ABSTRACT
OBJECTIVES: Military-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). DESIGN: Within-participant design. SETTING: The intervention was offered by Combat Stress, a mental health charity for veterans in the UK. PARTICIPANTS: The 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. METHODS: A 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. RESULTS: Significant 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 12â months. CONCLUSIONS: This 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.
Subject(s)
Anxiety/rehabilitation , Combat Disorders/psychology , Depression/rehabilitation , Residential Treatment , Stress Disorders, Post-Traumatic/rehabilitation , Substance-Related Disorders/psychology , Veterans , Adult , Anxiety/epidemiology , Combat Disorders/epidemiology , Combat Disorders/rehabilitation , Depression/epidemiology , Female , Follow-Up Studies , Humans , Male , Psychotherapy, Group , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/therapy , Substance-Related Disorders/epidemiology , Substance-Related Disorders/rehabilitation , Treatment Outcome , United Kingdom/epidemiology , Veterans/psychologyABSTRACT
OBJECTIVE: Combat Stress, a UK national charity for veterans with mental health problems, has been funded by the National Health Service (NHS) to provide a national specialist service to deliver treatment for post-traumatic stress disorder (PTSD). This paper reports the efficacy of a PTSD treatment programme for UK veterans at 6â months follow-up. DESIGN: A within subject design. SETTING: UK veterans with a diagnosis of PTSD who accessed Combat Stress. PARTICIPANTS: 246 veterans who received treatment between late 2012 and early 2014. INTERVENTION: An intensive 6-week residential treatment programme, consisting of a mixture of individual and group sessions. Participants were offered a minimum of 15 individual trauma-focused cognitive behavioural therapy sessions. In addition, participants were offered 55 group sessions focusing on psychoeducational material and emotional regulation. MAIN OUTCOME MEASURES: Clinicians completed measures of PTSD and functional impairment and participants completed measures of PTSD, depression, anger and functional impairment. RESULTS: We observed significant reductions in PTSD scores following treatment on both clinician completed measures (PSS-I: -13.0, 95% CI -14.5 to -11.5) and self-reported measures (Revised Impact of Events Scale (IES-R): -16.5, 95% CI -19.0 to -14.0). Significant improvements in functional impairment were also observed (eg, Health of the Nation Outcome Scales (HONOS): -6.85, 95% CI -7.98 to -5.72). There were no differences in baseline outcomes between those who completed and those who did not complete the programme, or post-treatment outcomes between those we were able to follow-up at 6â months and those lost to follow-up. CONCLUSIONS: In a naturalistic study we observed a significant reduction in PTSD scores and functional impairment following treatment. These improvements were maintained at 6â month follow-up. Our findings suggest it may be helpful to take a closer look at combining individual trauma-focused cognitive behaviour therapy and group sessions when treating veterans with PTSD. This is the first UK study of its kind, but requires further evaluation.
Subject(s)
Mental Health , Residential Treatment , Stress Disorders, Post-Traumatic/therapy , Veterans/psychology , Adult , Behavior Therapy , Disability Evaluation , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Dropouts/psychology , Psychiatric Status Rating Scales , Psychological Trauma/psychology , Psychotherapy, Group , Stress Disorders, Post-Traumatic/etiology , Treatment Outcome , United Kingdom , War-Related Injuries/psychologyABSTRACT
It has been unclear whether adolescent deliberate self-harm (DSH) is more associated with substance use or with characterological impairments. Multivariate determination of (N = 114 Scottish adolescents) ever engaging in DSH (Youth Risk Behavior Survey) from alcohol use, other substance use, and immature defense mechanism use (Defense Style Questionnaire; DSQ-40) revealed that a history of DSH was associated with more use of immature defense mechanisms by not with substance use or recent alcohol use. More research and clinical attention might be given to immature defense mechanisms in cases of DSH.