3094 — Inequity in Psychotherapy Services among Racial and Ethnic Minority Veterans with PTSD

Spoont MR, Minneapolis COIN; NCPTSD; Nelson D, Minneapolis COIN; Kehle-Forbes S, Minneapolis COIN; Meis L, Minneapolis COIN;

Objectives:
To determine whether there are racial or ethnic disparities in psychotherapy services for Veterans with PTSD, we examined the odds of psychotherapy receipt across racial and ethnic groups. Because more therapy is offered in mental health vs primary care settings, we compared the odds of any psychotherapy for Veterans diagnosed with PTSD in primary care vs. mental health clinics. Similar analyses were conducted for any individual psychotherapy specifically. Finally, we examined the odds of any individual psychotherapy among those who received any psychotherapy (individual or group).

Methods:
We used data from a national prospective cohort study of 7,645 Veterans with PTSD. Women and minorities were oversampled. Immediately following a PTSD diagnosis, Veterans were surveyed and followed for 6 months. Propensity model adjusted logistic regression was used to examine the odds of any psychotherapy and any individual psychotherapy among Veterans with PTSD from self-identified racial and ethnic groups. Predictors included demographics, treatment need, access factors, beliefs about psychotherapy and VISN in which Veterans were seen, and the interaction between race/ethnicity and clinic type (mental health vs. primary care).

Results:
Latino Veterans diagnosed with PTSD in a mental health clinic were less likely to receive any psychotherapy than were White Veterans. Latino, African American, and Asian/Pacific Islander Veterans diagnosed in mental health (but not primary care) clinics were less likely to receive any individual therapy than White Veterans. Facility/Network factors were partially contributory. Among those Veterans who received at least some psychotherapy, Latino, African American, and Asian/Pacific Islander Veterans were still less likely to receive individual therapy (vs. only group) than were White Veterans. Facility/Network factors accounted for most of this difference; however, for African American Veterans, and to a lesser extent Latino Veterans, within-facility factors remained significant.

Implications:
Racial and ethnic minority Veterans diagnosed with PTSD in a mental health clinic were less likely to receive resource-intensive psychotherapy services than White Veterans. Both within and between facility factors contributed to this finding.

Impacts:
Inequity in psychotherapy services for Veterans with PTSD seen in mental health clinics suggests problems in current service delivery models.