An effectiveness-implementation hybrid trial study protocol targeting posttraumatic stress disorder and comorbidity.

Area of Science:

• Trauma care
• Mental health services research
• Implementation science

Background:

• Millions of Americans experience severe injuries annually, often leading to hospitalization.
• Trauma survivors frequently present with co-occurring conditions such as posttraumatic stress disorder (PTSD), substance use disorders, depression, and chronic medical issues.
• These comorbidities are prevalent in individuals with and without traumatic brain injuries.

Purpose of the Study:

• To evaluate the effectiveness of a collaborative care intervention for physical trauma survivors with PTSD and comorbidities.
• To assess the implementation of this intervention across multiple trauma centers using an effectiveness-implementation hybrid design.
• To determine if the intervention leads to significant reductions in PTSD symptoms, depression, suicidal ideation, and alcohol consumption, alongside improvements in physical function.

Main Methods:

• A stepped wedge cluster randomized trial involving 960 patients across 24 US level I trauma centers.
• Patients identified as high-risk for PTSD via electronic health record screening were formally assessed.
• Intervention group received stepped collaborative care; control group received enhanced usual care, including training in care management, medication, CBT, and motivational interviewing.

Main Results:

• The study is designed to determine if intervention patients show significant reductions in PTSD and depressive symptoms, suicidal ideation, and alcohol consumption compared to controls.
• Improvements in physical function are also being assessed.
• Implementation science frameworks are used to evaluate the uptake of the intervention model.

Conclusions:

• The Trauma Survivors Outcomes and Support (TSOS) trial aims to establish the effectiveness of collaborative care for PTSD and comorbidities in trauma survivors.
• The study addresses sustainable implementation through partnerships with professional societies like the American College of Surgeons.
• The findings will inform healthcare policy and promote the long-term sustainability of effective interventions for trauma survivors.