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Giummarra MJ, Reeder S, Williams S, Devlin A, Knol R, Ponsford J, Arnold CA, Konstantatos A, Gabbe BJ, Clarke H, Katz J, Mitchell F, Robinson E, Zatzick D. Stepped collaborative care for pain and posttraumatic stress disorder after major trauma: a randomized controlled feasibility trial. Disabil Rehabil 2024; 46:3643-3659. [PMID: 37706486 PMCID: PMC10937328 DOI: 10.1080/09638288.2023.2254235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 06/29/2023] [Accepted: 08/27/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE To examine feasibility and acceptability of providing stepped collaborative care case management targeting posttraumatic stress disorder (PTSD) and pain symptoms after major traumatic injury. MATERIALS AND METHODS Participants were major trauma survivors in Victoria, Australia, at risk of persistent pain or PTSD with high baseline symptoms. Participants were block-randomized, stratified by compensation-status, to the usual care (n = 15) or intervention (n = 17) group (46% of eligible patients). The intervention was adapted from existing stepped collaborative care interventions with input from interdisciplinary experts and people with lived experience in trauma and disability. The proactive case management intervention targeted PTSD and pain management for 6-months using motivational interviewing, cognitive behavioral therapy strategies, and collaborative care. Qualitative interviews explored intervention acceptability. RESULTS Intervention participants received a median of 7 h case manager contact and reported that they valued the supportive and non-judgmental listening, and timely access to effective strategies, resources, and treatments post-injury from the case manager. Participants reported few disadvantages from participation, and positive impacts on symptoms and recovery outcomes consistent with the reduction in PTSD and pain symptoms measured at 1-, 3- and 6-months. CONCLUSIONS Stepped collaborative care was low-cost, feasible, and acceptable to people at risk of PTSD or pain after major trauma.IMPLICATIONS FOR REHABILITATIONAfter hospitalization for injury, people can experience difficulty accessing timely support to manage posttraumatic stress, pain and other concerns.Stepped case management-based interventions that provide individualized support and collaborative care have reduced posttraumatic stress symptom severity for patients admitted to American trauma centers.We showed that this model of care could be adapted to target pain and mental health in the trauma system in Victoria, Australia.The intervention was low cost, acceptable and highly valued by most participants who perceived that it helped them use strategies to better manage post-traumatic symptoms, and to access clinicians and treatments relevant to their needs.
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Affiliation(s)
- Melita J. Giummarra
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Alfred Health, Caulfield, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Sandra Reeder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Scott Williams
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Alfred Health, Caulfield, Australia
| | - Anna Devlin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rose Knol
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Social Work, Alfred Health, Melbourne, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Clayton, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Richmond, Australia
| | - Carolyn A. Arnold
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Alfred Health, Caulfield, Australia
- Academic Board of Anaesthesia & Perioperative Medicine, School of Medicine Nursing & Health Sciences, Monash University, Clayton, Australia
| | - Alex Konstantatos
- Department of Anaesthesia, The Alfred Hospital, Melbourne, Australia
| | - Belinda J. Gabbe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Health Data Research UK, Swansea University Medical School, Singleton Park, Swansea University, Swansea, UK
| | - Hance Clarke
- Department of Anaesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Canada
- Department of Anaesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Transitional Pain Service, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Joel Katz
- Department of Anaesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Canada
- Department of Anaesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Transitional Pain Service, Toronto General Hospital, University Health Network, Toronto, Canada
- Department of Psychology, York University, Toronto, Canada
| | - Fiona Mitchell
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Patient and Carer Coinvestigators with Lived Experience of Trauma, Australia
| | - Elizabeth Robinson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Patient and Carer Coinvestigators with Lived Experience of Trauma, Australia
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of WA School of Medicine, Seattle, WA, USA
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, WA, USA
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Shoyer J, Ruggiero KJ, Abu K, Birk N, Conde C, Ryan P, Knutzen T, Engstrom A, Russo J, Wang J, Zatzick DF. Engaging and following physical injury survivors at risk for developing posttraumatic stress disorder symptoms: A 25 site US national study. Injury 2024; 55:111426. [PMID: 38423897 PMCID: PMC11023765 DOI: 10.1016/j.injury.2024.111426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/12/2024] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Early intervention for patients at risk for Posttraumatic Stress Disorder (PTSD) relies upon the ability to engage and follow trauma-exposed patients. Recent requirements by the American College of Surgeons Committee on Trauma (College) have mandated screening and referral for patients with high levels of risk for the development of PTSD or depression. Investigations that assess factors associated with engaging and following physically injured patients may be essential in assessing outcomes related to screening, intervention, and referral. METHODS This investigation was a secondary analysis of data collected as part of a United States level I trauma center site randomized clinical trial. All 635 patients were ages ≥18 and had high PTSD symptom levels (i.e., DSM-IV PTSD Checklist score ≥35) at the time of the baseline trauma center admission. Baseline technology use, demographic, and injury characteristics were collected for patients who were followed up with over the course of the year after physical injury. Regression analyses were used to assess the associations between technology use, demographic and injury characteristics, and the attainment of follow-up outcome assessments. RESULTS Thirty-one percent of participants were missing one or more 3-, 6- or 12-month follow-up outcome assessments. Increased risk of missing one or more outcome assessments was associated with younger age (18-30 versus ≥55 Relative Risks [RR] = 1.78, 95 % Confidence Interval [CI] = 1.09, 2.91), lack of cell phone (RR = 1.32, 95 % CI = 1.01, 1.72), no internet access (RR = 1.47, 95 % CI = 1.01, 2.16), public versus private insurance (RR = 1.47, 95 % CI = 1.12, 1.92), having no chronic medical comorbidities (≥4 versus none, RR = 0.28, 95 % CI = 0.20, 0.39), and worse pre-injury mental health function (RR = 0.99, 95 % CI = 0.98, 0.99). CONCLUSIONS This multisite investigation suggests that younger and publicly insured and/or uninsured patients with barriers to cell phone and internet access may be particularly vulnerable to lapses in trauma center follow-up. Clinical research informing trauma center-based screening, intervention, and referral procedures could productively explore strategies for patients at risk for not engaging and adhering to follow-up care and outcome assessments.
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Affiliation(s)
- Jake Shoyer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Kenneth J Ruggiero
- Departments of Nursing and Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, USA
| | - Khadija Abu
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Navneet Birk
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Cristina Conde
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Paige Ryan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Tanya Knutzen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Douglas F Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
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Birk N, Russo J, Heagerty P, Parker L, Moloney K, Bulger E, Whiteside L, Moodliar R, Engstrom A, Wang J, Palinkas L, Abu K, Zatzick D. Can Baseline Patient Clinical and Demographic Characteristics Predict Response to Early Posttraumatic Stress Disorder Interventions After Physical Injury? Psychiatry 2024; 87:134-148. [PMID: 38497603 PMCID: PMC11116057 DOI: 10.1080/00332747.2024.2323367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
OBJECTIVE A growing evidence base supports stepped care interventions for the early treatment of posttraumatic stress disorder (PTSD) after physical injury. Few investigations have examined the characteristics of patients who do and do not respond to these interventions. METHOD This investigation was a secondary analysis that used previously collected data from three randomized clinical trials of stepped care interventions (patient N = 498). The study hypothesized that a subgroup of patients would manifest persistent PTSD symptoms regardless of randomization to intervention or control conditions, and that characteristics present at the time of baseline injury hospitalization could distinguish patients who would develop persistent symptoms from potential treatment responders. Regression analyses identified baseline patient clinical and demographic characteristics that were associated with persistent PTSD symptoms over the 6-months post-injury. Additional analyses identified treatment attributes of intervention patients who were and were not likely to demonstrate persistent symptoms. RESULTS A substantial subgroup of patients (n = 222, 44.6%) demonstrated persistent PTSD symptoms over time. Greater numbers of pre-injury trauma, pre-injury PTSD symptoms, elevated early post-injury PTSD symptoms, unemployment, and non-White race identified patients with persistent symptoms. Patients with ≥3 of these baseline risk characteristics demonstrated diminished treatment responses when compared to patients with <3 characteristics. Intervention patients with ≥3 risk characteristics were less likely to engage in treatment and required greater amounts of interventionist time. CONCLUSIONS Injured trauma survivors have readily identifiable characteristics at the time of hospitalization that can distinguish responders to PTSD stepped care interventions versus patients who may be treatment refractory.
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Affiliation(s)
- Navneet Birk
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Patrick Heagerty
- Department of Biostatistics University of Washington School of Medicine, Seattle, Washington, USA
| | - Lea Parker
- Department of Psychology Drexel University College of Arts and Sciences, Philadelphia, Pennsylvania, USA
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Eileen Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Rddhi Moodliar
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lawrence Palinkas
- Department of Public Health and Longevity Science, University of California, San Diego, California, USA
| | - Khadijah Abu
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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Abu K, Bedard-Gilligan M, Moodliar R, Bulger EM, Hernandez A, Knutzen T, Shoyer J, Birk N, Conde C, Engstrom A, Ryan P, Wang J, Russo J, Zatzick DF. Can stepped collaborative care interventions improve post-traumatic stress disorder symptoms for racial and ethnic minority injury survivors? Trauma Surg Acute Care Open 2024; 9:e001232. [PMID: 38287923 PMCID: PMC10824071 DOI: 10.1136/tsaco-2023-001232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/07/2024] [Indexed: 01/31/2024] Open
Abstract
Objectives No large-scale randomized clinical trial investigations have evaluated the potential differential effectiveness of early interventions for post-traumatic stress disorder (PTSD) among injured patients from racial and ethnic minority backgrounds. The current investigation assessed whether a stepped collaborative care intervention trial conducted at 25 level I trauma centers differentially improved PTSD symptoms for racial and ethnic minority injury survivors. Methods The investigation was a secondary analysis of a stepped wedge cluster randomized clinical trial. Patients endorsing high levels of distress on the PTSD Checklist (PCL-C) were randomized to enhanced usual care control or intervention conditions. Three hundred and fifty patients of the 635 randomized (55%) were from non-white and/or Hispanic backgrounds. The intervention included care management, cognitive behavioral therapy elements and, psychopharmacology addressing PTSD symptoms. The primary study outcome was PTSD symptoms assessed with the PCL-C at 3, 6, and 12 months postinjury. Mixed model regression analyses compared treatment effects for intervention and control group patients from non-white/Hispanic versus white/non-Hispanic backgrounds. Results The investigation attained between 75% and 80% 3-month to 12-month follow-up. The intervention, on average, required 122 min (SD=132 min). Mixed model regression analyses revealed significant changes in PCL-C scores for non-white/Hispanic intervention patients at 6 months (adjusted difference -3.72 (95% CI -7.33 to -0.10) Effect Size =0.25, p<0.05) after the injury event. No significant differences were observed for white/non-Hispanic patients at the 6-month time point (adjusted difference -1.29 (95% CI -4.89 to 2.31) ES=0.10, p=ns). Conclusion In this secondary analysis, a brief stepped collaborative care intervention was associated with greater 6-month reductions in PTSD symptoms for non-white/Hispanic patients when compared with white/non-Hispanic patients. If replicated, these findings could serve to inform future American College of Surgeon Committee on Trauma requirements for screening, intervention, and referral for PTSD and comorbidities. Level of evidence Level II, secondary analysis of randomized clinical trial data reporting a significant difference. Trial registration number NCT02655354.
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Affiliation(s)
- Khadija Abu
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Michelle Bedard-Gilligan
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Rddhi Moodliar
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Eileen M Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Alexandra Hernandez
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Tanya Knutzen
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jake Shoyer
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Navneet Birk
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Cristina Conde
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Allison Engstrom
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Paige Ryan
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jin Wang
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Joan Russo
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Douglas F Zatzick
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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Prater L, Bulger E, Maier RV, Goldstein E, Thomas P, Russo J, Wang J, Engstrom A, Abu K, Whiteside L, Knutzen T, Iles-Shih M, Heagerty P, Zatzick D. Emergency Department and Inpatient Utilization Reductions and Cost Savings Associated With Trauma Center Mental Health Intervention: Results From a 5-year Longitudinal Randomized Clinical Trial Analysis. Ann Surg 2024; 279:17-23. [PMID: 37747970 PMCID: PMC10843150 DOI: 10.1097/sla.0000000000006102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
OBJECTIVE To identify and refer patients at high risk for the psychological sequelae of traumatic injury, the American College of Surgeons Committee on Trauma now requires that trauma centers have in-place protocols. No investigations have documented reductions in utilization and associated potential cost savings associated with trauma center mental health interventions. BACKGROUND The investigation was a randomized clinical trial analysis that incorporated novel 5-year emergency department (ED)/inpatient health service utilization follow-up data. METHODS Patients were randomized to a mental health intervention, targeting the psychological sequelae of traumatic injury (n = 85) versus enhanced usual care control (n = 86) conditions. The intervention included case management that coordinated trauma center-to-community care linkages, psychotropic medication consultation, and psychotherapy elements. Mixed model regression was used to assess intervention and control group utilization differences over time. An economic analysis was also conducted. RESULTS Over the course of the 5-year intervention, patients demonstrated significant reductions in ED/inpatient utilization when compared with control patients [ F (19,3210) = 2.23, P = 0.009]. Intervention utilization reductions were greatest at 3 to 6 months (intervention 15.5% vs control 26.7%, relative risk = 0.58, 95% CI: 0.34, 1.00) and 12 to 15 months (intervention 16.5% vs control 30.6%, relative risk = 0.54, 95% CI: 0.32, 0.91) postinjury time points. The economic analysis suggested potential intervention cost savings. CONCLUSIONS Mental health intervention is associated with significant reductions in ED and inpatient utilization, as well as potential cost savings. These findings could be productively integrated into future American College of Surgeons Committee on Trauma policy discussions.
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Affiliation(s)
- Laura Prater
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
- Firearm Injury and Policy Research Program, University of Washington, Seattle, WA
| | - Eileen Bulger
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- Department of Surgery, University of Washington, Seattle, WA
| | - Ronald V. Maier
- Department of Surgery, University of Washington, Seattle, WA
| | - Evan Goldstein
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | | | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
| | | | - Khadija Abu
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Lauren Whiteside
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- Department of Emergency Medicine, University of Washington, Seattle, WA
| | - Tanya Knutzen
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Matt Iles-Shih
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Patrick Heagerty
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Doug Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
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Knutzen T, Bulger E, Iles-Shih M, Hernandez A, Engstrom A, Whiteside L, Birk N, Abu K, Shoyer J, Conde C, Ryan P, Wang J, Russo J, Heagerty P, Palinkas L, Zatzick D. Stepped collaborative care versus American College of Surgeons Committee on Trauma required screening and referral for posttraumatic stress disorder: Clinical trial protocol. Contemp Clin Trials 2024; 136:107380. [PMID: 37952714 PMCID: PMC11025340 DOI: 10.1016/j.cct.2023.107380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/13/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Each year in the US, approximately 1.5-2.5 million individuals are so severely injured that they require inpatient hospital admissions. The American College of Surgeons Committee on Trauma (College) now requires that trauma centers have in place protocols to identify and refer hospitalized patients at risk injury psychological sequelae. Literature review revealed no investigations that have identified optimal screening, intervention, and referral procedures in the wake of the College requirement. METHODS The single-site pragmatic trial investigation will individually randomize 424 patients (212 intervention and 212 control) to a brief stepped care intervention versus College required mental health screening and referral control conditions. Blinded follow-up interviews at 1-, 3-, 6-, and 12-months post-injury will assess the symptoms of PTSD and related comorbidity for all patients. The emergency department information exchange (EDIE) will be used to capture population-level automated emergency department and inpatient utilization data for the intent-to-treat sample. The investigation aims to test the primary hypotheses that intervention patients will demonstrate significant reductions in PTSD symptoms and emergency department/inpatient utilization when compared to control patients. The study incorporates a Rapid Assessment Procedure-Informed Clinical Ethnography (RAPICE) implementation process assessment. CONCLUSIONS The overarching goal of the investigation is to advance the sustainable delivery of high-quality trauma center mental health screening, intervention, and referral procedures for diverse injury survivors. An end-of-study policy summit will harness pragmatic trial data to inform the capacity for US trauma centers to implement high-quality acute care mental health screening, intervention and referral services for diverse injured patient populations. TRIAL REGISTRATION Clinicaltrials.govNCT05632770.
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Affiliation(s)
- Tanya Knutzen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Eileen Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, USA.
| | - Matt Iles-Shih
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Alexandra Hernandez
- Department of Surgery, University of Washington School of Medicine, Seattle, USA.
| | - Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
| | - Navneet Birk
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Khadija Abu
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Jake Shoyer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Cristina Conde
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Paige Ryan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Patrick Heagerty
- Department of Biostatistics, University of Washington School of Public Health, Seattle, USA.
| | - Larry Palinkas
- Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, USA.
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
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Sheehy KA, Hruska B, Waldrep EE, Pacella-LaBarbara ML, George RL, Benight CC, Delahanty DL. The mediating role of coping self-efficacy on social support and PTSD symptom severity among injury survivors. ANXIETY, STRESS, AND COPING 2023; 36:770-780. [PMID: 37128653 DOI: 10.1080/10615806.2023.2199208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 01/21/2023] [Accepted: 03/27/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Social support confers a protective effect against elevated PTSD symptomatology following injury. However, little is known about the mechanisms through which social support conveys this protective mental health effect in injury survivors. Coping self-efficacy is linked to both social support and PTSD symptomatology but has not been examined. OBJECTIVE To test coping self-efficacy as a mechanism for the relationship between social support and PTSD symptom severity among injury survivors. METHOD AND DESIGN Participants consisted of 61 injury survivors (62.3% male, 72.1% White) admitted to a Level-1 Trauma Center. Social support was assessed at 2-weeks post-injury; coping self-efficacy at 6-weeks post-injury; and PTSD symptom severity at 3-months post-injury. RESULTS A statistically significant indirect effect was found for the social support - coping self-efficacy - PTSD symptomatology pathway, providing evidence of mediation even after controlling for age, sex, race, and education (B = -0.51, SE = 0.18, CI = -0.92, -0.20). CONCLUSIONS Social support may exert an effect on PTSD symptom severity post-injury through its connection with coping self-efficacy. Coping self-efficacy represents an important intervention target following injury for those survivors with lower social support who are at risk for elevated PTSD symptom severity levels.
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Affiliation(s)
- Kriszha A Sheehy
- Department of Psychology, Pacific Lutheran University, Tacoma, USA
| | - Bryce Hruska
- Department of Public Health, Syracuse University, Syracuse, USA
| | | | | | | | - Charles C Benight
- Trauma, Health, and Hazards Center and Psychology Department, University of Colorado at Colorado Springs, Colorado Springs, USA
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Espeleta HC, Litvitskiy NS, Higgins K, Ridings LE, Bravoco O, Jones S, Ruggiero KJ, Davidson T. Implementation of a stepped care program to address posttraumatic stress disorder and depression in a Level II trauma center. Injury 2023; 54:110922. [PMID: 37422365 PMCID: PMC10528678 DOI: 10.1016/j.injury.2023.110922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 06/12/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND The Trauma Resilience and Recovery Program (TRRP) is a technology enhanced model of care that includes education, screening, and service referrals to address posttraumatic stress disorder and depression following traumatic injury. TRRP has shown high rates of engagement at a Level I trauma center, but Level II centers have fewer resources and face more challenges to addressing patients' mental health needs. METHODS We utilized clinical administrative data to examine engagement in TRRP in a Level II trauma center with 816 adult trauma activation patients. RESULTS Most patients (86%) enrolled in TRRP, but only 30% completed screens during a 30-day follow-up call. Three-quarters of patients who endorsed clinically significant symptoms accepted treatment recommendations/referrals. CONCLUSIONS Engagement at each step of the model was lower than previously reported in a Level I center. Differences likely correspond to lower rates of mental health symptoms in the trauma patients at this setting. We discuss program adaptations that may be needed to improve patient engagement.
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Affiliation(s)
- Hannah C Espeleta
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street Charleston, SC 29425, USA.
| | - Nicole S Litvitskiy
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street Charleston, SC 29425, USA
| | - Kristen Higgins
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street Charleston, SC 29425, USA
| | - Leigh E Ridings
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street Charleston, SC 29425, USA
| | - Olivia Bravoco
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street Charleston, SC 29425, USA
| | - Seon Jones
- Trident Medical Center, 9291 Medical Plaza Dr. Suite B, Charleston, SC 29406, USA
| | - Kenneth J Ruggiero
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street Charleston, SC 29425, USA
| | - Tatiana Davidson
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street Charleston, SC 29425, USA
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Systematic Review and Meta-Analysis of Stepped Care Psychological Prevention and Treatment Approaches for Posttraumatic Stress Disorder. Behav Ther 2022; 54:476-495. [PMID: 37088505 DOI: 10.1016/j.beth.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/07/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
Stepped care approaches have been developed to increase treatment accessibility for individuals with posttraumatic stress disorder (PTSD). However, despite guidelines recommending stepped care, it is currently unclear how the approach compares to other treatments for PTSD in terms of symptom reduction, cost, and client-rated acceptability. We conducted a systematic review and meta-analysis of randomized controlled and open trials evaluating stepped care prevention (i.e., targeting those with recent trauma exposure at risk of developing PTSD) and treatment approaches for adults and adolescents/children with PTSD. Eight prevention and four treatment studies were included. There was considerable variation in the sample types, stepped approaches, and control conditions. Most studies found no significant differences between stepped care (both prevention and treatment) and control (active and usual care) in terms of PTSD severity, loss of PTSD diagnosis, depression severity, and quality of life at the final follow-up. There was some evidence to suggest that stepped care was more cost-effective, and as acceptable or more acceptable compared to controls. Interpretations were tempered by high statistical heterogeneity, risk of bias, and lack of recommended evidence-based treatments. Stepped care can make PTSD treatment more accessible; however, more high-quality research is needed comparing stepped care to active controls.
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Nguyen J, Whiteside LK, Bulger EM, Veach L, Moloney K, Russo J, Nehra D, Wang J, Zatzick DF. Post-traumatic stress disorder (PTSD) symptoms and alcohol and drug use comorbidity at 25 US level I trauma centers. Trauma Surg Acute Care Open 2022; 7:e000913. [PMID: 35979039 PMCID: PMC9358953 DOI: 10.1136/tsaco-2022-000913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/13/2022] [Indexed: 11/06/2022] Open
Abstract
Background Questions regarding the extent to which post-traumatic stress disorder (PTSD) is comorbid with alcohol and drug use are particularly germane in an era when the American College of Surgeons Committee on Trauma (ACS-COT) is considering policy requiring screening, intervention and/or referral services for patients presenting with psychological sequalae of traumatic injury. Literature review revealed few multisite trauma-center-based investigations that have assessed the association between PTSD symptoms and alcohol and drug use comorbidities in injured patients. Methods This investigation was a secondary analysis of baseline data collected prior to randomization in a 25-site trauma center pragmatic clinical trial. All 635 patients included in the investigation had elevated PTSD symptom levels at the time of trauma center admission. Self-report questionnaire screening, laboratory toxicology results, and electronic health record data were combined to assess the frequencies of alcohol, stimulant (i.e., amphetamine and cocaine), opioid and marijuana use comorbidities for injured patients. Logistic regression was used to assess the associations between demographic and injury characteristics and alcohol and drug use comorbidity. Results The frequency of patients with one or more alcohol or substance use comorbidity was between 62% and 79%. Over 50% of patients were positive for one or more alcohol or cannabis comorbidity. Approximately 26% of patients were positive for stimulants and 10% for opioid comorbidity. Discussion This multisite investigation suggests that between 62% and 79% of hospitalized injury survivors with elevated PTSD symptoms have one or more alcohol or drug use comorbidity. Orchestrated ACS-COT policy and trauma center service delivery development should incorporate the key finding that a substantial majority of patients with high levels of psychological distress (eg, elevated PTSD symptoms) may have alcohol and drug use comorbidities. Level of evidence Level II (epidemiological investigation of untreated controls from a multisite randomized clinical trial) Trial registration number NCT02655354.
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Affiliation(s)
- Jefferson Nguyen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lauren K Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Eileen M Bulger
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Laura Veach
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Deepika Nehra
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Douglas F Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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11
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Leng Y, Wu Y, Wang Z, Zhou X, Liao J. A qualitative study exploring barriers and facilitators to establishing nurse-led, multidisciplinary psychological care for trauma patients: experiences from doctors and nurses. BMC Nurs 2022; 21:191. [PMID: 35854301 PMCID: PMC9297566 DOI: 10.1186/s12912-022-00971-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 07/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background Trauma patients are often in a state of psychological stress, experiencing helplessness, sadness, frustration, irritation, avoidance, irritability and other adverse emotions. Doctors and nurses are at the forefront of caring trauma patients and they play a crucial role in psychological supports and mental health care. However, few qualitative studies had based on the framework of the Theory of Planned Behavior (TPB) to explore the experiences in providing psychological care for trauma patients. We examined attitudinal, normative, and control beliefs underpinning medical staffs’ decisions to perform psychological care. Method A qualitative study of in-depth semi-structured interviews was conducted among 14 doctors and nurses engaging in trauma care. The participants came from six tertiary hospitals in Chongqing, China. Data analysis was performed using the approach of Colaizzi. According to the framework of TPB, the researchers identified and summarized the themes. Results Important advantages (mutual trust, patients' adherence and recovery), disadvantages (workload, short-term ineffective, practice unconfidently), referents (supportive: managers, patients, kinsfolk, nursing culture; unsupportive: some colleagues and patients), barriers (insufficient time or energy, resources situations), and facilitators (access to psychologist, training/education, reminders) were identified. Some demands, such as training diversity, multidisciplinary cooperation and families' support, reflected by doctors and nurses were important for them to carry out psychological care. Conclusion According to the TPB, this article explored the internal and external promotion and hindrance factors that affecting the intentions and behaviors of doctors and nurses in implementing psychological care for trauma patients. We also focused on the experience and demands of health professionals in conducting psychological care, which could provide references for managers to formulate corresponding psychological care procedures and norms.
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Affiliation(s)
- Yanan Leng
- Department of Hepatobiliary Surgery, Southwest Hospital, the first affiliated hospital to Army Medical University, Chongqing, China
| | - Ying Wu
- Department of Hepatobiliary Surgery, Southwest Hospital, the first affiliated hospital to Army Medical University, Chongqing, China
| | - Zonghua Wang
- Department of Clinical Nursing, School of Nursing, Army Medical University, Shapingba District, Gaotanyan Street 30, Chongqing, China.
| | - Xiaoping Zhou
- Department of Rehabilitation Medicine, Southwest Hospital, the first affiliated hospital to Army Medical University, Chongqing, China
| | - Jianmei Liao
- Department of Nursing, Southwest Hospital, the first affiliated hospital to Army Medical University, Chongqing, China.
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12
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Screening tools for predicting posttraumatic stress disorder in acutely injured adult trauma patients: A systematic review. J Trauma Acute Care Surg 2022; 92:e115-e126. [PMID: 34991124 DOI: 10.1097/ta.0000000000003524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adult trauma patients are at risk of developing posttraumatic stress disorder (PTSD). Early intervention reduces the development of PTSD, but few trauma patients seek and obtain care. Valid and reliable screening tools are needed to identify patients at risk of developing PTSD. The objective of this review is to identify existing screening tools and evaluate their accuracy for predicting PTSD outcomes. METHODS PubMed, PsychInfo, and ClinicalTrials.gov were searched for studies evaluating the predictive accuracy of PTSD screening tools among traumatically injured adult civilians. Eligible studies assessed patients during acute hospitalization and at least 1 month following injury to measure PTSD outcome. Eligible outcomes included measures of predictive accuracy, such as sensitivity and specificity. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the risk of bias of each study, and the strength of evidence was assessed following the Agency for Healthcare Research and Quality guidelines. RESULTS Forty-nine studies were included evaluating the predictive accuracy of 38 screening tools. Most tools were assessed in a single study. Questionnaire-style tools had more favorable predictive ability than diagnostic interview assessments. The Injured Trauma Survivor Screen, Posttraumatic Adjustment Screen, the PTSD Checklist for DSM-5, and the Richmond et al. tool demonstrated the most favorable predictive accuracy, with high sensitivity (75-100%) and specificity (67-94%). Common sources of bias were selection bias due to high attrition rate and using nondiagnostic tools to assess PTSD symptoms at follow-up. CONCLUSION Although sensitivity and specificity of PTSD predictive tools varied widely, several emerged with favorable predictive accuracy. Further research is needed to define the ability of screening and intervention to prevent PTSD in injured trauma survivors. The results of this review can inform screening tool options for screening programs and future intervention studies. LEVEL OF EVIDENCE Systematic review, level III.
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13
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Whiteside LK, Huynh L, Morse S, Hall J, Meurer W, Banta-Green CJ, Scheuer H, Cunningham R, McGovern M, Zatzick DF. The Emergency Department Longitudinal Integrated Care (ED-LINC) intervention targeting opioid use disorder: A pilot randomized clinical trial. J Subst Abuse Treat 2022; 136:108666. [PMID: 34952745 PMCID: PMC9056018 DOI: 10.1016/j.jsat.2021.108666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/09/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Opioid use disorder (OUD) and related comorbid conditions are highly prevalent among patients presenting to emergency department (ED) settings. Research has developed few comprehensive disease management strategies for at-risk patients presenting to the ED that both decrease illicit opioid use and improve initiation and retention in medication treatment for OUD (MOUD). METHODS The research team conducted a pilot pragmatic clinical trial that randomized 40 patients presenting to a single ED to a collaborative care intervention (n = 20) versus usual care control (n = 20) conditions. Interviewers blinded to patient intervention and control group status followed-up with participants at 1, 3, and 6 months after presentation to the ED. The 3-month Emergency Department Longitudinal Integrated Care (ED-LINC) collaborative care intervention for patients at risk for OUD included: 1) a Brief Negotiated Interview at bedside, 2) overdose education and facilitation of MOUD, 3) longitudinal proactive care management, 4) utilization of the statewide health information exchange platform for 24/7 tracking of recurrent ED utilization, and 5) weekly caseload supervision that incorporated measurement-based care treatment assessment with stepped-up care for patients with recalcitrant symptoms. RESULTS Overall, the ED-LINC intervention was feasibly delivered and acceptable to patients. The pilot study achieved >80% follow-up rates at 1, 3, and 6 months. In adjusted longitudinal mixed model regression analyses, no statistically significant differences existed in days of opioid use over the past 30 days for ED-LINC intervention patients when compared to patients receiving usual care (incidence-rate ratio (IRR) 1.50, 95% CI 0.54-4.16). The unadjusted mean number of days of illicit opioid use decreased at the 1-month and 3-month follow-up time points for both groups. ED-LINC intervention patients had increased rates of MOUD initiation compared to control patients (50% versus 30%); intervention versus control comparisons did not achieve statistical significance, although power to detect significant differences in the pilot was limited. CONCLUSIONS The ED-LINC intervention for patients with OUD can be feasibly implemented and warrants testing in larger scale, adequately powered randomized pragmatic clinical trial investigations. CLINICALTRIALS gov NCT03699085.
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Affiliation(s)
- Lauren K Whiteside
- Department of Emergency Medicine & Harborview Injury Prevention and Research Center, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America.
| | - Ly Huynh
- Department of Emergency Medicine, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America.
| | - Sophie Morse
- Department of Emergency Medicine, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America.
| | - Jane Hall
- Department of Emergency Medicine, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America.
| | - William Meurer
- Department of Emergency Medicine, University of Michigan Medical School, 1500 E Medical Center Drive, Ann Arbor, MI 48109-5303, United States of America.
| | - Caleb J Banta-Green
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America.
| | - Hannah Scheuer
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America.
| | - Rebecca Cunningham
- Department of Emergency Medicine, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Rd Bldg. 10-G080, Ann Arbor, MI 48109-2800, United States of America.
| | - Mark McGovern
- Department of Psychiatry & Behavioral Sciences and Department of Medicine, Stanford University School of Medicine, 1520 Page Mill Road Suite 158, MC 5721, Stanford, CA 94305, United States of America.
| | - Douglas F Zatzick
- Department of Psychiatry & Behavioral Sciences & Harborview Injury Prevention and Research Center, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America.
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Moon K, Sobolev M, Kane JM. Digital and Mobile Health Technology in Collaborative Behavioral Health Care: Scoping Review. JMIR Ment Health 2022; 9:e30810. [PMID: 35171105 PMCID: PMC8892315 DOI: 10.2196/30810] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/08/2021] [Accepted: 10/20/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The collaborative care model (CoCM) is a well-established system of behavioral health care in primary care settings. There is potential for digital and mobile technology to augment the CoCM to improve access, scalability, efficiency, and clinical outcomes. OBJECTIVE This study aims to conduct a scoping review to synthesize the evidence available on digital and mobile health technology in collaborative care settings. METHODS This review included cohort and experimental studies of digital and mobile technologies used to augment the CoCM. Studies examining primary care without collaborative care were excluded. A literature search was conducted using 4 electronic databases (MEDLINE, Embase, Web of Science, and Google Scholar). The search results were screened in 2 stages (title and abstract screening, followed by full-text review) by 2 reviewers. RESULTS A total of 3982 nonduplicate reports were identified, of which 20 (0.5%) were included in the analysis. Most studies used a combination of novel technologies. The range of digital and mobile health technologies used included mobile apps, websites, web-based platforms, telephone-based interactive voice recordings, and mobile sensor data. None of the identified studies used social media or wearable devices. Studies that measured patient and provider satisfaction reported positive results, although some types of interventions increased provider workload, and engagement was variable. In studies where clinical outcomes were measured (7/20, 35%), there were no differences between groups, or the differences were modest. CONCLUSIONS The use of digital and mobile health technologies in CoCM is still limited. This study found that technology was most successful when it was integrated into the existing workflow without relying on patient or provider initiative. However, the effect of digital and mobile health on clinical outcomes in CoCM remains unclear and requires additional clinical trials.
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Affiliation(s)
- Khatiya Moon
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
| | - Michael Sobolev
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States.,Cornell Tech, Cornell University, New York City, NY, United States
| | - John M Kane
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
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15
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Acceptability and effectiveness of CBT and psychologically based interventions for emergency department attenders with medical complaints: a systematic literature review. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Abstract
This systematic literature review surveyed the evidence for the acceptability and effectiveness of CBT and psychologically based interventions for emergency department (ED) attenders with physical health complaints as their primary concern, in light of over-burdened EDs and the existing evidence base for psychological interventions in other medical settings. The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018087860). A systematic search of three databases (APAPsychNet, Cochrane and PubMed) was performed to identify psychological treatment studies targeting physical health problems presenting in the ED, with broad inclusion criteria to capture a coherent understanding of the current knowledge base. A total of 2606 potential studies for inclusion were identified; 45 proceeded to full review. Twenty papers met the full inclusion. Included studies covered four clinical areas: trauma/PTSD-prevention, panic attacks, non-cardiac chest-pain and miscellaneous. A narrative description of findings reflected positive outcomes across all groups, but this was not consistent across any group. Few studies measured ED attendance (20%) or satisfaction/acceptability (10%). The majority of studies (90%) were underpinned by a cognitive behavioural framework, consistent with the current evidence base as applied to the management of medical conditions. Findings suggest there is some evidence that interventions in the ED are effective and acceptable to patients, but interpretation of findings is limited by the mixed quality of designs and risk of bias.
Key learning aims
(1)
To understand the current body of evidence for the feasibility and effectiveness of psychological interventions in the emergency department.
(2)
To gain a clear understanding of the models and format of the delivery of CBT and psychological interventions in an acute setting.
(3)
To identify gaps in the evidence to inform future development of CBT-based interventions to improve outcomes and clinical care.
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16
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Bertl M, Metsallik J, Ross P. A systematic literature review of AI-based digital decision support systems for post-traumatic stress disorder. Front Psychiatry 2022; 13:923613. [PMID: 36016975 PMCID: PMC9396247 DOI: 10.3389/fpsyt.2022.923613] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/15/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Over the last decade, an increase in research on medical decision support systems has been observed. However, compared to other disciplines, decision support systems in mental health are still in the minority, especially for rare diseases like post-traumatic stress disorder (PTSD). We aim to provide a comprehensive analysis of state-of-the-art digital decision support systems (DDSSs) for PTSD. METHODS Based on our systematic literature review of DDSSs for PTSD, we created an analytical framework using thematic analysis for feature extraction and quantitative analysis for the literature. Based on this framework, we extracted information around the medical domain of DDSSs, the data used, the technology used for data collection, user interaction, decision-making, user groups, validation, decision type and maturity level. Extracting data for all of these framework dimensions ensures consistency in our analysis and gives a holistic overview of DDSSs. RESULTS Research on DDSSs for PTSD is rare and primarily deals with the algorithmic part of DDSSs (n = 17). Only one DDSS was found to be a usable product. From a data perspective, mostly checklists or questionnaires were used (n = 9). While the median sample size of 151 was rather low, the average accuracy was 82%. Validation, excluding algorithmic accuracy (like user acceptance), was mostly neglected, as was an analysis concerning possible user groups. CONCLUSION Based on a systematic literature review, we developed a framework covering all parts (medical domain, data used, technology used for data collection, user interaction, decision-making, user groups, validation, decision type and maturity level) of DDSSs. Our framework was then used to analyze DDSSs for post-traumatic stress disorder. We found that DDSSs are not ready-to-use products but are mostly algorithms based on secondary datasets. This shows that there is still a gap between technical possibilities and real-world clinical work.
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Affiliation(s)
- Markus Bertl
- Department of Health Technologies, School of Information Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - Janek Metsallik
- Department of Health Technologies, School of Information Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - Peeter Ross
- Department of Health Technologies, School of Information Technologies, Tallinn University of Technology, Tallinn, Estonia
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17
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Engstrom A, Moloney K, Nguyen J, Parker L, Roberts M, Moodliar R, Russo J, Wang J, Scheuer H, Zatzick D. A Pragmatic Clinical Trial Approach to Assessing and Monitoring Suicidal Ideation: Results from A National US Trauma Care System Study. Psychiatry 2021; 85:13-29. [PMID: 34932440 PMCID: PMC8916972 DOI: 10.1080/00332747.2021.1991200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Few investigations have comprehensively described methods for assessing and monitoring suicidal ideation in pragmatic clinical trials of mental health services interventions. This investigation's goal was to assess a collaborative care intervention's effectiveness in reducing suicidal ideation and describe suicide monitoring implementation in a nationwide protocol. METHOD The investigation was a secondary analysis of a stepped wedge cluster randomized trial at 25-Level I trauma centers. Injury survivors (N = 635) were randomized to control (n = 370) and intervention (n = 265) conditions and assessed at baseline hospitalization and follow-up at 3-, 6- and 12-months post-injury. The Patient Health Questionnaire (PHQ-9) item-9 was used to evaluate patients for suicidal ideation. Mixed model regression was used to assess intervention versus control group changes in PHQ-9 item-9 scores over time and associations between baseline characteristics and development of suicidal ideation longitudinally. As part of the study implementation process assessment, suicide outreach call logs were also reviewed. RESULTS Over 50% of patients endorsed suicidal ideation at ≥1 assessment. Intervention patients relative to control patients demonstrated reductions in endorsements of suicidal ideation that did not achieve statistical significance (F[3,1461] = 0.74, P = .53). The study team completed outreach phone calls, texts or voice messages to 268 patients with PHQ-9 item-9 scores ≥1 (n = 161 control, n = 107 intervention). CONCLUSIONS Suicide assessment and monitoring can be feasibly implemented in large-scale pragmatic clinical trials. Intervention patients demonstrated less suicidal ideation over time; however, these comparisons did not achieve statistical significance. Intensive pragmatic trial monitoring may mask treatment effects by providing control patients a supportive intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT02655354.
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Affiliation(s)
- Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Jefferson Nguyen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Lea Parker
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- Department of Psychology, Drexel University College of Arts and Sciences, Philadelphia, US
| | - Michelle Roberts
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, USA
| | - Rddhi Moodliar
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- Department of Psychology, University of California, Los Angeles, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, USA
| | - Hannah Scheuer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- School of Social Work, University of Washington, Seattle, USA
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, USA
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18
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Nehra D, Bulger EM, Maier RV, Moloney KE, Russo J, Wang J, Anderson K, Zatzick DF. A Prospective US National Trauma Center Study of Firearm Injury Survivors Weapon Carriage and Posttraumatic Stress Disorder Symptoms. Ann Surg 2021; 274:e364-e369. [PMID: 34225296 PMCID: PMC8434993 DOI: 10.1097/sla.0000000000005043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the demographic, injury-related, and mental health characteristics of firearm injury patients and trace firearm weapon carriage and PTSD symptoms over the year after injury. SUMMARY AND BACKGROUND DATA Based on the increasing incidence of firearm injury and need for novel injury prevention strategies, hospital-based violence intervention programs are being implemented in US trauma centers. There is limited data on the long-term outcomes and risk behaviors of firearm injury survivors to guide this work. METHODS We conducted a secondary analysis of a pragmatic 25-trauma center randomized trial (N = 635). Baseline characteristics of firearm-injured patients (N = 128) were compared with other trauma patients. Mixed model regression was used to identify risk factors for postinjury firearm weapon carriage and PTSD symptoms. RESULTS Firearm injury patients were younger and more likely to be black, male and of lower socioeconomic status, and more likely to carry a firearm in the year before injury. Relative to preinjury, there was a significant drop in firearm weapon carriage at 3- and 6-months postinjury, followed by a return to preinjury levels at 12-months. Firearm injury was significantly and independently associated with an increased risk of postinjury firearm weapon carriage [relative risk = 2.08, 95% confidence interval (1.34, 3.22), P < 0.01] and higher PTSD symptom levels [Beta = 3.82, 95% confidence interval (1.29, 6.35), P < 0.01]. CONCLUSIONS Firearm injury survivors are at risk for firearm carriage and high PTSD symptom levels postinjury. The significant decrease in the high-risk behavior of firearm weapon carriage at 3-6 months postinjury suggests that there is an important postinjury "teachable moment" that should be targeted with preventive interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT02655354.
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Affiliation(s)
- Deepika Nehra
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Eileen M Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Ronald V Maier
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Kathleen E Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Jin Wang
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, USA
| | - Kristina Anderson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- The Koshka Foundation, Seattle, USA
| | - Douglas F Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, USA
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19
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Zatzick D, Jurkovich G, Heagerty P, Russo J, Darnell D, Parker L, Roberts MK, Moodliar R, Engstrom A, Wang J, Bulger E, Whiteside L, Nehra D, Palinkas LA, Moloney K, Maier R. Stepped Collaborative Care Targeting Posttraumatic Stress Disorder Symptoms and Comorbidity for US Trauma Care Systems: A Randomized Clinical Trial. JAMA Surg 2021; 156:430-474. [PMID: 33688908 DOI: 10.1001/jamasurg.2021.0131] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance To date, few multisite investigations have evaluated early interventions for injured patients with posttraumatic stress disorder (PTSD) symptoms. Objective To simultaneously assess the effectiveness and implementation of a brief stepped collaborative care intervention targeting PTSD and comorbidity. Design, Setting, and Participants A stepped-wedge cluster randomized clinical trial was conducted at 25 US level I trauma centers. Participants included hospitalized survivors of physical injury who underwent a 2-step evaluation for PTSD symptoms. Patients reporting high levels of distress on the PTSD Checklist (PCL-C) were randomized (N = 635) per the stepped-wedge protocol to enhanced usual care control (n = 370) or intervention (n = 265) conditions. The study was conducted from January 4, 2016, through November 2018. Data analysis was performed from November 4, 2019, to December 8, 2020. Interventions The Trauma Survivors Outcomes and Support collaborative care intervention included proactive injury case management that assisted patients transitioning from hospital inpatient to outpatient and community settings. The intervention also integrated evidence-based pharmacotherapy and psychotherapeutic elements targeting PTSD symptoms and comorbidity. Main Outcomes and Measures The primary study outcome was PTSD symptoms assessed with the PCL-C at baseline in the surgical ward and at 3, 6, and 12 months postinjury. Secondary outcomes included depressive symptoms, alcohol use, and physical function. Subgroup analyses examined the effect of baseline risk factors for enduring PTSD and quality of protocol implementation on study outcomes. Primary statistical analyses were conducted using the intent-to-treat sample. Results A total of 327 men (51.5%) were included in analysis; mean (SD) age was 39.0 (14.2) years. The investigation attained follow-up of 75% to 80% of the participants at 3 to 12 months. The intervention lasted a mean (SD) of 122 (132) minutes. Mixed model regression analyses revealed statistically significant changes in PCL-C scores for intervention patients compared with control patients at 6 months (difference, -2.57; 95% CI, -5.12 to -0.03; effect size, 0.18; P < .05) but not 12 months (difference, -1.27; 95% CI, -4.26 to 1.73; effect size, 0.08; P = .35). Subgroup analyses revealed larger PTSD treatment effects for patients with 3 or more baseline risk factors for enduring PTSD and for patients, including firearm injury survivors, treated at trauma centers with good or excellent protocol implementation. Intervention effects for secondary outcomes did not attain statistical significance. Conclusions and Relevance A brief stepped collaborative care intervention was associated with significant 6-month but not 12-month PTSD symptom reductions. Greater baseline PTSD risk and good or excellent trauma center protocol implementation were associated with larger PTSD treatment effects. Orchestrated efforts targeting policy and funding should systematically incorporate the study findings into national trauma center requirements and verification criteria. Trial Registration ClinicalTrials.gov Identifier: NCT02655354.
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Affiliation(s)
- Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.,Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle
| | - Gregory Jurkovich
- Department of Surgery, UC Davis School of Medicine, Sacramento, California
| | - Patrick Heagerty
- Department of Biostatistics, University of Washington School of Public Health, Seattle
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Doyanne Darnell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Lea Parker
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.,Department of Psychology, Drexel University College of Arts and Sciences, Philadelphia, Pennsylvania
| | - Michelle K Roberts
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.,Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle
| | - Rddhi Moodliar
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.,Department of Psychology, University of California, Los Angeles
| | - Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Jin Wang
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle
| | - Eileen Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle
| | - Deepika Nehra
- Department of Surgery, University of Washington School of Medicine, Seattle
| | - Lawrence A Palinkas
- Department of Children, Youth and Families, USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Ronald Maier
- Department of Surgery, University of Washington School of Medicine, Seattle
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20
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Haider A, Shahbaz H. Leveraging Collaborative Care Models to Mitigate Posttraumatic Stress Disorder After Injury: We Can Do This! JAMA Surg 2021; 156:442-443. [PMID: 33688934 DOI: 10.1001/jamasurg.2021.0132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Adil Haider
- Aga Khan University, Karachi, Pakistan.,Deputy Editor, JAMA Surgery
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21
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Bisson JI, Wright LA, Jones KA, Lewis C, Phelps AJ, Sijbrandij M, Varker T, Roberts NP. Preventing the onset of post traumatic stress disorder. Clin Psychol Rev 2021; 86:102004. [PMID: 33857763 DOI: 10.1016/j.cpr.2021.102004] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/25/2021] [Accepted: 02/26/2021] [Indexed: 12/15/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a common mental health condition that requires exposure to a traumatic event. This provides unique opportunities for prevention that are not available for other disorders. The aim of this review was to undertake a systematic review and evaluation of randomized controlled trials (RCTs) of interventions designed to prevent PTSD in adults. Searches involving Cochrane, Embase, Medline, PsycINFO, PILOTS and Pubmed databases were undertaken to identify RCTs of pre-incident preparedness and post-incident interventions until May 2019. Six pre-incident and 69 post-incident trials were identified that could be included in meta-analyses. The overall quality of the evidence was low. There was emerging evidence that some interventions may be helpful but an absence of evidence for any intervention that can be strongly recommended for universal, selected or indicated prevention before or within the first three months of a traumatic event. The strongest results were found for cognitive-behavioural therapy with a trauma focus (CBT-T) in individuals with a diagnosis of acute stress disorder which supports calls to detect and treat individuals with significant symptoms rather than providing blanket preventative interventions. Further research is required to optimally configure existing interventions with some evidence of effect and to develop novel interventions to address this major public health issue.
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Affiliation(s)
- Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, United Kingdom.
| | - Laurence Astill Wright
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, United Kingdom
| | - Kimberley A Jones
- Phoenix Australia- Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Victoria, Australia
| | - Catrin Lewis
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, United Kingdom
| | - Andrea J Phelps
- Phoenix Australia- Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Victoria, Australia
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Centre for Research and Dissemination of Psychological Interventions, VU University, Amsterdam, the Netherlands
| | - Tracey Varker
- Phoenix Australia- Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Victoria, Australia
| | - Neil P Roberts
- Psychology and Psychological Therapies Directorate, Cardiff & Vale University Health Board, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, United Kingdom
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22
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Larsen SE, Hunt JC, Geier T, Heyrman K, Schumann N, Brandolino A, Timmer-Murillo S, Bergner C, Larson C, deRoon-Cassini TA. A Randomized Trial of Modified Prolonged Exposure to Prevent the Development of Posttraumatic Stress Disorder in Patients Hospitalized With Traumatic Injuries. J Trauma Stress 2021; 34:104-115. [PMID: 33269808 DOI: 10.1002/jts.22580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/13/2020] [Accepted: 05/05/2020] [Indexed: 11/11/2022]
Abstract
Individuals who require hospitalization after traumatic injuries are at increased risk for developing posttraumatic stress disorder (PTSD); however, few early behavioral interventions have been effective at preventing PTSD within this population. The aim of this pilot study was to assess the feasibility and effectiveness of modified prolonged exposure therapy (mPE) to prevent PTSD and depression symptoms among patients hospitalized after a DSM-5 single-incident trauma. Hospitalized patients were eligible if they screened positive for PTSD risk. Participants (N = 74) were randomly assigned in a parallel-groups design to receive mPE (n = 38) or standard of care treatment (SoC; n = 36) while admitted to the hospital after a traumatic injury. Individuals randomized to the intervention condition received one (42.1%), two (36.8%), or three sessions (15.8%) of mPE, mainly depending on length of stay. There were no significant differences between groups regarding PTSD or depression severity at 1- or 3-months posttrauma, except for more PTSD diagnoses in the intervention group after 1 month, ϕ = -.326. Intervention differences were nonsignificant when we took baseline PTSD symptoms and the nonindependence of the repeated measurements within the data into account. No adverse events were reported. Overall, mPE was no more effective than SoC for hospitalized, traumatic injury survivors with a high PTSD risk. The results may point to a need for a stepped-care approach, where intervention protocols focus on first briefly treating individuals who are actively exhibiting acute stress reactions, then extensively treating those whose symptoms do not decrease over time.
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Affiliation(s)
- Sadie E Larsen
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA.,Milwaukee VA Medical Center, Milwaukee, Wisconsin, USA
| | - Joshua C Hunt
- Department of Surgery, Division of Trauma & Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Tim Geier
- Department of Surgery, Division of Trauma & Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katelyn Heyrman
- Department of Educational Psychology, University of Wisconsin Milwaukee, Milwaukee, Wisconsin, USA
| | - Nicholas Schumann
- Department of Surgery, Division of Trauma & Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Amber Brandolino
- Department of Surgery, Division of Trauma & Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Carisa Bergner
- Medical College of Wisconsin, Comprehensive Injury Center, Milwaukee, WI, USA
| | - Christine Larson
- Department of Psychology, University of Wisconsin Milwaukee, Milwaukee, Wisconsin, USA
| | - Terri A deRoon-Cassini
- Department of Surgery, Division of Trauma & Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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23
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Scheuer H, Engstrom A, Thomas P, Moodliar R, Moloney K, Walen ML, Johnson P, Seo S, Vaziri N, Martinez A, Maier R, Russo J, Sieber S, Anziano P, Anderson K, Bulger E, Whiteside L, Heagerty P, Palinkas L, Zatzick D. A comparative effectiveness trial of an information technology enhanced peer-integrated collaborative care intervention versus enhanced usual care for US trauma care systems: Clinical study protocol. Contemp Clin Trials 2020; 91:105970. [PMID: 32119926 PMCID: PMC9677945 DOI: 10.1016/j.cct.2020.105970] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/18/2020] [Accepted: 02/22/2020] [Indexed: 11/18/2022]
Abstract
Annually approximately 2-3 million Americans are so severely injured that they require inpatient hospitalization. The study team, which includes patients, clinical researchers, front-line provider and policy maker stakeholders, has been working together for over a decade to develop interventions that target improvements for US trauma care systems nationally. This pragmatic randomized trial compares a multidisciplinary team collaborative care intervention that integrates front-line trauma center staff with peer interventionists, versus trauma team notification of patient emotional distress with mental health consultation as enhanced usual care. The peer-integrated collaborative care intervention will be supported by a novel emergency department exchange health information technology platform. A total of 424 patients will be randomized to peer-integrated collaborative care (n = 212) and surgical team notification (n = 212) conditions. The study hypothesizes that patient's randomized to peer integrated collaborative care intervention will demonstrate significant reductions in emergency department health service utilization, severity of patient concerns, post traumatic stress disorder symptoms, and physical limitations when compared to surgical team notification. These four primary outcomes will be followed-up at 1- 3-, 6-, 9- and 12-months after injury for all patients. The Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE) method will be used to assess implementation processes. Data from the primary outcome analysis and implementation process assessment will be used to inform an end-of-study policy summit with the American College of Surgeons Committee on Trauma. The policy summit will facilitate acute care practice changes related to patient-centered care transitions over the course of a single 5-year funding cycle. Trial registration: (Clinicaltrials.govNCT03569878).
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Affiliation(s)
- Hannah Scheuer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America.
| | - Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America.
| | - Peter Thomas
- Powers Pyles Sutter & Verville PC, 501 M Street, NW, Seventh Floor, Washington, DC 20005, United States of America.
| | - Rddhi Moodliar
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America.
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America.
| | - Mary Lou Walen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America.
| | - Peyton Johnson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America.
| | - Sara Seo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America.
| | - Natalie Vaziri
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America.
| | - Alvaro Martinez
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America.
| | - Ronald Maier
- Department of Surgery, University of Washington School of Medicine, 410 9th Ave., Seattle, WA 98104, United States of America.
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America.
| | - Stella Sieber
- Molecular Genomics Core/Microarray Group, National Institute of Environmental Health Sciences, P.O. Box 12233, Mail Drop D2-04, Durham, N.C 27709, United States of America.
| | - Pete Anziano
- Shepherd Center, 2020 Peachtree Road NW, Atlanta, GA 30309-1465, United States of America.
| | - Kristina Anderson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America; The Koshka Foundation, United States of America.
| | - Eileen Bulger
- Department of Surgery, University of Washington School of Medicine, 410 9th Ave., Seattle, WA 98104, United States of America.
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104, United States of America.
| | - Patrick Heagerty
- Department of Biostatistics, University of Washington School of Public Health, 1705 NE Pacific St., Seattle, WA 98195, United States of America.
| | - Lawrence Palinkas
- Department of Children, Youth and Families, USC Suzanne Dworak-Peck School of Social Work, 669 W 34(th) St., Los Angeles, CA 90089, United States of America.
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America.
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24
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Darnell D, Parker L, Engstrom A, Fisher D, Diteman K, Dunn C. Evaluation of a Level I trauma center provider training in patient-centered alcohol brief interventions using the Behavior Change Counseling Index rated by standardized patients. Trauma Surg Acute Care Open 2019; 4:e000370. [PMID: 31922018 PMCID: PMC6937416 DOI: 10.1136/tsaco-2019-000370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/22/2019] [Accepted: 12/02/2019] [Indexed: 12/30/2022] Open
Abstract
Background Traumatic injury requiring hospitalization is common in the USA and frequently related to alcohol consumption. The American College of Surgeons requires that Level I and II verified trauma centers implement universal alcohol screening and brief intervention for injured patients. We examined whether Level I trauma center provider skill in patient-centered alcohol brief interventions improved after training and whether professional role (eg, nursing, social work) and education were associated with these skills. Methods We present evaluation data collected as part of training in alcohol brief interventions embedded within a larger clinical trial of a collaborative care intervention targeting posttraumatic stress disorder and related comorbidities. Sixty-five providers from 25 US Level I trauma centers engaged in a 1-day workshop, with 2 hours dedicated to training in patient-centered alcohol brief interventions followed by 6 months of weekly coaching in a collaborative care model. Providers completed standardized patient role-plays prior to and 6 months after the workshop training. The standardized patient actors rated provider quality of alcohol brief interventions immediately after each role-play using the Behavior Change Counseling Index (BECCI), a pragmatic measure designed to assess the quality of behavior change counseling, an adaptation of motivational interviewing suitable for brief healthcare consultations about behavior change. Results Seventy-two percent of providers completed both standardized patient role-play assessments. A statistically significant improvement in overall BECCI scores (t(41)=−2.53, p=0.02, Cohen’s d=−0.39) was observed among those providers with available pre–post data. Provider professional role was associated with BECCI scores at pre-training (F(3, 58)=11.25, p<0.01) and post-training (F(3, 41)=8.10, p<0.01). Discussion Findings underscore the need for training in patient-centered alcohol brief interventions and suggest that even a modest training helps providers engage in a more patient-centered way during a role-play assessment. Level of evidence Level V, therapeutic/care management.
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Affiliation(s)
- Doyanne Darnell
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Lea Parker
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Allison Engstrom
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Dylan Fisher
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Kaylie Diteman
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Christopher Dunn
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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25
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Early Interventions for the Prevention of Posttraumatic Stress Symptoms in Survivors of Critical Illness: A Qualitative Systematic Review. Crit Care Med 2019; 46:1328-1333. [PMID: 29794546 DOI: 10.1097/ccm.0000000000003222] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Posttraumatic stress disorder among survivors of critical illness is of public health importance, as it is common and reduces patient quality of life. The objective of this systematic review was to collate the world's literature on interventions aimed at preventing posttraumatic stress disorder among survivors of critical illness. DATA SOURCES We performed a search of CENTRAL, MEDLINE, EMBASE, CINAHL, and clinical trials registry platforms, with no restriction to language using a comprehensive strategy. STUDY SELECTION Study inclusion criteria were as follows: 1) adult human subjects, 2) patients treated in an ICU setting, 3) intervention arm aimed at reducing posttraumatic stress disorder symptoms, 4) use of a control arm, and 5) an outcome measure assessing development of acute stress or posttraumatic stress disorder symptoms. DATA EXTRACTION We performed a qualitative analysis to collate and summarize effects of identified interventions according to the recommended methodology from the Cochrane Handbook. DATA SYNTHESIS Seventeen studies met all inclusion and no exclusion criteria. There was heterogeneity in interventions and outcome measures used. All studies had some concern for risk of bias as per the Cochrane tool for assessing risk of bias. In eight of 12 studies (67%) testing early interventions (i.e., initiated in the ICU course) and one of five studies (20%) testing delayed interventions following ICU discharge, posttraumatic stress disorder symptoms were decreased among the intervention group compared with controls. CONCLUSIONS Despite a paucity of high-quality clinical investigations, the preponderance of evidence to date suggests that 1) posttraumatic stress disorder among survivors of critical illness may be preventable and 2) early interventions may be the most effective.
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26
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McCarty CA, Zatzick D, Hoopes T, Payne K, Parrish R, Rivara FP. Collaborative care model for treatment of persistent symptoms after concussion among youth (CARE4PCS-II): Study protocol for a randomized, controlled trial. Trials 2019; 20:567. [PMID: 31533799 PMCID: PMC6749638 DOI: 10.1186/s13063-019-3662-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 08/19/2019] [Indexed: 11/26/2022] Open
Abstract
Background Currently, there is limited evidence to guide intervention and service delivery coordination for youth who suffer a concussion and subsequently experience persistent post-concussive symptoms (PCS) (Lumba-Brown et al. JAMA Pediatr 172(11):e182853, 2018; Lumba-Brown A et al. JAMA Pediatr 172(11):e182847, 2018). We have developed a collaborative care intervention with embedded cognitive-behavioral therapy, care management, and stepped-up psychotropic medication consultation to address persistent PCS and related psychological comorbidities. The CARE4PCS-II study was designed to assess whether adolescents with persistent symptoms after sports-related concussion will demonstrate better outcomes when receiving this collaborative care intervention compared to a usual care (control) condition. Methods/design This investigation is a randomized comparative effectiveness trial to receive intervention (collaborative care) or control (usual care). Two hundred sports-injured male and female adolescents aged 11–18 years with three or more post-concussive symptoms that persist for at least 1 month but less than 9 months after injury will be recruited and randomized into the study. The trial focuses on the effects of the intervention on post-concussive, depressive, and anxiety symptoms measured 3, 6, and 12 months after baseline. Discussion The CARE4PCS II study is a large comparative effectiveness trial targeting symptomatic improvements in sports injured adolescents after concussion. The study is unique in its adaptation of the collaborative care model to a broad spectrum of primary care, sports medicine, and school settings. The investigation incorporates novel elements such as the delivery of CBT through HIPAA complaint video conferenceing technology and has excellent widespread dissemination potential should effectiveness be demonstrated. Trial registration ClinicalTrials.gov, NCT03034720. Registered on January 27, 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3662-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carolyn A McCarty
- Seattle Children's Research Institute, P.O. Box 5371, M/S: CW8-5, Seattle, WA, 98145-5005, USA. .,Department of Pediatrics, University of Washington, Seattle, USA.
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center 325 9th Avenue, Box 359911, Seattle, WA, 98104-2499, USA
| | - Teah Hoopes
- Seattle Children's Research Institute, P.O. Box 5371, M/S: CW8-5, Seattle, WA, 98145-5005, USA
| | - Katelyn Payne
- Seattle Children's Research Institute, P.O. Box 5371, M/S: CW8-5, Seattle, WA, 98145-5005, USA
| | - Rebecca Parrish
- Seattle Children's Research Institute, P.O. Box 5371, M/S: CW8-5, Seattle, WA, 98145-5005, USA
| | - Frederick P Rivara
- Seattle Children's Research Institute, P.O. Box 5371, M/S: CW8-5, Seattle, WA, 98145-5005, USA.,Department of Pediatrics, University of Washington, Seattle, USA
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27
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Roberts NP, Kitchiner NJ, Kenardy J, Robertson L, Lewis C, Bisson JI. Multiple session early psychological interventions for the prevention of post-traumatic stress disorder. Cochrane Database Syst Rev 2019; 8:CD006869. [PMID: 31425615 PMCID: PMC6699654 DOI: 10.1002/14651858.cd006869.pub3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The prevention of long-term psychological distress following traumatic events is a major concern. Systematic reviews have suggested that individual psychological debriefing is not an effective intervention at preventing post-traumatic stress disorder (PTSD). Over the past 20 years, other forms of intervention have been developed with the aim of preventing PTSD. OBJECTIVES To examine the efficacy of psychological interventions aimed at preventing PTSD in individuals exposed to a traumatic event but not identified as experiencing any specific psychological difficulties, in comparison with control conditions (e.g. usual care, waiting list and no treatment) and other psychological interventions. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO and ProQuest's Published International Literature On Traumatic Stress (PILOTS) database to 3 March 2018. An earlier search of CENTRAL and the Ovid databases was conducted via the Cochrane Common Mental Disorders Controlled Trial Register (CCMD-CTR) (all years to May 2016). We handsearched reference lists of relevant guidelines, systematic reviews and included study reports. Identified studies were shared with key experts in the field.We conducted an update search (15 March 2019) and placed any new trials in the 'awaiting classification' section. These will be incorporated into the next version of this review, as appropriate. SELECTION CRITERIA We searched for randomised controlled trials of any multiple session (two or more sessions) early psychological intervention or treatment designed to prevent symptoms of PTSD. We excluded single session individual/group psychological interventions. Comparator interventions included waiting list/usual care and active control condition. We included studies of adults who experienced a traumatic event which met the criterion A1 according to the Diagnostic and Statistical Manual (DSM-IV) for PTSD. DATA COLLECTION AND ANALYSIS We entered data into Review Manager 5 software. We analysed categorical outcomes as risk ratios (RRs), and continuous outcomes as mean differences (MD) or standardised mean differences (SMDs), with 95% confidence intervals (CI). We pooled data with a fixed-effect meta-analysis, except where there was heterogeneity, in which case we used a random-effects model. Two review authors independently assessed the included studies for risk of bias and discussed any conflicts with a third review author. MAIN RESULTS This is an update of a previous review.We included 27 studies with 3963 participants. The meta-analysis included 21 studies of 2721 participants. Seventeen studies compared multiple session early psychological intervention versus treatment as usual and four studies compared a multiple session early psychological intervention with active control condition.Low-certainty evidence indicated that multiple session early psychological interventions may be more effective than usual care in reducing PTSD diagnosis at three to six months' follow-up (RR 0.62, 95% CI 0.41 to 0.93; I2 = 34%; studies = 5; participants = 758). However, there was no statistically significant difference post-treatment (RR 1.06, 95% CI 0.85 to 1.32; I2 = 0%; studies = 5; participants = 556; very low-certainty evidence) or at seven to 12 months (RR 0.94, 95% CI 0.20 to 4.49; studies = 1; participants = 132; very low-certainty evidence). Meta-analysis indicated that there was no statistical difference in dropouts compared with usual care (RR 1.34, 95% CI 0.91 to 1.95; I2 = 34%; studies = 11; participants = 1154; low-certainty evidence) .At the primary endpoint of three to six months, low-certainty evidence indicated no statistical difference between groups in reducing severity of PTSD (SMD -0.10, 95% CI -0.22 to 0.02; I2 = 34%; studies = 15; participants = 1921), depression (SMD -0.04, 95% CI -0.19 to 0.10; I2 = 6%; studies = 7; participants = 1009) or anxiety symptoms (SMD -0.05, 95% CI -0.19 to 0.10; I2 = 2%; studies = 6; participants = 945).No studies comparing an intervention and active control reported outcomes for PTSD diagnosis. Low-certainty evidence showed that interventions may be associated with a higher dropout rate than active control condition (RR 1.61, 95% CI 1.11 to 2.34; studies = 2; participants = 425). At three to six months, low-certainty evidence indicated no statistical difference between interventions in terms of severity of PTSD symptoms (SMD -0.02, 95% CI -0.31 to 0.26; I2 = 43%; studies = 4; participants = 465), depression (SMD 0.04, 95% CI -0.16 to 0.23; I2 = 0%; studies = 2; participants = 409), anxiety (SMD 0.00, 95% CI -0.19 to 0.19; I2 = 0%; studies = 2; participants = 414) or quality of life (MD -0.03, 95% CI -0.06 to 0.00; studies = 1; participants = 239).None of the included studies reported on adverse events or use of health-related resources. AUTHORS' CONCLUSIONS While the review found some beneficial effects of multiple session early psychological interventions in the prevention of PTSD, the certainty of the evidence was low due to the high risk of bias in the included trials. The clear practice implication of this is that, at present, multiple session interventions aimed at everyone exposed to traumatic events cannot be recommended. There are a number of ongoing studies, demonstrating that this is a fast moving field of research. Future updates of this review will integrate the results of these new studies.
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Affiliation(s)
- Neil P Roberts
- Cardiff University School of MedicineDivision of Psychological Medicine and Clinical NeurosciencesHadyn Ellis BuildingMaindy RoadCardiffUKCF24 4HQ
| | - Neil J Kitchiner
- Cardiff & Vale, University Health BoardVeterans' NHS WalesGlobal LinkDunleavy DriveCardiffUKCF11 0SN
| | - Justin Kenardy
- The University of QueenslandSchool of MedicineHerston RoadHerstonAustralia4006
| | - Lindsay Robertson
- University of YorkCochrane Common Mental DisordersHeslingtonYorkUKYO10 5DD
| | - Catrin Lewis
- Cardiff University School of MedicineDivision of Psychological Medicine and Clinical NeurosciencesHadyn Ellis BuildingMaindy RoadCardiffUKCF24 4HQ
| | - Jonathan I Bisson
- Cardiff University School of MedicineDivision of Psychological Medicine and Clinical NeurosciencesHadyn Ellis BuildingMaindy RoadCardiffUKCF24 4HQ
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deRoon-Cassini TA, Hunt JC, Geier TJ, Warren AM, Ruggiero KJ, Scott K, George J, Halling M, Jurkovich G, Fakhry SM, Zatzick D, Brasel KJ. Screening and treating hospitalized trauma survivors for posttraumatic stress disorder and depression. J Trauma Acute Care Surg 2019; 87:440-450. [PMID: 31348404 PMCID: PMC6668348 DOI: 10.1097/ta.0000000000002370] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Traumatic injury affects over 2.6 million U.S. adults annually and elevates risk for a number of negative health consequences. This includes substantial psychological harm, the most prominent being posttraumatic stress disorder (PTSD), with approximately 21% of traumatic injury survivors developing the disorder within the first year after injury. Posttraumatic stress disorder is associated with deficits in physical recovery, social functioning, and quality of life. Depression is diagnosed in approximately 6% in the year after injury and is also a predictor of poor quality of life. The American College of Surgeons Committee on Trauma suggests screening for and treatment of PTSD and depression, reflecting a growing awareness of the critical need to address patients' mental health needs after trauma. While some trauma centers have implemented screening and treatment or referral for treatment programs, the majority are evaluating how to best address this recommendation, and no standard approach for screening and treatment currently exists. Further, guidelines are not yet available with respect to resources that may be used to effectively screen and treat these disorders in trauma survivors, as well as who is going to bear the costs. The purpose of this review is: (1) to evaluate the current state of the literature regarding evidence-based screens for PTSD and depression in the hospitalized trauma patient and (2) summarize the literature to date regarding the treatments that have empirical support in treating PTSD and depression acutely after injury. This review also includes structural and funding information regarding existing postinjury mental health programs. Screening of injured patients and timely intervention to prevent or treat PTSD and depression could substantially improve health outcomes and improve quality of life for this high-risk population. LEVEL OF EVIDENCE: Review, level IV.
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Affiliation(s)
- Terri A deRoon-Cassini
- From the Division of Trauma and Acute Care Surgery, Department of Surgery (T. A. d-C., T. D., T.J.G., M.H.), Milwaukee, Wisconsin; Baylor University Medical Center (A.M.W.), Baylor Scott and White Medical Psychology Consultants, Dallas, Texas; Medical University of South Carolina (K.J.R.), Departments of Nursing and Psychiatry, Charleston, South Carolina; University of Florida College of Medicine-Jacksonville, Department of Surgery, Division of Acute Care Surgery, Critical Care, TraumaOne (K.S.), Jacksonville, Florida; Parkland Health and Hospital System (J.G.), Rees-Jones Trauma Center, Dallas, Texas; University of California Davis Health (G.J.), Department of Surgery, Sacramento, California; Reston Hospital Center (S.M.F.), Trauma Surgery, Reston, Virginia; University of Washington School of Medicine (D.Z.), Department of Psychiatry and Behavioral Sciences, Seattle, Washington; and Oregon Health and Science University (K.J.B.), Department of Surgery, Portland, Oregon
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Racial Disparities in Outpatient Mental Health Service Use Among Children Hospitalized for Traumatic Brain Injury. J Head Trauma Rehabil 2019; 33:177-184. [PMID: 29194176 DOI: 10.1097/htr.0000000000000348] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine racial differences in mental health service utilization after hospitalization for traumatic brain injury (TBI) among children with Medicaid insurance. DESIGN AND MAIN MEASURES Retrospective analysis of the MarketScan Multi-State Medicaid database from 2007 to 2012 was performed. Outpatient mental health service utilization (psychiatric and psychological individual and group services) was compared at TBI hospitalization, from discharge to 3 months and from 4 to 12 months after discharge, between children of non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, and "Other" racial groups. Multivariable mixed-effects Poisson regression models with robust standard errors were utilized. RESULTS A total of 5674 children (aged <21 years) were included in the study. There were no differences by race/ethnicity in mental health service utilization during hospitalization. At 3 months postdischarge, NHB children and children in the "Other" racial category were significantly less likely to receive outpatient mental health services than NHW children (NHB relative risk [RR] = 0.84; 95% confidence interval [CI], 0.72-0.98; Other RR = 0.72; 95% CI, 0.57-0.90). At 12 months, all racial minority children were significantly less likely to receive outpatient mental health services than NHW children (NHB RR = 0.84; 95% CI, 0.75-0.94; Hispanic RR = 0.72; 95% CI, 0.55-0.94; Other RR = 0.71; 95% CI, 0.60-0.84). CONCLUSIONS Racial disparities in utilization of outpatient mental health services exist for minority children hospitalized for TBI and insured by Medicaid. Future research should focus on improving transitions of care from inpatient to outpatient services for these children.
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Abstract
PURPOSE OF REVIEW This article reviews recent evidence related to public health epidemiology and intervention for traumatic stress and PTSD. Recent evidence is presented regarding incidence of traumatic stress worldwide, as well as most frequent types of traumas, indicators of the public health burden of PTSD, and prevalence, predictors, and correlates of PTSD. Public health perspectives on intervention and treatment are delineated, and innovations in both psychosocial and psychopharmacological interventions are highlighted. RECENT FINDINGS PTSD has been associated with substantial medical and economic burden. Recent public health preventive innovations include integrated medical/behavioral health care, acute CBT and attention interventions, modifications to CBT protocols, use of novel and augmentative psychopharmacological agents, and use of technology. Recent research regarding the scope and impact of traumatic stress, as well as prevention strategies for PTSD, have resulted in an improved understanding of its impact and more effective public health interventions.
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Affiliation(s)
- Patricia Watson
- Department of Veterans Affairs (116D), National Center for PTSD, Executive Division, 215 N. Main ST, White River Junction, VT, 05009, USA.
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Bhatia-Lin A, Boon-Dooley A, Roberts MK, Pronai C, Fisher D, Parker L, Engstrom A, Ingraham L, Darnell D. Ethical and Regulatory Considerations for Using Social Media Platforms to Locate and Track Research Participants. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:47-61. [PMID: 31135323 PMCID: PMC7183769 DOI: 10.1080/15265161.2019.1602176] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
As social media becomes increasingly popular, human subjects researchers are able to use these platforms to locate, track, and communicate with study participants, thereby increasing participant retention and the generalizability and validity of research. The use of social media; however, raises novel ethical and regulatory issues that have received limited attention in the literature and federal regulations. We review research ethics and regulations and outline the implications for maintaining participant privacy, respecting participant autonomy, and promoting researcher transparency when using social media to locate and track participants. We offer a rubric that can be used in future studies to determine ethical and regulation-consistent use of social media platforms and illustrate the rubric using our study team's experience with Facebook. We also offer recommendations for both researchers and institutional review boards that emphasize the importance of well-described procedures for social media use as part of informed consent.
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Affiliation(s)
| | | | | | | | | | - Lea Parker
- a University of Washington School of Medicine
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The role of psychological support interventions in trauma patients on mental health outcomes: A systematic review and meta-analysis. J Trauma Acute Care Surg 2019; 87:463-482. [DOI: 10.1097/ta.0000000000002371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ranney ML, Patena JV, Dunsiger S, Spirito A, Cunningham RM, Boyer E, Nugent NR. A technology-augmented intervention to prevent peer violence and depressive symptoms among at-risk emergency department adolescents: Protocol for a randomized control trial. Contemp Clin Trials 2019; 82:106-114. [PMID: 31129373 DOI: 10.1016/j.cct.2019.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/10/2019] [Accepted: 05/22/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Peer violence and depressive symptoms are increasingly prevalent among adolescents, and for many, use the emergency department (ED) as their primary source of healthcare. Brief in-person interventions and longitudinal text-message-based interventions are feasible, acceptable, and may be effective in reducing peer violence and depressive symptoms when delivered in the ED setting. This paper presents the study design and protocol for an in-ED brief intervention (BI) and text messaging program (Text). METHODS This study will be conducted in a pediatric ED which serves over 50,000 pediatric patients per year. Recruitment of study participants began in August 2018 and anticipated to continue until October 2021. The study will enroll 800 adolescents (ages13-17) presenting to the ED for any reason who self-report past-year physical peer violence and past-two week mild-to-moderate depressive symptoms. The study will use a factorial randomized trial to test both overall intervention efficacy and determine the optimal combination of intervention components. A full 2 × 2 factorial design randomizes patients at baseline to 1) BI or no BI; and 2) Text or no Text. Peer violence and depressive symptoms improvements will be measured at 2, 4, and 8 months through self-report and medical record review. DISCUSSION This study has important implications for the progress of the greater field of mobile health interventions, as well as for adolescent violence and depression prevention in general. This proposal has high clinical and public health significance with high potential scalability, acceptability, and impact.
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Affiliation(s)
- Megan L Ranney
- Department of Emergency Medicine, Alpert Medical School of Brown University, 55 Claverick Street 2nd Floor, Providence, RI 02903, United States; Rhode Island Hospital, Department of Emergency Medicine, 593 Eddy Street, Providence, RI 02903, United States.
| | - John V Patena
- Rhode Island Hospital, Department of Emergency Medicine, 593 Eddy Street, Providence, RI 02903, United States.
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, Brown University, Box G-5121-4, Providence, RI 02912, United States.
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Brown University, 700 Butler Drive, Providence, RI 02906, United States.
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States; University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States.
| | - Edward Boyer
- Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States.
| | - Nicole R Nugent
- Department of Psychiatry and Human Behavior, Brown University, 700 Butler Drive, Providence, RI 02906, United States.
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Abstract
PURPOSE OF REVIEW Posttraumatic stress disorder is a chronic, heterogeneous disorder for which a multitude of psychotherapies, pharmaceuticals, and immerging treatment programs are available. Majority of efficacy studies focus on Caucasian male military populations, which may be a reason why not all patients respond to treatment with long-term positive outcomes. Additionally, effects of treatment on symptom clusters have been neglected. This work reviews treatment of PTSD and its symptom clusters exclusively in civilian populations, which have been historically under-examined in the literature. RECENT FINDINGS Exposure therapy stands at the forefront of successful PTSD treatment and offers a more cost-effective solution to pharmacotherapy; however, refugees and patients with comorbid depression may not experience such strong benefits. For exposure therapy and other forms of psychotherapy, non-inferiority studies point to promise of internet-delivered and telemedicine-based methods for reaching populations that may not have access to in-person care. SSRIs are the most widely used pharmaceutical treatment for PTSD; moderate initial benefits are observed yet long-term retention and outcomes may be enhanced by adjunct treatment. Again, refugees are a group that experiences lesser benefit. Research has begun to explore efficacy of treatments for individual symptom clusters, with hyperarousal benefiting most from currently available modalities. Avoidance, intrusion, negative thoughts and beliefs, and dissociation are symptoms requiring more research for focused interventions. Treatment of PTSD has evolved to (1) include equivalent proportions of men and women, along with focused female-exclusive cohorts; (2) explore novel methods of treatment online and in various cultural contexts; and (3) less focus on medication as evidenced by current clinical trials. In addition to further efficacy and safety studies in more diverse ethnic populations, work is needed to examine what therapies are best for targeting specific symptom clusters of PTSD. This research will drive precision treatment, and such research is beginning to point towards underlying mechanisms of pathology and change.
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Roberts NP, Kitchiner NJ, Kenardy J, Lewis CE, Bisson JI. Early psychological intervention following recent trauma: A systematic review and meta-analysis. Eur J Psychotraumatol 2019; 10:1695486. [PMID: 31853332 PMCID: PMC6913678 DOI: 10.1080/20008198.2019.1695486] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Post-traumatic stress disorder (PTSD) is a common and debilitating disorder which has a significant impact on the lives of sufferers. A number of early psychological interventions have been developed to try to prevent chronic difficulties. Objective: The objective of this study was to establish the current evidence for the effectiveness of multiple session early psychological interventions aimed at preventing or treating traumatic stress symptoms beginning within three months of trauma exposure. Methods: Randomized controlled trials of early multiple session psychological interventions aimed at preventing or reducing traumatic stress symptoms of individuals exposed to a traumatic event, fulfiling trauma criteria for an ICD or DSM diagnosis of PTSD were identified through a search of the Cochrane Common Mental Disorders Group Clinical Trials Registers database, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO and PILOTS. Two authors independently extracted study details and data and completed risk of bias assessments. Analyses were undertaken using Review Manager software. Quality of findings were rated according to 'Grades of Recommendation, Assessment, Development, and Evaluation' (GRADE) and appraised for clinical importance. Results: Sixty-one studies evaluating a variety of interventions were identified. For individuals exposed to a trauma who were not pre-screened for traumatic stress symptoms there were no clinically important differences between any intervention and usual care. For individuals reporting traumatic stress symptoms we found clinically important evidence of benefits for trauma-focused cognitive-behavioural therapy (CBT-T), cognitive therapy without exposure and eye movement desensitization and reprocessing (EMDR). Differences were greatest for those diagnosed with acute stress disorder (ASD) and PTSD. Conclusions: There is evidence for the effectiveness of several early psychological interventions for individuals with traumatic stress symptoms following trauma exposure, especially for those meeting the diagnostic threshold for ASD or PTSD. Evidence is strongest for trauma-focused CBT.
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Affiliation(s)
- Neil P Roberts
- Psychology & Psychological Therapies Directorate, Cardiff & Vale University Health Board, Cardiff, UK.,Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Neil J Kitchiner
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.,, Veterans' NHS Wales, Cardiff & Vale University Health Board, Cardiff, UK
| | - Justin Kenardy
- Psychology and Medicine, University of Queensland, Brisbane, Australia
| | - Catrin E Lewis
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
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Darnell DA, Parker LE, Wagner AW, Dunn CW, Atkins DC, Dorsey S, Zatzick DF. Task-shifting to improve the reach of mental health interventions for trauma patients: findings from a pilot study of trauma nurse training in patient-centered activity scheduling for PTSD and depression. Cogn Behav Ther 2018; 48:482-496. [PMID: 30499372 DOI: 10.1080/16506073.2018.1541928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Despite high rates of posttraumatic stress disorder (PTSD) and depression among traumatically injured patients, engagement in session-based psychotherapy early after trauma is limited due to various service utilization and readiness barriers. Task-shifting brief mental health interventions to routine trauma center providers is an understudied but potentially critical part of the continuum of care. This pilot study assessed the feasibility of training trauma nurses to engage patients in patient-centered activity scheduling based on a Behavioral Activation paradigm, which is designed to counteract dysfunctional avoidance/withdrawal behavior common among patients after injury. Nurses (N = 4) and patients (N = 40) were recruited from two level II trauma centers. A portion of a one day in-person workshop included didactics, demonstrations, and experiential activities to teach brief intervention delivery. Nurses completed pre- and posttraining standardized patient role-plays prior to and two months after training, which were coded for adherence to the intervention. Nurses also completed exit interviews to assess their perspectives on the training and addressing patient mental health concerns. Findings support the feasibility of training trauma nurses in a brief mental health intervention. Task-shifting brief interventions holds promise for reaching more of the population in need of posttrauma mental health care.
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Affiliation(s)
- Doyanne A Darnell
- Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle , DC , USA
| | - Lea E Parker
- Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle , DC , USA
| | - Amy W Wagner
- Department of Mental Health, Portland Department of Veteran Affairs Medical Center , Portland , OR , USA
| | - Christopher W Dunn
- Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle , DC , USA
| | - David C Atkins
- Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle , DC , USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington , Seattle , DC , USA
| | - Douglas F Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle , DC , USA
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Ennis N, Sijercic I, Monson CM. Internet-Delivered Early Interventions for Individuals Exposed to Traumatic Events: Systematic Review. J Med Internet Res 2018; 20:e280. [PMID: 30429113 PMCID: PMC6300083 DOI: 10.2196/jmir.9795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 07/12/2018] [Accepted: 07/17/2018] [Indexed: 12/20/2022] Open
Abstract
Background Over 75% of individuals are exposed to a traumatic event, and a substantial minority goes on to experience mental health problems that can be chronic and pernicious in their lifetime. Early interventions show promise for preventing trauma following psychopathology; however, a face-to-face intervention can be costly, and there are many barriers to accessing this format of care. Objective The aim of this study was to systematically review studies of internet-delivered early interventions for trauma-exposed individuals. Methods A literature search was conducted in PsycINFO and PubMed for papers published between 1991 and 2017. Papers were included if the following criteria were met: (1) an internet-based intervention was described and applied to individuals exposed to a traumatic event; (2) the authors stated that the intervention was intended to be applied early following trauma exposure or as a preventive intervention; and (3) data on mental health symptoms at pre-and postintervention were described (regardless of whether these were primary outcomes). Methodological quality of included studies was assessed using the Downs and Black checklist. Results The interventions in the 7 studies identified were categorized as selected (ie, delivered to an entire sample after trauma regardless of psychopathology symptoms) or indicated (ie, delivered to those endorsing some level of posttraumatic distress). Selected interventions did not produce significant symptom improvement compared with treatment-as-usual or no intervention control groups. However, indicated interventions yielded significant improvements over other active control conditions on mental health outcomes. Conclusions Consistent with the notion that many experience natural recovery following trauma, results imply that indicated early internet-delivered interventions hold the most promise in future prevention efforts. More studies that use rigorous methods and clearly defined outcomes are needed to evaluate the efficacy of early internet-delivered interventions. Moreover, basic research on risk and resilience factors following trauma exposure is necessary to inform indicated internet-delivered interventions.
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Affiliation(s)
- Naomi Ennis
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Iris Sijercic
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Candice M Monson
- Department of Psychology, Ryerson University, Toronto, ON, Canada
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Giummarra MJ, Black O, Smith P, Collie A, Hassani-Mahmooei B, Arnold CA, Gong J, Gabbe BJ. A population-based study of treated mental health and persistent pain conditions after transport injury. Injury 2018; 49:1787-1795. [PMID: 30154021 DOI: 10.1016/j.injury.2018.08.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/13/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Persistent pain and mental health conditions often co-occur after injury, cause enormous disability, reduce social and economic participation, and increase long-term healthcare costs. This study aimed to characterise the incidence, profile and healthcare cost implications for people who have a treated mental health condition, persistent pain, or both conditions, after compensable transport injury. METHODS The study comprised a population cohort of people who sustained a transport injury (n = 74,217) between 2008 to 2013 and had an accepted claim in the no-fault transport compensation system in Victoria, Australia. Data included demographic and injury characteristics, and payments for treatment and income replacement from the Compensation Research Database. Treated conditions were identified from 3 to 24-months postinjury using payment-based criteria developed with clinical and compensation system experts. Criteria included medications for pain, anxiety, depression or psychosis, and services from physiotherapists, psychologists, psychiatrists, and pain specialists. The data were analysed with Cox Proportional Hazards regression to examine rates of treated conditions, and general linear regression to estimate 24 month healthcare costs. RESULTS Overall, the incidence of treated mental health conditions (n = 2459, 3.3%) and persistent pain (n = 4708, 6.3%) was low, but rates were higher in those who were female, middle aged (35-64 years), living in metropolitan areas or neighbourhoods with high socioeconomic disadvantage, and for people who had a more severe injury. Healthcare costs totalled more than $A707 M, and people with one or both conditions (7.7%) had healthcare costs up to 7-fold higher (adjusting for demographic and injury characteristics) in the first 24 months postinjury than those with neither condition. CONCLUSIONS The incidence of treated mental health and persistent pain conditions was low, but the total healthcare costs for people with treated conditions were markedly higher than for people without either treated condition. While linkage with other public records of treatment was not possible, the true incidence of treated conditions is likely to be even higher than that found in this study. The present findings can be used to prioritise the implementation of timely access to treatment to prevent or attenuate the severity of pain and mental health conditions after transport injury.
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Affiliation(s)
- Melita J Giummarra
- Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Caulfield Pain Management and Research Centre, Caulfield Hospital, Caulfield, Victoria, Australia; Institute for Safety, Compensation and Recovery Research, Monash University, Melbourne, Victoria, Australia.
| | - Oliver Black
- Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter Smith
- Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Institute for Work and Health, Toronto, Ontario, Canada
| | - Alex Collie
- Insurance, Work and Health Group, Monash University, Melbourne, Victoria, Australia
| | | | - Carolyn A Arnold
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Caulfield, Victoria, Australia; Academic Board of Anaesthesia & Perioperative Medicine, School of Medicine Nursing & Health Sciences, Monash University, Clayton, VIC, Australia
| | - Jennifer Gong
- Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Belinda J Gabbe
- Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Farr Institute, Swansea University Medical School, Swansea University, Wales, UK
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The Louisiana Mental and Behavioral Health Capacity Project Trauma-Informed Integrated Care Model and Improved Posttraumatic Stress Outcomes. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 23 Suppl 6 Suppl, Gulf Region Health Outreach Program:S25-S31. [PMID: 28961649 DOI: 10.1097/phh.0000000000000652] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The Mental and Behavioral Health Capacity Project in Louisiana has been addressing health disparities by increasing accessibility and availability through integrating services into primary care clinics. Integrated health is becoming the standard of care, providing an opportunity to address the trauma-specific needs of communities, and allowing for informed and less stigmatized services. The purpose of this study is to test the efficacy of the Mental and Behavioral Health Capacity Project in Louisiana model in the primary care settings to reduce posttraumatic stress symptoms and physical health complaints. DESIGN A pre-experimental time series design was used on the basis of participants self-reporting at least 1 trauma at intake and follow-up collected at 1-, 3-, and 6-month intervals. The hypotheses were that posttraumatic stress and physical health complaints would significantly decrease over the course of treatment. SETTING This study was part of a larger study to evaluate the effectiveness of the Mental and Behavioral Health Capacity Project in Louisiana-integrated health efforts. Sample parameters included (1) intake date from January 2013 through December 2015; (2) at least 18 years of age; and (3) presented at 1 of 5 primary health care clinics in Southeast Louisiana. PARTICIPANTS A total of 235 patients were selected; the mean age was 44.7 years (SD = 13.6) and the majority were white (68%) and female (76%). INTERVENTION Brief behavioral-based trauma treatment was delivered using both on-site and telemedicine therapies provided by a psychologist, psychiatrist, or through a combined treatment model. MAIN OUTCOME MEASURE The main outcome measures were the Posttraumatic Stress Civilian Checklist (PCL-C) and the Patient Health Questionnaire (PHQ-15). RESULTS The hypothesis was supported. Statistically significant decreases in posttraumatic stress symptoms and physical health complaints were shown over the course of treatment, with 63% of the group demonstrating clinically significant change. CONCLUSIONS This study supports brief trauma treatment in primary care clinics as an effective method of reducing trauma and physical health symptoms in postdisaster environments.
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Early psychological interventions for posttraumatic stress, depression and anxiety after traumatic injury: A systematic review and meta-analysis. Clin Psychol Rev 2018; 62:11-36. [DOI: 10.1016/j.cpr.2018.05.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 02/27/2018] [Accepted: 05/03/2018] [Indexed: 12/22/2022]
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Zatzick D, Russo J, Thomas P, Darnell D, Teter H, Ingraham L, Whiteside LK, Wang J, Guiney R, Parker L, Sandgren K, Hedrick MK, Van Eaton EG, Jurkovich G. Patient-Centered Care Transitions After Injury Hospitalization: A Comparative Effectiveness Trial. Psychiatry 2018. [PMID: 29533154 DOI: 10.1080/00332747.2017.1354621] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The investigation aimed to compare two approaches to the delivery of care for hospitalized injury survivors, a patient-centered care transition intervention versus enhanced usual care. METHOD This pragmatic comparative effectiveness trial randomized 171 acutely injured trauma survivors with three or more early postinjury concerns and high levels of emotional distress to intervention (I; n = 85) and enhanced usual care control (C; n = 86) conditions. The care transition intervention components included care management that elicited and targeted improvement in patients' postinjury concerns, 24/7 study team cell phone accessibility, and stepped-up care. Posttraumatic concerns, symptomatic distress, functional status, and statewide emergency department (ED) service utilization were assessed at baseline and over the course of the 12 months after injury. Regression analyses assessed intervention and control group outcome differences over time. RESULTS Over 80% patient follow-up was attained at each time point. Intervention patients demonstrated clinically and statistically significant reductions in the percentage of any severe postinjury concerns expressed when compared to controls longitudinally (Wald chi-square = 11.29, p = 0.01) and at the six-month study time point (C = 74%, I = 53%; Fisher's exact test, p = 0.02). Comparisons of ED utilization data yielded clinically significant cross-sectional differences (one or more three- to six-month ED visits; C = 30.2%, I = 16.5%, [relative risk (95% confidence interval] C versus I = 2.00 (1.09, 3.70), p = 0.03) that did not achieve longitudinal statistical significance (F (3, 507) = 2.24, p = 0.08). The intervention did not significantly impact symptomatic or functional outcomes. CONCLUSIONS Orchestrated investigative and policy efforts should continue to evaluate patient-centered care transition interventions to inform American College of Surgeons' clinical guidelines for U.S. trauma care systems.
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Taylor CB, Ruzek JI, Fitzsimmons-Craft EE, Graham AK, Balantekin KN. A systematic digital approach to implementation and dissemination of eating disorders interventions to large populations identified through online screening: implications for post-traumatic stress. Mhealth 2018; 4:25. [PMID: 30598986 PMCID: PMC6289086 DOI: 10.21037/mhealth.2018.05.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/29/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND We describe an approach to implementation and dissemination that focuses on changing outcomes variables within a large, defined population and attempts to provide cost-effective opportunities and resources-which might include the provision of both digital and traditional interventions-to address individual needs and interests. We present a case example of how aspects of this model are being applied to increase reach, engagement and outcomes for individuals who complete a national eating disorders screen, and are likely to have an eating disorder but who are not in treatment. We then describe how this model can apply to post-traumatic stress (PTS) and conclude with a discussion of limitations and issues with the model. METHODS The National Eating Disorders Association (NEDA) provides online screening for eating disorders. RESULTS From February 2017 through March 2018, over 200,000 individuals completed the NEDA screen. Of these, 96% screened positive or at risk for an eating disorder, and most of those who screened positive for a clinical/subclinical eating disorder were not currently in treatment. Less than 10% engaged in self-help or guided self-help online digital program, or expressed interest in calling a helpline for referral to treatment. CONCLUSIONS A systematic digital approach to implementation and dissemination has the potential to increase the number of individuals who benefit from interventions in defined populations. Uptake rates need to be improved.
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Affiliation(s)
- C. Barr Taylor
- Center for m2 Health, Palo Alto University, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Josef I. Ruzek
- Center for m2 Health, Palo Alto University, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
- National Center for PTSD, Dissemination and Training Division, Veterans Affairs Palo Alto Health Care System (VAPAHCS), Menlo Park, USA
| | | | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University, IL, USA
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Abstract
PURPOSE OF REVIEW This review provides an overview of the current evidence base for and clinical applications of the use of virtual reality (VR) in psychiatric practice, in context of recent technological developments. RECENT FINDINGS The use of VR in psychiatric practice shows promise with much of the research demonstrating clinical effectiveness for conditions including post-traumatic stress disorder, anxiety and phobias, chronic pain, rehabilitation, and addictions. However, more research is needed before the use of VR is considered a clinical standard of practice in some areas. The recent release of first generation consumer VR products signals a change in the viability of further developing VR systems and applications. As applications increase so will the need for good quality research to best understand what makes VR effective, and when VR is not appropriate for clinical services. As the field progresses, it is hopeful that the flexibility afforded by this technology will yield superior outcomes and a better understanding of the underlying mechanisms impacting those outcomes.
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Zatzick DF, Rowhani-Rahbar A, Wang J, Russo J, Darnell D, Ingraham L, Whiteside LK, Guiney R, Hedrick MK, Rivara FP. The Cumulative Burden of Mental, Substance Use, and General Medical Disorders and Rehospitalization and Mortality After an Injury. Psychiatr Serv 2017; 68:596-602. [PMID: 28142384 PMCID: PMC5550030 DOI: 10.1176/appi.ps.201600311] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Each year in the United States, 1.5-2.5 million individuals require hospitalization for an injury. Multiple mental, substance use, and chronic general medical disorders are endemic among injury survivors with and without traumatic brain injury (TBI), yet few studies have assessed the association between the cumulative burden of these conditions and health care outcomes. This study of patients hospitalized for an injury assessed associations between comorbid mental, substance use, and general medical disorders, TBI, and violent events or suicide attempts and the postinjury outcomes of recurrent hospitalization and death. METHODS Recurrent hospitalization and all-cause mortality were examined in this population-based retrospective cohort study. A total of 76,942 patients hospitalized for an injury in Washington State during 2006-2007 were followed for five years. ICD-9-CM codes identified conditions prior to or at the index injury admission. Index admissions related to injuries from firearms, assaultive violence, suicide attempts, and overdoses were identified through E-codes. RESULTS Adjusted regression analyses demonstrated a significant, dose-response relationship between an increasing cumulative burden of disorders and an increasing risk of recurrent hospitalization (four or more conditions, relative risk=3.89, 95% confidence interval [CI]=3.66-4.14). Adjusted Cox proportional hazard regression demonstrated a similar relationship between increasing cumulative burden of disorders and all-cause mortality (four or more conditions, hazard ratio=5.33, CI=4.71-6.04). CONCLUSIONS Increasing cumulative burden of disorders was associated with greater postinjury risk of recurrent hospitalization and death. Orchestrated investigative and policy efforts could introduce screening and intervention procedures that target this spectrum of comorbidity.
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Affiliation(s)
- Douglas F Zatzick
- Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated
| | - Ali Rowhani-Rahbar
- Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated
| | - Jin Wang
- Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated
| | - Joan Russo
- Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated
| | - Doyanne Darnell
- Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated
| | - Leah Ingraham
- Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated
| | - Lauren K Whiteside
- Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated
| | - Roxanne Guiney
- Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated
| | - Margot Kelly Hedrick
- Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated
| | - Frederick P Rivara
- Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated
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Kelly CM, Van Eaton EG, Russo JE, Kelly VC, Jurkovich GJ, Darnell DA, Whiteside LK, Wang J, Parker LE, Payne TH, Mooney SD, Bush N, Zatzick DF. Technology Use, Preferences, and Capacity in Injured Patients at Risk for Posttraumatic Stress Disorder. Psychiatry 2017; 80:279-285. [PMID: 29087256 PMCID: PMC7428173 DOI: 10.1080/00332747.2016.1271162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVE This investigation comprehensively assessed the technology use, preferences, and capacity of diverse injured trauma survivors with posttraumatic stress disorder (PTSD) symptoms. METHOD A total of 121 patients participating in a randomized clinical trial (RCT) of stepped collaborative care targeting PTSD symptoms were administered baseline one-, three-, and six-month interviews that assessed technology use. Longitudinal data about the instability of patient cell phone ownership and phone numbers were collected from follow-up interviews. PTSD symptoms were also assessed over the course of the six months after injury. Regression analyses explored the associations between cell phone instability and PTSD symptoms. RESULTS At baseline, 71.9% (n = 87) of patients reported current cell phone ownership, and over half (58.2%, n = 46) of these patients possessed basic cell phones. Only 19.0% (n = 23) of patients had no change in cell phone number or physical phone over the course of the six months postinjury. In regression models that adjusted for relevant clinical and demographic characteristics, cell phone instability was associated with higher six-month postinjury PTSD symptom levels (p < 0.001). CONCLUSIONS Diverse injured patients at risk for the development of PTSD have unique technology use patterns, including high rates of cell phone instability. These observations should be strongly considered when developing technology-supported interventions for injured patients with PTSD.
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Affiliation(s)
- Cory M. Kelly
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | | | - Joan E. Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | | | | | - Doyanne A. Darnell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | - Lauren K. Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine
| | - Jin Wang
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine
| | - Lea E. Parker
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | - Thomas H. Payne
- Division of Internal Medicine, University of Washington School of Medicine
| | - Sean D. Mooney
- Academic Medical Center Information Systems, University of Washington School of Medicine
| | - Nigel Bush
- U.S. Department of Defense, National Center for Telehealth and Technology
| | - Douglas F. Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
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[Depressive, anxiety and posttraumatic stress disorders as long-term sequelae of intensive care treatment]. DER NERVENARZT 2016; 87:253-63. [PMID: 26908007 DOI: 10.1007/s00115-016-0070-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Modern intensive care medicine has led to increased survival rates even after severe life-threatening medical conditions. In self-critical and multidimensional outcome research, however, it must be considered that beyond survival rates treatment on intensive care units (ICU) can also be associated with high long-term rates of depressive, anxiety and posttraumatic stress disorders. Significant correlations with increased somatic morbidity and mortality, persisting cognitive impairments and significant deficits in health-related quality of life must also be taken into consideration. Empirical analysis of the risk factors reveals that a history of premorbid depression, sociodemographic and socioeconomic variables, age, female sex, personality traits, the underlying pathophysiological condition requiring ICU treatment, mode of sedation and analgesia, life support measures, such as mechanical ventilation, manifold traumatic experiences and memories during the stay in the ICU are all of particular pathogenetic importance. In order to reduce principally modifiable risk factors several strategies are illustrated, including well-reflected intensive care sedation and analgesia, special prophylactic medication regarding the major risk of traumatic memories and posttraumatic stress disorder (PTSD), psychological and psychotherapeutic interventions in states of increased acute stress symptoms and aids for personal memories and reorientation.
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Colston MJ, Belsher BE, Beech EH, Curry JC, Tyberg YA, Melmed AZ, McGraw KL, Stoltz RF. Posttraumatic Stress Disorder, Depression, and Other Comorbidities: Clinical and Systems Approaches to Diagnostic Uncertainties. Fed Pract 2016; 33:37-45. [PMID: 30766149 PMCID: PMC6373700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Overlap in the clinical presentation and significant rates of comorbidity complicate effective management of depression and PTSD, each presenting major health burdens for veterans and active-duty service members.
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Affiliation(s)
- Michael J Colston
- and are all affiliated with the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in Silver Spring, Maryland
| | - Bradley E Belsher
- and are all affiliated with the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in Silver Spring, Maryland
| | - Erin H Beech
- and are all affiliated with the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in Silver Spring, Maryland
| | - Justin C Curry
- and are all affiliated with the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in Silver Spring, Maryland
| | - Yonatan A Tyberg
- and are all affiliated with the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in Silver Spring, Maryland
| | - Andrew Z Melmed
- and are all affiliated with the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in Silver Spring, Maryland
| | - Kate L McGraw
- and are all affiliated with the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in Silver Spring, Maryland
| | - Richard F Stoltz
- and are all affiliated with the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in Silver Spring, Maryland
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Zatzick DF, Russo J, Darnell D, Chambers DA, Palinkas L, Van Eaton E, Wang J, Ingraham LM, Guiney R, Heagerty P, Comstock B, Whiteside LK, Jurkovich G. An effectiveness-implementation hybrid trial study protocol targeting posttraumatic stress disorder and comorbidity. Implement Sci 2016; 11:58. [PMID: 27130272 PMCID: PMC4851808 DOI: 10.1186/s13012-016-0424-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 04/20/2016] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Each year in the USA, 1.5-2.5 million Americans are so severely injured that they require inpatient hospitalization. Multiple conditions including posttraumatic stress disorder (PTSD), alcohol and drug use problems, depression, and chronic medical conditions are endemic among physical trauma survivors with and without traumatic brain injuries. METHODS/DESIGN The trauma survivors outcomes and support (TSOS) effectiveness-implementation hybrid trial is designed to test the delivery of high-quality screening and intervention for PTSD and comorbidities across 24 US level I trauma center sites. The pragmatic trial aims to recruit 960 patients. The TSOS investigation employs a stepped wedge cluster randomized design in which sites are randomized sequentially to initiate the intervention. Patients identified by a 10-domain electronic health record screen as high risk for PTSD are formally assessed with the PTSD Checklist for study entry. Patients randomized to the intervention condition will receive stepped collaborative care, while patients randomized to the control condition will receive enhanced usual care. The intervention training begins with a 1-day on-site workshop in the collaborative care intervention core elements that include care management, medication, cognitive behavioral therapy, and motivational-interviewing elements targeting PTSD and comorbidity. The training is followed by site supervision from the study team. The investigation aims to determine if intervention patients demonstrate significant reductions in PTSD and depressive symptoms, suicidal ideation, alcohol consumption, and improvements in physical function when compared to control patients. The study uses implementation science conceptual frameworks to evaluate the uptake of the intervention model. At the completion of the pragmatic trial, results will be presented at an American College of Surgeons' policy summit. Twenty-four representative US level I trauma centers have been selected for the study, and the protocol is being rolled out nationally. DISCUSSION The TSOS pragmatic trial simultaneously aims to establish the effectiveness of the collaborative care intervention targeting PTSD and comorbidity while also addressing sustainable implementation through American College of Surgeons' regulatory policy. The TSOS effectiveness-implementation hybrid design highlights the importance of partnerships with professional societies that can provide regulatory mandates targeting enhanced health care system sustainability of pragmatic trial results. TRIAL REGISTRATION ClinicalTrials.gov NCT02655354 . Registered 27 July 2015.
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Affiliation(s)
- Douglas F Zatzick
- Department of Psychiatry & Behavioral Sciences, University of Washington, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA.
- Harborview Injury Prevention Research Center, University of Washington, 325 Ninth Ave, Box 359960, Seattle, WA, 98104, USA.
| | - Joan Russo
- Department of Psychiatry & Behavioral Sciences, University of Washington, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - Doyanne Darnell
- Department of Psychiatry & Behavioral Sciences, University of Washington, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, BG 9609 MSC 9760, 9609 Medical Center Drive, Bethesda, MD, 20892-9760, USA
| | - Lawrence Palinkas
- School of Social Work, University of Southern California, Montgomery Ross Fisher Building, Room 339, Los Angeles, CA, 90089, USA
| | - Erik Van Eaton
- Department of Surgery, University of Washington, 325 Ninth Ave, Box 359796, Seattle, WA, 98104, USA
| | - Jin Wang
- Harborview Injury Prevention Research Center, University of Washington, 325 Ninth Ave, Box 359960, Seattle, WA, 98104, USA
| | - Leah M Ingraham
- Department of Psychiatry & Behavioral Sciences, University of Washington, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - Roxanne Guiney
- Department of Psychiatry & Behavioral Sciences, University of Washington, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - Patrick Heagerty
- Department of Biostatistics, University of Washington, 1705 NE Pacific St, Box 357232, Seattle, WA, 98195, USA
| | - Bryan Comstock
- Department of Biostatistics, University of Washington, 1705 NE Pacific St, Box 357232, Seattle, WA, 98195, USA
| | - Lauren K Whiteside
- Division of Emergency Medicine, University of Washington, 25 Ninth Ave, Box 359702, Seattle, WA, 98104, USA
| | - Gregory Jurkovich
- Department of Surgery, University of California in Davis, 2221 Stockton Blvd, Cypress #3111, Sacramento, CA, 95817, USA
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