PTSD Treatment: Effects on Health Behavior, Cardiovascular and Metabolic Disease

PTSD 治疗：对健康行为、心血管和代谢疾病的影响

• 批准号: 9265123
• 负责人: Jeffrey F. Scherrer
• 金额: $ 69.12万
• 依托单位: SAINT LOUIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-05-01 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9265123
• 关键词: Adoption; Affect; Afghanistan; Age; Alcohol abuse; Alcohols; American; Arteriosclerosis; Behavior; Behavior Therapy; Body Weight decreased; Cardiovascular Diagnostic Techniques; Cardiovascular Diseases; Characteristics; Clinic; Clinical Practice Guideline; Comorbidity; Cox Proportional Hazards Models; Data; Data Sources; Databases; Diagnosis; Disease remission; Drug abuse; Drug usage; Dyslipidemias; Enrollment; Evidence based treatment; Health; Health Promotion; Health behavior; Health behavior change; Healthcare; Heavy Drinking; Hypertension; Incidence; Individual; Iraq; Life; Link; Measures; Medical; Medical Records; Mental Health; Mental disorders; Metabolic; Metabolic Diseases; Modeling; Modification; Morbidity - disease rate; Myocardial Infarction; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Pathway interactions; Patient Monitoring; Patient Self-Report; Patients; Persons; Population; Post-Traumatic Stress Disorders; Prevention strategy; Preventive care; Private Sector; Probability; Psychiatric Diagnosis; Records; Recovery; Research; Resources; Retrospective cohort; Risk; Risk Factors; Site; Smoke; Smoking; Source; Stress; Symptoms; Testing; Time; Training; United States; United States Department of Veterans Affairs; Veterans; Weight; Weight maintenance regimen; Woman; cardiovascular disorder risk; cardiovascular risk factor; clinically relevant; cohort; cost efficient; demographics; design; disease diagnosis; disorder risk; evidence base; experience; improved; medication compliance; men; mortality; nutrition; physical inactivity; predictive modeling; premature; programs; public health relevance; reduce symptoms; sedentary lifestyle; smoking cessation; symptom treatment; treatment effect; treatment program; unhealthy lifestyle

 DESCRIPTION (provided by applicant): The objective of this study is to determine if evidence based treatment (EBT) for posttraumatic stress disorder (PTSD) leads to reduced risk of cardiovascular and metabolic disease (CMD) through adoption of healthy behaviors. PTSD affects approximately 7.7 million of Americans each year and is the 4th most common psychiatric disorder in the United States. One reason persons with PTSD develop CMD is poor health behaviors such as smoking, excessive drinking and sedentary lifestyle. Many patients will suffer premature morbidity and mortality unless we identify the mechanisms that mitigate the link between PTSD, poor health behavior and CMD. This 4-year R01 uses a cost efficient approach to investigate these issues by leveraging real-world clinic data from 4 sites in the Veterans Administration in which EBT is delivered with high fidelity, paired with repeat assessment of PTSD symptoms and merged with comprehensive medical records. We are not aware of similar multi-site sources of real world EBT clinic data in the private sector. EBT treatment data will be abstracted and merged with national medical record files resulting in a unique data base of 5,940 patients who engaged in EBT with about 40% completing treatment and 5,940 controls without PTSD. These data will allow us to determine, in Aim 1, if patients with PTSD, compared to controls, are less likely to engage in healthy behavior. In Aim 2, we determine if PTSD symptom reduction is associated with improved health behavior such as medication adherence, weight management and preventive care. In Aim 3 we determine if health behaviors moderate the contribution of PTSD symptom reduction to the risk of diagnosed CMD. In aim 4 we determine if a diagnosis of PTSD remains a risk factor for CMD even in patients who have symptom remission and improved health behavior. Last, in Aim 5, we derive a parsimonious predictive model of PTSD and incident CMD. Using propensity scores and inverse probability of treatment weighting, results from Cox proportional hazard models will disentangle the patient level factors, e.g. orientation toward health, associated with seeking and completing treatment from symptom reduction. This allows determining the independent contribution of PTSD symptom reduction and health behaviors. We believe the findings from our study will have important implications for clinical practice, guideline modifications, and the allocation of healthcare resources for all people with PTSD. If health behavior improves via PTSD symptom reduction, then clinicians should be trained to encourage health promotion during EBT. If patients remain at risk for CMD despite improved mental health and improved health behaviors, then life-long intensive monitoring of patients with PTSD is warranted to detect early signs of CMD.

 描述（由申请人提供）：本研究的目的是确定创伤后应激障碍（PTSD）的循证治疗（EBT）是否可以通过采取健康的行为来降低心血管和代谢疾病（CMD）的风险。创伤后应激障碍 (PTSD) 每年影响约 770 万美国人，是美国第四大常见精神疾病。患有创伤后应激障碍 (PTSD) 的人患上 CMD 的原因之一是不良的健康行为，如吸烟、过量饮酒和久坐的生活方式。除非我们找到减轻 PTSD、不良健康行为和 CMD 之间联系的机制，否则许多患者将过早发病和死亡。这项为期 4 年的 R01 采用经济高效的方法来调查这些问题，利用来自退伍军人管理局 4 个站点的真实临床数据，其中以高保真度提供 EBT，配合对 PTSD 症状的重复评估，并与全面的医疗记录合并。我们不知道私营部门是否有类似的真实世界 EBT 诊所数据的多站点来源。 EBT 治疗数据将被提取并与国家医疗记录文件合并，形成一个包含 5,940 名接受 EBT 的患者的独特数据库，其中约 40% 完成治疗，以及 5,940 名没有 PTSD 的对照患者。在目标 1 中，这些数据将使我们能够确定，与对照组相比，PTSD 患者是否不太可能采取健康行为。在目标 2 中，我们确定 PTSD 症状的减轻是否与健康行为的改善相关，例如药物依从性、体重管理和预防性护理。在目标 3 中，我们确定健康行为是否会调节 PTSD 症状减少对诊断 CMD 风险的影响。在目标 4 中，我们确定即使在症状缓解且健康行为改善的患者中，PTSD 的诊断是否仍然是 CMD 的危险因素。最后，在目标 5 中，我们推导出 PTSD 和事件 CMD 的简约预测模型。使用倾向评分和治疗权重的逆概率，Cox 比例风险模型的结果将理清患者水平因素，例如健康导向，与寻求并完成减轻症状的治疗有关。这可以确定 PTSD 症状减轻和健康行为的独立贡献。我们相信，我们的研究结果将对临床实践、指南修改以及所有 PTSD 患者的医疗资源分配产生重要影响。如果通过减少 PTSD 症状来改善健康行为，那么临床医生应该接受培训，鼓励在 EBT 期间促进健康。如果患者尽管心理健康和健康行为有所改善，但仍面临 CMD 风险，那么有必要对 PTSD 患者进行终生强化监测，以发现 CMD 的早期症状。