Impact of PTSD Comorbidity on One-Year Outcomes in a Depression Trial

Georgetown Center for Trauma and the Community, Georgetown University Medical Center, Washington, DC 20007, USA.
Journal of Clinical Psychology (Impact Factor: 2.12). 07/2006; 62(7):815-35. DOI: 10.1002/jclp.20279
Source: PubMed


Low-income African American, Latino, and White women were screened and recruited for a depression treatment trial in social service and family planning settings. Those meeting full criteria for major depression (MDD; N = 267) were randomized to cognitive-behavior therapy (CBT), antidepressant medication, or community mental health referral. All randomly assigned participants were evaluated by baseline telephone and clinical interview, and followed by telephone for one year. Posttraumatic stress disorder (PTSD) comorbidity was assessed at baseline and one-year follow-up in a clinical interview. At baseline, 33% of the depressed women had current comorbid PTSD. These participants had more exposure to assaultive violence, had higher levels of depression and anxiety, and were more functionally impaired than women with depression alone. Depression in both groups improved over the course of one year, but the PTSD subgroup remained more impaired throughout the one-year follow-up period. Thus, evidence-based treatments (antidepressant medication or structured psychotherapy) decrease depression regardless of PTSD comorbidity, but women with PTSD were more distressed and impaired throughout. Including direct treatment of PTSD associated with interpersonal violence may be more effective in alleviating depression in those with both diagnoses.

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Available from: Juned Siddique, Sep 30, 2015
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    • "It is reasonable to suppose that using CPT to lessen the severity of co-occurring depression symptoms may lessen the rates of self-injurious behaviors and lethality among clients with PTSD. This finding is especially encouraging given that individuals who have both PTSD and depression may be less responsive to medication than those with depression alone (Green et al., 2006; Hollon et al., 2005). "
    10/2014; 36(4):360-376. DOI:10.17744/mehc.36.4.1360805271967kvq
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    • "Comorbid depression and PTSD are especially common among women who have experienced multiple traumas [18] or gender-based violence [19]. Multiple forms of psychological distress compound each other, such that women with comorbid depression and PTSD suffer from much greater impairment relative to women with depression alone [20]. "
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    ABSTRACT: Background In South Africa, alcohol use poses a public health burden. Hazardous alcohol use often co-occurs with psychological distress (e.g., depression and post-traumatic stress). However, the majority of the research establishing the relationship between alcohol use and psychological distress has been cross-sectional, so the nature of co-occurring changes in psychological distress and alcohol use over time is not well characterized. The objective of this study is to examine the longitudinal relationship between psychological distress and alcohol use among South African women who attend alcohol serving venues.Methods Four waves of data were collected over the course of a year from 560 women in a Cape Town township who attended drinking venues. At each assessment wave, participants reported depressive symptoms, post-traumatic stress symptoms, and alcohol use. Multilevel growth models were used to: 1) assess the patterns of alcohol use; 2) examine how depressive symptoms uniquely, post-traumatic stress symptoms uniquely, and depressive and post-traumatic stress symptoms together were associated with alcohol use; and 3) characterize the within person and between person associations of depressive symptoms and post-traumatic stress symptoms with alcohol use.ResultsWomen reported high levels of alcohol use throughout the study period, which declined slightly over time. Post-traumatic stress symptoms were highly correlated with depressive symptoms. Modeled separately, both within person and between person depressive and post-traumatic stress symptoms were uniquely associated with alcohol use. When modeled together, significant between person effects indicated that women who typically have more post-traumatic stress symptoms, when controlling for depressive symptoms, are at risk for increased alcohol use; however, women with more depressive symptoms, controlling for post-traumatic stress symptoms, do not have differential risk for alcohol use. Significant within person effects indicated an interaction between depressive and post-traumatic stress symptoms; women reported more alcohol use than usual at times when they had higher post-traumatic stress symptoms, and this increase in alcohol use was further exacerbated for women who also had higher depressive symptoms than usual.Conclusions These findings suggest that interventions targeting post-traumatic stress, especially when post-traumatic stress is comorbid with depression, may reduce alcohol use among South African women who drink.
    BMC Psychiatry 08/2014; 14(1):224. DOI:10.1186/s12888-014-0224-9 · 2.21 Impact Factor
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    • "The first step involves patient screening by the recruitment coordinator (RC) using a brief 6-item screener [71] to identify those at risk for PTSD. For those with a positive brief screen, the RC assesses patients for exposure to traumatic events using the Stressful Life Events Screening Questionnaire (SLES-Q) [10] [72] and administers the Clinician Administered PTSD Scale (CAPS) [73] [74] to assess for a diagnosis of PTSD (Step 2). Patients who meet the criteria for PTSD are randomized to either the CM intervention or usual care and then complete the baseline evaluation assessment. "
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    ABSTRACT: Posttraumatic stress disorder (PTSD) is a common problem in primary care. Although effective treatments are available, little is known about whether such treatments are effective within the context of Federally Qualified Health Centers (FQHCs) that serve as national "safety nets" for providing primary care for low income and underinsured patients. The Violence and Stress Assessment (ViStA) study is the first randomized controlled trial (RCT) to test the impact of a care management intervention for treating PTSD in FQHCs. To develop a PTSD management intervention appropriate for lower resource FQHCs and the predominantly Latino patients they serve, formative work was conducted through a collaborative effort between researchers and an FQHC practice-based research network. This article describes how FQHC stakeholders were convened to review, assess, and prioritize evidence-based strategies for addressing patient, clinician, and system-level barriers to care. This multi-component care management intervention incorporates diagnosis with feedback, patient education and activation; navigation and linkage to community resources; clinician education and medication guidance; and structured cross-disciplinary communication and continuity of care, all facilitated by care managers with FQHC experience. We also describe the evaluation design of this five-year RCT and the characteristics of the 404 English or Spanish speaking patients enrolled in the study and randomized to either the intervention or to usual care. Patients are assessed at baseline, six months, and 12months to examine intervention effectiveness on PTSD, other mental health symptoms, health-related quality-of-life, health care service use; and perceived barriers to care and satisfaction with care.
    Contemporary clinical trials 04/2014; 38(2). DOI:10.1016/j.cct.2014.04.005 · 1.94 Impact Factor
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