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Am J Psychiatry 1995; 152:555-563
Copyright © 1995 by American Psychiatric Association
Effect of clinician-veteran racial pairing in the treatment of posttraumatic stress disorder
R Rosenheck, A Fontana and C Cottrol
Northeast Program Evaluation Center, VA Medical Center, West Haven, CT 06516.
OBJECTIVE: 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). METHOD: 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.
RESULTS: 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. CONCLUSIONS: 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.
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