Assessing and Enhancing Social Support to Improve Treatment Outcomes Among Veterans with PTSD

评估和加强社会支持，以改善患有创伤后应激障碍 (PTSD) 退伍军人的治疗效果

• 批准号: 10291716
• 负责人: Sarah Burns Campbell
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2025-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10291716
• 关键词: Address; Advocate; Affect; Appointment; Behavioral; Caring; Clinical; Clinical assessments; Data; Department of Defense; Development; Disclosure; Dropout; Effectiveness; Emotional; Evaluation; Evidence based treatment; Feasibility Studies; Feedback; Feeling suicidal; Funding; Future; Generations; Goals; Health Services; Hybrids; Impairment; Instruction; Intake; Intervention; Interview; Link; Maintenance; Measurement; Measures; Mental Depression; Mental Health; Mental Health Services; Mentors; Meta-Analysis; Methodology; Methods; Modeling; Monitor; Outcome; Participant; Patient Monitoring; Patient Outcomes Assessments; Patient Recruitments; Population; Post-Traumatic Stress Disorders; Practice Guidelines; Primary Health Care; Procedures; Protocols documentation; Provider; Psychotherapy; Quality of life; Randomized; Randomized Clinical Trials; Recovery; Reporting; Research; Research Personnel; Research Priority; Review Literature; Risk; Risk Factors; Social Network; Social support; Suicide prevention; Surveys; Symptoms; Testing; Treatment outcome; United States Department of Veterans Affairs; Veterans; Work; acceptability and feasibility; arm; base; brief intervention; care outcomes; career; clinical care; clinical practice; clinically significant; comparison intervention; depressive symptoms; design; disorder risk; evidence base; improved; improved outcome; innovation; instrument; medical specialties; military veteran; mortality; novel; pilot test; primary care setting; recruit; response; satisfaction; screening; social engagement; social health determinants; social relationships; stress related disorder; suicidal risk; suicide rate; systematic review; tool; treatment as usual; treatment planning; treatment response; trial comparing

Background: PTSD is a significant problem for Veterans, most of whom are initially treated for posttraumatic stress disorder (PTSD) in Primary Care Mental Health Integration (PCMHI). Poor social support in this population is a risk factor for suicidal ideation, all-cause mortality, and worse treatment engagement and response. Preliminary research shows that approximately 60% of Veterans with PTSD present to specialty care intake appointments with poor social support. However, none of the existing PCMHI-based treatments for PTSD explicitly focus on social support generation or reengagement. Moreover, although the limited existing research suggests that the routine assessment of social support to guide treatment planning (also known as measurement-based care, or MBC) improves treatment outcomes in civilian populations, social support is not routinely monitored as part of evidence-based treatments for PTSD. Thus, this CDA-2 will first identify an appropriate instrument for routinely measuring social support in the context of clinical care to improve PTSD treatment, and, subsequently, evaluate a novel PCMHI-based PTSD treatment as part of a stepped care model for Veterans who report poor social support and are at great risk of PTSD treatment non-response. Significance/Impact: The proposed research addresses several HSR&D research priorities, including evaluating the impact of social determinants of health, namely, social support, on the quality and outcomes of care; testing new models of mental health care to improve outcomes; and intervening with vulnerable Veterans with PTSD and suicide risk. By measuring and improving social support to enhance PTSD treatment, the proposed research plan explicitly addresses a key factor that impedes treatment outcomes for a sensitive population of Veterans. Innovation: Although poor social support is widely recognized as among the strongest predictors of PTSD development and maintenance, none of the existing PCMHI-based treatments for PTSD target or measure social support as a primary treatment focus. The proposed CDA-2 research is thus highly novel. No past or present HSR&D-funded studies have tested methods for monitoring or improving social support in PCMHI-based treatment among Veterans with PTSD, despite its association with poor clinical outcomes. Specific Aims: 1) Select an instrument for MBC of social support in clinical settings for Veterans with PTSD. 2) Iteratively refine and conduct a one-arm pilot test a brief, PCMHI-based behavioral activation and social engagement intervention for PTSD based on key stakeholder (e.g., Veteran and PCMHI provider) feedback. 3) Conduct a two-arm pilot randomized clinical trial (RCT) comparing the intervention to usual care in PCMHI. Methodology: Aim 1 will use quantitative data gathered in an online survey from 210 Veterans to assess the degree to which four measures of social support (identified via systematic review and clinical utility ranking) are acceptable, reliable, and sensitive, and select the best measure for use in Aim 2’s pilot. Aim 2 will involve the iterative refinement of the PTSD and social support intervention following, and followed by, qualitative interviews with key stakeholders. Aim 2 will obtain data on participant acceptability, provider fidelity, and social-support-related MBC. The pilot RCT comparing the social support and PTSD intervention to usual care in Aim 3 will evaluate the feasibility and acceptability of recruitment, randomization, intervention engagement, evaluation strategy, and outcome measurement of clinical outcomes (e.g., PTSD, depression symptoms, and social support), as well as mechanisms of change (e.g., disclosure) and multiple stepped-care outcomes (e.g., clinically-indicated evidence-based psychotherapy initiation/retention). Next Steps/Implementation: This work will support future trials establishing effectiveness and implementation potential of the intervention, as well as a model of MBC of social support. Future research will explore MBC and PCMHI-based interventions for poor social support in related conditions.

背景：PTSD对于退伍军人来说是一个重要的问题，其中大多数最初是在创伤后治疗的 初级保健心理健康整合（PCMHI）中的应激障碍（PTSD）。社会支持不佳 人口是自杀想法，全因死亡率和较差治疗参与的危险因素 回复。初步研究表明，大约60％的具有PTSD的退伍军人出现到专业 护理摄入量的社会支持差。但是，没有一种现有的基于PCMHI的治疗方法 PTSD明确专注于社会支持生成或重新接触。而且，尽管有限的现有 研究表明，社会支持的常规评估以指导治疗计划（也称为治疗计划 基于测量的护理或MBC）改善平民人口的治疗结果，社会支持不是 作为PTSD基于证据的治疗的一部分，经常监测。那就是这个CDA-2首先确定 适当的工具，以在临床护理的背景下定期衡量社会支持以改善PTSD 治疗，随后，作为阶梯护理模型的一部分，评估一种新型的基于PCMHI的PTSD治疗 对于报告社会支持不佳并且有PTSD治疗无响应风险的退伍军人而言。 意义/影响：拟议的研究涉及多个HSR＆D研究的重点，包括 评估社会决定者对健康的影响，即社会支持，对 关心;测试新的心理保健模式以改善结果；并与脆弱的退伍军人进行干预 具有PTSD和自杀风险。通过衡量和改善社会支持以增强PTSD治疗， 拟议的研究计划明确解决了阻碍敏感治疗结果的关键因素 退伍军人人口。创新：尽管社会支持不佳被广泛认为是强大的 PTSD开发和维护的预测因素，现有的基于PCMHI的PTSD治疗 目标或衡量社会支持作为主要治疗重点。因此，拟议的CDA-2研究很高 小说。没有过去或现在的HSR＆D资助研究已经测试了监视或改善社会的方法 PTSD的退伍军人对基于PCMHI的治疗的支持，目的地与临床不良的关联 结果。具体目的：1）在退伍军人的临床环境中选择一种社会支持的工具 与PTSD。 2）迭代完善并进行单臂飞行员测试，一种基于PCMHI的简短行为激活 基于关键利益相关者（例如，退伍军人和PCMHI提供商）的PTSD的社会参与干预措施 反馈。 3）进行两臂飞行员随机临床试验（RCT），将干预与通常的护理进行比较 在PCMHI中。方法论：AIM 1将使用在210名退伍军人的在线调查中收集的定量数据 评估四个社会支持措施的程度（通过系统审查和临床实用程序确定 排名）是可以接受的，可靠的和敏感的，并选择在AIM 2的飞行员中使用的最佳措施。 AIM 2意志 涉及PTSD和社会支持干预措施的迭代性完善，然后，然后 与主要利益相关者的定性访谈。 AIM 2将获得有关参与可接受性的数据，提供者保真度， 和与社会支持的MBC。试点RCT将社会支持和PTSD干预与常规进行比较 AIM 3中的护理将评估招聘，随机化，干预的可行性和可接受性 临床结果的参与，评估策略和结果测量（例如PTSD，抑郁症 符号和社会支持）以及变化机制（例如披露）和多个阶梯式护理 结果（例如，临床指示的基于证据的心理治疗计划/保留）。下一个 步骤/实施：这项工作将支持未来的试验，以建立有效性和实施 干预的潜力以及社会支持的MBC模型。未来的研究将探索MBC 在相关条件下，基于PCMHI的社会支持不良的干预措施。