Overcoming Adversity and Stress Injury Support (OASIS): Evaluation of Residential Treatment Outcomes for U.S. Service Members with Posttraumatic Stress Disorder

Abstract

Research on residential posttraumatic stress disorder (PTSD) treatment has predominantly focused on the U.S. veteran population, whereas limited research exists regarding active duty service members. The present study evaluated outcomes among service members who received treatment in the Department of Defense's only residential PTSD program, Overcoming Adversity and Stress Injury Support (OASIS). Over a 5‐year period, 289 male service members with combat‐related PTSD received treatment in the program. Service members completed an initial assessment and weekly PTSD and depression self‐report measures during the 10‐week program. Multilevel modeling results demonstrated statistically significant reductions in PTSD. On average, participants reported a 0.76‐point reduction on the PTSD Checklist, B = −0.76, p < .001, for each additional week of treatment. Pretreatment symptom scores and fitness‐for‐duty status predicted PTSD symptoms across time. Weekly changes in depression symptoms were not statistically significant; however, a significant Time × Pretreatment Depression Severity interaction emerged. Service members with higher baseline levels of depression severity showed larger reductions in depression symptom severity than those with lower levels, B = −0.02, p = .020, although a sizeable minority continued to retain symptoms at diagnostic levels. Depression symptom change was not related to any other treatment‐ or service‐related variables. Differing trajectories were found between service members whose symptoms improved over the course of residential treatment and those who did not. The results indicate that there were larger improvements in PTSD than depression symptoms and highlight the need to optimize care provision for service members with severe PTSD or comorbid symptoms.

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

“…This study extends our previous work (Walter et al., 2021 ) evaluating symptom and functioning outcomes, as well as response trajectories, for PTSD symptoms among active duty service members receiving treatment in the DoD's only residential PTSD program. The aim of the current study was to investigate demographic and military (i.e., age, treatment completion status, fitness for duty), mental health symptoms (i.e., pretreatment PTSD and depressive symptoms), and functional and behavioral health (i.e., pretreatment functional impairment, resilience, sleep duration, and sleep quality) predictors of the previously identified treatment response trajectories.…”

“…For a more detailed description of the OASIS program see Walter et al. ( 2021 ). Study procedures related to analyzing OASIS clinic data were approved by the Naval Medical Center San Diego Institutional Review Board.…”

“…Studies evaluating outcomes following residential PTSD treatment have demonstrated that in aggregate, service members and veterans report significantly decreased symptoms of PTSD (Campbell et al., 2016 ; Walter et al., 2021 , 2014 ) and related mental health symptoms, such as depression (Alvarez et al., 2011 ; Libretto et al., 2015 ; Walter et al., 2014 ). However, research also shows that elevated symptom levels often remain following residential PTSD treatment (e.g., Alvarez et al., 2011 ; Currier et al., 2014 ; Murphy & Smith, 2018 ; Walter et al., 2021 , 2014 ).…”

“…Studies evaluating outcomes following residential PTSD treatment have demonstrated that in aggregate, service members and veterans report significantly decreased symptoms of PTSD (Campbell et al., 2016 ; Walter et al., 2021 , 2014 ) and related mental health symptoms, such as depression (Alvarez et al., 2011 ; Libretto et al., 2015 ; Walter et al., 2014 ). However, research also shows that elevated symptom levels often remain following residential PTSD treatment (e.g., Alvarez et al., 2011 ; Currier et al., 2014 ; Murphy & Smith, 2018 ; Walter et al., 2021 , 2014 ). Due to the considerable time, personnel, and financial resources required for the provision of residential PTSD treatment, it is critical to identify both the service members and veterans most likely to benefit as well as those who are unlikely to benefit—or may even deteriorate—following residential treatment.…”

“…Most veterans (71%) comprised three classes that evidenced PTSD symptom response, whereas two classes comprised 29% of participants who were not responsive to treatment. In the only study to date that has evaluated treatment response among U.S. active duty service members over the course of treatment in a DoD residential PTSD program, Walter and colleagues ( 2021 ) identified response trajectories based on the classification developed by Wise ( 2004 ). The results indicated that for self‐reported PTSD symptoms, 24% of service members were classified as “reliably improved,” with an additional 8% classified as “improved,” 61% as “indeterminate,” 4% as “worsened,” and 3% as “deteriorated” over the course of residential PTSD treatment.…”