Hobfoll Stevan E, Blais Rebecca K, Stevens Natalie R, Walt Lisa, Gengler Richard
Rush University Medical Center.
Prevail Health Solutions.
J Consult Clin Psychol. 2016 Jan;84(1):31-42. doi: 10.1037/ccp0000041. Epub 2015 Aug 31.
Despite heightened rates of depression and posttraumatic stress disorder (PTSD) among in Iraq/Afghanistan veterans, the majority of distressed veterans will not receive mental health care. Overcoming barriers to mental health services requires innovative approaches to broaden the reach of evidence-based treatment. The current study examined the efficacy and acceptability of an innovative and dynamic online cognitive-behavioral therapy intervention for PTSD and depression called Vets Prevail.
A randomized clinical trial conducted between 2011 and 2013 assessed changes in PTSD and depression in veterans with mild-to-moderate distress. Veterans randomized to Vets Prevail (n = 209) were aged 34.2 ± 7.6 years, mostly male (81.3%), and nonminority (73.7%). Veterans randomized to adjustment as usual (n = 94) were aged 34.7 ± 8.9, mostly male (81.9%), and White (67.0%). Veterans completed the PTSD Checklist-Military Version and the Center for Epidemiological Studies Depression scale (10-item version) postintervention and at 12-week follow-up.
Veterans in the Vets Prevail condition reported significantly greater reductions in PTSD, t(250) = 3.24, p = .001 (Mreduction = 5.51, SD = 9.63), and depression, t(252) = 4.37, p = .001 (Mreduction = 2.31, SD = 5.34), at 12-week follow-up compared with veterans in the adjustment as usual condition (PTSD Mreduction = 1.00, SD = 7.32; depression Mreduction = 0.48, SD = 4.95), with moderate effect sizes for PTSD (Cohen's d = 0.42) and depression (Cohen's d = 0.56). Exploratory analysis shows that Vets Prevail may be effective regardless of combat trauma exposure, gender, and ethnic minority status.
Vets Prevail circumvents many barriers to care and effectively addresses the dire mental health needs of veterans.
尽管伊拉克/阿富汗战争退伍军人中抑郁症和创伤后应激障碍（PTSD）的发病率有所上升，但大多数痛苦的退伍军人仍无法获得心理健康护理。克服心理健康服务的障碍需要创新方法来扩大循证治疗的覆盖范围。本研究考察了一种名为“退伍军人必胜”（Vets Prevail）的创新动态在线认知行为疗法对PTSD和抑郁症的疗效及可接受性。
2011年至2013年进行的一项随机临床试验评估了轻度至中度痛苦的退伍军人PTSD和抑郁症的变化。随机分配到“退伍军人必胜”组（n = 209）的退伍军人年龄为34.2±7.6岁，大多数为男性（81.3%），非少数族裔（73.7%）。随机分配到常规调整组（n = 94）的退伍军人年龄为34.7±8.9岁，大多数为男性（81.9%），白人（67.0%）。退伍军人在干预后及12周随访时完成了PTSD检查表-军事版和流行病学研究中心抑郁量表（10项版本）。
与常规调整组的退伍军人相比，“退伍军人必胜”组的退伍军人在12周随访时报告PTSD显著减少，t(250) = 3.24，p = .001（平均减少量Mreduction = 5.51，标准差SD = 9.63），抑郁症也显著减少，t(252) = 4.37，p = .001（平均减少量Mreduction = 2.31，标准差SD = 5.34），PTSD的效应量中等（科恩d = 0.42），抑郁症的效应量中等（科恩d = 0.56）。探索性分析表明，无论是否经历过战斗创伤、性别和少数族裔身份如何，“退伍军人必胜”可能都是有效的。
“退伍军人必胜”规避了许多护理障碍，并有效满足了退伍军人迫切的心理健康需求。
