An RCT of a Primary Care-Based PTSD Intervention: Clinician-Supported PTSD Coach

Not Applicable

Completed

• Conditions: Posttraumatic Stress Disorder
• Interventions: Behavioral: Primary Care Mental Health Integrated Care as Usual; Behavioral: Clinician-Supported PTSD Coach

• Registration Number: NCT02685358
• Lead Sponsor: VA Office of Research and Development

Brief Summary

Posttraumatic Stress Disorder (PTSD) is an often severe and frequently disabling condition. It is associated with compromised health, early mortality, and substantial economic costs. PTSD is common in VA primary care patients; however, brief, effective treatments for PTSD are not available in the primary care setting. Instead, patients with PTSD are referred to mental health settings, yet many patients do not accept these referrals or do not adequately engage in such services. Thus, this project seeks to improve health care for Veterans by testing the effectiveness of a primary care-based treatment called clinician-supported PTSD Coach. In this treatment a primary care mental health clinician guides patients in using the PTSD Coach mobile app to learn about PTSD symptoms, treatment options, and strategies to cope with common PTSD-related concerns. If this treatment is found to be effective at reducing PTSD symptoms and increasing use of mental health care, it will provide a tremendous benefit to Veterans with PTSD seen in VA primary care.

Detailed Description

Posttraumatic Stress Disorder (PTSD) is an often severe and frequently disabling condition. It is associated with compromised health, early mortality, and substantial economic costs. PTSD is common in VA primary care patients; however, brief, effective treatments for PTSD are not available in the primary care setting. Instead, patients with PTSD are referred to mental health settings, yet many patients do not accept these referrals or do not adequately engage in such services. Thus, this project represents a unique opportunity to improve health care for Veterans by examining the effectiveness of a primary care-based treatment called Clinician-Supported PTSD Coach. In this treatment a primary care mental health clinician guides patients in using the PTSD Coach mobile app to learn about PTSD symptoms, treatment options, and strategies to cope with common PTSD-related concerns. This randomized clinical trial will enroll and treat 260 VA primary care patients (female and male) who have PTSD and are not currently being treated for it. Commonly used, well-established clinical interviews and self-report measures will be used to assess important clinical outcomes. If this direct treatment is found to be effective at reducing PTSD symptoms and increasing use of mental health care, it will provide a tremendous benefit to Veterans with PTSD seen in VA primary care.

Study Timeline

• Study First Submitted: 2016-02-12
• Study First Submitted QC: 2016-02-12
• Study First Posted: 2016-02-18
• Study Start: 2017-03-01
• Primary Completion: 2021-09-30
• Study Completion: 2021-09-30
• Results First Submitted: 2023-02-23
• Status Verified: 2024-02
• Results First Submitted QC: 2024-02-28
• Last Update Submitted: 2024-02-28
• Results First Posted: 2024-03-04
• Last Update Posted: 2024-03-04

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 234

Inclusion Criteria

• Veterans enrolled in primary care within the VA Syracuse and Palo Alto healthcare systems reporting 33 on the PTSD Checklist-5 (PCL-5) and a traumatic event on the Criterion A screener

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Exclusion Criteria

• Patients will be excluded if they demonstrate symptoms that would not allow them to actively engage in the CS PTSD Coach, i.e.,

  • gross cognitive impairment

• Current symptoms of mania or psychosis or who have more pressing concerns that need to be addressed first, i.e.,

  • suicide attempt in the last two months or current intent to commit suicide

• Patients with recent suicide attempts or intent are eligible to be enrolled follow the receipt of suicide prevention services

• The investigators will also exclude patients that are already receiving psychotherapy or MH counseling for PTSD outside of PC

• Started or changed the dose of a psychotropic medication for PTSD in the last two months that was prescribed outside of VA PC

• Voice a preference to be directly referred to MH specialty care

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Primary Care Mental Health Integrated Care as Usual	Primary Care Mental Health Integrated Care as Usual	Existing primary care mental health integrated treatment will serve as the comparison condition
Clinician-Supported PTSD Coach	Clinician-Supported PTSD Coach	Clinician-supported PTSD Coach is primary care-based treatment. In this treatment a primary care mental health clinician guides patients in using the PTSD Coach mobile app to learn about PTSD symptoms, treatment options, and strategies to cope with common PTSD-related concerns. It consisted of 4 brief sessions over 8 weeks.

Primary Outcome Measures

Name	Time	Method
Hospital Administrative Data Showing 2 Mental Health Visits Completed	16 and 24 weeks	Hospital administrative data will be examined to determine if the participant completed 2 visits to any specialty mental health clinic during the follow-up period.
Clinician Administered PTSD Scale for DSM-5 (CAPS-5)	Baseline	The CAPS-5 is a 30-item clinical interview that assesses the 20 DSM-5 PTSD symptoms. Scores on the CAPS-5 can range from 0 to 80, with higher scores reflecting worse PTSD symptom severity. In this study, clinician-rated PTSD symptom severity were based on blind assessor ratings.

Secondary Outcome Measures

Name	Time	Method
Patient Health Questionnaire (PHQ-9)	Baseline, 8 week, 16 week, 24 week	A 9-item self-report instrument used to assess depression severity. Items are scored 0 to 3, with the total score being the sum of the 9 items which can range from 0 as the minimum value to 27 as the maximum value. Higher scores indicate greater depression severity, with a score of 10 or greater indicating probable major depression, and scores of 20 or more severe major depression.
WHOQOL-BREF Social Relationships Subscale	Baseline, 8 week, 16 week, 24 week	The social relationships (3 items) subscale of the WHOQOL-BREF was used to assess the broader effects of the intervention on quality of life. Scores on this subscales range from 0-15 with higher scores reflecting better quality of life.
PTSD Checklist-5 (PCL-5)	Baseline, 8 week, 16 week, 24 week	The PCL-5 is a 20-item self-report measure assessing how much respondents have been bothered by DSM-5 PTSD symptoms in the past month. Scores can range from 0 to 80 with higher scores reflecting worse PTSD symptom severity.
Client Satisfaction Questionnaire (CSQ)	8 week	The CSQ is a widely used 8-item self-report measure assessing patient satisfaction with care. Scores can range from 8 to 32 with higher scores reflecting greater satisfaction.
WHOQOL-BREF Psychological Health Subscale	Baseline, 8 week, 16 week, 24 week	The psychological health (6 items) subscale of the WHOQOL-BREF was used to assess the broader effects of the intervention on quality of life. Scores on this subscales range from 0-30 with higher scores reflecting better quality of life.

Trial Locations

Locations (2)

Syracuse VA Medical Center, Syracuse, NY; 🇺🇸 Syracuse, New York, United States

VA Palo Alto Health Care System, Palo Alto, CA; 🇺🇸 Palo Alto, California, United States