Factors associated with PTSD symptom improvement among Iraq and Afghanistan veterans receiving evidenced-based psychotherapy

• Published in: Journal of affective disorders Vol. 273; pp. 1 - 7
• Main Authors: Maguen, Shira, Holder, Nicholas, Li, Yongmei, Madden, Erin, Neylan, Thomas C., Seal, Karen H., Lujan, Callan, Patterson, Olga V., DuVall, Scott L., Shiner, Brian
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.08.2020
• Subjects: Afghan Campaign 2001; Afghanistan; Female; Humans; Iraq; Iraq War, 2003-2011; Psychotherapy; Stress Disorders, Post-Traumatic - therapy; United States; United States Department of Veterans Affairs; Veterans; United States; Afghanistan; Iraq
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2020.04.039

•We identified a cohort receiving evidence-based psychotherapy (EBP) over 14 years.•Improvements in PTSD following EBP were associated with timing, dose and modality.•Modifiable factors like timing and modality can be used to improve EBP outcomes. Despite availability of evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD), not all veterans who initiate EBPs experience benefit. Better understanding factors associated with clinically significant improvement can help ameliorate care. A cohort of Iraq and Afghanistan War veterans who initiated an EBP was identified (N = 32,780) with ≥1 post-deployment psychotherapy visit at the Veterans Health Administration from 10/2001-6/2017, a post-deployment PTSD diagnosis, and ≥2 PTSD symptom measures. We used random-effects logistic regression to assess whether patient-level, diagnostic, and treatment factors were associated with achieving symptom improvement. Increased odds of PTSD symptom improvement were seen in women (OR = 1.19; 95% CI: 1.09--1.29), those who initiated EBP within a year of engaging in mental healthcare compared with the delayed EBP group (OR = 1.20; 95% CI: 1.14--1.28), those who completed at least 8 EBP sessions in 16 weeks (OR = 1.23; 95% CI:1.11--1.36), those who received PE only (vs. CPT or both; OR = 2.23; 95% CI: 1.86--2.68) or CPT individual therapy only (vs. CPT group or both; OR = 1.34; 95% CI: 1.22--1.48), and those with a drug dependence diagnosis (OR = 1.24; 95% CI: 1.11--1.39). Decreased odds of improvement were seen in Black veterans (OR=0.75; 95% CI: 0.69--0.81) and those with service-connected disability (OR = 0.61; 95% CI: 0.52--0.71). Diagnoses were from medical charts and not confirmed with gold standard assessment tools; we only included veterans with at least two PTSD measurements, which may cause bias. Modifiable factors associated with PTSD improvement (timing, dose, and modality) can be used to improve EBP outcomes.