Mott Juliette M, Mondragon Sasha, Hundt Natalie E, Beason-Smith Melissa, Grady Rebecca H, Teng Ellen J
Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA; Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, Houston, Texas, USA; South Central Mental Illness Research, Education, and Clinical Center, Houston, Texas, USA.
J Trauma Stress. 2014 Jun;27(3):265-73. doi: 10.1002/jts.21927.
This retrospective chart-review study examined patient-level correlates of initiation and completion of evidence-based psychotherapy (EBP) for posttraumatic stress disorder (PTSD) among treatment-seeking U.S. veterans. We identified all patients (N = 796) in a large Veterans Affairs PTSD and anxiety clinic who attended at least 1 individual psychotherapy appointment with 1 of 8 providers trained in EBP. Within this group, 91 patients (11.4%) began EBP (either Cognitive Processing Therapy or Prolonged Exposure) and 59 patients (7.9%) completed EBP. The medical records of all EBP patients (n = 91) and a provider-matched sample of patients who received another form of individual psychotherapy (n = 66) were reviewed by 4 independent raters. Logistic regression analyses revealed that Iraq and Afghanistan veterans were less likely to begin EBP than veterans from other service eras, OR = 0.48, 95% CI = [0.24, 0.94], and veterans who were service connected for PTSD were more likely than veterans without service connection to begin EBP, OR = 2.33, 95% CI = [1.09, 5.03]. Among those who began EBP, Iraq and Afghanistan veteran status, OR = 0.09, 95% CI = [0.03, 0.30], and a history of psychiatric inpatient hospitalization, OR = 0.13, 95% CI = [0.03, 0.54], were associated with decreased likelihood of EBP completion.
这项回顾性图表审查研究调查了寻求治疗的美国退伍军人中，创伤后应激障碍（PTSD）循证心理治疗（EBP）起始和完成情况的患者层面相关因素。我们在一家大型退伍军人事务部PTSD与焦虑症诊所中，识别出所有至少与8名接受过EBP培训的提供者之一进行过1次个体心理治疗预约的患者（N = 796）。在这组患者中，91名患者（11.4%）开始接受EBP（认知加工疗法或延长暴露疗法），59名患者（7.9%）完成了EBP。4名独立评估者对所有接受EBP治疗的患者（n = 91）以及接受另一种形式个体心理治疗的提供者匹配样本患者（n = 66）的病历进行了审查。逻辑回归分析显示，伊拉克和阿富汗退伍军人开始接受EBP的可能性低于其他服役时期的退伍军人，OR = 0.48，95% CI = [0.24, 0.94]，而因PTSD获得服役关联的退伍军人比未获得服役关联的退伍军人更有可能开始接受EBP，OR = 2.33，95% CI = [1.09, 5.03]。在开始接受EBP的患者中，伊拉克和阿富汗退伍军人身份，OR = 0.09，95% CI = [0.03, 0.30]，以及有精神病住院史，OR = 0.13，95% CI = [0.03, 0.54]，与EBP完成可能性降低相关。
