Suchergebnisse

OBJECTIVE: Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE) were widely disseminated to treat posttraumatic stress disorder (PTSD) in the Veterans Health Administration (VHA). However, few Iraq and Afghanistan war veterans (OEF/OIF/OND) diagnosed with PTSD have received CPT/PE and many initiate CPT/PE after substantial delay. Veterans who do not initiate CPT/PE or initiate CPT/PE after delay may have poorer treatment outcomes. This study aimed to identify predictors of CPT/PE initiation and timing. METHODS: Participants included OEF/OIF/OND veterans diagnosed with PTSD who received psychotherapy between 2001–2017 in the VHA (n=265,566). Logistic regression analysis was utilized to predict initiating CPT/PE (vs. no CPT/PE). Multinomial logistic regression analysis was utilized to predict initiating "early CPT/PE" (<1 year after first mental health visit) vs. delayed or not initiating. Analyzed predictors included demographic, military, and clinical complexity variables (e.g., comorbidities, reported military sexual trauma [MST] history). RESULTS: 78% of veterans did not initiate CPT/PE, with 7% initiating early and 15% initiating delayed CPT/PE. Reported MST history (OR=1.45, CI(95):1.39–1.51) and history of suicidal ideation/attempt (OR=1.42, CI(95):1.38–1.46) were strong predictors of CPT/PE initiation vs. no CPT/PE. Comorbid pain (RRR=1.35, CI(95):1.30–1.42) and depressive disorders (RRR=1.37, CI(95):1.32–1.43) were associated with increased likelihood of delayed vs. early CPT/PE. CONCLUSIONS: Most veterans in our study did not initiate CPT/PE. Generally, clinical complexity variables increased likelihood of initiating CPT/PE and initiating CPT/PE more than one year after first mental health visit. Additional research is needed to understand whether CPT/PE delay results from receipt of alternative intervention due to clinical complexity variables.