A Randomized Effectiveness Trial of a Systems-Level Approach to Stepped Care for War-Related PTSD
Technical Report,01 Sep 2009,28 Feb 2016
Henry M. Jackson Foundation for the Advancement of Military Medicine Bethesda United States
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During the 6.5 year study period, investigators developed the STEPS UP intervention for treatment of service members with PTSD andor depression conducted a randomized controlled trial evaluating the effectiveness of STEPS UP as compared to optimized usual care OUC in Army primary care clinics and created an effective research infrastructure to implement the project, per the SOW. Compared to OUC, STEPS UP participants reported significantly greater reductions in PTSD and depression symptoms over 12-months of follow-up primary outcomes. Differences in effects were statistically significant at 12-months for PTSD and at 6- and 12-months for depression STEPS UP was associated with clinically significant improvements. STEPS UP was also significantly associated with decreased physical symptom burden and improved mental health functioning no changes for alcohol consumption, physical health function, or pain were observed secondary aims. STEPS UP appears tobe a cost-effective strategy for managing PTSD and depression in the MHS. Results from the qualitative portion of the trial reveal that stakeholders within the MHS perceive significant barriers to mental health care and recognize the value of collaborative care in overcoming barriers to care, yet perspectives about the value and utility of different tools varied in this study. Investigators are currently completing multiple manuscripts to disseminate study findings.