Lead/Presenter: Shira Maguen,
All Authors: Maguen S (San Francisco VA Health Care System and UCSF School of Medicine), Li Y (San Francisco VA Health Care System), Madden E (San Francisco VA Health Care System) Seal KH (San Francisco VA Health Care System and UCSF School of Medicine) Neylan TC (San Francisco VA Health Care System and UCSF School of Medicine) Patterson OV (VA Salt Lake City Health Care System and University of Utah, School of Medicine) Duvall SL (VA Salt Lake City Health Care System and University of Utah, School of Medicine) Lujan C (San Francisco VA Health Care System) Shiner B (White River Junction VA Medical Center and Geisel School of Medicine at Dartmouth)
Despite its implementation and use in the Veterans Health Administration (VHA), little is known about predictors of initiation and completion of evidence-based psychotherapy (EBP) for posttraumatic stress disorder (PTSD), with most data coming from small cohort studies and post-hoc analyses of clinical trials. We examined patient and treatment factors associated with initiation and completion of EBP for PTSD in a large longitudinal cohort.
We conducted a national, retrospective cohort study of all Iraq and Afghanistan War veterans who had a post-deployment PTSD diagnosis from 10/01-9/15 at a facility and had at least one post-deployment psychotherapy visit. We examined utilization of PE and CPT (individual or group) during any 24-week period. We used ordered logistic, logistic, and Cox proportional hazards regressions to examine variables associated with EBP initiation, early termination, and completion, and time to completion.
Over a 15-year period, of 265,566 Iraq and Afghanistan war veterans with PTSD, 22.8% initiated an EBP, and only 9.1% completed treatment. Those who completed did so about three years after their initial mental health visit. Several factors were positively associated with EBP completion, including history of military sexual trauma (MST), older age, race/ethnicity (i.e., African-American race for PE), combat exposure, and multiple deployments.
The VHA has become timelier in delivering EBP for PTSD over the years, and several subgroups, such as those with MST are more likely to complete EBP.
While the VHA has made strides in proving timely EBPs due to several programs and initiatives, efforts can continue to focus on how to ensure that engaged veterans stay in treatment and complete an adequate dose of EBPs, with efforts targeted at retaining veterans who are most at risk.