Treatment of post traumatic stress disorder symptoms in emotionally distressed individuals

Abstract

Older individuals with emotional distress and a history of psychologic trauma are at risk for post traumatic stress disorder (PTSD) and major depression. This study was an exploratory, secondary analysis of data from the study "Prevention of Depression in Older African Americans". It examined whether Problem Solving Therapy-Primary Care (PST-PC) would lead to improvement in PTSD symptoms in patients with subsyndromal depression and a history of psychologic trauma. The control condition was dietary education (DIET). Participants (n=60) were age 50 or older with scores on the Center for Epidemiologic Studies-Depression scale of 11 or greater and history of psychologic trauma. Exclusions stipulated no major depression and substance dependence within a year. Participants were randomized to 6-8 sessions of either PST-PC or DIET and followed 2 years with booster sessions every 6 months; 29 participants were in the PST-PC group and 31 were in the DIET group. Mixed effects models showed that improvement of PTSD Check List scores was significantly greater in the DIET group over two years than in the PST-PC group (based on a group time interaction). We observed no intervention⁎time interactions in Beck Depression Inventory or Brief Symptom Inventory-Anxiety subscale scores.

Trial registration: ClinicalTrials.gov NCT00326677.

Keywords: Dietary education; Post traumatic stress disorder; Problem solving therapy.

Published by Elsevier Ireland Ltd.

Figures

Figure 1. Recruitment Flow Chart

This recruitment flow chart indicates that 60 of the randomized 247 individuals were exposed to psychologic trauma. The text box at the bottom describes reasons why some of the 60 participants did not complete. Abbreviations are as follows: PST-PC: Problem Solving Therapy in Primary Care; DIET: dietary education; MMSE: mini mental status examination; CES-D: Centers for Epidemiologic Studies – Depression scale: MDD – major depressive disorder.

Figure 2

This figure shows the Post Traumatic Stress Disorder Check List scores – Civilian version (PCL-C; mean ± standard error) over time for Problem Solving Therapy in Primary Care (PST-PC) and dietary education (DIET) interventions. The number of participants at each time point is indicated in the bottom portion of the graph. Time was treated as continuous with actual visit date used to model time. The graph shows data plotted at study designed time points for convenience. We found a significant time effect [linear time: F(1, 131) = 12.42, p <.001 and linear time interaction f p="0.01]." both interventions showed improvement over with the diet intervention decreasing by more. hamilton rating scale for depression items scaled score from late life function disability instrument were significant covariates. decreases in pcl scores associated increases functional frequency scores.>

Figure 3

This figure shows the Brief Symptom Inventory (BSI) anxiety scores (mean ± standard error) over time for Problem Solving Therapy in Primary Care (PST-PC) and dietary education (DIET) interventions. The number of participants at each time point is indicated in the bottom portion of the graph. Time was treated as continuous with actual visit date used to model time. The graph shows data plotted at study designed time points for convenience. We found a significant time effect [linear time: F (1, 194) = 19.15, p <.001 and quadratic time: f p="0.004]." thus both interventions showed improvement over time. however there were no differences in anxiety scores between groups:>