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

描述（由申请人提供）：鉴于与其他种族/族裔群体相比，拉丁美洲人的创伤后应激障碍患病率较高，以及拉丁美洲人口急剧增长的预测，为患有创伤后应激障碍的西班牙语拉丁美洲人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PTSD治疗效果的委员会报告了强有力的证据支持暴露疗法治疗PTSD的疗效。委员会进一步指出，虽然心理治疗可能在不同的种族/文化群体中提出特殊的挑战，但“证据大多没有说明治疗在种族和文化少数群体中的可接受性、有效性或普遍性。“消除不同文化群体的健康差距是公共卫生的优先事项，《2010年健康人民》提出的国家卫生目标之一呼吁消除所有种族/族裔群体在心理健康和心理保健方面的差距。然而，2010年医疗保健研究和质量机构进行的一项评估显示，拉丁美洲人获得的精神卫生保健比其他种族/族裔群体少。该报告承认，有限的英语能力可能是拉丁美洲人心理健康护理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强调了迫切需要使英语水平有限的拉丁美洲人获得创伤后应激障碍治疗的临床进展的好处。这项拟议的研究通过进行一项随机对照试验（RCT）来直接解决这种心理健康护理的差异，以测试西班牙语拉丁美洲人的长期暴露（PE）疗法。在初步工作中，我们翻译和文化适应的PE治疗手册，保持忠实于原来的治疗，并进行了一项试点研究，证明了可行性和可接受的PE为讲西班牙语的拉丁美洲人。作为我们的下一步，我们建议与讲西班牙语的拉丁美洲人进行随机对照试验，以确定在改善主要（PTSD症状）和次要（功能，健康相关的生活质量和抑郁症）结果方面，PE是否上级应用放松。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丁美洲人，年龄在18-65岁之间。将在基线、第20周和第28周进行评估。这项研究有可能有助于改善讲西班牙语的拉丁裔创伤后应激障碍患者的整体健康和生活质量，并可能扩展到他们的家庭。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。如果积极的结果证明了在波多黎各，以主导的拉丁裔取向为特征的未适应文化的拉丁美洲人，这项研究将建立一个证据基础，扩大研究，有可能改变目前的临床实践中的心理健康设置为拉丁美洲客户提供服务，促进通过语言和文化相关的PE手册为基础的治疗。

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.