Somohano Vanessa C, Cameron David, Lewis Meaghan M, O'Neill Allison, Phillips Rachel, Kaplan Joshua, O'Neil Maya E
Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, United States.
Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States.
Front Psychiatry. 2024 Aug 16;15:1432361. doi: 10.3389/fpsyt.2024.1432361. eCollection 2024.
To compare initiation of PTSD evidence-based psychotherapy (EBP) between Veterans with and without a co-occurring substance use disorder (SUD), and identify factors associated with EBP initiation among Veterans with PTSD-SUD.
A national sample of Veterans with PTSD ( = 301,872) and PTSD-SUD ( = 94,515) were identified from VA Electronic Health Record data. Treatment initiation was defined as having at least one mental health encounter associated with Cognitive Processing Therapy or Prolonged Exposure therapy. Generalized estimating equations were used to compare EBP initiation between Veterans with and without co-occurring SUD, and to identify patient- and facility characteristics associated with EBP initiation among Veterans with PTSD-SUD.
The majority of Veterans were 30 - 44 years old, male sex, and Non-Hispanic White. No significant differences were observed in EBP initiation between Veterans with and without a co-occurring SUD (=1.00, =0.985). Among Veterans with PTSD-SUD, co-occurring bipolar disorder (=0.83, =.000), co-occurring psychotic disorder (=0.69, =.000), service connection (=0.94, =.001), female sex (=0.87, =.000), and being 60 years or older (=0.57, =.000) were associated with a reduced likelihood of initiating a PTSD EBP. Having a co-occurring anxiety disorder (=1.06, =.020), MST history (=1.95, =.000), and high risk for suicide (=1.15, =.000) were associated with an increased likelihood of initiating EBP.
These findings support VA provision of EBP for Veterans with PTSD regardless of the presence of co-occurring SUD. Identifying characteristics that increase or reduce the likelihood of EBP initiation may provide insight into treatment pathways and subgroups warranting augmented outreach.
比较患有和未患有共病物质使用障碍（SUD）的退伍军人中创伤后应激障碍循证心理治疗（EBP）的启动情况，并确定创伤后应激障碍-物质使用障碍退伍军人中与EBP启动相关的因素。
从退伍军人事务部电子健康记录数据中识别出患有创伤后应激障碍（n = 301,872）和创伤后应激障碍-物质使用障碍（n = 94,515）的全国退伍军人样本。治疗启动被定义为至少有一次与认知加工疗法或延长暴露疗法相关的心理健康诊疗。使用广义估计方程比较患有和未患有共病物质使用障碍的退伍军人中EBP的启动情况，并确定创伤后应激障碍-物质使用障碍退伍军人中与EBP启动相关的患者和机构特征。
大多数退伍军人年龄在30 - 44岁之间，为男性，且是非西班牙裔白人。患有和未患有共病物质使用障碍的退伍军人在EBP启动方面未观察到显著差异（RR = 1.00，p = 0.985）。在患有创伤后应激障碍-物质使用障碍的退伍军人中，共病双相情感障碍（RR = 0.83，p = .000）、共病精神障碍（RR = 0.69，p = .000）、服役关联（RR = 0.94，p = .001）、女性（RR = 0.87，p = .000）以及60岁及以上（RR = 0.57，p = .000）与启动创伤后应激障碍EBP的可能性降低相关。共病焦虑障碍（RR = 1.06，p = .020）、军事性创伤史（RR = 1.95，p = .000）以及自杀高风险（RR = 1.15，p = .000）与启动EBP的可能性增加相关。
这些发现支持退伍军人事务部为患有创伤后应激障碍的退伍军人提供EBP，无论其是否存在共病物质使用障碍。确定增加或降低EBP启动可能性的特征可能有助于深入了解治疗途径以及需要加强外展服务的亚组。
