Rosenheck R, Fontana A, Cottrol C
Northeast Program Evaluation Center, VA Medical Center, West Haven, CT 06516.
Am J Psychiatry. 1995 Apr;152(4):555-63. doi: 10.1176/ajp.152.4.555.
This study explored the effect of veterans' race and of the pairing of veterans' and clinicians' race on the process and outcome of treatment for war-related posttraumatic stress disorder (PTSD).
As part of the national evaluation of the PTSD Clinical Teams program of the Department of Veterans Affairs, data on assessment of 4,726 white and black male veterans at admission to the program and on the race and other characteristics of their 315 primary clinicians were obtained. Measures of service delivery and treatment emphasis were obtained 2, 4, 8, and 12 months after program entry, along with clinicians' ratings of improvement.
After control for sociodemographic characteristics, clinical status, and clinicians' characteristics, multivariate analysis showed that black veterans had significantly lower program participation ratings than white veterans on 10 of 24 measures, but no differences in clinicians' improvement ratings were noted. Additional analyses showed that pairing of white clinicians with black veterans was associated with lower program participation on four of the 24 measures and with lower improvement ratings on one of 15 measures. When treated by either black or white clinicians, black veterans had poorer attendance than white veterans, seemed less committed to treatment, received more treatment for substance abuse, were less likely to be prescribed antidepressant medications, and showed less improvement in control of violent behavior.
Although no differences were noted on most measures, the pairing of black veterans with white clinicians was associated with receiving fewer services. According to some other measures, black veterans received less intensive services regardless of the clinician's race.
本研究探讨退伍军人的种族以及退伍军人与临床医生种族的配对情况对战时创伤后应激障碍（PTSD）治疗过程及结果的影响。
作为退伍军人事务部PTSD临床团队项目全国评估的一部分，获取了4726名白人和黑人男性退伍军人进入该项目时的评估数据，以及他们315名主要临床医生的种族和其他特征数据。在项目开始后的2、4、8和12个月获取了服务提供和治疗重点的测量数据，以及临床医生对改善情况的评分。
在控制了社会人口学特征、临床状况和临床医生特征后，多变量分析显示，在24项测量指标中的10项上，黑人退伍军人的项目参与评分显著低于白人退伍军人，但在临床医生的改善评分上未发现差异。进一步分析表明，白人临床医生与黑人退伍军人配对在24项测量指标中的4项上与较低的项目参与度相关，在15项测量指标中的1项上与较低的改善评分相关。由黑人或白人临床医生治疗时，黑人退伍军人的出勤率低于白人退伍军人，似乎对治疗的投入度较低，接受药物滥用治疗更多，被开抗抑郁药的可能性较小，并且在控制暴力行为方面改善较少。
尽管在大多数测量指标上未发现差异，但黑人退伍军人与白人临床医生配对与接受较少服务相关。根据其他一些测量指标，无论临床医生的种族如何，黑人退伍军人接受的服务强度都较低。
