Feb 3, 2020
This report identifies factors associated with changes in outcomes for soldiers who received Army behavioral health specialty care and provides recommendations to improve care and outcomes for posttraumatic stress disorder, depression, and anxiety. Analyses of 141 patient and treatment variables indicated that two treatment factors—therapeutic alliance and receipt of benzodiazepines—were associated with outcomes.
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This report identifies factors associated with changes in outcomes for soldiers who received Army behavioral health (BH) specialty care and provides recommendations to improve BH care and outcomes. RAND researchers identified three samples of soldiers who received Army BH care with diagnoses of posttraumatic stress disorder (PTSD), depression, or anxiety and whose symptoms were assessed during their care. Multivariate analyses included 141 patient and treatment variables to identify factors associated with symptom improvement. Analyses also examined patterns in how the symptoms changed over time.
Analyses suggest that the Behavioral Health Data Portal, an online system that allows for collection of multiple patient- and clinician-reported measures, is widely used to track symptoms of PTSD, depression, and anxiety, but there are opportunities to expand symptom tracking. Two treatment factors—therapeutic alliance and receipt of benzodiazepines—were associated with treatment outcomes. Specifically, a stronger therapeutic relationship or alliance with providers, as reported by soldiers, was associated with improved PTSD, depression, and anxiety outcomes. Further, receipt of more than a 30-day supply of benzodiazepines was associated with poorer PTSD, depression, and anxiety outcomes. Many soldiers' trajectories of symptom change did not demonstrate improvement.
Recommendations include providing feedback and guidance to providers on how to strengthen alliance with their patients, expanding tracking and feedback on benzodiazepine prescribing, and increasing provider use of measurement-based BH care.
Implementation of Treatment Outcome Monitoring and the Army's Outcome Measures
Characteristics and Representativeness of Soldiers in the Multivariate Analysis Samples
Identifying Pretreatment and Treatment Predictors of PTSD, Depression, and Anxiety Outcomes
Trajectories of PTSD, Depression, and Anxiety Symptom Change
Summary and Recommendations
Variables Used in the Multivariate Models
PTSD, Depression, and Anxiety Outcome Models: Full Model Results