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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1016 — Predictors, Consequences, and Reasons for Early Discharge from VA Intensive/Inpatient PTSD Treatment Programs

Libby DJ, MIRECC; Pilver CE, NCPTSD; Desai R, NEPEC, NCPTSD, MIRECC;

Objectives:
To examine the predictors, consequences, and reasons for early discharge from VA intensive/inpatient PTSD treatment programs.

Methods:
Program evaluation data collected by the Northeast Program Evaluation Center (NEPEC) were examined using SAS 9.1 software. The sample included 21,496 Veterans who were first admitted to intensive/inpatient PTSD treatment programs from FY 2003 through FY 2010. Descriptive statistics and multivariate logistic regression modeling were performed to document the prevalence, predictors, and consequences of early discharge. Generalized Estimating Equations (GEE) accounted for the clustering of Veterans within treatment program.

Results:
Over ten percent (n = 2,259) of Veterans did not complete the full length of intensive/inpatient PTSD treatment. The most commonly selected reasons for discharge included “violation of other program rules or requirements” and “use of alcohol or drugs”. In fully-adjusted analyses, baseline predictors of early discharge included age, race, marital status, and psychiatric service-connected disability. Participation in OEF/OIF, drug use, personality disorder diagnosis, prior inpatient stay, aggressive behavior, and the presence of nightmares increased Veterans’ risk for early discharge. Exaggerated startle response and difficulty with emotional expression were negatively associated with early discharge. Four-month outcome data demonstrated that early discharge was positively associated with PTSD symptoms, suicide attempts, drug and alcohol use, and aggressive behavior independently of sociodemographic and psychological/behavioral factors assessed at baseline.

Implications:
Early discharge from VA PTSD treatment is associated with several negative clinical outcomes. The risk factors for early discharge can be identified at the outset of treatment and represent an opportunity for clinical intervention.

Impacts:
These data will inform clinicians and program coordinators of the factors that increase Veterans’ risk for early discharge from intensive/inpatient PTSD treatment programs. Increased clinical focus on psychological/behavioral factors associated with risk of early discharge, such as drug use, nightmares, and the particular concerns of OEF/OIF Veterans, may result in improved treatment retention and treatment outcomes.


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