Effect of clinician-veteran racial pairing in the treatment of posttraumatic stress disorder

Abstract

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). 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. 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. 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.