United Against PTSD: A Multi-Stakeholder Collaboration

ANXIETY AND DEPRESSION ASSOCIATION OF AMERICA

COMMENTARY

In the United States, approximately 6% of people will develop posttraumatic stress disorder (PTSD), and the prevalence is higher in populations that are more likely to face chronic and excessive exposure to trauma (eg, women, Indigenous people, Black/African Americans, LGBTQ+ individuals, low-income individuals, first responders, military personnel, as well as survivors of physical assault, life-threatening injury, and/or sexual violence).^1,2 PTSD may be undiagnosed or misdiagnosed amongst individuals experiencing symptoms caused by trauma that do not meet the full diagnostic criteria of the DSM-5.^3,4 There is an urgent need for timely diagnosis and equitable access to care, particularly for members of communities that face disproportionately high rates of trauma.

Against this backdrop, Otsuka convened a multidisciplinary panel of experts, including individuals with lived PTSD experience, academic researchers, health care providers, and advocacy leaders, for a solution-oriented roundtable discussion. The discussion resulted in the following overarching themes.

Expand Trauma Lexicon

Although the participants agreed that progress has been made to improve support for people experiencing PTSD (including advocacy and funding from the US Department of Veterans Affairs for trauma-informed care⁵), they noted there is limited awareness around causes and symptomatology of PTSD amongst individuals suffering from trauma.⁶ The lack of understanding may, in turn, reduce or delay their efforts to seek help. The roundtable participants agreed that expanding and normalizing the lexicon of trauma could facilitate recognition of PTSD amongst patients, peers, and providers.⁷ A more accessible trauma lexicon would reduce shame, improve communication between patients and providers, and increase utilization of appropriate health services. PTSD is complex, and effective solutions require input from all stakeholders.⁸

Implementing Trauma-Informed Care: Identifying and Overcoming

Multidisciplinary panel also agreed that care health care professionals would benefit from additional education on evidence-based, trauma-informed care (TIC) (ie, tailored services that prioritize the patient voice and promote empathy and understanding in addressing the complex effects of trauma).⁹ The panel said the approach is not utilized regularly in routine clinical practice, despite evidence linking it to improved health outcomes.

Barriers to TIC may include leadership engagement (or lack thereof), limited resource availability, underdeveloped training or feedback processes and individual characteristics like resistance to change.¹⁰ Educating health care professional on TIC approaches could better equip them to recognize and support individuals presenting with PTSD symptoms, including those whose symptoms do not meet the full criteria for a DSM-5 PTSD diagnosis.^11,12 The successful implementation of TIC requires greater collaboration within organizations, investment in workforce training programs, and adjustments to internal care processes.¹⁰

Culturally Sensitive and Lived Experience Perspectives

Health care professionals who participated in the roundtable underscored the importance of culturally sensitive interventions in improving care and treatment for trauma-related mental health conditions, with an emphasis on interventions informed or co-created by individuals with lived experience. Culturally sensitive interventions integrate awareness and knowledge of a culture’s unique elements. As a result, they are more effective at addressing the unique needs and preferences of individuals.¹³ An expanding body of literature supports this perspective and suggests that culturally appropriate mental health interventions lead to increased utilization of health services, foster greater trust between patients and clinicians, and improve overall treatment outcomes.^14-16

The role of peer support is also important. Individuals navigating trauma who are supported by peers may feel less isolated and may seek treatment sooner when they see peers in a similar position who are progressing along their own treatment journeys.¹⁷ Research into the benefits of peer support for individuals with mental health conditions, while nascent, shows greater utilization of health care services, a decrease in self-stigma, and reduced overall costs to the health care system.¹⁸

Concluding Thoughts: The Path Forward

PTSD is complex, and effective solutions require input from all stakeholders. The multi-stakeholder dialogue explored the barriers that prevent individuals living with PTSD from seeking care. It also illuminated a path forward for future action and dialogue. Subsequent discussions are needed; they should likewise prioritize sharing perspectives from a diverse group of stakeholders.

References

1. US Department of Veterans Affairs. How Common is PTSD in Adults? September 13, 2018.Accessed April 18, 2024. https://www.ptsd.va.gov/understand/common/common_adults.asp#:~:text=Most%20people%20who%20go%20through,criteria%20for%20PTSD%20after%20treatment/

2. Schein J, Houle C, Urganus A et al. Prevalence of post-traumatic stress disorder in the United States: a systematic literature review. Curr Med Res Opin. 2021;37(12):2151-2161.

3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed). 2013. 4. US Department of Veteran Affairs, Department of Defense. The Management of Posttraumatic Stress Disorder Working Group. VA/DOD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder. Version 3.0. 11-12. June 2017. Accessed April 18, 2024. https://www.healthquality.va.gov/guidelines/MH/ptsd/VADoDPTSDCPGFinal012418.pdf

5. US Department of Veterans Affairs. Trauma-informed Care. September 1, 2018.Accessed April18, 2024.https://www.ptsd.va.gov/professional/treat/care/index.asp

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9. Berman S, Brown T, Mizelle C et al. Roadmap for Trauma-Informed Medical Education: Introducing an Essential Competency Set. J Assoc AM Med Coll. 2023;98(8):882-888.

10. Huo Y, Couzner L, Windsor T et al. Barriers and enablers for the implementation of trauma-informed care in healthcare settings: a systematic review. Implement Sci. 2023; 4(1):49.

11. Klein A.B, Schnurr PP, Bovin MJ et al. An empirical investigation of definitions of subthreshold posttraumatic stress disorder. J Trauma Stress. 2023; Advance online publication. https://doi.org/10.1002/jts.22987.

12. Burns CJ, Borah L, Terrell SM et al. Trauma-Informed Care Curricula for the Health Professions: A Scoping Review of Best Practices for Design, Implementation, and Evaluation. Acad Med. 2023;98(3):401-409.

13. Mongelli F, Georgakopoulos P, Pato MT. Challenges and Opportunities to Meet the Mental Health Needs of Underserved and Disenfranchised Populations in the United States. Focus.2020;18(1):16-24.

14. Dixon LE, Ahles E, Marques L. Treating posttraumatic stress disorder in diverse settings: Recent advances and challenges for the future - current psychiatry reports. Curr Psychiatry Rep 2016.

15. Sunkel C, Sartor C. Perspectives: involving persons with lived experience of mental health conditions in service delivery, development and leadership. B J Psych Bulletin. 2022;46(3):160-164.

16. Fortuna KL, Lebby S, Geiger P et al. Lived Experience-Led Research Agenda to Address Early Death in People With a Diagnosis of a Serious Mental Illness: A Consensus Statement. JAMA Netw Open.2023; 6(5): e2315479.

17. Jain S, McLean C, Adler E et al. Does the Integration of Peers into the Treatment of Adults with Posttraumatic Stress Disorder Improve Access to Mental Health Care? A Literature Review and Conceptual Model. J Trauma Stress. 2013;10.4172/2324-8947.1000109.

18. Substance Abuse and Mental Health Services Administration (SAMHSA). “Peers Supporting Recovery from Mental Health Conditions - SAMHSA.” Value of Peers Infographics: Peer Support. Accessed January 19, 2024. www.samhsa.gov/sites/default/files/programs_campaigns/brss_tacs/peers-supporting-recovery-substance-use-disorders-2017.pdf; 2017.