Symptom severity and lifetime and prospective health service use among military veterans evaluated for PTSD

Do functional impairments promote or hinder mental health treatment seeking: Differential results for women and men

Although symptom severity is a known predictor of treatment seeking, the role of functional impairment in this association is unclear. The purpose of this study was to examine the contribution of relationship and work impairment to service use among women and men with posttraumatic stress disorder (PTSD) and depression symptoms. Data from mailed surveys of 363 military veterans were examined longitudinally. Stratified regression analyses were applied to evaluate moderating and mediating effects of functional impairment in association between symptoms and mental health service use, with significant effects observed for relationship but not work impairment. For men, relationship impairment moderated the association between mental health and service use, such that the impact of depression symptoms on treatment seeking was reduced when accompanied by high impairment. For women, subsequently assessed relationship impairment acted as a mediator of the positive association between PTSD symptom severity and service use. The finding that relationship impairment interfered with treatment seeking for men but facilitated treatment seeking for women may help explain widely demonstrated sex differences in treatment seeking. Results underscore the importance of attending to the role of relationship impairment in veterans' treatment seeking and highlight the value of implementing sex-informed approaches to treatment promotion efforts.

The effect of medical comorbidities on male and female Veterans' use of psychotherapy for PTSD

BACKGROUND

Posttraumatic stress disorder (PTSD) is associated with an increased risk for medical comorbidities that may prevent participation in psychotherapy. The present study investigated whether medical comorbidities were associated with lower initiation rates and fewer psychotherapy visits for PTSD. Because women are more likely to initiate psychotherapy after traumatic events, we also assessed whether relationships were weaker among women.

METHODS

Veterans (N=482, 47% women) recently diagnosed with PTSD completed a survey assessing demographics, mood, functional status, and interest in treatment. Data on medical comorbidities, psychotherapy visits, antidepressant prescriptions, and service connection were assessed longitudinally through administrative files. Logistic and negative binomial regressions assessed associations between number of medical comorbidities in the 2 years before the survey and the initiation and number of psychotherapy visits for PTSD in the year after the survey. All analyses were stratified by sex and controlled for survey and administrative variables.

RESULTS

The relationship between medical comorbidities and number of psychotherapy visits was stronger among women than among men. A greater number of medical comorbidities was associated with significantly fewer psychotherapy visits in the total sample [incidence rate ratio: 0.91; 95% confidence interval (CI): 0.83, 1.00] and among women (incidence rate ratio: 0.87; 95% CI: 0.77, 0.99), but not among men (95% CI: 0.75, 1.01). Medical comorbidities were not associated with the initiation of psychotherapy among men or women.

CONCLUSIONS

Addressing medical comorbidities may help individuals remain in psychotherapy for PTSD. Medical comorbidities may play a larger role in the number of psychotherapy visits among women than men.

Multicomponent behavioral treatment for chronic combat-related posttraumatic stress disorder: a randomized controlled trial

This study examined the efficacy of a multicomponent cognitive-behavioral therapy, Trauma Management Therapy, which combines exposure therapy and social emotional rehabilitation, to exposure therapy only in a group of male combat veterans with chronic posttraumatic stress disorder (PTSD). Thirty-five male Vietnam veterans with PTSD were randomly assigned to receive either Trauma Management Therapy (TMT) or Exposure Therapy Only (EXP). Participants were assessed at pre-treatment, mid-treatment, and post-treatment. Primary clinical outcomes were reduction of PTSD symptoms and improved social emotional functioning. Results indicated that veterans in both conditions showed statistically significant and clinically meaningful reductions in PTSD symptoms from pre- to post-treatment, though consistent with a priori hypotheses there were no group differences on PTSD variables. However, compared to the EXP group, participants in the TMT group showed increased frequency in social activities and greater time spent in social activities. These changes occurred from mid-treatment (after completion of exposure therapy) to post-treatment (after completion of the social emotional rehabilitation component); supporting the hypothesis that TMT alone would result in improved social functioning. Although the TMT group also had a significant decrease in episodes of physical rage, that change occurred prior to introduction of the social emotional component of TMT. This study demonstrates efficacy of exposure therapy for treating the core symptoms of PTSD among combat veterans with a severe and chronic form of this disorder. Moreover, multi-component CBT shows promise for improving social functioning beyond that provided by exposure therapy alone, particularly by increasing social engagement/interpersonal functioning in a cohort of veterans with severe and chronic PTSD.