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拉丁裔移民书面暴露疗法开放试点试验中的感知障碍和创伤后应激障碍初步结果

Perceived Barriers and Preliminary PTSD Outcomes in an Open Pilot Trial of Written Exposure Therapy With Latinx Immigrants.

作者信息

Andrews Arthur R, Acosta Laura M, Acosta Canchila M Natalia, Haws James K, Holland Kathryn J, Holt Natalie R, Ralston Allura L

机构信息

University of Nebraska-Lincoln.

出版信息

Cogn Behav Pract. 2022 Aug;29(3):648-665. doi: 10.1016/j.cbpra.2021.05.004. Epub 2021 Jun 20.

Abstract

Latinx immigrants experience substantial disparities in mental health treatment access, particularly for posttraumatic stress disorder (PTSD). The availability of brief, flexible interventions in Spanish may assist in reducing these disparities. Written Exposure Therapy (WET) is a five-session PTSD intervention that appears as effective as longer, gold-standard interventions, but has yet to be tested among Latinx immigrants. To test the acceptability and preliminary effectiveness of WET, 20 Spanish-speaking, Latinx immigrants conducted structured interviews at pretreatment, were offered WET, and completed posttreatment structured interviews. Open thematic coding of pre- and posttreatment interview questions examined perceived barriers and benefits of WET. Quantitative components examined symptom change across PTSD (PCL-IV-C) and depression (PHQ-9). Quantitative results indicated clinically meaningful and statistically significant change in PTSD symptoms using intent-to-treat analyses (M = 17.06, SD = 9.97, range = 0-29, t(15) = 6.84, p < .001). Open thematic coding identified four barrier-related themes and three benefit-related themes at pretreatment. At posttreatment, three barrier-related themes and two benefit-related themes were identified. Qualitative results largely suggested that perceived barriers were common to other PTSD interventions (e.g., exposure components). Only one participant identified barriers specific to WET. Results suggested WET may reduce PTSD symptoms among Latinx immigrants. WET also appeared to be acceptable and primarily viewed as beneficial among this population. WET is a promising intervention with Latinx immigrants and warrants further testing larger trials, including testing implementation strategies that may improve access to care.

摘要

拉丁裔移民在获得心理健康治疗方面存在巨大差异,尤其是在创伤后应激障碍(PTSD)方面。提供西班牙语的简短、灵活干预措施可能有助于减少这些差异。书面暴露疗法(WET)是一种为期五节的PTSD干预措施,其效果似乎与更长的金标准干预措施一样有效,但尚未在拉丁裔移民中进行测试。为了测试WET的可接受性和初步有效性,20名讲西班牙语的拉丁裔移民在治疗前进行了结构化访谈,接受了WET治疗,并在治疗后完成了结构化访谈。对治疗前和治疗后访谈问题进行开放式主题编码,以检查WET的感知障碍和益处。定量部分检查了PTSD(PCL-IV-C)和抑郁症(PHQ-9)症状的变化。定量结果表明,使用意向性分析,PTSD症状有临床意义且具有统计学显著性变化(M = 17.06,SD = 9.97,范围 = 0 - 29,t(15) = 6.84,p < .001)。开放式主题编码在治疗前确定了四个与障碍相关的主题和三个与益处相关的主题。在治疗后,确定了三个与障碍相关的主题和两个与益处相关的主题。定性结果在很大程度上表明,感知到的障碍与其他PTSD干预措施常见的障碍相同(例如,暴露部分)。只有一名参与者确定了WET特有的障碍。结果表明,WET可能会减轻拉丁裔移民的PTSD症状。WET在这一人群中似乎也是可接受的,并且主要被视为有益的。WET对拉丁裔移民来说是一种一个有前景的干预措施,值得在更大规模的试验中进一步测试,包括测试可能改善医疗服务可及性的实施策略。

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