Stepped Care Intervention Improves PTSD Tx After Natural Disaster

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The researchers found that stepped care correlated with greater reach and was superior for reducing the prevalence of PTSD.
The researchers found that stepped care correlated with greater reach and was superior for reducing the prevalence of PTSD.

HealthDay News — A stepped care (SC) case-finding intervention is beneficial for individuals with post-traumatic stress disorder after a natural disaster, according to a study published online in JAMA Psychiatry.

Gregory H. Cohen, MPhil, from the Boston University School of Public Health, and colleagues simulated treatment scenarios that start 4 weeks after the landfall of Hurricane Sandy on Oct. 29, 2012, and end 2 years later.

The authors compared the effects of an SC case-finding intervention versus a moderate-strength single-level intervention (usual care [UC]) on treatment effectiveness and incremental cost-effectiveness.

Under SC, cases were referred to cognitive behavioral therapy and noncases to Skills for Psychological Recovery, which aims to reduce distress and improve coping and functioning. Under UC, all patients were referred to Skills for Psychological Recovery only.

The researchers found that SC correlated with greater reach and was superior for reducing the prevalence of PTSD; the absolute benefit was clear at 6 months (risk difference, −.004) and improved through 1.25 years (risk difference, −.015). At 6 months, the relative benefits of SC were also clear (risk ratio, .905), with continued gains through 1.75 years (risk ratio, .615).

Among cases, the absolute benefit of SC was stronger, emerging at three months (risk difference, −.006) and increasing through 1.5 years (risk difference, −.338). The incremental cost-effectiveness of SC versus UC was $3,428.71 to $6,857.68 per disability-adjusted life year avoided and 80 cents to $1.61 per PTSD-free day.

"These results provide further proof of concept for the SC approach to treating PTSD after a disaster, and they warrant further study and application in real-world settings," the authors write.

Reference

Cohen GH, Tamraker S, Lowe S, Et al. Comparison of simulated treatment and cost-effectiveness of a stepped care case-finding intervention vs usual care for posttraumatic stress disorder after a natural disaster [published online October 4, 2017]. JAMA Psychiatry. doi: 10.1001/jamapsychiatry.2017.3037

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