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A Randomized Stepped Care Intervention Trial Targeting Posttraumatic Stress Disorder for Surgically Hospitalized Injury Survivors

Zatzick, Douglas MD*,†; Jurkovich, Gregory MD†,‡; Rivara, Frederick P. MD, MPH†,§; Russo, Joan PhD*; Wagner, Amy PhD†,‖; Wang, Jin MS, PhD*,†; Dunn, Chris PhD*; Lord, Sarah Peregrine MA*; Petrie, Megan BA*; O'Connor, Stephen S. PhD*,†; Katon, Wayne MD*

Annals of Surgery:
doi: 10.1097/SLA.0b013e31826bc313
Features
Abstract

Objective: To test the effectiveness of a stepped care intervention model targeting posttraumatic stress disorder (PTSD) symptoms after injury.

Background: Few investigations have evaluated interventions for injured patients with PTSD and related impairments that can be feasibly implemented in trauma surgical settings.

Methods: The investigation was a pragmatic effectiveness trial in which 207 acutely injured hospitalized trauma survivors were screened for high PTSD symptom levels and then randomized to a stepped combined care management, psychopharmacology, and cognitive behavioral psychotherapy intervention (n = 104) or usual care control (n = 103) conditions. The symptoms of PTSD and functional limitations were reassessed at 1, 3, 6, 9, and 12 months after the index injury admission.

Results: Regression analyses demonstrated that over the course of the year after injury, intervention patients had significantly reduced PTSD symptoms when compared with controls [group by time effect, CAPS (Clinician-Administered PTSD Scale): F(2, 185) = 5.50, P < 0.01; PCL-C (PTSD Checklist Civilian Version): F(4, 185) = 5.45, P < 0.001]. Clinically and statistically significant PTSD treatment effects were observed at the 6-, 9-, and 12-month postinjury assessments. Over the course of the year after injury, intervention patients also demonstrated significant improvements in physical function [MOS SF-36 PCS (Medical Outcomes Study Short Form 36 Physical Component Summary) main effect: F(1, 172) = 9.87, P < 0.01].

Conclusions: Stepped care interventions can reduce PTSD symptoms and improve functioning over the course of the year after surgical injury hospitalization. Orchestrated investigative and policy efforts could systematically introduce and evaluate screening and intervention procedures for PTSD at US trauma centers. (Trial Registration: clinicaltrials.gov identifier: NCT00270959)

In Brief

Acutely injured surgically hospitalized trauma survivors were screened for high posttraumatic stress disorder (PTSD) symptom levels and then randomized to a stepped-care intervention (n = 104) or a usual-care intervention (n = 103). Intervention patients demonstrated clinically and statistically significant reductions in PTSD symptoms and improved physical function over the course of the year after injury. Orchestrated investigative and policy efforts could systematically introduce and evaluate screening and intervention procedures for PTSD at US trauma centers.

Author Information

*Department of Psychiatry and Behavioral Sciences

Harborview Injury Prevention and Research Center

Department of Surgery

§Department of Pediatrics, University of Washington School of Medicine; Seattle, WA

Portland Veterans Affairs Medical Center, Portland, OR.

Reprints: Douglas Zatzick, MD, Harborview Injury Prevention and Research Center, University of Washington School of Medicine, 325 Ninth Avenue, Box 359911, Seattle, WA 98104. E-mail: dzatzick@u.washington.edu.

Disclosure: This work was supported by the National Institute of Mental Health grants R01/MH073613 and K24/MH086814 (Dr Zatzick).

© 2013 Lippincott Williams & Wilkins, Inc.