Posttraumatic Stress Disorder in US Military Primary Care: Trajectories and Predictors of One-Year Prognosis

被引:10
作者
Bray, Robert M. [1 ]
Engel, Charles C. [2 ]
Williams, Jason [1 ]
Jaycox, Lisa H. [2 ]
Lane, Marian E. [1 ]
Morgan, Jessica K. [1 ]
Unuetzer, Juergen [3 ]
机构
[1] RTI Int, Behav Hlth & Criminal Justice Div, 3040 Cornwallis Rd, Res Triangle Pk, NC 27709 USA
[2] RAND Corp, Behav & Policy Sci, Arlington, VA USA
[3] Univ Washington, Sch Med, Dept Psychiat & Behav Sci, Seattle, WA 98195 USA
关键词
MENTAL-HEALTH PROBLEMS; TRAUMA SYMPTOMS; FEMALE VETERANS; PTSD; DEPRESSION; SOLDIERS; RESILIENCE; SEVERITY; COMBAT; COMORBIDITY;
D O I
10.1002/jts.22119
中图分类号
B849 [应用心理学];
学科分类号
040203 ;
摘要
We examined the longitudinal course of primary care patients in the active duty Army with posttraumatic stress disorder (PTSD) and identified prognostic indicators of PTSD severity. Data were drawn from a 6-site randomized trial of collaborative primary care for PTSD and dpression in the military. Subjects were 474 soldiers with PTSD (scores 50 on the PTSD Checklist -Civilian Version). Four assessments were completed at U.S. Army installations: baseline, and follow-ups at 3 months (92.8% response rate [RR]), 6 months (90.1% RR), and 12 months (87.1% RR). Combat exposure and 7 validated indicators of baseline clinical status (alcohol misuse, depression, pain, somatic symptoms, low mental health functioning, low physical health functioning, mild traumatic brain injury) were used to predict PTSD symptom severity on the Posttraumatic Diagnostic Scale (Cronbach's = .87, .92, .95, .95, at assessments 1-4, respectively). Growth mixture modeling identified 2 PTSD symptom trajectories: subjects reporting persistent symptoms (Persisters, 81.9%, n = 388), and subjects reporting improved symptoms (Improvers 18.1%, n = 86). Logistic regression modeling examined baseline predictors of symptom trajectories, adjusting for demographics, installation, and treatment condition. Subjects who reported moderate combat exposure, adjusted odds ratio (OR) = 0.44, 95% CI [0.20, 0.98], or who reported high exposure, OR = 0.39, 95% CI [0.17, 0.87], were less likely to be Improvers. Other baseline clinical problems were not related to symptom trajectories. Findings suggested that most military primary care patients with PTSD experience persistent symptoms, highlighting the importance of improving the effectiveness of their care. Most indicators of clinical status offered little prognostic information beyond the brief assessment of combat exposure. Resumen Trayectorias de TEPT y Predictores Pronosticos Evaluamos el curso longitudinal en la atencion primaria de pacientes con Trastorno por Estres Postraumatico (TEPT) activos en el ejercito e identificamos indicadores pronosticos de severidad de TEPT. La informacion se recolecto de un estudio randomizado de 6 lugares de atencion primaria para TEPT/Depresion en el Ejercito. Los sujetos fueron 474 soldados con TEPT (puntajes 50 en PTSD Checklist version civil). Cuatro evaluaciones se realizaron en instalaciones del Ejercito de Estados Unidos: en la linea de base, con seguimientos a 3 meses (92.8% tasa de respuesta [RR]), 6 meses (90.1% RR), y 12 meses (87.1% RR). La exposicion al combate y 7 indicadores validados del estado clinico en la linea de base (abuso de alcohol, depresion, dolor, sintomas somaticos, funcionamiento de salud mental bajo, funcionamiento de salud fisica bajo, lesion cerebral traumatica leve) se utilizaron para predecir la severidad de sintomas TEPT en la Escala Diagnostica Postraumatica (Cronbach's : .87, .92, .95, .95 en evaluaciones 1-4, respectivamente). El modelo de crecimiento de mezcla identifico dos trayectorias de sintomas de TEPT: sujetos que reportaron sintomas persistentes (Persistidores, 81.9%, n:388), y sujetos que reportaron mejoria de los sintomas (Mejoradores 18.1%, n: 86). Modelos de regresion logistico evaluaron predictores de la trayectoria de sintomas en la linea de base, controlando aspectos demograficos, implementacion y condicion del tratamiento. Los sujetos que reportaron exposicion al combate moderado (OR ajustado: 0.44, 95% CI: [0.20, 0.98]) o mas alto (OR: 0.39, 95% CI: [0.17, 0.87]) tuvieron menos probabilidades de ser Mejoradores. Otros problemas clinicos en la linea de base no se relacionaron a trayectorias de sintomas. Los hallazgos sugieren que la mayoria de los pacientes de atencion primaria en el ejercito con TEPT experimentan sintomas persistentes, resaltando la importancia de mejorar la efectividad de su cuidado. La mayoria de los indicadores de estado clinico ofrecieron informacion pronostica escasa mas alla de la evaluacion breve de exposicion a combate.
引用
收藏
页码:340 / 348
页数:9
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