Treatment Response and Predictors of Change for Military Service Members in Intensive TreatmentJennifer A Webb-Murphy, Ph.D.Naval Center for Combat & Operational Stress Control (NCCOSC)Bureau of Medicine and Surgery (BUMED)

Co-authors• Susan F. Fesperman, MPH

• Elizabeth A. Vishnyak, MA

• Scott C. Roesch, PhD

• Eileen M. Delaney, PhD

• Steven K. Gerard, BA

• Bonnie J. Nebeker, AA

• Stephanie C. Raducha, BA

• Courtney A. Dempsey, MPA

• Andrea L. Repp, MA

• Betsy J. Grant, MA, MFT

• CAPT Scott L. Johnston, PhD, USN

Disclaimer

The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense or United States Government.

Results presented are part of the Psychological Health Pathways Research Study, which is approved by the Naval Medical Center San Diego Institutional Review Board.

Agenda

• Brief Background• Psychological Health Pathways• Treatment Response• Predictors of Change

Mental Health Services Surge

• OEF/OIF resulted in a significant increase in demand for mental health services

• Military mental healthcare rapidly expanded to address demand

• Resulting system is novel, broad and dynamic

DeploymentHealth

Emergency RoomBranch Clinic

Mental Health Department

Unit level servicesCommunity care Residential

Intensive outpatientInpatient

OutpatientResearch

IndividualGroups

Couples Family

MedicationMedicationMedication

CAMAnimal Assisted

TherapyHolistic HealthAcupuncture

Healing Touch

Massage

Recreational TherapySurf Therapy

YogaRunningGolfing

Psychological Health Pathways

System Solution• Clinical Pathways• Case Management• Data Management

• Standardized outcome measures at baseline and 10 week intervals

• Patient Summaries• Aggregate Reporting• Population Level Research

PHP Assessment Process

Clinic

Patient

ISR

Patient

10 wks RSR TR

Patient Tx Team

10 wks

From Beta to Pilot: Paper vs. eCapture

vs.

Pilot PHP Assessments:Section A: Basic Demographics

Section B: Outcome Measures– PTSD– Depression– Social, Occupational & Relational Functioning– Resilience– Sleep– TBI Screen– Anxiety– Alcohol Use– Somatic

Section C: Deployment Information – Combat Exposure– Consequences of Combat

PHP Status

Individual Patient Summaries

PHP Aggregate Reports

Treatment Outcomes

• Intensive outpatient treatment for substance use and PTSD– 8 week program

– Variety of interventions

• Residential treatment for PTSD– 10 week program

– Variety of interventions

Significant Improvements

n=201

PTSD40414243444546474849

Depression02468

10121416

Sleep10.6

10.8

11

11.2

11.4

11.6

11.8

Significant Improvements

n=201

Functioning13.5

1414.5

1515.5

1616.5

17

Resilience40

42

44

46

48

50

52

54

Predictors of ChangeRelationship status

• Never being married = larger decrease in PTSD Sx

• Being married = smaller decrease in depression

Living with your spouse

• Smaller decrease in depression Sx

• Smaller improvement in functioning

Planning to leave military

• Larger decrease in PTSD and depression Sx

• Larger improvement in functioning

• Higher increase in resilience

Conclusions• Significant benefits of comprehensive, systematic military mental

health assessment, such as PHP

• Evaluate treatment progress

• Identify effective programs

• Successful specialized treatment

• Understand population seeking care

• Unique risk and protective factors

• Being single and not living with spouse could result in better treatment response

• Planning to leave the military doesn’t inhibit ability to obtain treatment gains