Health Services Research and Development/Center for Clinical Management Research, Ann Arbor Veterans Affairs Hospital (152), Ann Arbor, Michigan.
Silver School of Social Work, New York University, New York.
JAMA Netw Open. 2023 Dec 1;6(12):e2349098. doi: 10.1001/jamanetworkopen.2023.49098.
Despite the availability of several empirically supported trauma-focused interventions, retention in posttraumatic stress disorder (PTSD) psychotherapy is poor. Preliminary efficacy data shows that brief, family-based interventions may improve treatment retention in a veteran's individual PTSD treatment, although whether this occurs in routine clinical practice is not established.
To characterize receipt of family therapy among veterans diagnosed with PTSD and evaluate whether participation in family therapy is associated with an increased likelihood of completing individual trauma-focused treatment.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used the Veterans Health Administration (VHA) Informatics and Computing Infrastructure to extract electronic health record data of participants. All participants were US veterans diagnosed with PTSD between October 1, 2015, and December 31, 2019, who attended at least 1 individual trauma-focused treatment session. Statistical analysis was performed from May to August 2023.
Receipt of any family psychotherapy and subtype of family-based psychotherapy.
Minimally adequate individual trauma-focused treatment completion (ie, 8 or more sessions of trauma-focused treatment in a 6-month period).
Among a total of 1 516 887 US veterans with VHA patient data included in the study, 58 653 (3.9%) received any family therapy; 334 645 (23.5%) were Black, 1 006 168 (70.5%) were White, and 86 176 (6.0%) were other race; 1 322 592 (87.2%) were male; 1 201 902 (79.9%) lived in urban areas; and the mean (SD) age at first individual psychotherapy appointment was 52.7 (15.9) years. Among the 58 653 veterans (3.9%) who received any family therapy, 36 913 (62.9%) received undefined family therapy only, 15 528 (26.5%) received trauma-informed cognitive-behavioral conjoint therapy (CBCT) only, 5210 (8.9%) received integrative behavioral couples therapy (IBCT) only, and 282 (0.5%) received behavioral family therapy (BFT) only. Compared with receiving no family therapy, the odds of completing individual PTSD treatment were 7% higher for veterans who also received CBCT (OR, 1.07 [95% CI, 1.01-1.13]) and 68% higher for veterans received undefined family therapy (OR, 1.68 [95% CI, 1.63-1.74]). However, compared with receiving no family therapy care, veterans had 26% lower odds of completing individual PTSD treatment if they were also receiving IBCT (OR, 0.74 [95% CI, 0.66-0.82]).
In this cohort study of US veterans, family-based psychotherapies were found to differ substantially in their associations with individual PTSD psychotherapy retention. These findings highlight potential benefits of concurrently providing family-based therapy with individual PTSD treatment but also the need for careful clinical attention to the balance between family-based therapies and individual PTSD treatment.
尽管有几种经验证有效的创伤焦点干预措施，但创伤后应激障碍（PTSD）心理治疗的保留率仍然很差。初步疗效数据表明，简短的、以家庭为基础的干预措施可能会提高退伍军人个体 PTSD 治疗的保留率，尽管这种情况是否在常规临床实践中发生尚不确定。
描述 PTSD 诊断的退伍军人接受家庭治疗的情况，并评估参与家庭治疗是否与增加完成个体创伤焦点治疗的可能性相关。
设计、地点和参与者：本回顾性队列研究使用退伍军人事务部（VA）信息学和计算基础设施提取参与者的电子健康记录数据。所有参与者均为 2015 年 10 月 1 日至 2019 年 12 月 31 日期间被诊断为 PTSD 的美国退伍军人，他们至少参加了 1 次个体创伤焦点治疗。统计分析于 2023 年 5 月至 8 月进行。
接受任何家庭心理治疗和家庭为基础的心理治疗亚类。
最低限度足够的个体创伤焦点治疗完成（即，在 6 个月内接受 8 次或更多次创伤焦点治疗）。
在包括在研究中的 1516887 名有 VA 患者数据的美国退伍军人中，58653 名（3.9%）接受了任何家庭治疗；334645 名（23.5%）为黑人，1006168 名（70.5%）为白人，86176 名（6.0%）为其他种族；1322592 名（87.2%）为男性；1201902 名（79.9%）居住在城市地区；首次个体心理治疗预约的平均（SD）年龄为 52.7（15.9）岁。在接受任何家庭治疗的 58653 名退伍军人（3.9%）中，36913 名（62.9%）仅接受了未定义的家庭治疗，15528 名（26.5%）仅接受了创伤知情认知行为联合治疗（CBCT），5210 名（8.9%）接受了综合行为夫妻治疗（IBCT），282 名（0.5%）接受了行为家庭治疗（BFT）。与未接受家庭治疗相比，同时接受 CBCT 的退伍军人完成个体 PTSD 治疗的可能性高 7%（OR，1.07[95%CI，1.01-1.13]），同时接受未定义家庭治疗的退伍军人完成个体 PTSD 治疗的可能性高 68%（OR，1.68[95%CI，1.63-1.74]）。然而，与未接受家庭治疗相比，同时接受 IBCT 的退伍军人完成个体 PTSD 治疗的可能性低 26%（OR，0.74[95%CI，0.66-0.82]）。
在这项对美国退伍军人的队列研究中，发现基于家庭的心理治疗与个体 PTSD 心理治疗保留率的关联有很大差异。这些发现强调了同时提供家庭为基础的治疗与个体 PTSD 治疗的潜在益处，但也需要谨慎关注家庭为基础的治疗和个体 PTSD 治疗之间的平衡。
