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

说明(申请人提供)：鉴于与其他种族/族裔群体相比，拉丁裔创伤后应激障碍的患病率较高，而且预计拉丁裔人口将大幅增长，因此有必要为讲西班牙语的拉丁裔人提供有效的创伤后应激障碍治疗。由医学研究所召集的评估创伤后应激障碍治疗有效性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有效性。委员会进一步指出，尽管心理治疗在不同的族裔/文化群体中可能会带来特殊的挑战，但“在少数民族和文化少数群体中，关于治疗的可接受性、有效性或普适性的证据大多没有。”消除不同文化群体的健康差距是一项公共卫生优先事项。《2010年健康人》提出的国家健康目标之一，呼吁消除所有种族/民族在心理健康和心理健康保健方面的差异。然而，医疗保健研究和质量机构在2010年进行的一项评估显示，与其他种族/族裔群体相比，拉美裔得到的精神卫生保健较少。报告承认，有限的英语水平可能是拉美裔精神卫生保健差距的一个促成因素。与创伤后应激障碍相关的重大损害和高昂的社会成本突出表明，迫切需要向英语水平有限的拉美裔人提供创伤后应激障碍治疗方面的临床进步的好处。这项拟议的研究通过对讲西班牙语的拉丁裔进行随机对照试验(RCT)来测试长期暴露(PE)疗法，直接解决了这种精神卫生保健方面的差异。在前期工作中，我们翻译并在文化上改编了体育治疗手册，保持了对原始治疗的忠诚度，并进行了一项试点研究，证明了西班牙语拉美裔人接受体育治疗的可行性和可接受性。作为下一步，我们建议对讲西班牙语的拉丁裔进行随机对照试验，以确定在改善初级(创伤后应激障碍症状)和次级(功能、与健康相关的生活质量和抑郁)结果方面，PE是否优于应用放松。我们将在初级保健诊所招募100名患有创伤后应激障碍的拉美人，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说西班牙语的拉美裔创伤后应激障碍患者的整体幸福感和生活质量，进而可能也有助于改善他们的家人。对暴露疗法的误解可能会限制其在为拉丁裔服务的临床实践中的采用。如果波多黎各以拉丁裔为主的未适应文化的拉丁裔有积极的结果，这项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上相关的PE手册治疗，有可能改变目前为拉丁裔客户服务的心理健康环境中的临床实践。

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.