Residential Treatment for Combat-Related Posttraumatic Stress Disorder: Identifying Trajectories of Change and Predictors of Treatment Response

Abstract

BackgroundCombat-related posttraumatic stress disorder (PTSD) can be a difficult condition to treat and has been associated with serious medical and economic issues among U.S. military veterans. Distinguishing between treatment responders vs. non-responders in this population has become an important public health priority. This study was conducted to identify pre-treatment characteristics of U.S. veterans with combat-related PTSD that might contribute to favorable and unfavorable responses to high value treatments for this condition.MethodThis study focused on 805 patients who completed a VHA PTSD residential program between 2000 and 2007. These patients completed the PTSD Clinical Checklist at pre-treatment, post-treatment, and a four-month follow-up assessment. Latent growth curve analysis (LCGA) was incorporated to determine trajectories of changes in PTSD across these assessments and whether several key clinical concerns for this population were associated with their treatment responses.Study FindingsLCGA indicated three distinct trajectories in PTSD outcomes and identified several clinical factors that were prospectively linked with changes in veterans' posttraumatic symptomatology. When compared to a group with high PTSD symptom severity that decreased over the program but relapsed at follow-up (41%), the near half (48.8%) of the sample with an improving trajectory had less combat exposure and superior physical/mental health. However, when compared to a minority (10.2%) with relatively low symptomatology that also remained somewhat stable, patients in the improving group were younger and also reported greater combat exposure, poorer physical/mental health status, and more problems with substance abuse before the start of treatment.ConclusionsFindings suggest that veterans are most likely to benefit from residential treatment in an intermediate range of symptoms and risk factors, including PTSD symptom severity, history of combat exposure, and comorbid issues with physical/mental health. Addressing these factors in an integrative manner could help to optimize the effectiveness of treatments of combat-related PTSD in many cases.

Exploring Outcome Predictors in UK Veterans Treated for PTSD

“…Further research within a different larger sample of Canadian veterans did observe a relationship between symptoms of depression severity and PTSD treatment outcomes (Richardson et al, 2014). A similar pattern has been observed in US veterans undergoing treatment for PTSD with individuals with lower levels of baseline mental health having better outcomes (Currier et al, 2014;Hammarberg & Silver, 1994). The findings presented within the current study that suggest a different pattern for UK veterans with generalised anxiety and dissociative symptoms predicting changes in PTSD scores post-treatment.…”

“…This is because it suggests that individuals who have suffered from symptoms of PTSD for considerable periods of time are just as likely to profit from treatment as their counterparts who sought help sooner. A relationship has been observed between poorer physical health and worse PTSD treatment outcomes in US veterans (Currier et al, 2014). Given this, an area for future research would be to explore the relationship between physical health and mental health difficulties in UK veterans.…”

“…The picture from US studies is mixed with older programmes that had less emphasis on individual trauma therapy and a greater reliance on group sessions demonstrating significant improvements but that these are not always maintained at follow up (Johnson et al, 1996;Goodson & Helstrom, 2011;Currier, Holland Drescher, 2014;Hammarberg & Silver, 1994;Fontana & Rosenheck, 1997). More recently, US researchers have demonstrated the efficacy of using Cognitive Processing Therapy (CPT) for veterans with PTSD (Morland et al, 2014;Chard, Schumm, Owens, & Cottingham, 2010;Monson et al, 2006).…”

“…Evidence has been presented that suggests that the presence of co-morbid mental health difficulties and PTSD severity (Belsher, Tiet, Garvert, & Rosen, 2012) negatively predict positive treatment outcomes. In particular, co-morbid symptoms of depression (Richardson et al, 2014;Currier et al, 2014), problems with anger (Owens, Chard, & Cox, 2008;Forbes, Parslow, Creamer, Allen, McHugh, & Hopwood, 2008b) and alcohol use (Forbes et al, 2008b) have been shown to predict worse treatment outcomes in veterans with PTSD.…”

Exploring optimum cut-off scores to screen for probable posttraumatic stress disorder within a sample of UK treatment-seeking veterans

“…This could have useful clinical implications when both assessing for the presence of PTSD, but also evaluating treatment outcomes. For example, data from a range of countries reporting on PTSD treatment outcomes in veterans suggest that, whilst significant reductions in the severity of symptoms are evident, many participants have scores on psychometric measures that still indicate meeting diagnostic criteria for PTSD (Creamer, Morris, Biddle, & Elliot, 1999; Currier, Holland, Drescher, & Elhai, 2014; Murphy et al, 2016; Richardson et al, 2014). It may be that the use of lower cut-offs, validated within different populations, could be masking positive treatment outcomes.…”