Treatment Efficacy for Veterans With Posttraumatic Stress Disorder: Latent Class Trajectories of Treatment Response and Their Predictors
Treatment Efficacy for Veterans With Posttraumatic Stress Disorder: Latent Class Trajectories of Treatment Response and Their Predictors
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DOI：
10.1002/jts.22333
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发表时间：
2018-10-01
影响因子：
3.3
通讯作者：
Smith, Kirsten V.
中科院分区：
文献类型：
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作者：
Murphy, Dominic;Smith, Kirsten V.
结果表明，患有创伤后应激障碍(PTSD)的退伍军人比非退伍军人的治疗反应更差。在这项研究中，我们探索了960名患有创伤后应激障碍的英国退伍军人的治疗反应的异质性，这些退伍军人接受了由小组会议和以个人创伤为重点的认知行为治疗(TF-CBT)组成的混合住宅干预。主要结果为创伤后应激障碍事件影响量表修订版(IES-R)评分。协变量包括抑郁、焦虑、愤怒、酗酒、功能障碍和社会人口学特征。在治疗后的固定时间点进行为期12个月的随访。我们提出了创伤后应激障碍严重程度的预测指标，并通过潜在类别增长分析获得了随访，以确定不同的治疗轨迹。使用多项Logistic回归模型识别预测类成员资格的协变量，确定了5个类。在参与者中，71.3%的人属于治疗反应积极的三个类别，1.2%的人最初有改善，但后来复发。此外，27.5%的参与者被确定为耐药类别，其症状严重程度几乎没有变化。抑郁、焦虑和在服兵役期间担任过战斗角色增加了成为耐药类别成员的可能性，优势比(OR)分别为1.12-1.53、1.16-1.32和2.89。此外，耐受治疗班的参与者在治疗前的创伤后应激障碍再体验、回避和高度觉醒症状方面的得分较高，OR分别为5.24、2.62和3.86。研究结果表明，对个体进行分类并提供根据病情严重程度量身定制的干预措施非常重要。
Resumen Evidence suggests that veterans with posttraumatic stress disorder (PTSD) have a poorer treatment response than nonveterans. In this study, we explored heterogeneity in treatment response for 960 veterans in the United Kingdom with PTSD who had been offered a residential intervention consisting of a mixture of group sessions and individual trauma-focused cognitive behavioral therapy (TF-CBT). The primary outcome was PTSD score on the Impact of Event Scale-Revised (IES-R). Covariates included depression, anxiety, anger, alcohol misuse, functional impairment, and sociodemographic characteristics. Follow-up occurred posttreatment at set time points for 12 months. We present predictors of PTSD severity at posttreatment and follow-up obtained using a latent class growth analysis to identify different treatment trajectories. Multinomial logistic regression models were used to identify covariates predicting class membership, and five classes were identified. Of participants, 71.3% belonged to three classes showing positive treatment responses, and 1.2% showed initial improvement but later relapsed. Additionally, 27.5% of participants were identified within a treatment-resistant class that showed little change in severity of presentation. Depression, anxiety, and having had a combat role during military service increased the likelihood of membership in the treatment-resistant class, odds ratios (ORs) = 1.12-1.53, 1.16-1.32, and 2.89, respectively. Additionally, participants in the treatment-resistant class had higher pretreatment PTSD scores for reexperiencing, avoidance, and hyperarousal symptoms, ORs = 5.24, 2.62, and 3.86, respectively. Findings suggest the importance of triaging individuals and offeringinterventions tailored to severity of presentation.