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Maguen, Shira; Li, Yongmei; Madden, Erin; Seal, Karen H.; Neylan, Thomas C.; Patterson, Olga V.; DuVall, Scott L.; Lujan, Callan; Shiner, Brian
Psychiatry research, April 2019, 2019-04-00, 20190401, Volume: 274Journal Article
•265,566 post-9/11 veterans with PTSD had >1 coded psychotherapy visit at the VA in 15 years.•While 22.8% initiated an evidence-based psychotherapy (EBP), only 9.1% completed treatment.•Veterans who completed EBP did so about 3 years after their initial mental health visit.•Factors associated with EBP completion included MST and combat/deployments. Little is known about predictors of initiation and completion of evidence-based psychotherapy (EBP) for posttraumatic stress disorder (PTSD), with most data coming from small cohort studies and post-hoc analyses of clinical trials. We examined patient and treatment factors associated with initiation and completion of EBP for PTSD in a large longitudinal cohort. We conducted a national, retrospective cohort study of all Iraq and Afghanistan War veterans who had a post-deployment PTSD diagnosis from 10/01–9/15 at a Veterans Health Administration facility and had at least one coded post-deployment psychotherapy visit. We examined utilization of PE and CPT (individual or group) during any 24-week period. We used ordered logistic, logistic, and Cox proportional hazards regressions to examine variables associated with EBP initiation, early termination, and completion, and time to completion. Over a 15-year period, of 265,566 veterans with PTSD, 22.8% initiated an EBP, and only 9.1% completed treatment. Completers did so about three years after their initial mental health visit. Factors positively associated with EBP completion included military sexual trauma, older age, race/ethnicity (i.e., African-American race for PE), combat, and multiple deployments. The VHA has become timelier in delivering EBP for PTSD, and several subgroups are more likely to complete EBP.
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