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Key patterns and predictors of response to treatment for military veterans with post-traumatic stress disorder: a growth mixture modelling approach

Published online by Cambridge University Press:  15 November 2017

A. J. Phelps ,
Z. Steel ,
O. Metcalf ,
N. Alkemade ,
K. Kerr ,
M. O'Donnell ,
J. Nursey ,
J. Cooper ,
A. Howard  and
R. Armstrong
...Show all authors
A. J. Phelps*
Affiliation:
Department of Psychiatry, Phoenix Australia – Centre for Posttraumatic Mental Health, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry St, Carlton, Australia
Z. Steel
Affiliation:
St John of God Richmond Hospital and School of Psychiatry, University of New South Wales, Sydney, Australia
O. Metcalf
Affiliation:
Department of Psychiatry, Phoenix Australia – Centre for Posttraumatic Mental Health, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry St, Carlton, Australia
N. Alkemade
Affiliation:
Department of Psychiatry, Phoenix Australia – Centre for Posttraumatic Mental Health, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry St, Carlton, Australia
K. Kerr
Affiliation:
Toowong Private Hospital, 496 Milton Road, Toowong, Queensland, Australia
M. O'Donnell
Affiliation:
Department of Psychiatry, Phoenix Australia – Centre for Posttraumatic Mental Health, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry St, Carlton, Australia
J. Nursey
Affiliation:
Department of Psychiatry, Phoenix Australia – Centre for Posttraumatic Mental Health, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry St, Carlton, Australia
J. Cooper
Affiliation:
Department of Psychiatry, Phoenix Australia – Centre for Posttraumatic Mental Health, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry St, Carlton, Australia
A. Howard
Affiliation:
Department of Psychiatry, Phoenix Australia – Centre for Posttraumatic Mental Health, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry St, Carlton, Australia
R. Armstrong
Affiliation:
Department of Psychiatry, Phoenix Australia – Centre for Posttraumatic Mental Health, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry St, Carlton, Australia
D. Forbes
Affiliation:
Department of Psychiatry, Phoenix Australia – Centre for Posttraumatic Mental Health, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry St, Carlton, Australia
*
*Address for correspondence: Dr A. J. Phelps, Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton VIC 3053, Australia. (Email: [email protected])
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Abstract

Background

To determine the patterns and predictors of treatment response trajectories for veterans with post-traumatic stress disorder (PTSD).

Methods

Conditional latent growth mixture modelling was used to identify classes and predictors of class membership. In total, 2686 veterans treated for PTSD between 2002 and 2015 across 14 hospitals in Australia completed the PTSD Checklist at intake, discharge, and 3 and 9 months follow-up. Predictor variables included co-morbid mental health problems, relationship functioning, employment and compensation status.

Results

Five distinct classes were found: those with the most severe PTSD at intake separated into a relatively large class (32.5%) with small change, and a small class (3%) with a large change. Those with slightly less severe PTSD separated into one class comprising 49.9% of the total sample with large change effects, and a second class comprising 7.9% with extremely large treatment effects. The final class (6.7%) with least severe PTSD at intake also showed a large treatment effect. Of the multiple predictor variables, depression and guilt were the only two found to predict differences in response trajectories.

Conclusions

These findings highlight the importance of assessing guilt and depression prior to treatment for PTSD, and for severe cases with co-morbid guilt and depression, considering an approach to trauma-focused therapy that specifically targets guilt and depression-related cognitions.

Keywords

post-traumatic stress disorderpredictorsPTSDtreatment responseveterans
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 1 , January 2018 , pp. 95 - 103
Creative Commons
This contribution has been produced using funding provided by the Department of Veterans' Affairs (DVA). However, the views expressed in the contribution do not necessarily represent the views of the Minister for Veterans' Affairs or the Department of Veterans' Affairs. The Commonwealth of Australia does not give any warranty nor accept any liability in relation to the contents of this contribution.
Copyright
Copyright © Commonwealth of Australia and Cambridge University Press 2017

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