Sripada Rebecca K, Bohnert Kipling M, Ganoczy Dara, Blow Frederic C, Valenstein Marcia, Pfeiffer Paul N
Veterans Affairs Center for Clinical Management Research.
Psychol Serv. 2016 Nov;13(4):349-355. doi: 10.1037/ser0000077. Epub 2016 May 12.
Accessibility of psychotherapy for individuals with posttraumatic stress disorder (PTSD) and retention in treatment are major concerns for the Veterans Health Administration (VA). Group therapy is a common method for improving access to psychotherapy; however, PTSD patients may prefer individual therapy. This study assessed whether initial treatment with individual versus group psychotherapy relates to subsequent psychotherapy adequacy among VA patients with PTSD. The sample consisted of all VA patients who received a new PTSD diagnosis during a subspecialty PTSD clinical team visit in fiscal year 2010. Logistic and negative binomial regression analyses examined the relationship between modality of the first psychotherapy encounter and subsequent number of psychotherapy encounters within 14 weeks. Among 35,144 VA patients who initiated treatment for PTSD, 38% initiated group therapy and 62% initiated individual therapy. Patients who initiated with group therapy received a greater mean number of psychotherapy visits than those who initiated with individual therapy (4.7 vs. 2.8), and were about twice as likely (29.5% vs. 14.2%) to receive a minimally effective dose of 8 or more psychotherapy encounters. Group therapy predicted a greater number of psychotherapy visits (β = 0.46, SE = .01, p < .001) and greater likelihood of 8 or more sessions of psychotherapy (OR = 2.31, 95% CI [2.19, 2.45], p < .001), after adjusting for differences in demographic characteristics, comorbid conditions, and other service use. Greater treatment adequacy among group therapy participants suggests that these patients have greater access to frequent psychotherapy sessions or are more likely to persist with psychotherapy for PTSD than those treated individually. (PsycINFO Database Record
创伤后应激障碍（PTSD）患者获得心理治疗的机会以及治疗的持续性是退伍军人健康管理局（VA）主要关注的问题。团体治疗是改善心理治疗可及性的常用方法；然而，PTSD患者可能更喜欢个体治疗。本研究评估了PTSD退伍军人患者最初接受个体心理治疗与团体心理治疗是否与后续心理治疗的充分性有关。样本包括在2010财年PTSD专科临床团队就诊期间首次被诊断为PTSD的所有VA患者。逻辑回归和负二项回归分析检验了首次心理治疗方式与14周内后续心理治疗次数之间的关系。在35144名开始接受PTSD治疗的VA患者中，38%开始接受团体治疗，62%开始接受个体治疗。开始接受团体治疗的患者平均接受心理治疗的次数比开始接受个体治疗的患者更多（4.7次对2.8次），接受至少8次心理治疗有效剂量的可能性约为后者的两倍（29.5%对14.2%）。在调整了人口统计学特征、共病情况和其他服务使用方面的差异后，团体治疗预测了更多的心理治疗次数（β = 0.46，标准误 = 0.01，p < 0.001）以及接受8次或更多次心理治疗的可能性更大（比值比 = 2.31，95%置信区间[2.19, 2.45]，p < 0.001）。团体治疗参与者的治疗充分性更高，这表明这些患者比接受个体治疗的患者有更多机会频繁接受心理治疗，或者更有可能坚持接受PTSD心理治疗。（PsycINFO数据库记录）
