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Cited by 229Posttraumatic Stress Disorder ResearchTraumatic Brain Injury ResearchTrauma and Emergency Care Studies

A Randomized Stepped Care Intervention Trial Targeting Posttraumatic Stress Disorder for Surgically Hospitalized Injury Survivors

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Zatzick, Douglas, Jurkovich, Gregory, Rivara, Frederick P., Russo, Joan, Wagner, Amy, Wang, Jin, Dunn, Chris, Lord, Sarah Peregrine +3 more·2013·Annals of Surgery
DOI 10.1097/sla.0b013e31826bc313PMC PMC3582367
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Abstract

In Brief Objective: To test the effectiveness of a stepped care intervention model targeting posttraumatic stress disorder (PTSD) symptoms after injury. Background: Few investigations have evaluated interventions for injured patients with PTSD and related impairments that can be feasibly implemented in trauma surgical settings. Methods: The investigation was a pragmatic effectiveness trial in which 207 acutely injured hospitalized trauma survivors were screened for high PTSD symptom levels and then randomized to a stepped combined care management, psychopharmacology, and cognitive behavioral psychotherapy intervention (n = 104) or usual care control (n = 103) conditions. The symptoms of PTSD and functional limitations were reassessed at 1, 3, 6, 9, and 12 months after the index injury admission. Results: Regression analyses demonstrated that over the course of the year after injury, intervention patients had significantly reduced PTSD symptoms when compared with controls [group by time effect, CAPS (Clinician-Administered PTSD Scale): F(2, 185) = 5.50, P < 0.01; PCL-C (PTSD Checklist Civilian Version): F(4, 185) = 5.45, P < 0.001]. Clinically and statistically significant PTSD treatment effects were observed at the 6-, 9-, and 12-month postinjury assessments. Over the course of the year after injury, intervention patients also demonstrated significant improvements in physical function [MOS SF-36 PCS (Medical Outcomes Study Short Form 36 Physical Component Summary) main effect: F(1, 172) = 9.87, P < 0.01]. Conclusions: Stepped care interventions can reduce PTSD symptoms and improve functioning over the course of the year after surgical injury hospitalization. Orchestrated investigative and policy efforts could systematically introduce and evaluate screening and intervention procedures for PTSD at US trauma centers. (Trial Registration: clinicaltrials.gov identifier: NCT00270959) Acutely injured surgically hospitalized trauma survivors were screened for high posttraumatic stress disorder (PTSD) symptom levels and then randomized to a stepped-care intervention (n = 104) or a usual-care intervention (n = 103). Intervention patients demonstrated clinically and statistically significant reductions in PTSD symptoms and improved physical function over the course of the year after injury. Orchestrated investigative and policy efforts could systematically introduce and evaluate screening and intervention procedures for PTSD at US trauma centers.

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  • Step-up PTSD screening and mental health care models have the potential to improve support for pediatric and adult trauma patients, adapt to trauma centers with varying resources, and extend services via telehealth to address mental healthcare barriers.

    “Step-up models of care for PTSD screening and mental health care have the potential to improve mental health support for pediatric and adult trauma patients, be adapted to meet the needs of trauma centers with varying resources, and extend services via telehealth to address barriers to mental healthcare [93, 94•, 95].”

    From Adolescent Suicide—Understanding Unique Risks and Opportunities for Trauma Centers to Recognize, Intervene, and Prevent a Leading Cause of Death (2022) · cites this paper as [93]

    The Methods (Participants; Stepped Collaborative Care Intervention; pages not supplied) describe a stepped PTSD intervention for adults aged 18 and older that was designed for delivery in person or by telephone. The Discussion says the model could inform trauma-center screening and care, but cautions that its screening and care management may be too resource-intensive for broad use. This paper does not establish its applicability to pediatric patients or to trauma centers with varying resources, and it does not assess whether telephone delivery overcomes barriers to mental healthcare. (LLM, conf=0.87)

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  • The step-up model provides universal PTSD screening but focuses intervention time and resources on those who screen positive.

    “A promising model of assessing and providing treatment PTSD for patients after traumatic injury is the step-up model of care that provides universal screening for PTSD, but focuses time and resources for intervention on only those that screen positive.”

    From Adolescent Suicide—Understanding Unique Risks and Opportunities for Trauma Centers to Recognize, Intervene, and Prevent a Leading Cause of Death (2022) · cites this paper as [93]

    The Methods (Design and Setting; Assessments: PTSD Symptoms, page not available) describe screening eligible, consenting surgical inpatients and enrolling only those who screened positive twice for the intervention trial. This supports directing intervention to patients with positive screens, but not universal screening of all patients after traumatic injury. The Discussion (page not available) also cautions that the trial’s screening and care-management procedures may be too resource-intensive for broad use. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • The step-up model has demonstrated improved PTSD outcomes and quality of life.

    “This model has demonstrated improved outcomes related to PTSD and improved quality of life”

    From Adolescent Suicide—Understanding Unique Risks and Opportunities for Trauma Centers to Recognize, Intervene, and Prevent a Leading Cause of Death (2022) · cites this paper as [93]

    The Results (Symptomatic and Functional Outcomes; page not provided) report reduced PTSD symptoms and improved physical function in intervention patients. The Methods identify the functional measure as the SF-36 Physical Component Summary, but the copy does not report an improvement in overall quality of life. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 3

  1. [24]National Institute of Mental Health Mental health and mass violence: evidence-based early psychological intervention for victims/survivors of mass violence: a workshop to reach consensus on best practices Bethesda, MD, Washington, D.C National Institute of Mental Health: U.S. Government Printing Office 2002
  2. [34]Weathers F Ford J Stamm B Psychometric review of PTSD Checklist (PCL-C, PCL-S. PCL-M, PCL-PR) Measurement of stress, trauma, and adaptation Lutherville Sidran Press 1996 250 251
  3. [45]Johns Hopkins Health Services Research and Development Center Determining injury severity from hospital discharges: A program to map ICD-9-CM diagnoses into AIS and ISS severity scores The Johns Hopkins University Press 1989

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Authors
Zatzick, D., Jurkovich, G., Rivara, F. P., Russo, J., Wagner, A., Wang, J., Dunn, C., Lord, S. P., Petrie, M., O'Connor, S. S., & Katon, W.
Affiliations
University of Washington (US)
Corresponding author
  • Zatzick, Douglas
  • Russo, Joan
  • Wang, Jin
  • Dunn, Chris
  • Lord, Sarah Peregrine
  • Petrie, Megan
  • Katon, Wayne
ORCID
Venue
Annals of Surgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2013-03
Volume
257
Issue
3
Pages
390-399
ISSN
0003-4932 (ISSN-L)
DOI
10.1097/sla.0b013e31826bc313
PMC
PMC3582367
OpenAlex
W2044773414
Cited by
229
References
53
Citations by year
2026: 8 · 2025: 15 · 2024: 14 · 2023: 16 · 2022: 23 · 2021: 17 · 2020: 9 · 2019: 17 · 2018: 15 · 2017: 14 · 2016: 18 · 2015: 23 · 2014: 22 · 2013: 14 · 2012: 3
FWCI
22.45
Type
journal article
Language
en
Open access
Locations
  • Annals of Surgery (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (5r01mh073613-05, 5k24mh086814-05)
  • National Institute of Mental Health (R01/MH073613, K24/MH086814)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
  • Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
Keywords
post-traumatic stress disorder, stepped-care intervention, trauma survivors, surgical hospitalization, cognitive behavioral therapy, psychopharmacology, PTSD screening, physical function, functional limitations, trauma centers, PTSD treatment
MeSH terms
Adult, Feasibility Studies, Female, Follow-Up Studies, Humans, Male, Retrospective Studies, Severity of Illness Index, Stress Disorders, Post-Traumatic, Trauma Centers, Wounds and Injuries, Cognitive Behavioral Therapy, Treatment Outcome

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