Department of Psychiatry, Amsterdam University Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
Sinai Center, Amstelveen, The Netherlands.
Clin Psychol Psychother. 2023 Nov-Dec;30(6):1338-1348. doi: 10.1002/cpp.2933. Epub 2023 Nov 20.
To test the hypothesis that self-rated personality disorder (PD) symptoms are a significant and clinically relevant predictor of treatment outcomes in a naturalistic treatment setting specialized in trauma-focused treatment using a single-group pretest-posttest design.
Treatment-seeking patients reporting clinical levels of posttraumatic stress disorder (PTSD) symptoms filled out questionnaires at intake and after treatment. The primary outcome was change in PTSD severity after treatment, measured by the PTSD Checklist for DSM-5 (PCL-5). PD symptoms were measured with the Structured Clinical Interview for DSM-5 Screening Personality Questionnaire (SCID-5-SPQ). Secondary outcomes were general mental health problems, treatment response, number of sessions and dropout.
N = 1174 patients (59% female, baseline PCL-5 score M [SD] = 53.0 [10.8]) were included for the primary analysis. Regression analysis revealed that PD symptoms explained 0.4% of variance in PTSD symptom change (p = .066). After controlling for baseline PTSD symptoms, PD symptoms explained 0.0% of variance (p = .311). The fully adjusted model including baseline PTSD symptom severity, age, gender, cumulative exposure to potentially traumatic experiences, PD symptoms, and number of sessions together explained 5% of the observed variance in PTSD symptom change. Baseline PTSD severity was the only significant predictor and negatively predicted outcome. Sensitivity analyses with imputed data from N = 2694 cases yielded comparable results. Finally, secondary analyses showed that PD symptoms did not predict significant or clinically relevant changes in treatment response status, general mental health problems, dropout rates or number of sessions.
The findings provide no evidence that self-rated PD symptoms predict treatment outcomes for patients suffering from clinical levels of PTSD symptoms in a naturalistic treatment setting specializing in trauma-focused treatment. Self-report screening for these symptoms to inform clinicians about expected effects of PTSD treatment is not supported by the evidence.
采用单组前后测设计，检验以下假设，即自评人格障碍（PD）症状是创伤聚焦治疗自然治疗环境中治疗结果的一个重要且具有临床意义的预测因素。
报告临床水平创伤后应激障碍（PTSD）症状的治疗寻求者在入组时和治疗后填写问卷。主要结局是治疗后 PTSD 严重程度的变化，用 PTSD 检查表第五版（PCL-5）测量。PD 症状用 DSM-5 筛选人格问卷结构临床访谈（SCID-5-SPQ）测量。次要结局是一般心理健康问题、治疗反应、治疗次数和脱落率。
共纳入 1174 名患者（59%为女性，基线 PCL-5 得分的均数[标准差]为 53.0[10.8]）进行主要分析。回归分析显示，PD 症状对 PTSD 症状变化的解释方差为 0.4%（p=0.066）。在控制基线 PTSD 症状后，PD 症状解释的方差为 0.0%（p=0.311）。包括基线 PTSD 症状严重程度、年龄、性别、潜在创伤性经历的累积暴露、PD 症状和治疗次数在内的完全调整模型共同解释了 PTSD 症状变化的 5%。基线 PTSD 严重程度是唯一显著的预测因素，且呈负相关。用 2694 例病例的缺失数据进行敏感性分析得出了类似的结果。最后，二级分析显示，PD 症状不能预测治疗反应状态、一般心理健康问题、脱落率或治疗次数的显著或临床相关变化。
这些发现表明，在专门从事创伤聚焦治疗的自然治疗环境中，自评 PD 症状不能预测患有临床水平 PTSD 症状患者的治疗结果。自评这些症状以告知临床医生 PTSD 治疗的预期效果的方法，并没有得到证据的支持。
