Youn Soo-Jeong, Mackintosh Margaret-Anne, Wiltsey Stirman Shannon, Patrick Kaylie A, Aguilar Silvan Yesenia, Bartuska Anna D, Shtasel Derri L, Marques Luana
Deparment of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Gen Psychiatr. 2019 Dec 10;32(6):e100153. doi: 10.1136/gpsych-2019-100153. eCollection 2019.
Despite the availability of evidence-based treatments for posttraumatic stress disorder (PTSD), significant heterogeneity in the effectiveness of PTSD treatment persists, especially in community settings. Client demographics used to understand this variability in treatment outcome and dropout have yielded mixed results. Despite increasing evidence for the importance of attending to treatment engagement in community settings, few studies have explored client-level predictors.
The purpose of this study is to explore client-level predictors of treatment outcome and dropout beyond client demographics, and to identify client-level predictors of treatment engagement in community settings.
Secondary data analysis was conducted with data collected as part of an implementation-effectiveness hybrid study of cognitive processing therapy (CPT) for PTSD in a diverse community health centre. Providers (n=19) treated (n=52) clients as part of their routine clinical care. Non-demographic client-level predictors included barriers to treatment, quality of life, session-level language and employment history assessed at baseline. Treatment engagement included number of weeks in the study, number of sessions with repeated CPT content, number of unique CPT sessions attended, frequency of session attendance and consistency of session attendance.
Results showed language as a significant predictor of treatment engagement. There were significant differences between Spanish and English-speaking clients, with the former having a tendency to repeat more session content than the latter (β=1.4 sessions, =0.003), and also less likely to attend treatment frequently (=0.62, =0.009) and consistently ( 0.57, =0.027) if high logistical and financial barriers were endorsed. Irrespective of language, clients who reported high quality of life at baseline were less likely to repeat CPT session content (β=-0.3, =0.04), and those with increased baseline barriers to treatment had deceleration in PTSD symptom improvement over time (β=-0.62, <0.05). In terms of treatment engagement moderators impacting treatment outcome, clients who repeated more session content were more likely to complete treatment (OR=1.84, =0.037).
Identification of client-level predictors of treatment engagement, outcome and dropout is essential to optimise treatment, particularly in community settings.
尽管有针对创伤后应激障碍（PTSD）的循证治疗方法，但PTSD治疗效果仍存在显著异质性，尤其是在社区环境中。过去用于理解治疗结果和脱落情况差异的患者人口统计学特征得出了不一致的结果。尽管越来越多的证据表明关注社区环境中的治疗参与度很重要，但很少有研究探讨患者层面的预测因素。
本研究旨在探讨除患者人口统计学特征之外的患者层面治疗结果和脱落的预测因素，并确定社区环境中治疗参与度的患者层面预测因素。
对作为认知加工疗法（CPT）在不同社区健康中心治疗PTSD的实施-效果混合研究一部分收集的数据进行二次数据分析。提供者（n = 19）治疗了（n = 52）名患者作为其常规临床护理的一部分。非人口统计学的患者层面预测因素包括治疗障碍、生活质量、基线时评估的会话语言和就业史。治疗参与度包括研究中的周数、重复CPT内容的会话次数、参加的独特CPT会话次数、会话出席频率和会话出席一致性。
结果显示语言是治疗参与度的重要预测因素。说西班牙语和说英语的患者之间存在显著差异，前者比后者更倾向于重复更多会话内容（β = 1.4次会话，P = 0.003），并且如果认可存在高后勤和经济障碍，前者也不太可能频繁（P = 0.62，P = 0.009）和持续（P = 0.57，P = 0.027）参加治疗。无论语言如何，基线时报告生活质量高的患者不太可能重复CPT会话内容（β = -0.3，P = 0.04），并且基线时治疗障碍增加的患者随着时间推移PTSD症状改善减缓（β = -0.62，P < 0.05）。就影响治疗结果的治疗参与度调节因素而言，重复更多会话内容的患者更有可能完成治疗（OR = 1.84，P = 0.037）。
识别治疗参与度、结果和脱落的患者层面预测因素对于优化治疗至关重要，尤其是在社区环境中。
