Randomized Trial of Prolonged Exposure for the Treatment of PTSD among Latinos

长期接触治疗拉丁裔 PTSD 的随机试验

• 批准号: 8889303
• 负责人: MILDRED VERA
• 金额: $ 37.1万
• 依托单位: UNIVERSITY OF PUERTO RICO MED SCIENCES
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-05 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8889303
• 关键词: Accidents; Address; Adoption; Affect; Anxiety Disorders; Area; Caucasians; Centers for Disease Control and Prevention (U.S.); Client; Clinic; Clinical; Cognitive Therapy; Development; Domestic Violence; Early treatment; Effectiveness; Emotional; Ethnic group; Evaluation; Evidence based intervention; Exposure to; Failure; Family; Forcible intercourse; Foundations; Goals; Group Affiliation; Growth; Health; Health Services; Health Services Research; Healthcare; Healthy People 2010; High Prevalence; Hispanics; Impairment; Individual; Institute of Medicine (U.S.); Intervention; Latino; Lead; Light; Limited English Proficiency; Manuals; Measures; Mental Depression; Mental Health; Mental disorders; Military Personnel; Minority; Modeling; Natural Disasters; Outcome; Pain; Personal Satisfaction; Pilot Projects; Population; Post-Traumatic Stress Disorders; Primary Health Care; Psychotherapy; Public Health; Published Comment; Publishing; Puerto Rican; Puerto Rico; Quality of life; Randomized Controlled Trials; Recruitment Activity; Relaxation; Reporting; Research; Risk; Sexual abuse; Social Welfare; Societies; Solid; Surgeon; Symptoms; Terrorism; Testing; Translating; Treatment Efficacy; Work; assault; base; clinical practice; combat; cost; effective therapy; evidence base; experience; health care quality; health disparity; health related quality of life; human old age (65+); improved; innovation; member; psychologic; public health priorities; racial and ethnic; randomized trial; secondary outcome; traumatic event; violent attack

DESCRIPTION (provided by applicant): The need to provide effective treatment to Spanish-speaking Latinos with PTSD is critical given the high prevalence of PTSD among Latinos in comparison to other racial/ethnic groups and the projections for dramatic demographic growth of the Latino population. The committee convened by the Institute of Medicine to assess the evidence on the efficacy of treatments for PTSD reported strong evidence supporting the efficacy of exposure therapies for the treatment of PTSD. The committee further noted that although psychotherapies may present special challenges in different ethnic/cultural groups, "the evidence is mostly silent on the acceptability, efficacy, or generalizability of treatment in ethnic and cultural minorities." Eliminating health disparities for diverse cultural groups is a public health priority.One of the nation's health objectives presented in Healthy People 2010, called for eliminating disparities in mental health and mental health care for all racial/ethnic groups. Nevertheless, an evaluation conducted by the Agency for Healthcare Research and Quality in 2010 revealed that Latinos received less mental health care than other racial/ethnic groups. The report acknowledges that limited English proficiency could be a contributing factor for the gap in mental health care for Latinos. The significant impairment and the high societal costs associated with PTSD underscore the urgency of the need to make the benefits of clinical advances in the treatment of PTSD available to Latinos with limited English proficiency. The proposed study directly addresses this mental health care disparity by conducting a randomized controlled trial (RCT) to test Prolonged Exposure (PE) therapy with Spanish- speaking Latinos. In preliminary work, we translated and culturally adapted the PE therapy manual, maintaining fidelity to the original treatment, and conducted a pilot study that evidenced the feasibility and acceptability of PE for Spanish-speaking Latinos. As our next step, we propose to conduct a RCT with Spanish-speaking Latinos to determine whether PE is superior to applied relaxation in improving primary (PTSD symptoms) and secondary (functioning, health-related quality of life, and depression) outcomes. We will recruit 100 Latinos with PTSD, 18-65 years old, in primary care clinics. Assessments will be conducted at baseline, week 20, and week 28. This study has the potential to contribute to improvements in the overall well- being and quality of life of Spanish-speaking Latinos with PTSD and, by extension, likely their families as well. Misconceptions about exposure therapy can contribute to limit its adoption in clinical practices serving Latinos. If positive results are evidenced for unacculturated Latinos in Puerto Rico, characterized by dominant Latino orientation, this study would establish an evidence base for expanded research that has the potential to shift current clinical practice in mental health settings serving Latino clients by facilitating adoption of a linguistically and culturally relevan PE manual-based treatment.

描述（由申请人提供）：鉴于与其他种族/族裔群体相比，拉丁裔人群中 PTSD 的患病率较高，并且预计拉丁裔人口将急剧增长，因此为患有 PTSD 的讲西班牙语的拉丁裔人群提供有效治疗的需求至关重要。由医学研究所召集的评估 PTSD 治疗功效证据的委员会报告了强有力的证据，支持暴露疗法治疗 PTSD 的功效。委员会进一步指出，尽管心理治疗可能对不同种族/文化群体提出特殊挑战，但“对于治疗在少数族裔和文化群体中的可接受性、有效性或普遍性，证据大多没有提及。”消除不同文化群体的健康差异是一项公共卫生优先事项。《2010 年健康人民》中提出的国家健康目标之一是呼吁消除所有种族/族裔群体在心理健康和心理保健方面的差异。然而，医疗保健研究与质量机构 2010 年进行的一项评估显示，拉丁裔获得的心理保健护理少于其他种族/族裔群体。该报告承认，英语水平有限可能是拉美裔心理健康护理差距的一个因素。与 PTSD 相关的重大损害和高昂的社会成本凸显了迫切需要让英语水平有限的拉丁裔也能受益于 PTSD 治疗的临床进展。拟议的研究通过进行一项随机对照试验（RCT）来测试讲西班牙语的拉丁裔人的长期暴露（PE）疗法，从而直接解决这种心理健康保健差异。在前期工作中，我们对体育治疗手册进行了翻译和文化改编，保持了对原始治疗的忠实度，并进行了一项试点研究，证明了体育运动对于讲西班牙语的拉丁裔美国人的可行性和可接受性。作为我们的下一步，我们建议对讲西班牙语的拉丁美洲人进行随机对照试验，以确定体育运动在改善主要（创伤后应激障碍症状）和次要（功能、健康相关的生活质量和抑郁）结果方面是否优于应用放松。我们将在初级保健诊所招募 100 名患有 PTSD 的拉丁裔，年龄在 18-65 岁之间。评估将在基线、第 20 周和第 28 周进行。这项研究有可能有助于改善患有 PTSD 的西班牙语拉丁美洲人的整体福祉和生活质量，进而也可能改善他们的家人。对暴露疗法的误解可能会限制其在为拉丁裔提供服务的临床实践中的采用。如果波多黎各未受文化熏陶的拉丁裔（以拉丁裔取向为主导）的积极结果得到证实，这项研究将为扩大研究奠定证据基础，该研究有可能通过促进采用语言学方法来改变当前为拉丁裔客户提供服务的心理健康环境中的临床实践。以及与文化相关的体育手动治疗。