Article Text
Abstract
Background Despite the availability of evidence-based treatments for posttraumatic stress disorder (PTSD), significant heterogeneity in the effectiveness of PTSD treatment persists, especially in community settings. Client demographics used to understand this variability in treatment outcome and dropout have yielded mixed results. Despite increasing evidence for the importance of attending to treatment engagement in community settings, few studies have explored client-level predictors.
Aim The purpose of this study is to explore client-level predictors of treatment outcome and dropout beyond client demographics, and to identify client-level predictors of treatment engagement in community settings.
Method Secondary data analysis was conducted with data collected as part of an implementation-effectiveness hybrid study of cognitive processing therapy (CPT) for PTSD in a diverse community health centre. Providers (n=19) treated (n=52) clients as part of their routine clinical care. Non-demographic client-level predictors included barriers to treatment, quality of life, session-level language and employment history assessed at baseline. Treatment engagement included number of weeks in the study, number of sessions with repeated CPT content, number of unique CPT sessions attended, frequency of session attendance and consistency of session attendance.
Results Results showed language as a significant predictor of treatment engagement. There were significant differences between Spanish and English-speaking clients, with the former having a tendency to repeat more session content than the latter (β=1.4 sessions, p=0.003), and also less likely to attend treatment frequently (r=0.62, p=0.009) and consistently (r=0.57, p=0.027) if high logistical and financial barriers were endorsed. Irrespective of language, clients who reported high quality of life at baseline were less likely to repeat CPT session content (β=−0.3, p=0.04), and those with increased baseline barriers to treatment had deceleration in PTSD symptom improvement over time (β=−0.62, p<0.05). In terms of treatment engagement moderators impacting treatment outcome, clients who repeated more session content were more likely to complete treatment (OR=1.84, p=0.037).
Conclusion Identification of client-level predictors of treatment engagement, outcome and dropout is essential to optimise treatment, particularly in community settings.
- predictors
- dropout
- treatment engagement
- posttraumatic stress disorder
- diverse populations
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Footnotes
DLS and LM are joint senior authors.
Contributors SJY, SWS, DLS and LM were responsible for the conceptualisation and design of the study, and for writing all sections of the manuscript. MAM conducted the statistical analyses, interpreted the data and wrote the statistical analyses and results sections. KAP and YAS contributed to the drafting of the introduction and method sections. ADB contributed to the revisions and formatting of the manuscript in preparation for publication. All authors read, revised and approved the final manuscript.
Funding This study was funded by a grant through the National Institutes of Health (NIMH K23 MH096029-01A1) awarded to LM. Contributions of SWS to the study were partially funded by another grant through the National Institutes of Health (NIMH 1R01MH112628-01).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval All study procedures were approved by the site’s institutional review board.
Provenance and peer review Commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.