Comorbid Posttraumatic Stress Disorder and Depression Among Hispanics in an Integrated Health Care Intervention

Background and Purpose: Posttraumatic Stress Disorder (PTSD) is challenging to diagnose and treat and is often comorbid with other mental health conditions. Vulnerable Hispanic populations, including those that are immigrants and low-income, are at increased risk for comorbid PTSD and depression due to high levels of trauma exposure. PTSD can complicate the course of depression treatment and can lead to worse outcomes for patients receiving treatment in integrated primary care settings. However, little is known about the relationship between comorbid PTSD and depression in low-income, Hispanic populations receiving mental health treatment within these settings. This study examined this comorbidity and its association with depression treatment outcomes among Hispanic patients enrolled in an integrated health care intervention.

Methods: Data for this study was from a clinical trial that implemented a culturally adapted integrated care model for depression treatment in a community health center. Participants were 18 years or older, Hispanic, met criteria for depression, and were not in treatment. All participants were enrolled for a one-year intervention period with a Depression Care Manager (DCM). Baseline assessments included demographics and measurement of symptom severity for depression (PHQ-9), anxiety (GAD-7), and PTSD (PCL-C). Participants were categorized as having a presumptive PTSD diagnosis at baseline based on PCL-C responses that met DSM-IV criteria. Depression and anxiety severity were assessed at the 6- and 12-month follow-ups.

Results: Participants (n=102) were primarily female (87.3%) and Spanish speaking (89.2%). Nearly two thirds of participants (62.7%) met criteria for a presumptive PTSD diagnosis. Compared to those without PTSD, participants with PTSD were younger (t(100)=2.55, p=.012), had a higher percentage of females (92% vs. 79%, 𝜒²(1,1)=3.76, p=.053), and had higher baseline anxiety scores (t(100)=3.68, p<.001). There were no differences between groups in number of sessions attended with the DCM; however, a higher percentage of participants with PTSD engaged in antidepressant medication treatment compared to those that did not have PTSD (68% vs. 42%, 𝜒²(1,1)=6.49, p=.011). Depression (F[1,79]=194.58, p<.001, η²=.711) and anxiety scores (F[1,81]=180.75, p<.001, η²=.691) each significantly decreased from baseline through 6- and 12-month follow-ups, but scores did not significantly differ by PTSD diagnosis.

Conclusions and Implications: Identifying patient characteristics, such as trauma exposure and PTSD, is an important step towards understanding the relationship between these characteristics and the need for trauma informed care to achieve improved mental health. Findings from this study illustrate that culturally adapted integrated care models have the potential to improve depression and anxiety symptoms for Hispanics regardless of an underlying PTSD diagnosis. Since the intervention was not specifically designed to address trauma or PTSD, more research is needed to understand what elements of the treatment model benefitted participants the most.