PTSD Treatment: Effects on Health Behavior, Cardiovascular and Metabolic Disease

PTSD 治疗：对健康行为、心血管和代谢疾病的影响

• 批准号: 9265123
• 负责人: Jeffrey F. Scherrer
• 金额: $ 69.12万
• 依托单位: SAINT LOUIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-05-01 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9265123
• 关键词: Adoption; Affect; Afghanistan; Age; Alcohol abuse; Alcohols; American; Arteriosclerosis; Behavior; Behavior Therapy; Body Weight decreased; Cardiovascular Diagnostic Techniques; Cardiovascular Diseases; Characteristics; Clinic; Clinical Practice Guideline; Comorbidity; Cox Proportional Hazards Models; Data; Data Sources; Databases; Diagnosis; Disease remission; Drug abuse; Drug usage; Dyslipidemias; Enrollment; Evidence based treatment; Health; Health Promotion; Health behavior; Health behavior change; Healthcare; Heavy Drinking; Hypertension; Incidence; Individual; Iraq; Life; Link; Measures; Medical; Medical Records; Mental Health; Mental disorders; Metabolic; Metabolic Diseases; Modeling; Modification; Morbidity - disease rate; Myocardial Infarction; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Pathway interactions; Patient Monitoring; Patient Self-Report; Patients; Persons; Population; Post-Traumatic Stress Disorders; Prevention strategy; Preventive care; Private Sector; Probability; Psychiatric Diagnosis; Records; Recovery; Research; Resources; Retrospective cohort; Risk; Risk Factors; Site; Smoke; Smoking; Source; Stress; Symptoms; Testing; Time; Training; United States; United States Department of Veterans Affairs; Veterans; Weight; Weight maintenance regimen; Woman; cardiovascular disorder risk; cardiovascular risk factor; clinically relevant; cohort; cost efficient; demographics; design; disease diagnosis; disorder risk; evidence base; experience; improved; medication compliance; men; mortality; nutrition; physical inactivity; predictive modeling; premature; programs; public health relevance; reduce symptoms; sedentary lifestyle; smoking cessation; symptom treatment; treatment effect; treatment program; unhealthy lifestyle

 DESCRIPTION (provided by applicant): The objective of this study is to determine if evidence based treatment (EBT) for posttraumatic stress disorder (PTSD) leads to reduced risk of cardiovascular and metabolic disease (CMD) through adoption of healthy behaviors. PTSD affects approximately 7.7 million of Americans each year and is the 4th most common psychiatric disorder in the United States. One reason persons with PTSD develop CMD is poor health behaviors such as smoking, excessive drinking and sedentary lifestyle. Many patients will suffer premature morbidity and mortality unless we identify the mechanisms that mitigate the link between PTSD, poor health behavior and CMD. This 4-year R01 uses a cost efficient approach to investigate these issues by leveraging real-world clinic data from 4 sites in the Veterans Administration in which EBT is delivered with high fidelity, paired with repeat assessment of PTSD symptoms and merged with comprehensive medical records. We are not aware of similar multi-site sources of real world EBT clinic data in the private sector. EBT treatment data will be abstracted and merged with national medical record files resulting in a unique data base of 5,940 patients who engaged in EBT with about 40% completing treatment and 5,940 controls without PTSD. These data will allow us to determine, in Aim 1, if patients with PTSD, compared to controls, are less likely to engage in healthy behavior. In Aim 2, we determine if PTSD symptom reduction is associated with improved health behavior such as medication adherence, weight management and preventive care. In Aim 3 we determine if health behaviors moderate the contribution of PTSD symptom reduction to the risk of diagnosed CMD. In aim 4 we determine if a diagnosis of PTSD remains a risk factor for CMD even in patients who have symptom remission and improved health behavior. Last, in Aim 5, we derive a parsimonious predictive model of PTSD and incident CMD. Using propensity scores and inverse probability of treatment weighting, results from Cox proportional hazard models will disentangle the patient level factors, e.g. orientation toward health, associated with seeking and completing treatment from symptom reduction. This allows determining the independent contribution of PTSD symptom reduction and health behaviors. We believe the findings from our study will have important implications for clinical practice, guideline modifications, and the allocation of healthcare resources for all people with PTSD. If health behavior improves via PTSD symptom reduction, then clinicians should be trained to encourage health promotion during EBT. If patients remain at risk for CMD despite improved mental health and improved health behaviors, then life-long intensive monitoring of patients with PTSD is warranted to detect early signs of CMD.

 描述（由适用提供）：本研究的目的是确定创伤后应激障碍（PTSD）基于证据的治疗（EBT）是否导致通过采用健康行为的心血管和代谢疾病（CMD）的风险降低。 PTSD每年影响约770万美国人，是美国第四大最常见的精神疾病。 PTSD发展CMD的人的原因之一是健康行为不良，例如吸烟，饮酒过多和久坐的生活方式。除非我们确定减轻PTSD，健康行为不良和CMD之间联系的机制，否则许多患者将遭受过早的发病率和死亡率。这项为期4年的R01使用一种经济高效的方法来调查这些问题，通过利用退伍军人管理中的4个地点的现实世界诊所数据，其中EBT以高保真度交付，并与PTSD症状的重复评估并与全面的医疗记录合并。我们不知道私营部门的现实世界EBT诊所数据的类似多站点来源。 EBT治疗数据将抽象并与国家病历文件合并，导致5,940名患者的独特数据库，他们接受了约40％的完成治疗，而没有PTSD的5,940个对照。这些数据将使我们在AIM 1中确定如果与对照组相比，患有PTSD的患者不太可能从事健康行为。在AIM 2中，我们确定减少PTSD症状是否与改善的健康行为有关，例如药物依从性，体重管理和预防性护理。在AIM 3中，我们确定健康行为是否在减少PTSD症状对诊断CMD风险的贡献中。即使在症状缓解并改善健康行为的患者中，CMD仍然是CMD的危险因素。最后，在AIM 5中，我们得出了PTSD和ID INDECT CMD的偏小动物预测模型。使用承诺得分和治疗加权的逆概率，COX比例危害模型的结果将使患者水平的因素（例如与健康有关的方向，与降低症状相关的治疗有关。这允许确定减少PTSD症状和健康行为的独立贡献。我们认为，我们研究的发现将对临床实践，指南修改以及为所有患有PTSD患者的医疗资源分配具有重要意义。如果健康行为通过减少PTSD症状改善，则应培训临床医生，以鼓励EBT期间的健康促进。如果患者仍处于CMD目的地的风险，可以改善心理健康并改善了健康行为，则有必要对PTSD患者进行终身密集监测以检测CMD的早期迹象。