Walter Kristen H, Varkovitzky Ruth L, Owens Gina P, Lewis Jennifer, Chard Kathleen M
Health Services Research & Development, Veterans Medical Research Foundation.
PTSD Outpatient Clinic, Veterans Affairs Puget Sound Health Care System, American Lake Division.
J Consult Clin Psychol. 2014 Aug;82(4):551-61. doi: 10.1037/a0037075. Epub 2014 Jun 9.
Across the Veterans Affairs (VA) Healthcare System, outpatient and residential posttraumatic stress disorder (PTSD) treatment programs are available to veterans of all ages and both genders; however, no research to date has compared these treatment options. This study compared veterans who received outpatient (n = 514) to those who received residential treatment (n = 478) within a VA specialty clinic on demographic and pretreatment symptom variables. Further, the study examined pre- to posttreatment symptom trajectories across the treatment programs.
All 992 veterans met diagnostic criteria for PTSD and attended at least 1 session of cognitive processing therapy (CPT) in either the outpatient or residential program. Bivariate analyses were utilized to investigate differences between samples on demographic variables and severity of pretreatment symptoms. Multilevel modeling (MLM) was used to investigate the change in symptomatology between the 2 samples from pre- to posttreatment.
Analyses indicated that the samples differed on all demographic and pretreatment symptom variables, with residential patients reporting higher scores on all assessment measures. MLM results demonstrated that symptom scores improved for all veterans across time, with outpatients consistently reporting fewer symptoms at both time points. The time by program interaction was significant for PTSD-related symptom trajectories, but not for the depression-related symptom trajectory.
This is the 1st study to compare pretreatment characteristics and treatment outcome between veterans receiving outpatient and residential PTSD treatment. Findings may help clinicians select appropriate care for their patients by identifying relevant pretreatment characteristics and generally informing expectations of treatment outcome.
在退伍军人事务部（VA）医疗系统中，为所有年龄段和性别的退伍军人提供门诊和住院创伤后应激障碍（PTSD）治疗项目；然而，迄今为止尚无研究对这些治疗方案进行比较。本研究比较了在VA专科诊所接受门诊治疗（n = 514）和住院治疗（n = 478）的退伍军人在人口统计学和治疗前症状变量方面的情况。此外，该研究还考察了各治疗项目治疗前至治疗后的症状轨迹。
所有992名退伍军人均符合PTSD诊断标准，并在门诊或住院项目中至少参加了1次认知加工疗法（CPT）治疗。采用双变量分析来研究样本在人口统计学变量和治疗前症状严重程度方面的差异。使用多水平模型（MLM）来研究两个样本从治疗前到治疗后症状学的变化。
分析表明，样本在所有人口统计学和治疗前症状变量上均存在差异，住院患者在所有评估指标上的得分均较高。MLM结果显示，所有退伍军人的症状评分随时间均有所改善，门诊患者在两个时间点报告的症状始终较少。治疗项目与时间的交互作用对PTSD相关症状轨迹有显著影响，但对抑郁相关症状轨迹无显著影响。
这是第一项比较接受门诊和住院PTSD治疗的退伍军人治疗前特征和治疗结果的研究。研究结果可能有助于临床医生通过识别相关的治疗前特征并总体告知对治疗结果的预期，为患者选择合适的治疗方案。
