Improving Behavioral Health Care for U.S. Army Personnel: Identifying Predictors of Treatment Outcomes

Abstract

Limited Print and Electronic Distribution RightsThis document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions.The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.

Psychological comorbidity: Predictors of residential treatment response among U.S. service members with posttraumatic stress disorder

“…It should be noted that consistent with prior work (Walter et al., 2021 ), most participants (60.6) were classified in the indeterminate trajectory, which represented a PTSD treatment response that met neither clinical significance nor a significant RCI. Although the percentage of participants in the indeterminate trajectory exceeded the reported proportions of nonresponders in some studies of outpatient and residential PTSD treatment for military samples (19%–28%; Clapp et al., 2016 ; Murphy & Smith, 2018 ; Schumm et al., 2013 ), it was lower than reported in others (82%–83%; Allan et al., 2017 ; Hepner et al., 2020 ). Even if the percentage of participants in the indeterminate trajectory fell within the ranges found in the literature, it is critical to explore how to help these individuals move into the response category, whether by offering different treatments, providing adjunctive interventions, or identifying additional factors that may impede recovery.…”

“…( 2017 ) found that most (82%) participants who received PE with components of behavioral activation were nonresponders, suggesting that this protocol modification may not be recommended for most veterans with PTSD. Finally, in a study of Army soldiers, 35% of those with PTSD and 45% of those with depression showed response or remission within 1–6 months following treatment (Hepner et al., 2020 ). However, most soldiers with PTSD (83%) were in a response trajectory that was categorized by no symptom improvement.…”

“…Although less frequently explored in the literature, treatment‐related variables have also been examined as predictors of treatment response. Research among Army soldiers indicates that stronger patient‐reported therapeutic alliance is associated with more improvement, whereas receiving more than a 30‐day supply of benzodiazepines has been associated with poorer response for PTSD, depressive, and anxiety symptoms (Hepner et al., 2020 ). Given the heterogeneity within the literature, the precise delineation of symptom, demographic, and treatment factors that predict response trajectories to residential PTSD treatment can help identify individuals who are the most likely to benefit from this high‐level treatment option, which is critical to optimize limited resources on behalf of patients, staff, and programs.…”

Project Safe Guard: Challenges and opportunities of a universal rollout of peer‐delivered lethal means safety counseling at a US military installation

“…First, recent observational and experimental work has suggested that other service members, rather than clinicians, may be optimal messengers of secure firearm storage (Anestis et al., 2022; Anestis, Bond, et al., 2021); thus, peer delivery may garner greater buy‐in to recommended actions regarding secure firearm storage. Second, with a nationwide shortage of mental health clinicians, including within the Military Health System (MHS; Hepner et al., 2023), trained peers may help fill critical gaps in the healthcare workforce. Finally, recent studies have suggested that peer delivery of interventions focused on suicide prevention (cf.…”