Improving function through primary care treatment of posttraumatic stress disorder study outcomes: A randomized controlled trial of prolonged exposure for primary care in veterans.

IF 1.2 4区医学 Q3 FAMILY STUDIES

Families Systems & Health Pub Date : 2023-12-01 Epub Date: 2023-08-31 DOI:10.1037/fsh0000823

Sheila A M Rauch, H Myra Kim, Ron Acierno, Carly Ragin, Bethany Wangelin, Kimberly Blitch, Wendy Muzzy, Stephanie Hart, Kara Zivin

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Abstract

Introduction: Despite high cost and wide prevalence of posttraumatic stress disorder (PTSD) in veteran populations, and Veterans Health Administration (VA)-wide mental health provider training in evidence-based treatments for PTSD, most veterans with PTSD do not receive best practices interventions. This may be because virtually all evidence-based PTSD treatment is offered through specialty clinics, which require multiple steps and referrals to access. One solution is to offer PTSD treatment in VA primary care settings, which are often the first and only contact point for veterans.

Method: The present study, Improving Function Through Primary Care Treatment of PTSD (IMPACT), used a randomized controlled design to compare an adaptation of prolonged exposure for PTSD to primary care (PE-PC) versus best practices Primary Care Mental Health Integration (PCMHI) clinic treatment as usual (TAU) in terms of both functioning and psychological symptoms in 120 veterans recruited between April 2019 and September 2021.

Results: Participants were mostly males (81.7%) with a mean age of 43.6 years (SD = 12.8), and more than half were non-White veterans (50.8%). Both conditions evinced significant improvement over baseline across functioning, PTSD, and depression measures, with no differences observed between groups. As observed in prior studies, PTSD symptoms continued to improve over time in both conditions, as measured by structured clinical interview.

Discussion: Both PE-PC and best-practices TAU are effective in improving function and reducing PTSD severity and depression severity. Although we did not observe differences between the two treatments, note that this study site and two PCMHI clinics employ primarily cognitive behavioral therapies (e.g., exposure and behavioral activation). (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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通过初级保健治疗改善创伤后应激障碍的功能研究结果:退伍军人长期暴露于初级保健的随机对照试验。

导论:尽管创伤后应激障碍(PTSD)在退伍军人群体中成本高昂且普遍存在，而且退伍军人健康管理局(VA)在PTSD循证治疗方面对心理健康提供者进行了广泛的培训，但大多数患有PTSD的退伍军人并未接受最佳实践干预措施。这可能是因为几乎所有基于证据的PTSD治疗都是通过专业诊所提供的，这需要多个步骤和转诊才能进入。一个解决方案是在退伍军人事务部的初级保健机构提供创伤后应激障碍治疗，这通常是退伍军人的第一个也是唯一的接触点。方法:本研究通过初级保健治疗改善创伤后应激障碍(IMPACT)，采用随机对照设计，比较长期暴露于初级保健(PE-PC)与最佳实践初级保健心理健康整合(PCMHI)诊所治疗(TAU)对120名退伍军人的功能和心理症状的适应。结果:参与者以男性居多(81.7%)，平均年龄43.6岁(SD = 12.8)，非白人退伍军人过半(50.8%)。两种情况在功能、创伤后应激障碍和抑郁测量方面都比基线有显著改善，组间无差异。正如在先前的研究中观察到的那样，通过结构化的临床访谈测量，PTSD症状在两种情况下都随着时间的推移而持续改善。讨论:PE-PC和最佳实践TAU都能有效改善功能，降低创伤后应激障碍严重程度和抑郁严重程度。虽然我们没有观察到两种治疗方法之间的差异，但请注意，本研究地点和两家PCMHI诊所主要采用认知行为疗法(例如，暴露和行为激活)。(PsycInfo数据库记录(c) 2023 APA，版权所有)。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Families Systems & Health HEALTH CARE SCIENCES & SERVICES-PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

CiteScore

1.50

自引率

7.70%

发文量

审稿时长

>12 weeks

期刊介绍： Families, Systems, & Health publishes clinical research, training, and theoretical contributions in the areas of families and health, with particular focus on collaborative family healthcare.