Usual Course of Treatment and Predictors of Treatment Utilization for Patients With Posttraumatic Stress Disorder

Abstract

Objective Posttraumatic stress disorder (PTSD) is a debilitating psychiatric illness that frequently remains undiagnosed and untreated. While extensive research has been conducted among veterans, little research has evaluated course of treatment for PTSD in a general hospital setting. Method We utilized data from the Partners Healthcare Research Patient Database Registry to evaluate mental health treatment utilization, including psychotherapy and pharmacotherapy, by patients with recently diagnosed primary PTSD following Diagnostic and Statistical Manual IV criteria between January 1, 2002 and June 30, 2011. We additionally evaluated predictors of treatment utilization 6 months post-diagnosis. Results Among 2,475 patients with recently diagnosed prim ary PTSD, approximately half (55.7%) had any therapy visit and 10% at least 12 therapy visits in the 6 months following diagnosis. Approximately half (47.0%) received a psychiatric prescription, with 29.3% receiving a selective serotonin reuptake inhibitor (SSRI), 11.8% an atypical antipsychotic and 24.4% a benzodiazepine. Latinos were 25% more likely to have an SSRI prescription, 35% more likely to have an atypical antipsychotic prescription and 28% more likely to have any psychotherapy. Men were 96% more likely to have an atypical antipsychotic prescription. Patients with Medicare were 20% less likely to have any psychotherapy, and patients with Medicaid were 35% less likely to have 12 or more therapy visits. Conclusion Many patients with a primary diagnosis of PTSD do not receive psychotherapy, and psychiatric prescriptions, including atypical antipsychotics and benzodiazepines, are common. Future research is needed to determine quality of care received and explore sub-population specific barriers limiting access to care.

Risks of Benzodiazepines in Chronic Obstructive Pulmonary Disease with Comorbid Posttraumatic Stress Disorder

“…Our findings with respect to the respiratory risks of long-term benzodiazepine use are contrary to those from a prior case-control study that linked long-term benzodiazepine use among patients with COPD with a substantial increase in respiratory failure (6). Given the frequent use of benzodiazepines for dyspnea in end-stage COPD (21,39), the disparate results may stem from our restriction to individuals with comorbid PTSD, patients who commonly use benzodiazepines for nonrespiratory indications (27). Sample restriction to groups with common indications is an important tool in pharmacoepidemiology to reduce the risk of confounding by indication (40).…”

“…PTSD is present in 6% of the general population (25), and symptoms of PTSD are found in up to 40% of those with COPD (26). Individuals with PTSD frequently have symptoms of anxiety and insomnia that prompt therapy with benzodiazepines, and almost 25% of patients with PTSD receive benzodiazepines-many long-term (27).…”

Implementation and Utility of an Automated Text Messaging System to Facilitate Symptom Self-Monitoring and Identify Risk for Post-Traumatic Stress Disorder and Depression in Trauma Center Patients

“…42 White patients who were enrolled in the service were more likely to respond to text messages compared with Black patients, consistent with literature suggesting lower treatment utilization in Black patients with significant mental health symptoms. [43][44][45] Further, patients injured in a fall were less likely to enroll in the service, and patients injured in motor vehicle collisions were more likely to respond to text messages once enrolled. The fact that older adults are more likely to be injured in a fall, 46 and that older adults are less likely to engage in the text messaging service, may explain this finding, in part.…”

A Case Study of Interpreter-Mediated Prolonged Exposure Therapy for Posttraumatic Stress Disorder: Challenges and Recommendations for Effective Implementation

“…The omission of examination of PE in this format is notable, particularly in light of efforts to increase the dissemination and availability of PE and other empirically supported trauma-focused interventions (Foa, Gillihan, & Bryant, 2013). These efforts are bolstered by data indicating that a large proportion of individuals with PTSD do not receive treatment for the disorder, and even fewer individuals receive best practice therapies (Hoge et al, 2014; Nobles et al, 2017). Even if trained providers are available to apply evidence-based interventions for PTSD such as PE, difference in the language spoken by the therapist and client represents a barrier to care that can prevent individuals from accessing and receiving these interventions.…”