Center for Chronic Disease Outcomes Research
Background: PTSD, a potentially disabling psychiatric disorder that follows exposure to life threatening or traumatic experiences, is highly prevalent among combat Veterans. The prevalence of PTSD is even higher among Veterans who use VHA medical care: 29% of Veterans returning from the conflicts in Iraq and Afghanistan (Operations Enduring Freedom, Iraqi Freedom, and New Dawn; OEF/OIF/OND) have a PTSD diagnosis in their VHA medical record (VHA Office of Public Health, 2011). The majority of Veterans with PTSD do not receive evidence-based psychotherapy or pharmacotherapy. In fact, only about half receive any form of mental health treatment after an initial PTSD diagnosis, let alone evidence based therapies (Spoont et al., 2010) and only a small proportion of those who receive treatment receive an adequate trial (Seal et al., 2010). Rates for both pharmacotherapy and psychotherapy are particularly low among Veterans whose PTSD is diagnosed in primary care clinics (Spoont et al., 2010). Furthermore, nearly 400,000 Veterans receive compensation for military-related PTSD and the interplay between disability compensation, treatment engagement, and treatment outcomes is complex and poorly understood.
Treating PTSD is a high priority for VA, and effective evidence-based PTSD treatments—such as cognitive behavioral therapies and medications—are available. In FY15, CCDOR supported seven HSR&D studies in this core focus area, including three EBT4PTSD CREATE projects. The goal of the EBT4PTSD CREATE is to improve access and engagement in evidence-based PTSD treatments. In FY15, one EBT4PTSD CREATE project was completed and the remaining were in data collection.
- Dr. Erbes completed the HSR&D-funded pilot investigation entitled “Helping Families Help Veterans with PTSD and Alcohol Abuse: An RCT of VA-CRAFT.” This project tested an innovative web-based tool that delivers an online version of Community Reinforcement and Family Training (VACRAFT) to families to promote Veteran involvement in care for PTSD and problem drinking. VACRAFT was developed by the National Center for PTSD, who partnered in its evaluation. Findings demonstrated that VA-CRAFT reduces caregiver burden among its users, but also suggested key ways to improve the intervention and its outcomes. These findings will be used to enhance VACRAFT and evaluate its success in a larger trial.
- Drs. Sayer and Rosen completed data collection for the HSR&D-funded study, “Promoting Effective, Routine, and Sustained Implementation of Stress Treatments (PERSIST).” This is one of the first studies to address organizational- and team-level barriers to implementation of evidence-based psychotherapies for PTSD. It will improve Veterans’ access to PTSD treatments and inform efforts to implement and sustain rollouts of evidenced-based treatments for other disorders.
- Dr. Spoont began data collection for the multi-site CREATE project," Promoting Evidence-Based Pharmacotherapy for PTSD in CBOCs". This project is testing an intervention designed to improve Veteran access to evidence based pharmacotherapy for PTSD in CBOCs by engaging primary care providers (PCP) in their care. Dr. Spoont has presented on products developed for this study which can be used to improve clinical care at the 2015 HSR&D/ QUERI and ISTSS meetings.