Factors associated with completing evidence-based psychotherapy for PTSD among veterans in a national healthcare system

• DOI: 10.1016/j.psychres.2019.02.027
• Publication Date: 2019-02-11T23:36:44Z
• Authors: Shira Maguen; Yongmei Li; Erin Madden; Karen H. Seal; Thomas C. Neylan; Olga V. Patterson; Scott L. DuVall; Callan Lujan; Brian Shiner
• Keywords: Adult; Male; 05 social sciences; Middle Aged; Patient Acceptance of Health Care; United States; 3. Good health; Cohort Studies; Psychotherapy; Stress Disorders, Post-Traumatic; United States Department of Veterans Affairs; Young Adult; Mental Health; Evidence-Based Practice; Humans; Female; 0501 psychology and cognitive sciences; Aged; Veterans

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 Veterans Health Administration facility and had at least one coded 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 veterans with PTSD, 22.8% initiated an EBP, and only 9.1% completed treatment. Completers did so about three years after their initial mental health visit. Factors positively associated with EBP completion included military sexual trauma, older age, race/ethnicity (i.e., African-American race for PE), combat, and multiple deployments. The VHA has become timelier in delivering EBP for PTSD, and several subgroups are more likely to complete EBP.