Long-term responses to treatment in UK veterans with military-related PTSD: an observational study

Abstract

ObjectivesMilitary-related trauma can be difficult to treat. Evaluating longer term responses to treatment and identifying which individuals may need additional support could inform clinical practice. We assessed 1-year outcomes in UK veterans treated for post-traumatic stress disorder (PTSD).DesignWithin-participant design.SettingThe intervention was offered by Combat Stress, a mental health charity for veterans in the UK.ParticipantsThe sample included 401 veterans who completed a standardised 6-week residential treatment. Of these, 268 (67%) were successfully followed up a year after the end of treatment.MethodsA range of health outcomes were collected pretreatment and repeated at standard intervals post-treatment. The primary outcome was severity of PTSD symptoms, and secondary outcomes included measures of other mental health difficulties (depression, anxiety and anger), problems with alcohol, and social and occupational functioning.ResultsSignificant reductions in PTSD severity were observed a year after treatment (PSS-I: −11.9, 95% CI −13.1 to −10.7). Reductions in the secondary outcomes were also reported. Higher levels of post-treatment functional impairment (0.24, 95% CI 0.08 to 0.41) and alcohol problems (0.18, 95% CI 0.03 to 0.32) were associated with poorer PTSD treatment response at 12 months.ConclusionsThis uncontrolled study suggests the longer term benefits of a structured programme to treat UK veterans with PTSD. Our findings point to the importance of continued support targeted for particular individuals post-treatment to improve longer term outcomes.

Exploring optimum cut-off scores to screen for probable posttraumatic stress disorder within a sample of UK treatment-seeking veterans

“…This could have useful clinical implications when both assessing for the presence of PTSD, but also evaluating treatment outcomes. For example, data from a range of countries reporting on PTSD treatment outcomes in veterans suggest that, whilst significant reductions in the severity of symptoms are evident, many participants have scores on psychometric measures that still indicate meeting diagnostic criteria for PTSD (Creamer, Morris, Biddle, & Elliot, 1999; Currier, Holland, Drescher, & Elhai, 2014; Murphy et al, 2016; Richardson et al, 2014). It may be that the use of lower cut-offs, validated within different populations, could be masking positive treatment outcomes.…”

Treatment Efficacy for Veterans With Posttraumatic Stress Disorder: Latent Class Trajectories of Treatment Response and Their Predictors

“…Previously published literature gives a fuller description of the treatment program and demonstrates high rates of treatment completion (94.1%), the lack of a response bias when following up with participants posttreatment, and, in smaller sample sizes, treatment efficacy at 6 and 12 months posttreatment (Murphy, Hodgman et al., ; Murphy, Spencer‐Harper et al., ).…”

“…Many research papers have reported the efficacy of PTSD treatment programs for veterans from a range of different countries (Chard, Schumm, Owens, & Cottingham, ; Currier, Holland, Drescher, & Elhai, ; Forbes, Lewis, Parslow, Hawthorne, & Creamer, ; Morland et al., ; Murphy, Spencer‐Harper et al., ; Richardson et al., ). In general, the data suggest that existing programs are effective at reducing the burden of PTSD symptoms.…”

The provision of services in the UK for UK armed forces veterans with PTSD: a rapid evidence synthesis

“…The 20 remaining studies (24 articles) used designs typically regarded as less methodologically sound. These were primarily single-group designs, comprising the following: five observational studies (eight articles), 36,47,51,52,[58][59][60]64 five descriptive pieces, 48,49,53,57,61 four before-and-after studies (five articles), 50,54,55,62,63 two quasi-experimental studies, 46,56 a critical review/guideline, 44 a survey, 45 a service evaluation 35 and a non-randomised comparison. 65 Although these studies were not formally assessed for methodological quality, they were carefully considered and retained as important contributors to the evidence picture on models of care.…”

“…Fifteen studies reported in 18 articles were conducted in the USA [48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65] (13 of these were delivered in the context of the Veterans Health Administration, US Department of Veterans Affairs); three studies were carried out in Australia, [44][45][46] and two studies (three articles) were carried out in the UK. 35,36,47 The types of care models and an overview of the studies within each are summarised in the following sections. We draw particular attention to studies with an evaluative component.…”