Long-Term Outcome of Early Interventions to Prevent Posttraumatic Stress Disorder

Article AbstractBackground: Failing to prevent posttraumatic stress disorder (PTSD) has major clinical and public health consequences. This work evaluates the 3-year outcome of offering early interventions to survivors with acute PTSD.Methods: Adults admitted consecutively to the hospital with acute DSM-IV PTSD were randomized, between June 2003 and October 2007, to 12 weeks of prolonged exposure (n = 63) or cognitive therapy (n = 40) or concealed SSRI (escitalopram; n = 23) versus placebo (n = 23). Eighty-two participants who declined treatment were followed as well. Treatment started 1 month after the traumatic event, and participants were reassessed 5 and 36 months later. Assessors were blinded to treatment allocation and acceptance. The Clinician-Administered PTSD Scale (CAPS) evaluated PTSD and PTSD symptoms. Self-reported symptoms, general functioning, and employment status were secondary outcomes. Participants lost to follow-up were missing completely at random.Results: Prolonged exposure and cognitive therapy significantly reduced PTSD and PTSD symptoms between 1 and 5 months (mean CAPS total scores at 1 month: prolonged exposure = 73.59 and cognitive therapy = 71.78 ; mean CAPS total scores at 5 months: prolonged exposure = 28.59 and cognitive therapy = 29.48 , P < .001), and their results remained stable. At 3 years, however, the study groups had similar levels of PTSD symptoms (mean CAPS total scores : prolonged exposure = 31.51 ; cognitive therapy = 32.08 ; SSRI = 34.31 ; placebo = 32.13 ; and no intervention = 30.59 ), similar prevalence of PTSD (28.6%-46.2%), and similar secondary outcomes.Conclusion: Early prolonged exposure and cognitive therapy accelerated the recovery from acute PTSD. Their effect remained stable, however, without reducing the 3-year prevalence of the disorder. The lingering prevalence of PTSD, despite efficient interventions, illustrates a nonremitting, treatment-refractory subset of survivors and outlines a major clinical and public health challenge.Trial Registration: ClinicalTrials.gov identifier: NCT00146900