HSR&D Home » Research » IIR 16-070 – HSR&D Study
Connecting Women to Care: Home-based Psychotherapy for Women with MST Living in Rural Areas
Marylene Cloitre, PhD
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, CA
Funding Period: April 2018 - December 2022
Military Sexual Trauma (MST) among women Veterans is a problem of epidemic proportion associated with significant mental health and functional impairment and substantial access to care barriers. Surveillance data indicate that one in four women Veterans reports MST when screened. Compared to women Veterans with other service-related stressors, those experiencing MST have greater mental health problems, are more likely to report difficulty in functioning in social, family and intimate relationships and are more likely to be unemployed and to report difficulties in finding a job. Nevertheless, women with MST engage less frequently in VA health care than other women Veterans. Barriers to care include distance from specialty services, financial difficulties, childcare and family responsibilities, and gender-related discomfort in male-dominated VA facilities. Research over the past decade has clearly identified the problems and concerns of women Veterans with MST but programs addressing their mental health needs and responsive to identified barriers are lacking. The current application addresses this gap.
The objectives of the current proposal are:
1. To evaluate the effectiveness of a skills training treatment, Skills Training in Affective and Interpersonal Regulation (STAIR) compared to an active nonspecific treatment, Present Centered Therapy (PCT), both delivered via home-based video. It is hypothesized that STAIR will be superior to PCT in reducing PTSD and related symptoms and in improving perceived social support, community engagement and social functioning. Assessments will occur five times: baseline (week 0), mid-treatment (week 5), post-treatment (week 10), 2 month follow-up (week 18) and 4 month follow-up (week 26).
2. To elucidate facilitators and barriers of implementing STAIR via home- based video treatment (HBVT) and (b) contextualize the quantitative findings of the clinical trial to enhance our understanding of both treatment processes and effectiveness.
The current study proposes to conduct a Hybrid Type 1 effectiveness-implementation design to assess the effectiveness of STAIR relative to a nonspecific active comparator, Present Centered Therapy (PCT) among women Veterans with MST, with dedicated resources to ensure engagement of those living in rural areas. We will also evaluate remote delivery of the treatment to the home rather than a VA clinic.
1. A randomized controlled trial will be conducted to assess the relative effectiveness of STAIR vs. PCT.
2. Qualitative assessment will be conducted via a multi-stakeholder mixed-methods evaluation of the delivery of STAIR via HBVT, based on two integrated frameworks: the Consolidated Framework for Implementation Research (CFIR) and the Replicating Effective Programs (REP).
PTSD symptoms declined in both conditions by posttreatment but significantly more in STAIR (d = 1.13 [0.87, 1.37]) than PCT (d = 0.71 [0.54, 1.02]). STAIR was also superior in improving social support, emotion regulation, depression and negative cognitions. Improvement in psychosocial functioning was moderate (d = 0.44, 0.40, respectively) and did not differ between conditions. All changes were maintained through follow-up. Dropout rates were low and equivalent (17.4%, 12.5%, respectively). Both interventions provided significant reduction in suicidal ideation, however, STAIR provided these benefits 6 weeks into treatment and maintained them through 4-month follow-up while PCT benefits were observed at 2-month follow-up and maintained them to 4-month follow-up. Participants in PCT engaged in significantly more additional treatment interventions during the study but this did not influence outcomes.
STAIR provided superior outcomes to PCT across several outcomes. These results could have a major impact on the treatment of women veterans with MST where interventions addressing social support and multiple types of mental health problems are needed. The substantial effect sizes in PTSD symptoms in both treatments suggest the viability of treatments that do not focus on trauma as an alternative intervention among individuals who do not wish to engage in trauma-focused CBT. Availability of these types of treatment may increase engagement in mental health services.
External Links for this Project
NIH ReporterGrant Number: I01HX002211-01A2
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DRA: Mental, Cognitive and Behavioral Disorders, Health Systems
DRE: Treatment - Comparative Effectiveness, TRL - Applied/Translational
Keywords: Outcomes - Patient, PTSD, Rural, Sexual Trauma/Assault
MeSH Terms: none