A randomized trial of self-management and psychoeducational group therapies for comorbid chronic posttraumatic stress disorder and depressive disorder

Authors

  • Nancy Jo Dunn,

    Corresponding author
    1. Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Houston Center for Quality of Care and Utilization Studies, Houston, TX; Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center (MIRECC), Houston, TX, anchor site; and Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
    • Mental Health Care Line (116MHCL-TRP), Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030.
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  • Lynn P. Rehm,

    1. Department of Psychology, University of Houston, Houston, TX
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  • Jeanne Schillaci,

    1. VeriCare, San Diego, CA
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  • Julianne Souchek,

    1. Michael E. DeBakey Veterans Affairs Medical Center, Houston Center for Quality of Care and Utilization Studies, and Department of Medicine, Baylor College of Medicine, Houston, TX
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  • Paras Mehta,

    1. Department of Psychology, University of Houston, Houston, TX
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  • Carol M. Ashton,

    1. Michael E. DeBakey Veterans Affairs Medical Center, Houston Center for Quality of Care and Utilization Studies, and Department of Medicine, Baylor College of Medicine, Houston, TX
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  • Elisia Yanasak,

    1. Veterans Affairs Puget Sound Health Care System, Tacoma, WA
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  • Joseph D. Hamilton

    1. Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center (MIRECC), Houston, TX, anchor site; and Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
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Abstract

The authors randomized 101 male veterans with chronic combat-related posttraumatic stress disorder (PTSD) and depressive disorder to an evidence-based depression treatment (self-management therapy; n = 51) or active-control therapy (n = 50). Main outcome measures for efficacy, using intention-to-treat analyses, were subjective and objective PTSD and depression scales at pretest, posttest, and 3-, 6-, and 12-month follow-up. Other measures included treatment compliance, satisfaction, treatment-targeted constructs, functioning, service utilization, and costs. Self-management therapy's modestly greater improvement on depression symptoms at treatment completion disappeared on follow-up. No other differences on symptoms or functioning appeared, although psychiatric outpatient utilization and overall outpatient costs were lower with self-management therapy. Despite success in other depressed populations, self-management therapy produced no clinically significant effect in depression with chronic PTSD.

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