Spoont Michele, Nelson David, van Ryn Michelle, Alegria Margarita
*National Center for PTSD, Pacific Islands Division †Center for Chronic Disease Outcomes Research, a VA HSR&D Center of Innovation, Minneapolis VA Healthcare System Departments of ‡Medicine and Psychiatry §Medicine and Biostatistics, University of Minnesota, Minneapolis, MN ∥Department of Health Services Research, Division of Health Care Policy & Research, Mayo Clinic College of Medicine ¶Office of Health Disparities Research, Mayo Clinic, Rochester, NY #Department of Medicine, Disparities Research Unit, Massachusetts General Hospital **Departments of Medicine and Psychiatry, Harvard Medical School, Boston, MA.
Med Care. 2017 Sep;55 Suppl 9 Suppl 2:S33-S42. doi: 10.1097/MLR.0000000000000755.
Veterans with posttraumatic stress disorder (PTSD) who seek mental health care in the Veterans Health Administration frequently discontinue treatment prematurely. Early discontinuation of mental health treatment is more common among Veterans with PTSD who are of minority race or ethnicity.
To determine whether retention in individual therapy or pharmacotherapy among Veterans with PTSD are associated with patients' ratings of their mental health providers, and if those associations differ depending on Veteran race or ethnicity.
Latino, African American, and white Veterans (n=2452) who participated in a prospective national cohort study of Veterans with PTSD at the beginning of an episode of care were surveyed immediately following Veterans' PTSD diagnoses and 6 months later. Pharmacy and mental health service utilization were abstracted from Veterans Health Administration administrative databases for 6 months postdiagnosis. Retention in treatments were modeled using logistic regression among Veterans who initiated individual therapy or pharmacotherapy. Demographics, treatment need, treatment-related beliefs, treatment process measures, and ratings of mental health providers were considered as predictors.
Ratings of mental health providers, more than treatment beliefs, were associated with treatment retention. Among African American Veterans, retention in pharmacotherapy was reduced if the provider was perceived as not having helped manage medication side-effects (odds ratio, 0.36; confidence interval, 0.16-0.80). All Latino Veterans but one (99% or n=64) who rated their therapist as not caring discontinued individual psychotherapy.
Ratings of mental health providers were associated with treatment retention. The salience of specific provider behaviors to treatment retention varied by Veteran race or ethnicity.
在退伍军人健康管理局寻求心理健康护理的创伤后应激障碍（PTSD）退伍军人经常过早停止治疗。在少数族裔的PTSD退伍军人中，心理健康治疗的早期中断更为常见。
确定PTSD退伍军人接受个体治疗或药物治疗的持续情况是否与患者对其心理健康服务提供者的评价相关，以及这些关联是否因退伍军人的种族或族裔而异。
参与一项针对PTSD退伍军人的前瞻性全国队列研究的拉丁裔、非裔美国人和白人退伍军人（n = 2452），在护理开始时即接受了PTSD诊断，并在诊断后6个月进行了调查。从退伍军人健康管理局行政数据库中提取诊断后6个月的药房和心理健康服务使用情况。对开始个体治疗或药物治疗的退伍军人，使用逻辑回归对治疗持续情况进行建模。将人口统计学、治疗需求、与治疗相关的信念、治疗过程指标以及心理健康服务提供者的评价作为预测因素。
与治疗信念相比，心理健康服务提供者的评价与治疗持续情况的关联更大。在非裔美国退伍军人中，如果认为服务提供者没有帮助管理药物副作用，则药物治疗的持续率会降低（优势比，0.36；置信区间，0.16 - 0.80）。所有将其治疗师评价为不关心的拉丁裔退伍军人中，除一人外（99%或n = 64）都停止了个体心理治疗。
心理健康服务提供者的评价与治疗持续情况相关。特定提供者行为对治疗持续情况的重要性因退伍军人的种族或族裔而异。
