Is a Combination of Treatment Modalities Always Better?
Upcoming SlideShare
Loading in...5
×
 

Is a Combination of Treatment Modalities Always Better?

on

  • 405 views

 

Statistics

Views

Total Views
405
Views on SlideShare
402
Embed Views
3

Actions

Likes
0
Downloads
1
Comments
0

1 Embed 3

https://twitter.com 3

Accessibility

Categories

Upload Details

Uploaded via

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Is a Combination of Treatment Modalities Always Better? Is a Combination of Treatment Modalities Always Better? Presentation Transcript

  • Is a Combination of Treatment Modalities Always Better? Comparing the Amount of Treatment in Military Mental Health Eileen Delaney, PhD, Elizabeth Vishnyak, MA, Susan Fesperman, MPH, Scott Roesch, PhD, Jennifer Webb-Murphy, PhD, Courtney Dempsey, MPA, Steven Gerard, BA, Bonnie Nebeker, AA, Stephanie Raducha, BA, Andrea Repp, MA, Betsy Henderson-Grant, MFT, & CAPT Scott L. Johnston, PhD, USN --A population based study done in 2006 indicated that between 11.3% and 19.1% of OIF/OEF combat veterans reported psychological health problems. --Mental disorders are the most significant source of medical and occupational morbidity among active duty personnel. --Thus, there is great interest in early identification and treatment of mental health problems in the military. --In the military mental health system, service members receive a variety of psychological treatment modalities that include (but are not limited to) medication management, individual therapy, and group therapy as well as inpatient and outpatient treatment. --We retrospectively analyzed self-report data from military service members who entered the Psychological Health Pathways (PHP) program between March 1, 2009, and February 29, 2012. --Throughout treatment, patients completed self report assessments of PTSD, depression, sleep quality and functional impairment (PCL-M, PHQ-9, PSQI and SDS, respectively). Treatment reviews were also conducted by clinic staff. --Paired comparison t-tests were conducted to compare means of outcomes at T1 and T2. --To compare symptom changes between those who received one treatment modality and those who received more than one treatment modality, change scores of mental health outcomes were calculated for the two groups. --Number of sessions was compared between those who received one treatment modality and those who received more than one treatment modality. Overall symptom reductions: --From T1 to T2 (M=93.52±106.1 days), patients improved on measures of PTSD (df=769, t=7.46), depression (df=773, t=9.54), sleep quality (df=690, t=2.80) and functional impairment (df=571, t=7.56). All ps<.01. Change scores based on number of treatment modalities received: -Patients were categorized into one of two groups: those who received one treatment modality and those who received more than one treatment modality. -At T1, symptom levels of PTSD, depression, sleep quality and functional impairment did not statistically differ between the two groups. --A variety of treatment modalities are offered in the military mental health system such as medication management, individual therapy and group therapy as well as inpatient, intensive outpatient and outpatient treatment. --Patients receiving mental health care in military treatment facilities experienced symptom improvements in PTSD, depression, sleep and functional impairment. -- Over the course of a 3-month period, outcomes improved more for those who received one treatment modality compared to those who received more than one treatment modality. --While the majority of those who received more than one treatment modality participated in more than 10 sessions, the majority of those who received one treatment modality participated in 10 sessions or less; and, half of those who received one treatment modality participated in six sessions or less. --We hypothesize that those patients who received one modality experienced a greater reduction in symptoms with fewer sessions compared to those who received multiple modalities because they were better able to focus and apply more personal resources into a single treatment domain. --Greater monitoring and understanding of patients’ treatment progress could lead to improvements in both patient care and allocation of resources. Number of sessions between T1 and T2 One treatment modality (n=77) More than one treatment modality (n=388) 1-3 sessions 25% (19) 4% (15) 4-6 sessions 25% (19) 8% (32) 7-10 sessions 20% (15) 7% (27) +10 sessions 27% (21) 78% (304) Symptom reductions from T1 to T2 (n=463) One treatment modality (16.3% of patients) More than one treatment modality (82% of patients) PTSD -11.29* -5.28* Depression -4.47* -2.55* Sleep -2.07* -0.54* Functional impairment -5.19* -2.47* Introduction: With the large number of service members having deployed in support of OIF/OEF, identifying and treating mental health problems has become a primary focus in military health. Aims: To evaluate mental health symptom changes as military service members undergo mental health treatment. Method: Retrospectively analyzed self-report data and treatment reviews. Results: From T1 to T2, patients improved on measures of PTSD, depression, sleep quality and functional impairment. Analyses also indicated that from T1 to T2 outcomes improved more for those who received one treatment modality compared to those who received more than one treatment modality. Conclusion: Service members’ mental health symptoms are improving in the current military mental health system. Findings also showed that those receiving one treatment modality had greater symptom reductions than those receiving a combination of treatment modalities. ABSTRACT INTRODUCTION METHOD CONCLUSIONSRESULTS LIMITATIONS --Data are comprised of 10% of the mental health population at two military treatment facilities and were not randomly sampled; therefore, these findings may not be representative of the military mental health population. --Treatment reviews were not completed at a high rate (T2=59.2%; T3=63.4%), which limits generalizability of the results. --Treatment reviews did not differentiate between types of services (e.g., intake vs. individual therapy vs. group therapy) which limits the strength of the conclusions that can be drawn from the data. --Certain outcome measures (e.g., alcohol use) were not collected which may have been the focus of treatment thereby impacting treatment response. FUTURE ANALYSES --Currently data is being collected from 100% of patients at military mental health clinics participating in PHP, greatly improving generalizability. --Current treatment reviews collect specific information about types of services and treatments provided which improves validity. --Current treatment reviews indicate who specifically completes the form which also improves validity. --Collecting more specific information via the treatment reviews will allow for future comparisons of treatment effectiveness. --Additional outcome measures (i.e., alcohol use, anxiety) that are commonly addressed in mental health treatment have been added to the assessment battery. *Significant difference between groups at p=0.01 level Demographics for full sample (n=2364): --Age: 18-24 yrs: 43.2%; 25-30 yrs: 31.8%; 30-35 yrs: 11.5%; >35 yrs: 13.5% --Gender: Male: 90.2%; Female: 9.8% --Branch: Marines: 73.3%; Navy: 23.3%; Army: 2.7%; Air Force: 0.6%; Coast Guard: 0.1%