apa conference 2013: treatment response and predictors of change for military service members in...
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Treatment Response and Predictors of Change for Military Service Members in Intensive TreatmentJennifer A Webb-Murphy, Ph.D.Naval Center for Combat & Operational Stress Control (NCCOSC)Bureau of Medicine and Surgery (BUMED)
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Co-authors• Susan F. Fesperman, MPH
• Elizabeth A. Vishnyak, MA
• Scott C. Roesch, PhD
• Eileen M. Delaney, PhD
• Steven K. Gerard, BA
• Bonnie J. Nebeker, AA
• Stephanie C. Raducha, BA
• Courtney A. Dempsey, MPA
• Andrea L. Repp, MA
• Betsy J. Grant, MA, MFT
• CAPT Scott L. Johnston, PhD, USN
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Disclaimer
The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense or United States Government.
Results presented are part of the Psychological Health Pathways Research Study, which is approved by the Naval Medical Center San Diego Institutional Review Board.
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Agenda
• Brief Background• Psychological Health Pathways• Treatment Response• Predictors of Change
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Mental Health Services Surge
• OEF/OIF resulted in a significant increase in demand for mental health services
• Military mental healthcare rapidly expanded to address demand
• Resulting system is novel, broad and dynamic
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DeploymentHealth
Emergency RoomBranch Clinic
Mental Health Department
Unit level servicesCommunity care Residential
Intensive outpatientInpatient
OutpatientResearch
IndividualGroups
Couples Family
MedicationMedicationMedication
CAMAnimal Assisted
TherapyHolistic HealthAcupuncture
Healing Touch
Massage
Recreational TherapySurf Therapy
YogaRunningGolfing
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Psychological Health Pathways
System Solution• Clinical Pathways• Case Management• Data Management
• Standardized outcome measures at baseline and 10 week intervals
• Patient Summaries• Aggregate Reporting• Population Level Research
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PHP Assessment Process
Clinic
Patient
ISR
Patient
10 wks RSR TR
Patient Tx Team
10 wks
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From Beta to Pilot: Paper vs. eCapture
vs.
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Pilot PHP Assessments:Section A: Basic Demographics
Section B: Outcome Measures– PTSD– Depression– Social, Occupational & Relational Functioning– Resilience– Sleep– TBI Screen– Anxiety– Alcohol Use– Somatic
Section C: Deployment Information – Combat Exposure– Consequences of Combat
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PHP Status
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Individual Patient Summaries
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PHP Aggregate Reports
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Treatment Outcomes
• Intensive outpatient treatment for substance use and PTSD– 8 week program
– Variety of interventions
• Residential treatment for PTSD– 10 week program
– Variety of interventions
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Significant Improvements
n=201
PTSD40414243444546474849
Depression02468
10121416
Sleep10.6
10.8
11
11.2
11.4
11.6
11.8
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Significant Improvements
n=201
Functioning13.5
1414.5
1515.5
1616.5
17
Resilience40
42
44
46
48
50
52
54
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Predictors of ChangeRelationship status
• Never being married = larger decrease in PTSD Sx
• Being married = smaller decrease in depression
Living with your spouse
• Smaller decrease in depression Sx
• Smaller improvement in functioning
Planning to leave military
• Larger decrease in PTSD and depression Sx
• Larger improvement in functioning
• Higher increase in resilience
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Conclusions• Significant benefits of comprehensive, systematic military mental
health assessment, such as PHP
• Evaluate treatment progress
• Identify effective programs
• Successful specialized treatment
• Understand population seeking care
• Unique risk and protective factors
• Being single and not living with spouse could result in better treatment response
• Planning to leave the military doesn’t inhibit ability to obtain treatment gains