Timing of evidence-based psychotherapy for posttraumatic stress disorder initiation among Iraq and Afghanistan war veterans in the Veterans Health Administration.

Abstract

Objective: Cognitive processing therapy (CPT) and prolonged exposure therapy (PE) were widely disseminated to treat posttraumatic stress disorder (PTSD) in the Veterans Health Administration (VHA). However, few Iraq and Afghanistan war veterans (Operation Enduring Freedom [OEF], Operation Iraqi Freedom [OIF], Operation New Dawn [OND]) diagnosed with PTSD have received CPT/PE and many initiate CPT/PE after substantial delay. Veterans who do not initiate CPT/PE or initiate CPT/PE after delay may have poorer treatment outcomes. This study aimed to identify predictors of CPT/PE initiation and timing. Methods: Participants included OEF/OIF/OND veterans diagnosed with PTSD who received psychotherapy between 2001 and 2017 in the VHA (n ϭ 265,566). Logistic regression analysis was utilized to predict initiating CPT/PE (vs. no CPT/PE). Multinomial logistic regression analysis was This article was published Online First July 25, 2019.

Effectiveness and comparative effectiveness of evidence-based psychotherapies for posttraumatic stress disorder in clinical practice

“…We used greedy 1:1 nearest neighbor matching, with exact matching on trial, without replacement, within caliper widths <0.2 (Austin, 2014 ). Due to the small number of eligible persons initiating EBP within 2 weeks of the start of the trial, the number of predictors included in the logistic regression models used to create the propensity scores was necessarily restricted to baseline variables known a priori to be associated with both treatment selection and follow-up PCL score: age, baseline PCL z -score, and comorbid conditions (alcohol abuse, alcohol dependence, depression, drug abuse, drug dependence, psychosis, pain, suicide, and TBI; Holder et al, 2020 ). The EBP initiator and non-EBP initiator groups were compared with standardized mean differences, where an absolute difference of <0.1 on confounders of age and comorbidities was indicative of group similarity (e.g.…”

Racial and ethnic disparities in clinical outcomes six months after receiving a PTSD diagnosis in Veterans Health Administration.

“…Although such treatment-related disparities may contribute to these findings, it is likely complex and nontreatment factors may also impact treatment outcomes. For example, African American and/or Latinx veterans are more likely to delay treatment initiation (Holder et al, 2020), to experience deployment-related social stressors (Muralidharan et al, 2016), to experience discrimination (Sibrava et al, 2019), and to have low income (Chen et al, 2019) – any of these factors may contribute to worse outcomes. Whether these or other variations in mental health treatment engagement, treatment delivery, or in nonhealth care system factors (e.g., social determinants of health such as income; Duran & Pérez-Stable, 2019) underlie the disparities in the observed outcomes cannot be discerned from these data.…”

A home-based telehealth randomized controlled trial of skills training in affective and interpersonal regulation versus present-centered therapy for women veterans who have experienced military sexual trauma.

“…Trauma-focused cognitive behavioral therapies (TF-CBT) have been identified as the most effective treatments for PTSD to date (VA/DoD Clinical Practice Guideline, 2023). Yet, despite U.S. Department of Veterans Affairs (VA) efforts to expand the provision of TF-CBTs, only a minority of returning Operation Enduriing Freedom/Operation Iraqi Freedom veterans have ever initiated a TF-CBT, and many did not initiate it until several years after they returned from deployment (Holder et al, 2020). Initiating treatment can be difficult (Kehle-Forbes et al, 2016), and some clients are afraid or unwilling to engage in treatments that focus on trauma (Hundt et al, 2018).…”