Residual posttraumatic stress disorder and depression symptoms following a residential posttraumatic stress disorder treatment program for U.S. active duty service members.

Abstract

Objective: Even after the most effective posttraumatic stress disorder (PTSD) treatments, symptoms often persist. Understanding residual symptoms is particularly relevant in military populations, who may be less responsive to PTSD interventions. Method: The sample consisted of 282 male service members who engaged in a residential PTSD treatment program at a military treatment facility that provided evidence-based PTSD psychotherapies and adjunctive interventions. PTSD and depression symptoms were assessed before and after treatment and weekly during treatment via the PTSD Checklist-Military Version and Patient Health Questionnaire-8. Logistic regression with Hochberg's step-up procedure compared the likelihood of individual residual symptoms between service members who did (n = 92, 32.6%) and did not (n = 190, 67.4%) experience clinically significant PTSD change (≥10-point PTSD Checklist-Military Version reduction). Results: Not achieving clinically significant PTSD change was associated with greater odds of nearly all residual symptoms (OR = 2.03-6.18), excluding two Patient Health Questionnaire-8 items (appetite and psychomotor changes). Among service members experiencing clinically significant PTSD change, concentration difficulties (73.3%), physical reactions to reminders (71.1%), and intrusions (70.8%) were PTSD symptoms most likely to persist. Poor sleep (56.2%), low energy (50.0%), and concentration difficulties (48.3%) were the most common for depression. Conclusions: To our knowledge, this study is the first to examine residual PTSD and depression symptoms following residential PTSD treatment for active duty service members. Given the low rates of clinically significant PTSD change and the high frequency of residual symptoms, strategies may be needed to improve residential PTSD treatment outcomes in the military. Clinical Impact StatementStudy findings show that residual posttraumatic stress disorder (PTSD) and depression symptoms were frequently reported among U.S. active duty service members who received treatment in a residential PTSD program. Results support prior literature on residual symptoms in PTSD treatment by indicating that several symptoms, particularly those from the hyperarousal cluster, are common across different PTSD treatment settings, therapies, and populations. Residual symptoms were commonly reported, even among service members who experienced clinically significant decreases in PTSD severity. Study results highlight that improvements may be needed for residential care and other treatment options for active duty service members with PTSD.