Does Evidence-Based PTS Treatment Reduce PTS Symptoms and Suicide in Iraq and Afghanistan Veterans Seeking VA Care

Abstract

To compare effectiveness of evidence-based psychotherapy (EBP) for PTS in Iraq and Afghanistan War Veterans who use Veterans HealthAdministration (VHA) care (Aim 1), we used an approach that mimics a sequence of randomized trials by implementing propensity scoremodels within each trial to achieve covariate balance, using matching. We found that Veterans who completed EBP for PTS experienced asignificant improvement in PTSD Checklist (PCL) scores compared to the non-completers (i.e., 5.7 to 6.3-point improvement on the PCL). We also completed an analysis of factors associated with completing EBP for PTS (Aim 2). Using ordered logistic regression, we identified factors associated with achievement of hierarchal outcome categories (no EBP, EBP dropout, EBP completion) during any 24-week period. Using Cox proportional hazards regression, we also assessed factors associated with faster time to completion of PE or CPT from VA mental health entry. Over a 15-year period, 265,566 Iraq and Afghanistan War Veterans with PTS initiated psychotherapy in the VHA. While 22.8% initiated an EBP, only 9.1% completed treatment. Those who completed did so about three years after their initial mental health visit. Several factors were associated with EBP completion, including history of military sexual trauma (MST), older age, gender, and race/ethnicity. Prior psychotherapy sessions were associated with EBP completion, and initiation of psychotherapy in the last few years was associated with timelier EBP. Next, consistent with Aim 3, we examined the association between PTS symptom improvement and three treatment profiles (no EBP, early EBP use and delayed EBP use, defined as greater than one year). Using random effects logistic regression, we found that earlier EBP initiation was a strong predictor of PTSD improvement. Among the EBP group, decreased odds of improvement were seen in African-Americans, those who were prescribed medications, and had pain diagnoses and depression.

Open PDF

Document Details

Document Type
Technical Report
Publication Date
Jul 01, 2019
Accession Number
AD1079685

Entities

People

  • Callan Lujan
  • Erin Madden
  • Shira Maguen
  • Yongmei Li

Organizations

  • Northern California Institute for Research and Education

Tags

Communities of Interest

  • Human Systems

DTIC Thesaurus Topics

  • Antidepressants
  • Anxiety Disorders
  • Brain Injuries
  • Cognition
  • Drug Abuse
  • Health Care
  • Health Services
  • Information Processing
  • Information Science
  • Machine Learning
  • Medical Personnel
  • Natural Language Processing
  • Propensity Score Matching
  • Psychiatry
  • Psychology
  • Supervised Machine Learning
  • Traumatic Stress Disorder

Fields of Study

  • Medicine
  • Psychology

Readers

  • Mental Health of Military Veterans with Posttraumatic Stress Disorder (PTSD): Risk Factors, Prevalence, Symptoms, and Treatment.