Stepped Care Intervention Beneficial After Natural Disaster
WEDNESDAY, Oct. 4, 2017 -- A stepped care (SC) case-finding intervention is beneficial for individuals with post-traumatic stress disorder after a natural disaster, according to a study published online Oct. 4 in JAMA Psychiatry.
Gregory H. Cohen, M.Phil., from the Boston University School of Public Health, and colleagues simulated treatment scenarios that start four weeks after the landfall of Hurricane Sandy on Oct. 29, 2012, and end two years later. The authors compared the effects of an SC case-finding intervention versus a moderate-strength single-level intervention (usual care [UC]) on treatment effectiveness and incremental cost-effectiveness. Under SC, cases were referred to cognitive behavioral therapy and noncases to Skills for Psychological Recovery, which aims to reduce distress and improve coping and functioning. Under UC, all patients were referred to Skills for Psychological Recovery only.
The researchers found that SC correlated with greater reach and was superior for reducing the prevalence of PTSD; the absolute benefit was clear at six months (risk difference, −0.004) and improved through 1.25 years (risk difference, −0.015). At six months, the relative benefits of SC were also clear (risk ratio, 0.905), with continued gains through 1.75 years (risk ratio, 0.615). Among cases, the absolute benefit of SC was stronger, emerging at three months (risk difference, −0.006) and increasing through 1.5 years (risk difference, −0.338). The incremental cost-effectiveness of SC versus UC was $3,428.71 to $6,857.68 per disability-adjusted life year avoided and 80 cents to $1.61 per PTSD-free day.
"These results provide further proof of concept for the SC approach to treating PTSD after a disaster, and they warrant further study and application in real-world settings," the authors write.
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Posted: October 2017