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Long-term outcome of early interventions to prevent posttraumatic stress disorder
Arieh Y Shalev1, Yael Ankri, Moran Gilad
1Department of Psychiatry, NYU Langone Medical Center, One Park Ave, 8-221, New York, NY 10016 Arieh.shalev@nyumc.org.
Insights
Early interventions like prolonged exposure and cognitive therapy accelerate acute posttraumatic stress disorder (PTSD) recovery. However, these treatments do not reduce the 3-year prevalence of PTSD, highlighting a persistent clinical challenge.
Area of Science:
- Psychiatry
- Clinical Psychology
- Public Health
Background:
- Posttraumatic stress disorder (PTSD) poses significant clinical and public health challenges.
- Effective prevention and early intervention strategies for acute PTSD are crucial.
Purpose of the Study:
- To evaluate the 3-year outcomes of early interventions for survivors with acute PTSD.
- To compare the long-term effectiveness of prolonged exposure, cognitive therapy, and SSRI treatment against placebo and no intervention.
Main Methods:
- Adults with acute DSM-IV PTSD were randomized to prolonged exposure, cognitive therapy, escitalopram (SSRI), or placebo.
- A group declining treatment was also followed.
- Assessments for PTSD and symptoms occurred at 1, 5 months, and 3 years post-event.
- The Clinician-Administered PTSD Scale (CAPS) was the primary outcome measure.
Main Results:
- Prolonged exposure and cognitive therapy significantly reduced PTSD symptoms from 1 to 5 months, with stable results.
- At 3 years, all intervention groups and the no-intervention group showed similar PTSD symptom levels.
- The prevalence of PTSD and secondary outcomes were comparable across all groups at the 3-year follow-up.
Conclusions:
- Early prolonged exposure and cognitive therapy effectively accelerate recovery from acute PTSD.
- These interventions do not reduce the 3-year prevalence of PTSD, indicating a treatment-refractory subset.
- The persistent prevalence of PTSD underscores a major clinical and public health challenge in managing this disorder.
Background:
Failing to prevent posttraumatic stress disorder (PTSD) has major clinical and public health consequences. This work evaluates the 3-year outcome of offering early interventions to survivors with acute PTSD.
Methods:
Adults admitted consecutively to the hospital with acute DSM-IV PTSD were randomized, between June 2003 and October 2007, to 12 weeks of prolonged exposure (n = 63) or cognitive therapy (n = 40) or concealed SSRI (escitalopram; n = 23) versus placebo (n = 23). Eighty-two participants who declined treatment were followed as well. Treatment started 1 month after the traumatic event, and participants were reassessed 5 and 36 months later. Assessors were blinded to treatment allocation and acceptance. The Clinician-Administered PTSD Scale (CAPS) evaluated PTSD and PTSD symptoms. Self-reported symptoms, general functioning, and employment status were secondary outcomes. Participants lost to follow-up were missing completely at random.
Results:
Prolonged exposure and cognitive therapy significantly reduced PTSD and PTSD symptoms between 1 and 5 months (mean CAPS total scores [95% CI] at 1 month: prolonged exposure = 73.59 [68.21-78.96] and cognitive therapy = 71.78 [66.92-78.93]; mean CAPS total scores [95% CI] at 5 months: prolonged exposure = 28.59 [21.89-35.29] and cognitive therapy = 29.48 [21.32-37.95], P < .001), and their results remained stable. At 3 years, however, the study groups had similar levels of PTSD symptoms (mean CAPS total scores [95% CI]: prolonged exposure = 31.51 [20.25-42.78]; cognitive therapy = 32.08 [20.74-43.42]; SSRI = 34.31 [16.54-52.07]; placebo = 32.13 [20.15-44.12]; and no intervention = 30.59 [19.40-41.78]), similar prevalence of PTSD (28.6%-46.2%), and similar secondary outcomes.
Conclusion:
Early prolonged exposure and cognitive therapy accelerated the recovery from acute PTSD. Their effect remained stable, however, without reducing the 3-year prevalence of the disorder. The lingering prevalence of PTSD, despite efficient interventions, illustrates a nonremitting, treatment-refractory subset of survivors and outlines a major clinical and public health challenge.
Trial Registration:
ClinicalTrials.gov identifier: NCT00146900.
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