Department of Psychiatry and Behavioral Sciences, and Research Faculty, Harborview Injury Prevention and Research Center, at the University of Washington School of Medicine in Seattle, WA, USA.
Psychiatry. 2009 Winter;72(4):346-59. doi: 10.1521/psyc.2009.72.4.346.
The population impact of a preventive intervention depends on two factors: what proportion of the full population at risk receives the intervention and how large a reduction in risk occurs among those who receive it. We sought to illustrate how information from a cognitive behavioral psychotherapy (CBT) trial and stepped collaborative care (CC) trial could be used to estimate the population impact of two contrasting approaches to PTSD prevention. We first specified trauma center target populations represented by participants in each trial. Patient characteristics were compared, as were effect size and reach indices and population-level reductions in PTSD incidence. The CBT trial demonstrated a larger effect size (50% PTSD prevention), but minimal reach (27/10,000), while the CC trial demonstrated a smaller effect size (7% PTSD prevention) but greater reach (1762/10,000). Modeling of the population impact suggested that a 9.5-fold greater cumulative reduction in the incidence of PTSD would result from the dissemination of the CC broad reach prevention strategy. A reciprocal relationship between effect size and reach was evident in these two trials. By specifying a target population, effect size and reach could be combined to project the overall population impact of each PTSD prevention approach.
有风险的全部人群中有多大比例接受了干预，以及接受干预的人群中风险降低了多少。我们试图说明如何利用认知行为心理疗法 (CBT) 试验和分级协作护理 (CC) 试验的信息来估计两种截然不同的 PTSD 预防方法的人群影响。我们首先指定了每个试验中参与者代表的创伤中心目标人群。比较了患者特征、效果大小和覆盖指数以及 PTSD 发病率的人群水平降低。CBT 试验显示出更大的效果大小（50%的 PTSD 预防），但最小的覆盖率（27/10000），而 CC 试验显示出较小的效果大小（7%的 PTSD 预防），但更大的覆盖率（1762/10000）。对人群影响的建模表明，通过传播 CC 的广泛覆盖预防策略，将导致 PTSD 发病率累计减少 9.5 倍。这两项试验中都明显存在效果大小和覆盖率之间的相互关系。通过指定目标人群，可以将效果大小和覆盖率结合起来，预测每种 PTSD 预防方法的总体人群影响。
