在退伍军人健康管理局中，对伊拉克和阿富汗战争老兵创伤后应激障碍的证据为基础的心理疗法的启动时机。
Timing of evidence-based psychotherapy for posttraumatic stress disorder initiation among Iraq and Afghanistan war veterans in the Veterans Health Administration.
机构信息
Mental Health Service.
National Center for PTSD.
出版信息
Psychol Trauma. 2020 Mar;12(3):260-271. doi: 10.1037/tra0000496. Epub 2019 Jul 25.
OBJECTIVE
Cognitive processing therapy (CPT) and prolonged exposure therapy (PE) were widely disseminated to treat posttraumatic stress disorder (PTSD) in the Veterans Health Administration (VHA). However, few Iraq and Afghanistan war veterans (Operation Enduring Freedom [OEF], Operation Iraqi Freedom [OIF], Operation New Dawn [OND]) diagnosed with PTSD have received CPT/PE and many initiate CPT/PE after substantial delay. Veterans who do not initiate CPT/PE or initiate CPT/PE after delay may have poorer treatment outcomes. This study aimed to identify predictors of CPT/PE initiation and timing.
METHODS
Participants included OEF/OIF/OND veterans diagnosed with PTSD who received psychotherapy between 2001 and 2017 in the VHA ( = 265,566). Logistic regression analysis was utilized to predict initiating CPT/PE (vs. no CPT/PE). Multinomial logistic regression analysis was utilized to predict not initiating or initiating delayed CPT/PE versus "early CPT/PE" (< 1 year after first mental health visit). Analyzed predictors included demographic, military, and clinical complexity variables (e.g., comorbidities, reported military sexual trauma [MST] history).
RESULTS
Seventy-Seven percent of veterans did not initiate CPT/PE, with 7.4% initiating early and 15.4% initiating delayed CPT/PE. Reported MST history (odds ratio [OR] = 1.45, 95% CI [1.39, 1.51]) and history of suicidal ideation/attempt (OR = 1.42, 95% CI [1.38, 1.46]) were strong predictors of CPT/PE initiation versus no CPT/PE. Comorbid pain (relative risk ratio [RRR] = 1.35, 95% CI [1.30, 1.42]) and depressive disorders (RRR = 1.37, 95% CI [1.32, 1.43]) were associated with increased likelihood of delayed versus early CPT/PE.
CONCLUSIONS
Most veterans in our study did not initiate CPT/PE. Generally, clinical complexity variables increased likelihood of initiating CPT/PE and initiating CPT/PE more than 1 year after first mental health visit. Additional research is needed to understand whether CPT/PE delay results from receipt of alternative intervention due to clinical complexity variables. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
目的
认知加工疗法（CPT）和延长暴露疗法（PE）在退伍军人事务部（VA）中被广泛用于治疗创伤后应激障碍（PTSD）。然而，很少有被诊断患有 PTSD 的伊拉克和阿富汗战争老兵（持久自由行动[OEF]、伊拉克自由行动[OIF]、新黎明行动[OND]）接受过 CPT/PE，许多人在延迟后才开始接受 CPT/PE。没有开始 CPT/PE 或延迟开始 CPT/PE 的退伍军人可能治疗效果较差。本研究旨在确定开始 CPT/PE 治疗的预测因素和时机。
方法
参与者包括 2001 年至 2017 年期间在 VA 接受过心理治疗的被诊断患有 PTSD 的 OEF/OIF/OND 退伍军人（n=265566）。使用逻辑回归分析预测开始 CPT/PE（与未开始 CPT/PE 相比）。使用多项逻辑回归分析预测未开始或延迟开始 CPT/PE 与“早期 CPT/PE”（首次心理健康就诊后<1 年）。分析的预测因素包括人口统计学、军事和临床复杂性变量（例如，合并症、报告的军事性创伤史[MST]）。
结果
77%的退伍军人没有开始 CPT/PE，其中 7.4%的退伍军人开始的时间较早，15.4%的退伍军人开始的时间较晚。报告的 MST 病史（优势比[OR] = 1.45，95%CI [1.39, 1.51]）和自杀意念/尝试史（OR = 1.42，95%CI [1.38, 1.46]）是开始 CPT/PE 治疗而非未开始 CPT/PE 治疗的强预测因素。合并疼痛（相对风险比[RRR] = 1.35，95%CI [1.30, 1.42]）和抑郁障碍（RRR = 1.37，95%CI [1.32, 1.43]）与延迟开始 CPT/PE 的可能性增加相关。
结论
我们研究中的大多数退伍军人都没有开始 CPT/PE。一般来说，临床复杂性变量增加了开始 CPT/PE 的可能性，并增加了首次心理健康就诊后 1 年以上开始 CPT/PE 的可能性。需要进一步研究以了解 CPT/PE 延迟是否是由于临床复杂性变量而导致接受替代干预。
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