers note that the majority of post-injury care occurred within the first 6 months, possibly contributing to the lack of significant outcomes at 3 months and the decline in outcomes at 12 months.
In contrast, no significant group differences were found in non-Hispanic White patients. Those who received standard care or combined care showed the same change in PTSD symptoms at all times, which indicates that the intervention was no more beneficial than standard care for the rights of White patents in this study.
There was no change in self-reported depressive symptoms, alcohol use problems, or physical activity for either group, whether they received usual care or integrated care . This suggests that the intervention is particularly helpful with PTSD but not with other common trauma-related symptoms.
What do the findings mean?
Findings from this large, randomized trial support comprehensive care provided by therapists as effective for treating mental disorders, including PTSD. The study also suggests that this comprehensive type of care is beneficial for racial and ethnic minorities, who often face disparities in medical care. Among the factors that researchers cite for the success of interventions for various groups of disaster survivors are patient-centeredness, flexibility based on individual needs, and emphasis on shared decision making.
This study has already had a real impact in the world by informing the guidelines of trauma care in the United States. The researchers’ long-term work with this community has helped to develop better ways to diagnose and treat mental health and substance use problems among disaster survivors. Based on the results of this study, trauma centers are now implementing a process to assess and refer patients at high risk of post-traumatic stress disorder as part of a new approach to care. The next step for the researchers is to test this new approach to care against a collaborative care process .
This study was limited by dividing racial and ethnic groups into two groups, possibly masking differences in treatment responses. Repeating the study with larger samples will allow for greater comparisons to see which groups perform better. In addition, many study patients had previous traumatic events and were hospitalized for PTSD, which may lead to different results compared to other collaborative care studies. Researchers should continue to explore collaborative care with different groups of patients across different health care settings and other mental disorders to improve interventions and help make mental health care more effective. be more equal and more effective.
Reference
Abu, K., Bedard-Gilligan, M., Moodliar, R., Bulger, EM, Hernandez, A., Knutzen, T., Shoyer, J., Birk, N., Conde, C., Engstrom, A. , Ryan, P., Wang, J., Russo, J., & Zatzick, DF (2024). Can collaborative care interventions improve posttraumatic stress symptoms for racial and ethnic minority trauma survivors? Trauma & Care Surgery Open, 9, Article e001232. https://doi.org/10.1136/tsaco-2023-001232
Grants
MH130460 MH106338 AT009676
Clinical trial
NCT02655354
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