ABSTRACT
BACKGROUND: There have only been two efficacy trials reporting a head-to-head comparison of medications and psychotherapy for posttraumatic stress disorder (PTSD), and neither was conducted in primary care. Therefore, in this pragmatic trial we compare outcomes of primary care patients randomized to initially receive a brief trauma-focused psychotherapy or a choice of three antidepressants. In addition, because there are few trials examining the effectiveness of subsequent treatments for patients not responding to the initial treatment, we also compare the outcomes of those switching or augmenting treatments. METHOD: Patients screening positive for PTSD (nâ¯=â¯700) were recruited from the primary care clinics of 7 Federally Qualified Health Centers (FQHC) and 8 Department of Veterans Affairs (VA) Medical Centers and randomized in the ratio 1:1:2 to one of three treatment sequences: 1) selective serotonin reuptake inhibitor (SSRI) followed by augmentation with Written Exposure Therapy (WET), 2) SSRI followed by a switch to serotonin-norepinephrine reuptake inhibitor (SNRI), or 3) WET followed by a switch to SSRI. Participants complete surveys at baseline, 6â¯months, and 12â¯months. The primary outcome is PTSD symptom severity as measured by the PTSD Checklist (PCL-5). RESULTS: The average PCL-5 score was 52.8 (SDâ¯=â¯11.1), indicating considerable severity. The most common bothersome traumatic event for VA enrollees was combat (47.8%), and for FQHC enrollees was other (28.2%), followed by sexual assault (23.4%), and child abuse (19.8%). Only 22.4% were taking an antidepressant at baseline. CONCLUSION: Results will help healthcare systems and clinicians make decisions about which treatments to offer to patients. CLINICALTRIALS: govID - NCT04597190.
ABSTRACT
Family-driven care is a key principle of the system of care framework, but little research has documented the impact caring for a child with a serious mental health challenge has on families. In partnership with family advocates, this prospective, descriptive study was conducted to understand the impact a child's mental health challenge has on families' time, finances, life events, and caregiver employment. Study results showed the average family spent over $250 a week in unreimbursed costs, even though 84% of the children in the study received Medicaid. Caregivers spent approximately 10 h per week attending to the child's mental health needs, not including direct care for the child. Caregivers also reported a substantial impact on their employment. The results of this study have implications for the system of care supports for families. Perhaps most importantly, systems must utilize two-generation strategies in systems of care to minimize the impact on caregiver employment.
Subject(s)
Mental Health , Patient Advocacy , Child , Humans , Prospective Studies , Employment , Caregivers/psychology , Family/psychologyABSTRACT
OBJECTIVE: This study used statewide administrative data sets to estimate the prevalence of tobacco use among persons with mental illnesses who were accessing public-sector mental health care in Colorado and to determine the relationships between tobacco use and primary diagnosis and alcohol and drug use. METHODS: This study utilized the Colorado Client Assessment Record to examine predictors of tobacco use among 111,984 persons with mental illnesses who were receiving services in the public mental health system. RESULTS: Thirty-nine percent of the sample (N=43,508) used tobacco. Multiple logistic regression analysis found that schizophrenia, schizoaffective disorder, and bipolar disorder (p<.001 for all), and depression or dysthymia (p<.01) were associated with greater tobacco use than other diagnoses. Significant differences in tobacco use existed across gender, age group, race or ethnicity, and substance use categories. CONCLUSIONS: Findings suggest that an administrative database is a low-burden means of identifying persons at high risk of tobacco use to inform resource allocation.
