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IIR 95-074 – HSR&D Study

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IIR 95-074
Treatment of Depression in Patients with PTSD
Nancy Jo Dunn PhD
Michael E. DeBakey VA Medical Center, Houston, TX
Houston, TX
Funding Period: October 1997 - September 2002

BACKGROUND/RATIONALE:
Post-traumatic stress disorder is a mental health problem of enormous proportion within the VA system for both male and female veterans. The 40 percent of veterans with PTSD and concurrent clinically significant depression are particularly difficult to treat. Effective and efficient treatment of veterans with this combination of disorders would be of benefit to a significant number of veterans.

OBJECTIVE(S):
Well-validated treatments of PTSD and its complications are rare. There are no studies of treatment addressing the sequelae of chronic PTSD, including depressive symptomatology. Our study is the first randomized, controlled study of group psychosocial interventions for the combination of PTSD and depression in male and female veterans. The purpose of the study is to evaluate the impact of two psychosocial interventions on clinical outcomes and on the use of hospital resources by veterans with these co-existing disorders.

METHODS:
Male and female veterans with both PTSD and depressive diagnoses will be recruited for the study. Male veterans must have combat-related PTSD, and female veterans will have trauma related to sexual assault. Veterans will be randomly assigned to either Self-Management Therapy (Rehm, 1984), a cognitive-behavioral treatment program for depression, or to a Psychoeducational Group Therapy (Dunn, et al., 1998). Both programs involve short-term group therapies that teach veterans about their disorders, and provide them with new strategies and skills for overcoming them. These therapy groups will be in addition to other standard care that veterans receive within the Trauma Recovery Program at the Houston VA Medical Center. Approximately 120 male veterans and 60 female veterans will be enrolled in the program. Participants will be assessed at pretest, posttest, and at 3-, 6-, and 12-month follow-up periods, utilizing various clinician-administered and self-report instruments of psychiatric symptomatology, psychosocial functioning, constructs targeted by the therapy groups, treatment compliances, and satisfaction.

FINDINGS/RESULTS:
During the first year of the project, we completed a pilot study on the reliability of our assessment procedures with appropriate levels of reliability being demonstrated. Development, refinement and pilot testing of the Psychoeducational Group Therapy protocol were also completed. To date, the male sample has completed the therapy phase of the study and most of the follow up assessments. Therapy completion rates (77%) and retention rates (89-93%) on follow up assessments for veterans who completed therapy were exceptional. Patient satisfaction ratings of the therapies indicated that veterans felt that both therapies were beneficial and clear. Analyses of the outcome data for male veterans over the course of therapy and initial follow up assessments are currently being conducted. Female veterans have recently completed therapy and posttest assessments. If study treatments are shown to improve the lives of veterans and to cut psychiatric and medical services demand, this treatment approach may become a model within the national VA system.

IMPACT:
It is anticipated that appropriate treatment of individuals with PTSD and depression will enhance the quality of life of the veterans being served. The inclusion of women is consistent with VA's efforts to reach women veterans and provide them with improved services. The inclusion of women who are victims of sexual trauma will enhance the generalizability of the study to individuals in the general population who have suffered from civilian trauma such as rape. The study is also significant for its examination of both clinical and economic impacts of the interventions.

PUBLICATIONS:

Journal Articles

  1. Dunn NJ, Yanasak E, Schillaci J, Simotas S, Rehm LP, Souchek J, Menke T, Ashton C, Hamilton JD. Personality disorders in veterans with posttraumatic stress disorder and depression. Journal of traumatic stress. 2004 Feb 1; 17(1):75-82.
Conference Presentations

  1. Dunn N, Schillaci J, Yanasak E, Rehm L. Treatment of Depression in Veterans with PTSD and Depression. Paper presented at: Society for Psychotherapy Research International Annual Meeting; 2002 Jun 1; Santa Barbara, CA.
  2. Yanasak E, Adams J, Dodrill C, Simotas S, Wagner A, Schillaci J, Rehm L, Hamilton J, Dunn N. Successful Recruitment and Retention Strategies for Study Participants. Paper presented at: International Society for Traumatic Stress Studies Annual Symposium; 2000 Nov 18; San Antonio, TX.
  3. Dunn NJ, Schillaci J, Wagner A, Rehm L, Souchek J, Menke T, Ashton C, Hamilton J. Development of a psychoeducational group therapy protocol. Paper presented at: International Society for Traumatic Stress Studies Annual Symposium; 2000 Nov 17; San Antonio, TX.
  4. Dunn NJ. Posttraumatic Stress Disorder. Paper presented at: Houston Police Department Crisis Intervention Team Training Annual Lecture; 2000 Nov 1; Houston, TX.


DRA: Mental, Cognitive and Behavioral Disorders, Health Systems, Military and Environmental Exposures
DRE: Treatment - Observational, Epidemiology
Keywords: Comorbidity, Depression, Gulf War I, PTSD
MeSH Terms: Depression, Stress Disorders, Post-Traumatic

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