Engel Charles C, Litz Brett, Magruder Kathryn M, Harper Elizabeth, Gore Kristie, Stein Nathan, Yeager Derik, Liu Xian, Coe T Ray
Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, USA.
Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, 150 S. Huntington Ave, Jamaica Plain, MA, USA; Department of Psychiatry, Boston University, 715 Albany St., M-8th Floor, Boston, MA, USA.
Gen Hosp Psychiatry. 2015 Jul-Aug;37(4):323-8. doi: 10.1016/j.genhosppsych.2015.04.007. Epub 2015 Apr 13.
This randomized controlled trial examined the effectiveness of a nurse assisted online cognitive-behavioral self-management intervention for war-related posttraumatic stress disorder (PTSD), compared to optimized usual primary care PTSD Treatment (OUC) to reduce PTSD symptoms.
Participants were 80 veterans of recent military conflicts with PTSD as assessed by the PTSD Checklist (PCL) seeking primary care treatment at one of three Veterans Affairs (VA) and four Army clinics. DESTRESS-PC consisted of logins to a secure website three times per week for 6 weeks with monitoring by a study nurse. All participants received nurse care management in the form of phone check-ins every two weeks and feedback to their primary care providers. Blinded raters assessed outcomes 6, 12, and 18 weeks post-randomization.
DESTRESS-PC was associated with a significantly greater decrease in PTSD symptoms compared to OUC (F(3, 186)=3.72, p=.012). The effect was largest at the 12-week assessment (∆PCL=12.6±16.6 versus 5.7±12.5, p<0.05) with the treatment effect disappearing by the 18-week follow-up. Notably, there was a dose effect; number of logins correlated significantly with PTSD outcomes, with more logins associated with greater PTSD symptom improvement. None of the secondary outcomes (depression, anxiety, somatic symptoms, and functional status) showed statistically significant improvement; however, the treatment effect on depression approached significance (F(3, 186)=2.17, p=.093).
DESTRESS-PC shows promise as a means of delivering effective, early PTSD treatment in primary care. Larger trials are needed.
本随机对照试验探讨了与优化的常规初级保健创伤后应激障碍治疗（OUC）相比，护士辅助的在线认知行为自我管理干预对战争相关创伤后应激障碍（PTSD）的有效性，以减轻PTSD症状。
参与者为80名近期军事冲突退伍军人，经创伤后应激障碍检查表（PCL）评估患有PTSD，他们在三个退伍军人事务部（VA）和四个陆军诊所之一寻求初级保健治疗。DESTRESS-PC包括每周登录安全网站三次，持续6周，并由研究护士进行监测。所有参与者均接受护士护理管理，形式为每两周进行一次电话随访，并向其初级保健提供者反馈情况。在随机分组后6周、12周和18周，由盲法评估者评估结果。
与OUC相比，DESTRESS-PC与PTSD症状的显著更大程度减轻相关（F(3, 186)=3.72，p=.012）。在12周评估时效果最大（∆PCL=12.6±16.6对5.7±12.5，p<0.05），到18周随访时治疗效果消失。值得注意的是，存在剂量效应；登录次数与PTSD结果显著相关，登录次数越多，PTSD症状改善越大。所有次要结果（抑郁、焦虑、躯体症状和功能状态）均未显示出统计学上的显著改善；然而，对抑郁的治疗效果接近显著（F(3, 186)=2.17，p=.093）。
DESTRESS-PC有望成为在初级保健中提供有效、早期PTSD治疗的一种手段。需要进行更大规模的试验。
