Improving function through primary care treatment of posttraumatic stress disorder study outcomes: A randomized controlled trial of prolonged exposure for primary care in veterans.
Improving function through primary care treatment of posttraumatic stress disorder study outcomes: A randomized controlled trial of prolonged exposure for primary care in veterans.
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通过创伤后应激障碍的初级保健治疗改善功能研究结果：一项针对退伍军人长期接受初级保健的随机对照试验。
DOI：
10.1037/fsh0000823
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Zivin,Kara
中科院分区：
文献类型：
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作者：
Rauch,SheilaAM;Kim,HMyra;Acierno,Ron;Ragin,Carly;Wangelin,Bethany;Blitch,Kimberly;Muzzy,Wendy;Hart,Stephanie;Zivin,Kara
前言尽管创伤后应激障碍(PTSD)在退伍军人中的高成本和广泛流行，以及退伍军人健康管理局(VA)范围内的精神卫生提供者对创伤后应激障碍的循证治疗进行培训，但大多数患有创伤后应激障碍的退伍军人没有接受最佳实践干预。这可能是因为几乎所有基于证据的创伤后应激障碍治疗都是通过专科诊所提供的，需要多个步骤和转诊才能获得。一种解决方案是在退伍军人的初级保健环境中提供创伤后应激障碍治疗，这通常是退伍军人的第一个也是唯一的接触点。方法本研究通过创伤后应激障碍的初级保健治疗改善功能(IMPACT)，采用随机对照设计，比较长期暴露于初级保健的创伤后应激障碍(PE-PC)与初级保健精神卫生综合治疗(PCMHI)常规临床治疗(TAU)的最佳实践在功能和心理症状方面的差异(TAU)。超过一半的人是非白人退伍军人(50.8%)。这两种情况在功能、创伤后应激障碍和抑郁指标上都比基线有了显著的改善，组间没有观察到差异。在先前的研究中观察到，根据结构化的临床访谈，两种情况下的PTSD症状都随着时间的推移而继续改善。讨论PE-PC和最佳实践TAU在改善功能和降低PTSD严重程度和抑郁严重程度方面都是有效的。尽管我们没有观察到这两种疗法之间的差异，但请注意，该研究网站和两家PCMHI诊所主要采用认知行为疗法(例如，暴露和行为激活)。
IntroductionDespite high cost and wide prevalence of posttraumatic stress disorder (PTSD) in veteran populations, and Veterans Health Administration (VA)-wide mental health provider training in evidence-based treatments for PTSD, most veterans with PTSD do not receive best practices interventions. This may be because virtually all evidence-based PTSD treatment is offered through specialty clinics, which require multiple steps and referrals to access. One solution is to offer PTSD treatment in VA primary care settings, which are often the first and only contact point for veterans.MethodThe present study, Improving Function Through Primary Care Treatment of PTSD (IMPACT), used a randomized controlled design to compare an adaptation of prolonged exposure for PTSD to primary care (PE-PC) versus best practices Primary Care Mental Health Integration (PCMHI) clinic treatment as usual (TAU) in terms of both functioning and psychological symptoms in 120 veterans recruited between April 2019 and September 2021.ResultsParticipants were mostly males (81.7%) with a mean age of 43.6 years (SD= 12.8), and more than half were non-White veterans (50.8%). Both conditions evinced significant improvement over baseline across functioning, PTSD, and depression measures, with no differences observed between groups. As observed in prior studies, PTSD symptoms continued to improve over time in both conditions, as measured by structured clinical interview.DiscussionBoth PE-PC and best-practices TAU are effective in improving function and reducing PTSD severity and depression severity. Although we did not observe differences between the two treatments, note that this study site and two PCMHI clinics employ primarily cognitive behavioral therapies (eg, exposure and behavioral activation).(PsycInfo Database Record (c) 2024 APA, all rights reserved)