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2015 HSR&D/QUERI National Conference Abstract

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1068 — Initial Group versus Individual Therapy for Posttraumatic Stress Disorder and Subsequent Follow-Up Treatment Adequacy

Sripada RK, Ann Arbor VA CCMR; Bohnert KM, Ann Arbor VA CCMR; Ganoczy D, Ann Arbor VA CCMR; Blow FC, Ann Arbor VA CCMR; Valenstein M, Ann Arbor VA CCMR; Pfeiffer PN, Ann Arbor VA CCMR;

Objectives:
Accessibility of psychotherapy for individuals with posttraumatic stress disorder (PTSD) and retention in treatment are major concerns for the Veterans Health Administration (VA). Group therapy is a common method for improving access to psychotherapy; however, PTSD patients may prefer individual therapy. This study assessed whether initial treatment with individual versus group psychotherapy relates to subsequent psychotherapy adequacy among VA patients with PTSD.

Methods:
The sample consisted of all VA patients who received a new PTSD diagnosis during a subspecialty PTSD clinical team visit in FY2010. Logistic and negative binomial regression analyses examined the relationship between modality of the first psychotherapy encounter and subsequent number of psychotherapy encounters within 14 weeks.

Results:
Among 35,270 VA patients who initiated treatment for PTSD, 38% initiated group therapy and 62% initiated individual therapy. Patients who initiated with group therapy received a greater mean number of psychotherapy visits than those who initiated with individual therapy (4.7 vs. 2.8), and were about twice as likely (30.0% vs. 14.6%) to receive an adequate dose of 8 or more psychotherapy encounters. Group therapy predicted a greater number of psychotherapy visits (? = 0.46, p < .001) and greater likelihood of adequate psychotherapy (OR = 2.31, 95% CI = 2.19-2.44, p < .001), after adjusting for differences in demographic characteristics, comorbid conditions, and other service use.

Implications:
Greater treatment adequacy among group therapy participants suggests that these patients have greater access to frequent psychotherapy sessions or are more likely to persist with psychotherapy for PTSD than those treated individually. Our findings suggest that group therapy for PTSD may offer advantages over individual therapy in terms of treatment engagement and retention.

Impacts:
Further research is indicated to investigate the comparative effectiveness of group versus individual therapy in routine clinical practice and the trade-offs with respect to treatment initiation and completion. Interventions to address system-level and patient barriers to initiating group therapy rather than individual therapy may substantially improve Veterans' access to effective care for PTSD.