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

描述（由申请人提供）：考虑到拉美裔创伤后应激障碍在拉美裔人群中的发病率高于其他种族/民族，以及拉美裔人口急剧增长的预测，为拉美裔创伤后应激障碍患者提供有效治疗的必要性至关重要。由医学研究所召集的评估创伤后应激障碍治疗效果证据的委员会报告了强有力的证据支持暴露疗法治疗创伤后应激障碍的疗效。委员会进一步指出，尽管心理治疗在不同的种族/文化群体中可能会面临特殊的挑战，但“关于治疗在少数民族和文化群体中的可接受性、有效性或普遍性，证据大多是沉默的。”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》提出的国家卫生目标之一要求消除所有种族/族裔群体在心理健康和心理保健方面的差距。然而，2010年卫生保健研究和质量局进行的一项评估显示，拉丁美洲人获得的心理保健比其他种族/族裔群体少。该报告承认，英语水平有限可能是拉美裔人在精神卫生保健方面存在差距的一个因素。与创伤后应激障碍相关的重大损害和高昂的社会成本强调了迫切需要使英语水平有限的拉美裔人能够从创伤后应激障碍治疗的临床进展中获益。本研究通过随机对照试验（RCT）对说西班牙语的拉丁美洲人进行延长暴露（PE）治疗，直接解决了这种精神卫生保健差异。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，并进行了一项试点研究，以证明体育对讲西班牙语的拉丁美洲人的可行性和可接受性。下一步，我们建议对说西班牙语的拉丁美洲人进行一项随机对照试验，以确定PE在改善原发性（PTSD症状）和继发性（功能、健康相关生活质量和抑郁）结局方面是否优于应用放松疗法。我们将招募100名患有创伤后应激障碍的拉丁裔患者，年龄在18-65岁之间，在初级保健诊所工作。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创伤后应激障碍的西班牙裔拉美人的整体幸福感和生活质量，进而可能对他们的家庭也有帮助。对暴露疗法的误解可能会限制其在为拉丁美洲人服务的临床实践中的采用。如果在以拉美裔为主的波多黎各未适应文化的拉美裔人群中证实了积极的结果，本研究将为扩大研究建立证据基础，通过促进采用语言和文化相关的PE手册治疗，有可能改变目前为拉美裔客户服务的心理健康机构的临床实践。

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.