PTSD Treatment for Veterans with Serious Mental Illness to Improve Functional Outcomes

对患有严重精神疾病的退伍军人进行创伤后应激障碍 (PTSD) 治疗，以改善功能结果

• 批准号: 10641181
• 负责人: Mary Katherine Howell
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10641181
• 关键词: Address; Adherence; Aftercare; Area; Assessment tool; Bipolar Disorder; Black race; Caring; Characteristics; Chronic; Clinic; Clinical; Clinical Trials; Data; Diagnosis; Disease; Disparity; Dropout; Education; Equity; Evaluation; Evidence based practice; Exclusion; Exhibits; Formulation; Future; Goals; Healthcare; High Prevalence; Impaired cognition; Impaired health; Improve Access; Indigenous; Individual; Intervention; Interview; K-Series Research Career Programs; Knowledge; Lead; Measures; Mental Health; Mental Health Services; Mental disorders; Mentors; Methodology; Methods; Minority; Monitor; Outcome; Participant; Patient Self-Report; Physical Function; Pilot Projects; Population; Post-Traumatic Stress Disorders; Prevalence; Protocols documentation; Psychotherapy; Quality of life; Questionnaires; Randomized; Randomized, Controlled Trials; Recording of previous events; Recovery; Recovery of Function; Rehabilitation therapy; Research; Research Personnel; Severities; Specific qualifier value; Symptoms; System; Testing; Therapeutic; Therapeutic Intervention; Therapy trial; Training; Trauma; Treatment Efficacy; Treatment outcome; Veterans; Veterans Health Administration; Writing; acceptability and feasibility; brief intervention; career; career development; cognitive capacity; contextual factors; equity, diversity, and inclusion; ethnic disparity; ethnic minority; evidence base; experience; feasibility testing; follow-up; functional improvement; functional outcomes; improved; instrument; people of color; physical conditioning; pilot test; process evaluation; programs; psychoeducation; psychoeducational; psychotic; racial disparity; racial minority; recruit; rehabilitation research; research and development; response; satisfaction; severe mental illness; skills; treatment trial; Address; Adherence; Aftercare; Area; Assessment tool; Bipolar Disorder; Black race; Caring; Characteristics; Chronic; Clinic; Clinical; Clinical Trials; Data; Diagnosis; Disease; Disparity; Dropout; Education; Equity; Evaluation; Evidence based practice; Exclusion; Exhibits; Formulation; Future; Goals; Healthcare; High Prevalence; Impaired cognition; Impaired health; Improve Access; Indigenous; Individual; Intervention; Interview; K-Series Research Career Programs; Knowledge; Lead; Measures; Mental Health; Mental Health Services; Mental disorders; Mentors; Methodology; Methods; Minority; Monitor; Outcome; Participant; Patient Self-Report; Physical Function; Pilot Projects; Population; Post-Traumatic Stress Disorders; Prevalence; Protocols documentation; Psychotherapy; Quality of life; Questionnaires; Randomized; Randomized, Controlled Trials; Recording of previous events; Recovery; Recovery of Function; Rehabilitation therapy; Research; Research Personnel; Severities; Specific qualifier value; Symptoms; System; Testing; Therapeutic; Therapeutic Intervention; Therapy trial; Training; Trauma; Treatment Efficacy; Treatment outcome; Veterans; Veterans Health Administration; Writing; acceptability and feasibility; brief intervention; career; career development; cognitive capacity; contextual factors; equity, diversity, and inclusion; ethnic disparity; ethnic minority; evidence base; experience; feasibility testing; follow-up; functional improvement; functional outcomes; improved; instrument; people of color; physical conditioning; pilot test; process evaluation; programs; psychoeducation; psychoeducational; psychotic; racial disparity; racial minority; recruit; rehabilitation research; research and development; response; satisfaction; severe mental illness; skills; treatment trial

Anticipated Impact on Veteran's Healthcare: PTSD is a critical obstacle to the recovery of Veterans with serious mental illness (SMI; psychotic spectrum and bipolar disorders). The Veterans Health Administration (VHA) has made treatment of PTSD a high priority and has initiated dissemination of evidence-based practices (EBPs) for PTSD across the national VHA system. However, EBPs for PTSD have not been tested among, and are largely not provided to Veterans living with both PTSD and SMI, despite high co-occurrence rates and profound associated negative functional impact. This study will: [Aim 1) administer the Cultural Formulation Interview (CFI) during a pre-pilot study of WET with 10 Veterans with SMI and PTSD to inform how best to incorporate aspects of cultural identity into the WET intervention pilot-testing in Aim 2; Aim 2) conduct a pilot randomized controlled trial (RCT) with 48 Veterans with SMI and PTSD to examine the feasibility and acceptability of WET, [monitor fidelity], and preliminarily evaluate clinical and functional outcomes; Aim 3) complete a well-specified process evaluation to determine what, if any, considerations are needed to optimize WET for Veterans with SMI and regarding culturally responsive methods. Overall impact will be to move WET towards full evaluation as a potential EBP for Veterans with PTSD and SMI. Project Background: PTSD is prevalent among Veterans and others with SMI,3-8contributing to substantial mental and physical health impairments.7,14-22 Written Exposure Therapy (WET) is a new EBP for PTSD that may have special clinical utility for Veterans with SMI and PTSD. 31,41-42,44 However, such Veterans have been largely excluded from PTSD clinical trials, and no WET trials to date have focused on an SMI population.42,45 Further, there are significant race and ethnicity disparities in PTSD and SMI prevalence and treatment, even in VHA.2,47 For instance, persistence and chronicity of SMI and PTSD are higher for Black, Indigenous, and other people of color (BIPOC),48,103 underlining the need for PTSD EBPs to be delivered in culturally responsive ways. Project Objectives: The proposed CDA-2 research will address research and clinical gaps by integrating culturally responsive assessment methods and testing the feasibility and acceptability of WET among Veterans with SMI and PTSD. [The first step of this research will focus on administering culturally responsive assessments and WET to Veterans with PTSD and SMI in a training trial (n = 10), including qualitative interviews exploring participants' experiences with and views of these instruments and WET.] The second step will involve completing a small randomized controlled trial of WET to examine feasibility, acceptability, and fidelity of WET, and to preliminary explore changes to clinical outcomes and functioning among 48 Veterans randomized to WET (n = 32) vs. a PTSD psychoeducation control intervention (n = 16). We will assess rates of recruitment, initial intervention engagement, and session attendance (feasibility); Veteran satisfaction with WET (acceptability); and preliminarily explore response to WET. The final step of this research will involve conducting a process evaluation to consider ways to optimize WET for future clinical trials to improve functional recovery for Veterans with SMI. This evaluation will synthesize information from: 1) WET interventionist notes and 2) qualitative interviews with a subset of Veterans in the WET condition (n = 15). Project Methods: This project will include: [1) delivering WET with the CFI during a training trial followed by qualitative interviews with Veterans with PTSD and SMI;] 2) completing a randomized control trial (RCT) with 48 Veteran participants, monitoring fidelity, feasibility, and acceptability; and 3) studying Veterans' experiences of WET and culturally responsive assessment methods through qualitative interviews. We will measure functional outcomes during the RCT at baseline, post-treatment and 3-month follow-up using clinician-rated and self-report questionnaires for preliminary exploratory analysis, preparatory to a future full RCT if WET proves promising.

对退伍军人的医疗保健的预期影响：PTSD是退伍军人恢复的关键障碍 严重的精神疾病（SMI；精神病谱和躁郁症）。退伍军人卫生管理局 （VHA）将PTSD的治疗作为高优先级，并启动了循证实践的传播 （EBP）在全国VHA系统中为PTSD而言。但是，PTSD的EBP尚未在之间进行测试，并且 尽管同时出现率很高，但在很大程度上没有向具有PTSD和SMI的退伍军人提供 深刻相关的负面功能影响。这项研究将：[AIM 1）管理文化配方 访谈（CFI）在与10名具有SMI和PTSD的退伍军人的湿thot研究中，以告知如何最好地合并 在AIM 2中，文化身份对湿干预试点测试的各个方面；目标2）进行飞行员随机控制 有48名具有SMI和PTSD的退伍军人的试验（RCT）检查湿的可行性和可接受性，[Monitor Fidelity]， 并初步评估临床和功能结果；目标3）完成明确指定的过程评估 确定需要考虑什么（如果有），以优化具有SMI的退伍军人 具有文化响应的方法。总体影响将是作为潜在的EBP进行全面评估的潮湿 适用于有PTSD和SMI的退伍军人。 项目背景：PTSD在退伍军人和SMI的其他人中普遍存在，3-8概括至实质性 精神和身体健康障碍。7,14-22书面暴露疗法（湿）是PTSD的新EBP 具有SMI和PTSD的退伍军人的特殊临床实用程序。 31,41-42,44但是，这类退伍军人在很大程度上是 从PTSD临床试验中排除，迄今为止尚无湿试验的重点是SMI人群。42,45，进一步 PTSD和SMI患病率和治疗中存在重大种族和种族差异，即使在VHA.2,47中 例如，SMI和PTSD的持久性和慢性性对于黑人，土著和其他人的持久性和长期性更高 颜色（BIPOC），48,103强调了对PTSD EBP的需求，以文化响应的方式传递。 项目目标：拟议的CDA-2研究将通过整合来解决研究和临床差距 具有文化响应式评估方法并测试退伍军人湿的可行性和可接受性 与SMI和PTSD。 [这项研究的第一步将着重于管理文化响应式评估 在培训试验中，用PTSD和SMI向退伍军人湿（n = 10），包括定性访谈探索 参与者对这些乐器和湿的观点的经验和观点。]第二步将涉及完成 湿的一项小型随机对照试验，以检查湿的可行性，可接受性和保真度，并 初步探讨了48名随机湿润的退伍军人之间临床结果的变化和功能（n = 32）与PTSD心理教育控制干预措施（n = 16）。我们将评估招聘率，初始 干预参与和会议出勤（可行性）；对湿（可接受性）的退伍军人满意；和 初步探索对湿的反应。这项研究的最后一步将涉及进行过程评估 考虑为将来的临床试验优化湿湿的方法，以改善SMI退伍军人的功能恢复。 此评估将从以下方式综合信息：1）湿干预主义笔记和2）与 在湿条件下的退伍军人子集（n = 15）。 项目方法：该项目将包括：[1）在培训试验中与CFI湿润，然后 与PTSD和SMI的退伍军人进行定性访谈;] 2）完成一项随机对照试验（RCT）48 退伍军人参与者，监视忠诚，可行性和可接受性； 3）研究退伍军人的经验 通过定性访谈进行湿和文化响应式评估方法。我们将测量功能 使用临床医生和自我报告的基线时RCT期间的结果，治疗后和3个月的随访 初步探索性分析的问卷，如果湿有望有望为未来的完整RCT准备。