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Can Families Help Shape Former Service Members' Adherence to Trauma-Focused Treatments for PTSD?
Meis LA, Spoont MR, Noorbaloochi S, Hagel Campbell EM, Erbes CR, Polusny MA, Eftekhari A, Rosen C, Tuerk PW, Kattar KA, Velasquez TL, Cutting AH, Burmeister LB, Henriksen KR, Baltutis E, Rynda KM. Can Families Help Shape Former Service Members' Adherence to Trauma-Focused Treatments for PTSD? Poster session presented at: Military Health System Research Symposium; 2016 Aug 16; Orlando/Kissimmee, FL.
Background: Posttraumatic stress disorder (PTSD) occurs in as many as 1 in 5 service members returning from Iraq and Afghanistan and is associated with a host of negative, long-term consequences. Despite strong evidence of the effectiveness of evidence based psychotherapies (EBPs) for PTSD, these trauma-focused treatments are not well-tolerated by some patients. Dropout rates are especially high among our most recent generation of service members. While most theories of health behavior consider the role of an individual's social environment, social influences on treatment adherence are rarely studied. More work is needed to determine if and how family members can support PTSD treatment adherence. Consequently, we surveyed former service members initiating an EBP for PTSD to examine how family factors influence treatment adherence. The present set of analyses focus on the role of family members' attitudes about EBPs for PTSD and behaviors that may discourage participation.
Methods: We surveyed former service members initiating an EBP for PTSD across four VA medical centers as well as support person (SP) nominated by the former service member. Surveys were administered by mail at treatment initiation (Time 1; Veterans N = 548; SPs N = 294) and again at either treatment completion or 4 months later for those who discontinued treatment (Time 2; Veterans = 352; SPs = 230). Veterans' electronic medical records were coded for session attendance and homework compliance.
Results: Data analysis is ongoing. Preliminary regressions models were conducted examining associations between family factors and EBP adherence (i.e., attendance and homework compliance). Analyses controlled for site, treatment type (Cognitive Processing Therapy vs Prolonged Exposure), and Time 1 PTSD symptom severity. Findings suggest that veterans were more likely to complete treatment if they veteran told an SP about their EBP participation (OR = 3.04; p < .001) and/or if the veteran believed their SPs found the treatment credible (OR = 1.26, p = .004). In contrast, veterans who reported that a SP encouraged them to quit treatment attended fewer sessions ( = -.12, p = .031) and completed less homework ( = -.19, p = .002) than veterans who were not encouraged to quit. The more strongly SPs believed that facing difficult things is helpful (vs. avoiding them), the more likely veterans were to complete treatment (OR = 1.31, p = .019). On the other hand, in those dyads where the SP adjusted their behavior to accommodate veterans' PTSD symptoms, veterans attended fewer sessions ( = -.15, p = .040) and completed less homework ( = -.16, p = .042). Additional analyses planned for the conference will include how findings vary with the characteristics of the veteran and his/her family (i.e., relationship strain, type of SP, gender, and returning veteran status).
Conclusions: A highly publicized 2014 Institute of Medicine report highlighted a deficit in family-oriented programming within the Department of Defense and VA. Our initial analyses support the importance of such programming through suggesting family factors can influence former service members' treatment participation. Additional implications and limitations will be discussed.