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Articles   |    
Associations of Psychotherapy Dose and SSRI or SNRI Refills With Mental Health Outcomes Among Veterans With PTSD
Hana J. Shin, Ph.D.; Mark A. Greenbaum, M.S., M.A.; Shaili Jain, M.D.; Craig S. Rosen, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300234
View Author and Article Information

Dr. Shin is with the Psychology Service, U.S. Department of Veterans Affairs (VA) Long Beach Healthcare System, Long Beach, California (e-mail: hana.shin@va.gov). Mr. Greenbaum is with the Mental Illness Research, Education and Clinical Center, and Dr. Jain and Dr. Rosen are with the National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California. Dr. Jain and Dr. Rosen are also with the Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, California.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  This study assessed associations between psychotherapy and pharmacotherapy for posttraumatic stress disorder (PTSD) and longitudinal changes in PTSD, depression, and mental health functioning among U.S. veterans diagnosed as having PTSD.

Methods  Information about self-reported symptoms experienced from .5 to over three years was collected from 482 veterans diagnosed as having PTSD. Administrative data from the U.S. Department of Veterans Affairs (VA) were used to calculate initiation of a course of selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs), days of medication coverage, and number of PTSD-related psychotherapy visits during the year after a baseline survey. Hierarchical linear modeling was used to analyze the effects of psychotherapy dose, initiation of an SSRI or SNRI, and medication coverage on symptoms over one year.

Results  In the year after baseline, over half of the sample (55%) received no psychotherapy for PTSD, and only 8% met the VA’s proposed standard of eight PTSD-related sessions within 14 weeks. Nearly half of the participants (47%) were prescribed an SSRI or SNRI and 37% completed a 90-day trial in the year after baseline. Participants’ symptoms improved slightly over time. Participants who received eight or more psychotherapy sessions in 14 weeks, completed a 90-day course of SSRIs or SNRIs, or had more days of medication coverage did not improve more than participants who received less treatment.

Conclusions  These dose-of-care benchmarks were not related to symptom improvement, highlighting the importance of directly assessing the impact of particular treatments on patient outcomes rather than solely relying on process measures.

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Anchor for Jump
Table 1Effects of psychotherapy visits for PTSD and of other variables on PTSD, depression, and functioning among 472 veteransa
Table Footer Note

a Ten veterans who completed ≥8 psychotherapy visits within 14 weeks between the diagnosis of PTSD and the completion of a baseline survey were excluded. For PTSD and depression, negative values indicate better health. For functioning, higher values indicate better health.

Table Footer Note

b OEF/OIF, Operation Enduring Freedom/Operation Iraqi Freedom

Anchor for Jump
Table 2Effects of trials of SSRIs or SNRIs and of other variables on PTSD, depression, and functioning among 447 veteransa
Table Footer Note

a Thirty-five veterans who received a 90-day trial of selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs) between the diagnosis of PTSD and the completion of a baseline survey were excluded. For PTSD and depression, negative values indicate better health. For functioning, higher values indicate better health.

Table Footer Note

b OEF/OIF, Operation Enduring Freedom/Operation Iraqi Freedom

Anchor for Jump
Table 3Effects of continuous supply of SSRIs or SNRIs and of other variables on PTSD, depression, and functioning among 247 veteransa
Table Footer Note

a Veterans (N=235) who were not prescribed a selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI) between diagnosis of PTSD and completion of the baseline survey were excluded. Continuous supply was measured by medication possession ratio (MPR). For PTSD and depression, negative values indicate better health. For functioning, higher values indicate better health.

Table Footer Note

b OEF/OIF, Operation Enduring Freedom/Operation Iraqi Freedom

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