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BACKGROUND/RATIONALE:
PTSD increases risks for poverty, unemployment, hospitalization, substance abuse, and chronic medical conditions. In direct costs alone, the VA's provision of compensation and treatment to veterans with PTSD exceeds $1.2 billion dollars annually. How can the human and institutional costs of PTSD be minimized? Although many factors contribute to PTSD's chronicity, one particularly notable factor is inconsistent treatment participation. About three-quarters patients receiving VA outpatient PTSD treatment participate only episodically, with long periods of non-use interspersed between episodes of care. Our pilot study sampled over a one year period veterans with no non-substance abuse mental health-related visits in the prior year who received a PTSD diagnosis (n=20,284). In the six months after the index PTSD-related episode, 36% received no follow-up care and only 18% received an adequate trial of antidepressants. Of great concern is the fact that women and racial minorities were even less likely to receive an adequate antidepressant trial. Despite numerous studies evaluating treatment adherence in patients with major depression or schizophrenia, there have been no studies examining treatment adherence in veterans with PTSD.
OBJECTIVE(S):
1) Fill the gap in the PTSD treatment evidence base by ascertaining rates and extent of treatment participation among veterans for whom PTSD was recently identified as a problem, 2) Identify patient, treatment and contextual factors associated with treatment drop-out or lack of follow-up in the six months following receipt of a PTSD diagnosis, 3). Identify specific targets in the PTSD treatment pathway amenable to intervention.
METHODS:
To determine factors predicting treatment participation, this study uses a longitudinal panel design to follow veterans from an initial diagnosis of PTSD through the subsequent six months. The study will sample nationally and stratify by race, ethnicity and gender, since these groups are of primary interest. Primary outcome measures : 1) the presence or absence of participation in behavioral counseling and/or pharmacotherapy, and 2) among those in treatment, the presence or absence of a minimally adequate trial of treatment. Outcome measures will be determined by administrative data. Participants will be surveyed twice -- immediately following the index appointment and six months after it. The initial survey will assess variables believed to impact PTSD treatment behavior: race, ethnicity, gender, beliefs about PTSD and MH treatment, treatment preferences, PTSD symptoms, functioning, social support and treatment access. The survey at six months will assess self-reported PTSD treatment behavior (as a qualitative component), experience of PTSD treatments, treatment satisfaction, quality of the patient-provider relationship use of unconventional treatments and current symptoms and functioning. Administrative data, including demographics, diagnoses, pharmacy information and utilization of MH services, will be extracted for each participant for the six months following the index appointment.
FINDINGS/RESULTS:
No results from the primary study at this time.
IMPACT:
A significant number of veterans newly diagnosed with PTSD do not receive any mental health care. Among those who do participate, only about half receive an adequate trial of treatment within the six months after the initial diagnosis. This project is designed to identify factors associated with treatment participation, treatment drop-out or non-initiation, so that effective interventions can be made to facilitate PTSD treatment participation and promote recovery from this often chronic and debilitating illness.
PUBLICATIONS:
None at this time.
DRA:
Mental Illness, Military and Environmental Exposures
DRE:
Prevention, Epidemiology, Treatment
Keywords:
PTSD, Operation Enduring Freedom, Operation Iraqi Freedom
MeSH Terms:
none
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