Developing a pilot study of evidence-based PTSD treatment in Port-au-Prince, Haiti

Post-Traumatic Stress Disorder (PTSD) is a significant public health problem in Haiti, with prevalence as high as 36.8% in Port-au-Prince. Untreated PTSD is known to result in high rates of depression, anxiety, substance use, suicide, premature mortality, medical complications, homelessness, unemployment, sexual-risk-taking behaviors, domestic violence, and second-generation mental and physical health problems. The clinical science of PTSD has advanced quickly, producing gold-standard therapies with strong evidentiary support and effectiveness rates of approximately 85%. While prevalence of PTSD in Port-au-Prince is five times that seen in the United States, there are no published studies testing these therapies’ effectiveness and no treatment programs offering these gold-standard approaches in Haiti. Bringing effective PTSD therapy to Haiti requires a careful analysis of the historical, political, cultural, and religious context. Haiti’s experience of public health interventions has been shaped by a complex history of colonialism, foreign intervention, missionary medicine, conflict between belief systems, second-class or non-existent services for the poor majority, and persistent power imbalances between provider institutions and the patients they serve. Such troubling dynamics have been particularly acute in mental health. For a mental health intervention to be effective and accepted in this context, practitioners must be aware of these undercurrents, define services as a concrete benefit to participants, not compromise international gold-standards of care, position services as compliments to existing healing strategies, establish local oversight, transparently share findings, and partner with local organizations to scale up. The proposed pilot program aims to fill these gaps in the literature and services by testing whether individual Prolonged Exposure (PE) Therapy, an intensive 12-week talk therapy protocol, is effective at reducing symptom severity among adults with PTSD in the Cité Soleil neighborhood of Port-au-Prince. This thesis develops the pilot program implementation plan, evaluation plan, and supporting literature reviews. If the pilot is able to show effectiveness on this small scale, the proposed project will make a significant contribution to public health by advancing the literature of evidence-based PTSD treatment in Haiti, and laying the foundation for expanding effective PTSD care to the hundreds of thousands of Haitians suffering from this debilitating, but highly treatable condition