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CDA 07-015 – HSR&D Study

 
CDA 07-015
Improving Mental Health Services for Diverse Veterans with PTSD and SMI
Anouk L. Grubaugh PhD MA BS
Ralph H. Johnson VA Medical Center, Charleston, SC
Charleston, SC
Funding Period: October 2007 - December 2011

BACKGROUND/RATIONALE:
Rates of trauma exposure among adults with severe mental illness (SMI) range from 51% to 98% and include high rates of both physical and sexual assault. Rates of posttraumatic stress disorder (PTSD) in this population are also high, ranging from 19% to 43%, and these rates are consistently higher than those found in the general population of trauma survivors. Furthermore, there is evidence that the experience of victimization among patients with SMI is strongly correlated with psychiatric difficulties, lower quality of life, and substance abuse. Despite the impact of PTSD on functioning in this population, patients with SMI have historically been excluded from PTSD service delivery studies. As such, there are few PTSD treatment outcome data by which to guide evidence-based care in this population.

OBJECTIVE(S):
The research aims of this application focus on establishing the feasibility and preliminary efficacy of an empirically evaluated cognitive-behavioral exposure intervention for PTSD in Veterans with SMI at the Charleston VAMC in a single arm, open trial design using multiple health services outcome measures.

METHODS:
34 adult (>18) female and male Veterans with PTSD and SMI served by the Charleston VAMC were enrolled in the study and included in intent-to-treat analyses. Data collected included feasibility indices (i.e., recruitment, compliance, and drop-out) and measures of clinical improvement (i.e., PTSD) and quality of life (i.e., SF-12). Data were collected at pre, post, and 6-months. Additionally, qualitative interviews were conducted post-treatment to learn more about patients' reactions, perceptions, beliefs, preferences, and suggestions for the PTSD intervention.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
More data are needed regarding optimal treatment strategies for PTSD, particularly exposure-based techniques, in individuals with severe psychiatric comorbidity. The proposed research project is inherently significant as it serves to provide preliminary support for the feasibility and efficacy of a frontline PTSD intervention for Veterans with severe mental illness. Additionally, the quantitative and qualitative data gathered from this project will help ensure that cognitive behavioral exposure interventions are responsive to the unique needs of and barriers faced by low-income, racially diverse trauma survivors with SMI who are served by VAMCs. Ultimately, these data (and those from a recently funded HSR&D Merit) along the same theme will help establish a clear standard of care to a historically underserved population of trauma survivors.


External Links for this Project

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PUBLICATIONS:

Journal Articles

  1. Grubaugh AL, Cusack KJ, Zinzow HM. "Trumping rules" affect diagnoses of persons with severe mental illness. Psychiatric services (Washington, D.C.). 2008 Oct 1; 59(10):1219-20. [view]
  2. Grubaugh AL, Long ME, Elhai JD, Frueh BC, Magruder KM. An examination of the construct validity of posttraumatic stress disorder with veterans using a revised criterion set. Behaviour Research and Therapy. 2010 Sep 1; 48(9):909-14. [view]
  3. Tuerk P, Brady KT, Grubaugh AL. Clinical Case Discussion: Combat PTSD and Substance Use Disorders. Journal of addiction medicine. 2009 Dec 1; 3(4):189-93. [view]
  4. Long ME, Elhai JD, Schweinle A, Gray MJ, Grubaugh AL, Frueh BC. Differences in posttraumatic stress disorder diagnostic rates and symptom severity between Criterion A1 and non-Criterion A1 stressors. Journal of anxiety disorders. 2008 Oct 1; 22(7):1255-63. [view]
  5. Frueh BC, Grubaugh AL, Cusack KJ, Elhai JD. Disseminating evidence-based practices for adults with PTSD and severe mental illness in public-sector mental health agencies. Behavior Modification. 2009 Jan 1; 33(1):66-81. [view]
  6. Hall BJ, Elhai JD, Grubaugh A, Tuerk P, Magruder K. Examining the factor structure of PTSD between male and female veterans in primary care. Journal of anxiety disorders. 2012 Apr 1; 26(3):409-15. [view]
  7. Frueh BC, Grubaugh AL, Cusack KJ, Kimble MO, Elhai JD, Knapp RG. Exposure-based cognitive-behavioral treatment of PTSD in adults with schizophrenia or schizoaffective disorder: a pilot study. Journal of anxiety disorders. 2009 Jun 1; 23(5):665-75. [view]
  8. Tuerk PW, Yoder M, Grubaugh A, Myrick H, Hamner M, Acierno R. Prolonged exposure therapy for combat-related posttraumatic stress disorder: an examination of treatment effectiveness for veterans of the wars in Afghanistan and Iraq. Journal of anxiety disorders. 2011 Apr 1; 25(3):397-403. [view]
  9. Yoder M, Tuerk PW, Price M, Grubaugh AL, Strachan M, Myrick H, Acierno R. Prolonged exposure therapy for combat-related posttraumatic stress disorder: comparing outcomes for veterans of different wars. Psychological Services. 2012 Feb 1; 9(1):16-25. [view]
  10. Naifeh JA, Elhai JD, Kashdan TB, Grubaugh AL. The PTSD symptom scale's latent structure: an examination of trauma-exposed medical patients. Journal of anxiety disorders. 2008 Dec 1; 22(8):1355-68. [view]
  11. Long ME, Grubaugh AL, Elhai JD, Cusack KJ, Knapp R, Frueh BC. Therapist fidelity with an exposure-based treatment of PTSD in adults with schizophrenia or schizoaffective disorder. Journal of Clinical Psychology. 2010 Apr 1; 66(4):383-93. [view]
  12. Grubaugh AL, Zinzow HM, Paul L, Egede LE, Frueh BC. Trauma exposure and posttraumatic stress disorder in adults with severe mental illness: a critical review. Clinical Psychology Review. 2011 Aug 1; 31(6):883-99. [view]
Book Chapters

  1. Grubaugh AL. Social skills training for the treatment of PTSD. In: Reeves G, Elhai JD, Ford JD, editors. The Encyclopedia of Psychological Trauma. Hoboken, NJ: John Wiley & Sons; 2008. [view]
Conference Presentations

  1. Grubaugh AL, Egede LE, Frueh BC, Knapp RG. An open trial of prolonged exposure for PTSD in patents with severe mental illness. Paper presented at: VA National Mental Health Conference; 2011 Aug 15; Baltimore, MD. [view]
  2. Grubaugh AL, Egede LE, Frueh BC, Knapp RG. An open trial of prolonged exposure for PTSD in patents with severe mental illness. Paper presented at: Anxiety Disorders Association of America Annual Conference; 2011 Mar 25; New Orleans, LA. [view]
  3. Grubaugh AL, Egede LE, Frueh BC, Knapp RG. An open trial of prolonged exposure for PTSD in patents with severe mental illness. Paper presented at: Association for Behavioral and Cognitive Therapies Annual Convention; 2010 Nov 18; San Francisco, CA. [view]
  4. Grubaugh AL, Magruder KM, Frueh BC. Delayed-onset posttraumatic stress disorder among patients in Veterans Affairs primary care clinics. Poster session presented at: VA HSR&D National Meeting; 2008 Feb 13; Baltimore, MD. [view]
  5. Grubaugh AL. Do reductions in VA psychiatric services lead to increased private hospital ED utilization? Paper presented at: AcademyHealth Annual Research Meeting; 2009 Jun 28; Chicago, IL. [view]
  6. Grubaugh AL, Knapp RG, Egede LE, Frueh BC. Enhancing Posttraumatic Stress Disorder services for Veterans with severe mental illness. Poster session presented at: VA HSR&D Career Development Annual Meeting; 2010 Feb 25; San Francisco, CA. [view]
  7. Grubaugh AL, Egede LE, Frueh BC, Knapp RG. Enhancing posttraumatic stress disorder services for veterans with severe mental illness. Poster session presented at: VA HSR&D Career Development Annual Meeting; 2011 Feb 15; National Harbor, MD. [view]
  8. Frueh BC, Grubaugh AL, Cusack KJ, Kimble MO, Elhai JD, Knapp RG. Exposure-based cognitive behavioral treatment of PTSD in adults with schizophrenia or schizoaffective disorder. Poster session presented at: Anxiety Disorders Association of America Annual Conference; 2009 Mar 15; Santa Ana Pueblo, NM. [view]
  9. Grubaugh AL, Slagle DM, Long ME, Frueh BC, Magruder KM. Racial disparities in trauma exposure, PTSD, and service use among female veterans in primary care. Poster session presented at: International Society for Traumatic Stress Studies Annual Meeting; 2008 Nov 13; Chicago, IL. [view]
  10. Long ME, Grubaugh AL, Elhai JD, Knapp RG, Frueh BC. Therapist fidelity with an exposure-based treatment of PTSD in adults with Schizophrenia or Schizoaffective Disorder. Poster session presented at: Association for Behavioral and Cognitive Therapies Annual Convention; 2008 Nov 15; Orlando, FL. [view]


DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders, Health Systems
DRE: Treatment - Observational, Treatment - Efficacy/Effectiveness Clinical Trial
Keywords: PTSD
MeSH Terms: none

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