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Not enough veterans complete psychotherapy for PTSD

In a national sample of more than 16,000 Veteran Affairs patients with PTSD, only about one-third of veterans completed the adequate amount of evidence-based psychotherapy, according to study findings.

Prior research has shown that many people who start trauma-focused treatment do not complete a full course of evidence-based psychotherapy for PTSD, Andrew C. Hale, PhD, from the VA Center for Clinical Management Research, and department of psychiatry, University of Michigan, and colleagues wrote.

Hale and colleagues analyzed data from a national sample of VA patients who started cognitive processing therapy (CPT) or prolonged exposure (PE) in 2015 to determine the number of veterans receiving adequate evidence-based psychotherapy for PTSD, and the factors associated with treatment completion in VA hospitals. They evaluated individual-level predictors — obtained through electronic medical record data — of treatment adequacy, defined as eight sessions of psychotherapy within 14 weeks of treatment initiation, and facility-level factors.

Individual-analysis revealed that 5,142 of 16,559 (31.1%) veterans who started evidence-based psychotherapy for PTSD received eight or more sessions within 14 weeks and 1,561 of 10,914 (14.3%) veterans received 12 or more sessions within 6 months.

More veterans used CPT than PE (74.2% vs. 25.8%) and a higher proportion of veterans receiving CPT received eight or more sessions of psychotherapy than those receiving PE (32.5% vs. 26.9%; P < .001). Results from the adjusted model showed that older adults were more likely to receive adequate psychotherapy (OR = 1.02; 95% CI, 1.01-1.02) and those with comorbid bipolar or psychotic disorders were at higher risk for not receiving adequate psychotherapy (OR = 0.89; 95% CI, 0.8-0.99).

After adjustment, the facility-level model indicated that the percentage of patients who completed eight or more sessions was higher at facilities with higher percentages of evidence-based psychotherapy use among all veterans with PTSD (beta = 6.55; P = .001) and greater numbers of providers certified to offer psychotherapy (beta = 0.004; P = .038). In addition, fewer patients completed adequate treatment at facilities with a higher percentage of patients receiving a PTSD Checklist (beta = –1.16; P = .011).

Because the rate of treatment completion during evidence-based psychotherapy (EBP) for PTSD was low in this national sample of veterans, additional efforts are needed at both the individual and facility levels, Hale and colleagues wrote.

“At the individual level, patients at higher risk for receiving less than adequate treatment may benefit from adjunctive interventions, such as addressing comorbidity concurrently with or prior to initiating EBP for PTSD, or carefully assessing treatment barriers and motivations,” they wrote. “At the facility level, future work may seek to examine whether promotion of EBPs through clinic policies and provider training may increase completion of adequate treatment.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.