Barriers to Receiving Early Care for PTSD: Results From the Jerusalem Trauma Outreach and Prevention Study

Abstract

Despite successful outreach, many symptomatic participants declined clinical care and subsequently recovered less well. Screening for DSM-IV PTSD criterion A effectively identified survivors at low risk for PTSD. Systematic outreach is costly and might be reserved for exceptionally traumatic events.

Evaluating web-based cognitive-affective remediation in recent trauma survivors: study rationale and protocol

“…Methodological challenges emanating from the above include the following: samples studied at the early aftermath of traumatic events necessarily include participants who recover spontaneously and thus effect of early interventions might be confounded by an unknown rate of spontaneous recovery , which the study design must be able to address; interventions’ optimal timing relative to the traumatic event poses another problem, where treatment administered too soon necessarily addresses numerous survivors with short-lived reactions to the trauma, but treatment provided too late may miss a critical window of opportunity; the acceptance of early interventions by survivors is often low and potentially biased (Shalev et al, 2011) and such bias must be measurable at studies’ termination. Solutions to these challenges have been poorly mapped, and their implementation requires explicit study-specific methodological choices, addressed below.

(2) Treatment engagement and implementing efficient web-based intervention

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“…Experience from a previous large early intervention study (Shalev et al, 2012, 2011) informed many of our choices in this work. To facilitate the enrolment of participants at substantial risk of PTSD, we opted to employ skilled clinicians, thoroughly trained in the specific evaluation procedures.…”

“…Shalev, Ankri, Peleg, Israeli-Shalev, & Freedman, 2011). Pharmacological interventions that target the acquisition and extinction of fear responses have generally failed to prevent PTSD (Cohen et al, 2011; Hoge et al, 2012; Pitman et al, 2002; Stein, Kerridge, Dimsdale, & Hoyt, 2007).…”

“…Pharmacological interventions that target the acquisition and extinction of fear responses have generally failed to prevent PTSD (Cohen et al, 2011; Hoge et al, 2012; Pitman et al, 2002; Stein, Kerridge, Dimsdale, & Hoyt, 2007). Early cognitive behavioural interventions, although often effective (Roberts, Kitchiner, Kenardy, & Bisson, 2010), do not reach many symptomatic survivors (Hoge et al, 2004; Shalev et al, 2012, 2011), are costly, and are difficult to carry out in trauma-affected areas such as war and disaster zones. Devising novel interventions to prevent PTSD is a major public health need (Berg et al, 2008).…”

“…Studies have shown that participants at low risk for PTSD recover equally with or without treatment (Roberts, Kitchiner, Kenardy, & Bisson, 2009; Shalev et al, 2011) and their inclusion in a study protocol creates a confound to early interventions efficacy estimation. Studies have also shown significant barriers to accepting early treatment and a non-random loss of subjects to follow-up reflecting early symptom severity.…”