Journal article
Stepped Collaborative Care Targeting Posttraumatic Stress Disorder Symptoms and Comorbidity for US Trauma Care Systems: A Randomized Clinical Trial
JAMA surgery, Vol.156(5), pp.430-442
May 2021
PMID: 33688908
Featured in Collection : UN Sustainable Development Goals @ Drexel
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.
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Details
- Title
- Stepped Collaborative Care Targeting Posttraumatic Stress Disorder Symptoms and Comorbidity for US Trauma Care Systems: A Randomized Clinical Trial
- Creators
- Douglas Zatzick - University of WashingtonGregory Jurkovich - University of California, DavisPatrick Heagerty - University of WashingtonJoan Russo - University of WashingtonDoyanne Darnell - University of WashingtonLea Parker - Drexel UniversityMichelle K Roberts - University of WashingtonRddhi Moodliar - University of WashingtonAllison Engstrom - University of WashingtonJin Wang - Harborview Injury Prevention and Research CenterEileen Bulger - University of WashingtonLauren Whiteside - Department of Emergency Medicine, University of Washington School of Medicine, SeattleDeepika Nehra - University of WashingtonLawrence A Palinkas - University of Southern CaliforniaKathleen Moloney - University of WashingtonRonald Maier - University of Washington
- Publication Details
- JAMA surgery, Vol.156(5), pp.430-442
- Publisher
- AMER MEDICAL ASSOC; CHICAGO
- Number of pages
- 13
- Grant note
- This research was supported within the National Institutes of Health (NIH) Health Care Systems Research Collaboratory by cooperative agreement 1UH2MH106338-01/4UH3MH106338-02 from the NIH Common Fund and by UH3 MH 106338-05S1 from the National Institute for Mental Health (NIMH). Support was also provided by the NIH Common Fund through cooperative agreement U24AT009676 from the Office of Strategic Coordination within the Office of the NIH director.
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Psychology
- Identifiers
- 991021860763504721
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- Web of Science research areas
- Surgery