Levis Maxwell, Dimambro Monica, Levy Joshua, Platt Henry, Fraade Abby, Shiner Brian
Mental Health, VAMC White River Junction, White River Junction, Vermont, USA.
Department of Psychiatry, Geisel School of Medicine, Hanover, New Hampshire, USA.
Clin Psychol Psychother. 2025 Jan-Feb;32(1):e70041. doi: 10.1002/cpp.70041.
Posttraumatic stress disorder (PTSD) is a prevalent psychiatric condition, particularly among US Veterans. PTSD-diagnosed patients are more likely to experience suicidal ideation, suicide attempts and death by suicide when compared to non-PTSD-diagnosed patients. The US Department of Veterans Affairs (VA) emphasizes evidence-based psychotherapy (EBP) for PTSD, including prolonged exposure and cognitive processing therapy. This study focuses on how suicide risk impacts PTSD by evaluating utilization of nondifferentiated psychotherapy and EBP in a national sample of VA patients diagnosed with PTSD who died by suicide in 2017-2018. The study used a dataset of VA patients diagnosed with PTSD who died by suicide and received psychotherapy in the year before death (cases) and patients who had comparable diagnoses, demographics and received psychotherapy during the same interval and remained alive (controls). Cases and controls were matched on suicide risk (high, moderate and low). The study tracked nondifferentiated psychotherapy and EBP and analyzed cases and control utilization rates across risk-tiers. The final sample included high-risk (cases = 171; controls = 2052), moderate-risk (cases = 428; controls = 4280) and low-risk (cases = 53; controls = 529) patients. EBP utilization was markedly low, especially among cases. Higher proportions of moderate- and low-risk controls received EBP and received more sessions than matched cases. Even with VA efforts to promote EBPs, usage remains limited, particularly among patients who die by suicide. Further research is needed to understand utilization barriers and improve EBP delivery to better support PTSD-diagnosed patients and reduce their suicide risk.
创伤后应激障碍（PTSD）是一种常见的精神疾病，在美国退伍军人中尤为普遍。与未被诊断为PTSD的患者相比，被诊断为PTSD的患者更有可能出现自杀意念、自杀未遂和自杀死亡。美国退伍军人事务部（VA）强调针对PTSD的循证心理治疗（EBP），包括延长暴露疗法和认知加工疗法。本研究通过评估2017 - 2018年在VA诊断为PTSD并自杀死亡的患者全国样本中未分化心理治疗和EBP的使用情况，重点关注自杀风险如何影响PTSD。该研究使用了一个数据集，其中包括在VA被诊断为PTSD并在死前一年接受心理治疗后自杀死亡的患者（病例），以及具有可比诊断、人口统计学特征且在同一时间段接受心理治疗并存活的患者（对照）。病例和对照在自杀风险（高、中、低）方面进行了匹配。该研究跟踪了未分化心理治疗和EBP，并分析了不同风险等级的病例和对照使用率。最终样本包括高风险（病例 = 171；对照 = 2052）、中度风险（病例 = 428；对照 = 4280）和低风险（病例 = 53；对照 = 529）患者。EBP的使用率明显较低，尤其是在病例中。中低风险对照接受EBP的比例更高，且接受的疗程比匹配的病例更多。即使VA努力推广EBP，但使用仍然有限，特别是在自杀死亡的患者中。需要进一步研究以了解使用障碍并改善EBP的提供，以更好地支持被诊断为PTSD的患者并降低他们的自杀风险。
