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

 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）是否通过采取健康行为降低心血管和代谢疾病（CMD）的风险。PTSD每年影响大约770万美国人，是美国第四大最常见的精神疾病。PTSD患者患CMD的原因之一是不良的健康行为，如吸烟，过度饮酒和久坐不动的生活方式。许多患者将遭受过早的发病率和死亡率，除非我们确定的机制，减轻创伤后应激障碍，不良的健康行为和CMD之间的联系。这个为期4年的R01使用具有成本效益的方法来调查这些问题，方法是利用退伍军人管理局4个站点的真实临床数据，其中EBT以高保真度提供，与PTSD症状的重复评估配对，并与全面的医疗记录合并。我们不知道私营部门的真实的世界EBT诊所数据的类似多站点来源。EBT治疗数据将被提取并与国家医疗记录文件合并，从而产生一个独特的数据库，其中包括5，940名参与EBT的患者，约40%完成治疗，5，940名没有PTSD的对照。这些数据将使我们能够确定，在目标1中，与对照组相比，PTSD患者是否不太可能从事健康行为。在目标2中，我们确定PTSD症状的减轻是否与改善的健康行为有关，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调节PTSD症状减轻对诊断CMD风险的贡献。在目标4中，我们确定即使在症状缓解和健康行为改善的患者中，PTSD的诊断是否仍然是CMD的风险因素。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加权的逆概率，来自考克斯比例风险模型的结果将理清患者水平因素，例如与寻求和完成治疗与症状减轻相关的健康取向。这允许确定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、指南修改和所有PTSD患者的医疗资源分配产生重要影响。如果健康行为通过减少PTSD症状得到改善，那么临床医生应该接受培训，以鼓励在EBT期间促进健康。如果患者在心理健康和健康行为改善的情况下仍然存在CMD的风险，那么有必要对PTSD患者进行终身强化监测，以检测CMD的早期迹象。

 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.