Population Impact of PTSD and Depression Care for Military Service Members: Reach and Effectiveness of an Enhanced Collaborative Care Intervention

Abstract

Objective: Epidemiologic studies suggest high rates of posttraumatic stress disorder (PTSD) and depression among military members and veterans. To meet the needs of this population, evidence-based treatments are recommended as first-line interventions, based on their clinical efficacy and not the proportion of the target population that the intervention reaches. We apply a public health framework to examine the population impact of an enhanced collaborative care model on a targeted population that takes into account effectiveness and reach.Methods: Using data collected from a 2012 - 2016 randomized trial, the effectiveness of enhanced collaborative care for PTSD and depression was evaluated using probable diagnostic status as the primary outcome. Exclusion criteria were then applied to a 2011 disease registry to examine the representativeness of the trial sample and estimate the potential reach of the intervention. Population impact was derived from the estimated effectiveness and reach of the intervention.Results: Enhanced collaborative care was associated with a significantly greater probability of PTSD/depression remission by the end of the trial (conditional effect = -0.066, chisq = 51.1, p < 0.001). Based on the effectiveness and reach of the enhanced intervention, an estimated 250 (out of the 3,436) more Army soldiers with PTSD and/or depression would experience diagnostic remission during the preceding year if the enhanced model was available.Conclusion: The population framework permits the estimated differential impact of two collaborative care models to inform implementation considerations. These results highlight the value of applying public health models to identify front line treatments.

ACKNOWLEDGMENTS

We wish to thank the committed care managers, research site investigators, site coordinators, primary care clinicians, clinic staff, and mental health specialists who supported the STEPS-UP study. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, the Department of Defense, the National Institutes of Health, or any U.S. government agency.

Additional information

Funding

The STEPS-UP study was supported by a Department of Defense Deployment Related Medical Research Program award (DR080409). The award was a joint award to the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (W81XWH-09-2-0077), Research Triangle Institute (W81XWH-09-2-0078), and RAND Corporation (W81XWH-09-2-0079). The sponsor had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.This work was supported by the Congressionally Directed Medical Research Programs (DR080409).