{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:45:51Z","timestamp":1785408351526,"version":"3.56.0"},"reference-count":50,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,1,24]],"date-time":"2024-01-24T00:00:00Z","timestamp":1706054400000},"content-version":"unspecified","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006093","name":"Patient-Centered Outcomes Research Institute","doi-asserted-by":"publisher","award":["IHS-2017C1-6151"],"award-info":[{"award-number":["IHS-2017C1-6151"]}],"id":[{"id":"10.13039\/100006093","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R01 MH130460"],"award-info":[{"award-number":["R01 MH130460"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2024,1,7]]},"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>No large-scale randomized clinical trial investigations have evaluated the potential differential effectiveness of early interventions for post-traumatic stress disorder (PTSD) among injured patients from racial and ethnic minority backgrounds. The current investigation assessed whether a stepped collaborative care intervention trial conducted at 25 level I trauma centers differentially improved PTSD symptoms for racial and ethnic minority injury survivors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The investigation was a secondary analysis of a stepped wedge cluster randomized clinical trial. Patients endorsing high levels of distress on the PTSD Checklist (PCL-C) were randomized to enhanced usual care control or intervention conditions. Three hundred and fifty patients of the 635 randomized (55%) were from non-white and\/or Hispanic backgrounds. The intervention included care management, cognitive behavioral therapy elements and, psychopharmacology addressing PTSD symptoms. The primary study outcome was PTSD symptoms assessed with the PCL-C at 3, 6, and 12 months postinjury. Mixed model regression analyses compared treatment effects for intervention and control group patients from non-white\/Hispanic versus white\/non-Hispanic backgrounds.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The investigation attained between 75% and 80% 3-month to 12-month follow-up. The intervention, on average, required 122\u2009min (SD=132\u2009min). Mixed model regression analyses revealed significant changes in PCL-C scores for non-white\/Hispanic intervention patients at 6\u2009months (adjusted difference \u22123.72 (95% CI \u22127.33 to \u20130.10) Effect Size =0.25, p&lt;0.05) after the injury event. No significant differences were observed for white\/non-Hispanic patients at the 6-month time point (adjusted difference \u22121.29 (95% CI \u22124.89 to 2.31) ES=0.10, p=ns).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this secondary analysis, a brief stepped collaborative care intervention was associated with greater 6-month reductions in PTSD symptoms for non-white\/Hispanic patients when compared with white\/non-Hispanic patients. If replicated, these findings could serve to inform future American College of Surgeon Committee on Trauma requirements for screening, intervention, and referral for PTSD and comorbidities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Level II, secondary analysis of randomized clinical trial data reporting a significant difference.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number<\/jats:title><jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT02655354\">NCT02655354<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.1136\/tsaco-2023-001232","type":"journal-article","created":{"date-parts":[[2024,1,24]],"date-time":"2024-01-24T19:20:12Z","timestamp":1706124012000},"page":"e001232","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Can stepped collaborative care interventions improve post-traumatic stress disorder symptoms for racial and ethnic minority injury survivors?"],"prefix":"10.1136","volume":"9","clinical-trial-number":[{"clinical-trial-number":"nct02655354","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Khadija","family":"Abu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Bedard-Gilligan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rddhi","family":"Moodliar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eileen M","family":"Bulger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Hernandez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanya","family":"Knutzen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jake","family":"Shoyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navneet","family":"Birk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Conde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Engstrom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paige","family":"Ryan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan","family":"Russo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7339-1020","authenticated-orcid":false,"given":"Douglas F","family":"Zatzick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,1,24]]},"reference":[{"key":"2025010104401009000_9.1.e001232.1","unstructured":"Centers for Disease Control and Prevention . Web-based injury statistics query and reporting system (WISQARS). 2021."},{"key":"2025010104401009000_9.1.e001232.2","unstructured":"Institute of Medicine . Reducing the burden of injury: advancing prevention and treatment. Washington, DC: National Academy Press, 1999."},{"key":"2025010104401009000_9.1.e001232.3","unstructured":"Committee on Military Trauma Care\u2019s Learning Health System and Its Translation to the Civilian Sector, Board on Health Sciences Policy, Populations BotHoS . A national trauma care system: integrating military and civilian trauma systems to achieve zero preventable deaths after injury. In: Berwick D , Downey A , Cornett E , eds. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. National Academies Press (US), Washington (DC. 2016."},{"key":"2025010104401009000_9.1.e001232.4","first-page":"1560","article-title":"Prevalence of posttraumatic stress disorder and major depression after trauma center hospitalization","volume":"69","author":"Shih","year":"2010","journal-title":"J Trauma"},{"key":"2025010104401009000_9.1.e001232.5","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1017\/S0033291707000943","article-title":"A nationwide US study of post-traumatic stress after hospitalization for physical injury","volume":"37","author":"Zatzick","year":"2007","journal-title":"Psychol Med"},{"key":"2025010104401009000_9.1.e001232.6","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199905000-00003"},{"key":"2025010104401009000_9.1.e001232.7","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.161.8.1390"},{"key":"2025010104401009000_9.1.e001232.8","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1111\/sltb.12085","article-title":"Correlates of suicidal Ideation in physically injured trauma survivors","volume":"44","author":"O\u2019Connor","year":"2014","journal-title":"Suicide Life Threat Behav"},{"key":"2025010104401009000_9.1.e001232.9","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1176\/appi.ps.201600311","article-title":"The cumulative burden of mental, substance use, and general medical disorders and rehospitalization and mortality after an injury","volume":"68","author":"Zatzick","year":"2017","journal-title":"Psychiatr Serv"},{"key":"2025010104401009000_9.1.e001232.10","unstructured":"American College of Surgeons Committee on Trauma TQIP . Best practices guideline for screening and treating mental health disorders and substance use and misuse in the acute trauma patient. 2022."},{"key":"2025010104401009000_9.1.e001232.11","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1001\/jamasurg.2019.1622","article-title":"Contributors to postinjury mental health in urban black men with serious injuries","volume":"154","author":"Richmond","year":"2019","journal-title":"JAMA Surg"},{"key":"2025010104401009000_9.1.e001232.12","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1521\/psyc.2011.74.4.349","article-title":"Staying connected: a feasibility study linking American Indian and Alaska native trauma survivors to their tribal communities","volume":"74","author":"Tsosie","year":"2011","journal-title":"Psychiatry"},{"key":"2025010104401009000_9.1.e001232.13","doi-asserted-by":"publisher","DOI":"10.1521\/psyc.2008.71.3.234"},{"key":"2025010104401009000_9.1.e001232.14","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1002\/jts.20534","article-title":"Ethnoracial variations in acute PTSD symptoms among hospitalized survivors of traumatic injury","volume":"23","author":"Stephens","year":"2010","journal-title":"J Trauma Stress"},{"key":"2025010104401009000_9.1.e001232.15","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1002\/jts.22670","article-title":"Racial discrimination is associated with acute posttraumatic stress symptoms and predicts future posttraumatic stress disorder symptom severity in trauma-exposed black adults in the United States","volume":"34","author":"Bird","year":"2021","journal-title":"J Trauma Stress"},{"key":"2025010104401009000_9.1.e001232.16","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31828c331d"},{"key":"2025010104401009000_9.1.e001232.17","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1097\/TA.0000000000003604","article-title":"Differences in mental health engagement and follow-up among black and white patients after traumatic injury","volume":"94","author":"Bernard","year":"2023","journal-title":"J Trauma Acute Care Surg"},{"key":"2025010104401009000_9.1.e001232.18","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1993.03500120075029"},{"key":"2025010104401009000_9.1.e001232.19","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e31815b9d8e"},{"key":"2025010104401009000_9.1.e001232.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2019.03.024"},{"key":"2025010104401009000_9.1.e001232.21","doi-asserted-by":"crossref","first-page":"1758","DOI":"10.1007\/s11606-019-05078-4","article-title":"Effects of a transitional care practice for a vulnerable population: a pragmatic, randomized comparative effectiveness trial","volume":"34","author":"Liss","year":"2019","journal-title":"J Gen Intern Med"},{"key":"2025010104401009000_9.1.e001232.22","doi-asserted-by":"crossref","first-page":"1959","DOI":"10.1007\/s11606-018-4615-3","article-title":"Self-identified social determinants of health during transitions of care in the medically underserved: a narrative review","volume":"33","author":"Virapongse","year":"2018","journal-title":"J Gen Intern Med"},{"key":"2025010104401009000_9.1.e001232.23","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e31826bc313"},{"key":"2025010104401009000_9.1.e001232.24","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1001\/jamasurg.2021.0131","article-title":"Stepped collaborative care targeting posttraumatic stress disorder symptoms and comorbidity for US trauma care systems: a randomized clinical trial","volume":"156","author":"Zatzick","year":"2021","journal-title":"JAMA Surg"},{"key":"2025010104401009000_9.1.e001232.25","doi-asserted-by":"crossref","first-page":"e364","DOI":"10.1097\/SLA.0000000000005043","article-title":"A prospective US national trauma center study of firearm injury survivors weapon carriage and posttraumatic stress disorder symptoms","volume":"274","author":"Nehra","year":"2021","journal-title":"Ann Surg"},{"key":"2025010104401009000_9.1.e001232.26","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1097\/SLA.0000000000003473","article-title":"The hidden burden of mental health outcomes following firearm-related injures","volume":"270","author":"Joseph","year":"2019","journal-title":"Ann Surg"},{"key":"2025010104401009000_9.1.e001232.27","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1097\/TA.0000000000002635","article-title":"Survivors of gun violence and the experience of recovery","volume":"89","author":"O\u2019Neill","year":"2020","journal-title":"J Trauma Acute Care Surg"},{"key":"2025010104401009000_9.1.e001232.28","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1177\/0886260516669545","article-title":"Post-discharge needs of victims of gun violence in Chicago: a qualitative study","volume":"34","author":"Patton","year":"2019","journal-title":"J Interpers Violence"},{"key":"2025010104401009000_9.1.e001232.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2013.04.016"},{"key":"2025010104401009000_9.1.e001232.30","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1001\/jamasurg.2016.0014","article-title":"Setting a national agenda for surgical disparities research: recommendations from the National Institutes of Health and American College of Surgeons summit","volume":"151","author":"Haider","year":"2016","journal-title":"JAMA Surg"},{"key":"2025010104401009000_9.1.e001232.31","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1001\/jamasurg.2021.0132","article-title":"Leveraging collaborative care models to mitigate posttraumatic stress disorder after injury: we can do this","volume":"156","author":"Haider","year":"2021","journal-title":"JAMA Surg"},{"key":"2025010104401009000_9.1.e001232.32","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1002\/jts.22041","article-title":"Technology-enhanced stepped collaborative care targeting Posttraumatic stress disorder and comorbidity after injury: a randomized controlled trial","volume":"28","author":"Zatzick","year":"2015","journal-title":"J Trauma Stress"},{"key":"2025010104401009000_9.1.e001232.33","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1080\/00332747.2017.1354621","article-title":"Patient-centered care transitions after injury hospitalization: a comparative effectiveness trial","volume":"81","author":"Zatzick","year":"2018","journal-title":"Psychiatry"},{"key":"2025010104401009000_9.1.e001232.34","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.psc.2020.05.008","article-title":"Achieving mental health equity: collaborative care","volume":"43","author":"Jackson-Triche","year":"2020","journal-title":"Psychiatr Clin North Am"},{"key":"2025010104401009000_9.1.e001232.35","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.61.8.827"},{"key":"2025010104401009000_9.1.e001232.36","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000156852.09920.b1"},{"key":"2025010104401009000_9.1.e001232.37","doi-asserted-by":"crossref","DOI":"10.1186\/s13012-016-0424-4","article-title":"An effectiveness-implementation hybrid trial study protocol targeting posttraumatic stress disorder and comorbidity","volume":"11","author":"Zatzick","year":"2016","journal-title":"Implement Sci"},{"key":"2025010104401009000_9.1.e001232.38","unstructured":"Weathers F , Ford J . Psychometric review of PTSD checklist (PCL-C, PCL-S. PCL-M, PCL-PR). In: Stamm B , ed. Measurement of stress, trauma, and adaptation. Sidran Press, Lutherville. 1996: 250\u20131."},{"key":"2025010104401009000_9.1.e001232.39","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.61.5.498"},{"key":"2025010104401009000_9.1.e001232.40","unstructured":"National Academies of Sciences E, Medicine . Communities in action: pathways to health equity. Washington, DC: The National Academies Press, 2017: 582."},{"key":"2025010104401009000_9.1.e001232.41","doi-asserted-by":"publisher","DOI":"10.1177\/00333549141291S206"},{"key":"2025010104401009000_9.1.e001232.42","doi-asserted-by":"crossref","unstructured":"La Rosa A , Abu K , Hernandez A , Zatzick D . Advancing concerns of Spanish-speaking physical injury survivors: equitable trauma care system service delivery. 2023, [Epub ahead of print Psychiatry: Biological and Interpersonal Processes].","DOI":"10.1080\/00332747.2023.2238573"},{"key":"2025010104401009000_9.1.e001232.43","doi-asserted-by":"crossref","first-page":"2215","DOI":"10.1017\/S0033291718003082","article-title":"Racial\/ethnic variation in trauma-related psychopathology in the United States: a population-based study","volume":"49","author":"McLaughlin","year":"2019","journal-title":"Psychol Med"},{"key":"2025010104401009000_9.1.e001232.44","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.13304"},{"key":"2025010104401009000_9.1.e001232.45","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"2025010104401009000_9.1.e001232.46","first-page":"371","article-title":"From clinical research to secondary prevention: International collaboration in the development of the alcohol use disorders identification test","volume":"13","author":"Babor","year":"1989","journal-title":"Alcohol Health Res World"},{"key":"2025010104401009000_9.1.e001232.47","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199603000-00003"},{"key":"2025010104401009000_9.1.e001232.48","unstructured":"The Johns Hopkins Health Services Research and Development Center . Determining injury severity from hospital sischarges: a program to map ICD-9Dm diagnoses into AIS, and ISS severity scores. Baltimore, MD, 1989."},{"key":"2025010104401009000_9.1.e001232.49","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2010.158"},{"key":"2025010104401009000_9.1.e001232.50","article-title":"Multiple session early psychological interventions for the prevention of post\u2010traumatic stress disorder","volume":"2019","author":"Roberts","year":"2009","journal-title":"Cochrane Database Syst Rev"}],"container-title":["Trauma Surgery &amp; Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2023-001232","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T12:40:35Z","timestamp":1735735235000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2023-001232"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":50,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1,24]]},"published-print":{"date-parts":[[2024,1]]}},"alternative-id":["10.1136\/tsaco-2023-001232"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2023-001232","relation":{},"ISSN":["2397-5776"],"issn-type":[{"value":"2397-5776","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1]]}}}