Individuals with posttraumatic stress disorder (PTSD) are more likely to engage in unhealthy behaviors, such as tobacco use, drug use, and alcohol misuse, and have high rates of morbidity/mortality. PTSD negatively impacts marriages, educational attainment, and occupational functioning. Some patients with PTSD can be successfully referred to specialty mental health clinics, but most patients with PTSD cannot engage in specialty care because of geographical, financial, or cultural barriers and so must be treated in primary care. However, the best way to treat PTSD in primary care clinics isn’t known, especially for patients who do not respond to the initial treatment choice. There are effective treatments for PTSD that are feasible to deliver in primary care; these treatments include commonly prescribed antidepressants and brief exposure-based therapies. However, because there are no head-to-head comparisons between pharmacotherapy and psychotherapy in primary care settings, primary care providers do not know which treatments to recommend to their patients. In addition, despite high treatment nonresponse rates, very few studies have examined which treatment should be recommend next when patients do not respond well to the first option, and no such studies have been conducted in primary care settings.
This trial will be conducted in Federally Qualified Health Centers and Veterans Affairs Medical Centers, where the prevalence of both past trauma exposure and PTSD are particularly high. We will enroll 1,500 primary care patients. We propose to
- compare outcomes among patients randomized to initially receive pharmacotherapy or brief psychotherapy;
- compare outcomes among patients randomized to treatment sequences (i.e., switching and augmenting) for patients who do not respond to the initial treatment; and
- examine variation in treatment outcomes among different subgroups of patients.
Telephone and web surveys will be used to assess outcomes important to patients (e.g., such as self-reported symptom burden, side effects, health related quality of life, recovery outcomes) at baseline, three months, and six months. Results will help patients and primary care providers choose which treatment to try first and which treatment to try second if the first is not effective.
Other Clinical Interventions
Other Health Services Interventions
Training and Education Interventions
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.