A Randomized Stepped Care Intervention Trial Targeting Posttraumatic Stress Disorder for Surgically Hospitalized Injury Survivors

Abstract

Objective To test the effectiveness of a stepped care intervention model targeting posttraumatic stress disorder (PTSD) symptoms after injury. Background Few investigations have evaluated interventions for injured patients with PTSD and related impairments that can be feasibly implemented in trauma surgical settings. Methods The investigation was a pragmatic effectiveness trial in which 207 acutely injured hospitalized trauma survivors were screened for high PTSD symptom levels and then randomized to a stepped combined, care management, psychopharmacology, and cognitive behavioral psychotherapy intervention (n = 104) or usual care control (n = 103) conditions. The symptoms of PTSD and functional limitations were reassessed at one-, three-, six-, nine-, and twelve-months after the index injury admission. Results Regression analyses demonstrated that over the course of the year after injury, intervention patients had significantly reduced PTSD symptoms when compared to controls (group by time effect, CAPS, F(2, 185) = 5.50, P < 0.01; PCL-C, F(4, 185) = 5.45, P < 0.001). Clinically and statistically significant PTSD treatment effects were observed at the six-, nine-, and twelve-month post-injury assessments. Over the course of the year after injury, intervention patients also demonstrated significant improvements in physical function (MOS SF-36 PCS main effect, F(1, 172) = 9.87, P < 0.01). Conclusion Stepped care interventions can reduce PTSD symptoms and improve functioning over the course of the year after surgical injury hospitalization. Orchestrated investigative and policy efforts could systematically introduce and evaluate screening and intervention procedures for PTSD at United States trauma centers. (Trial Registration: clinicaltrials.gov identifier: NCT00270959)

Psychological Sequelae of Surgery in a Prospective Cohort of Patients From Three Intraoperative Awareness Prevention Trials

“…A similar step-wise care pathway has been shown to improve PTSD symptoms and remission rates in traumatic injury survivors. 37 The incidence of PTSD-related symptom complexes in Psych SOS was substantially higher than would be expected from a random sample of adults in the community. Using DSM-IV criteria, the National Comorbidity Survey Replication suggested that the lifetime prevalence of PTSD in United States adults is about 6.8%.…”

In-Hospital Acute Stress Symptoms Are Associated with Impairment in Cognition 1 Year after Intensive Care Unit Admission

“…could be identified before hospital discharge to facilitate receipt of evidencebased treatments with the aim of preventing the development of PTSD (36,37). Additional research is warranted to determine if implementing such interventions for medical-surgical ICU survivors could also prevent post-ICU cognitive impairment.…”

Validation of the Injustice Experiences Questionnaire in a heterogeneous trauma sample.

“…Recent research on traumatic injury has focused on psychosocial variables that may impact individuals' recovery, specifically those influencing the onset of depression and posttraumatic symptoms following injury (Bryant et al, 2010;Zatzick et al, 2013;deRoon-Cassini, Mancini, Rusch & Bonanno, 2010;Shih et al, 2012;Powers et al, 2014). One such variable of interest has been perceived injustice, which describes an appraisal reflecting the severity and irreparability of injury-related loss, blame, and unfairness (Sullivan et al, 2008).…”