Can Baseline Patient Clinical and Demographic Characteristics Predict Response to Early Posttraumatic Stress Disorder Interventions After Physical Injury?

Abstract

Objective

A growing evidence base supports stepped care interventions for the early treatment of posttraumatic stress disorder (PTSD) after physical injury. Few investigations have examined the characteristics of patients who do and do not respond to these interventions.

Method

This investigation was a secondary analysis that used previously collected data from three randomized clinical trials of stepped care interventions (patient N = 498). The study hypothesized that a subgroup of patients would manifest persistent PTSD symptoms regardless of randomization to intervention or control conditions, and that characteristics present at the time of baseline injury hospitalization could distinguish patients who would develop persistent symptoms from potential treatment responders. Regression analyses identified baseline patient clinical and demographic characteristics that were associated with persistent PTSD symptoms over the 6-months post-injury. Additional analyses identified treatment attributes of intervention patients who were and were not likely to demonstrate persistent symptoms.

Results

A substantial subgroup of patients (n = 222, 44.6%) demonstrated persistent PTSD symptoms over time. Greater numbers of pre-injury trauma, pre-injury PTSD symptoms, elevated early post-injury PTSD symptoms, unemployment, and non-White race identified patients with persistent symptoms. Patients with ≥3 of these baseline risk characteristics demonstrated diminished treatment responses when compared to patients with <3 characteristics. Intervention patients with ≥3 risk characteristics were less likely to engage in treatment and required greater amounts of interventionist time.

Conclusions

Injured trauma survivors have readily identifiable characteristics at the time of hospitalization that can distinguish responders to PTSD stepped care interventions versus patients who may be treatment refractory.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

DATA AVAILABILITY STATEMENT

De-identified participant data will be shared with investigators whose proposed data use has been approved through requests to the principal investigator.

Additional information

Funding

This study was supported in part by the National Institutes of Health Common Fund and NIMH, through cooperative agreements (U54 AT007748, 1UH2MH106338-01/4UH3MH106338-02, & NIMH R01 MH130460) from the Office of Strategic Coordination within the Office of the NIH Director and in part by the Patient-Centered Outcomes Research Institute Awards (IH-1304-6319, IHS-2017C1-6151). All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the National Institutes of Health or the Patient-Centered Outcomes Research Institute, its Board of Governors or Methodology Committee.

Notes on contributors

Douglas Zatzick

Navneet Birk, BS is a Research Coordinator with the Trauma Survivors Outcome & Support research team in the Department of Psychiatry and Behavioral Sciences. She received her bachelor’s degree in Medical Anthropology and Global Health from the University of Washington. Joan Russo, PhD is an Associate Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington. Dr. Russo is currently a psychometrician/statistician for the Trauma Survivors Outcomes & Support research team. Patrick Heagerty, PhD is a professor of Biostatics at the University of Washington. Dr. Heagerty is the lead statistician for the Trauma Survivors Outcomes & Support research team. Lea Parker, MS is a former Research Coordinator in the Department of Psychiatry and Behavioral Sciences at the University of Washington. She is a pre-doctoral intern at the Office of Forensic Mental Health Services (formerly Western State Hospital). Kathleen Moloney, BA is a former Research Coordinator in the Department of Psychiatry and Behavioral Sciences at the University of Washington. She is currently a Research Coordinator in the Department of Environmental and Health Sciences at the University of Washington. Eileen Bulger, MD is a Surgeon and Chief at the Harborview Medical Center and a Professor of Surgery at the University of Washington School of Medicine. Dr. Bulger is currently the medical director of the American Colleges Committee on Trauma. Lauren Whiteside, MD is an Associate Professor in the Department of Emergency Medicine at the University of Washington School of Medicine. Dr. Whiteside is a co-investigator with the Trauma Survivors Outcomes & Support research team. Rddhi Moodliar, BA is a former a Research Coordinator at the Department of Psychiatry and Behavioral Sciences at the University of Washington. She is currently a graduate student in the Department of Psychology at the University of California Los Angeles. Allison Engstrom, MSW is a Senior Coordinator with the Trauma Survivors Outcome & Support study team in the Department of Psychiatry and Behavioral Sciences. She is currently a social welfare PhD student at the University of Washington. Jin Wang, PhD is a Data Analyst/Statistician with the Trauma Survivors Outcome & Support research team. Dr. Wang is currently in the Department of Pediatrics at the University of Washington. Lawrence Palinkas, PhD is currently a Clinical Professor at the Herbert Wertheim School of Public Health and Longevity Science. Dr. Palinkas is a co-investigator with the Trauma Survivors Outcomes & Support research team. Khadija Abu, BA is a Research Coordinator with the Trauma Survivors Outcome & Support study team in the Department of Psychiatry and Behavioral Sciences. She received her bachelor’s degree in Psychology from the University of Washington. Douglas Zatzick, MD is a Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington. Dr. Zatzick is currently the principal investigator Trauma Survivors Outcomes & Support research team.