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Measurement Strategies for Evidence-Based Antidepressants for Posttraumatic Stress Disorder Delivery: Trends and Associations with Patient-Reported Outcomes

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Abstract

We sought to develop a quality standard for the prescription of antidepressants for posttraumatic stress disorder (PTSD) that is both consistent with the underlying evidence supporting antidepressants as a treatment for PTSD and associated with the best levels of symptom improvement. We quantified antidepressant initiation during the first year of PTSD treatment in a 10-year national cohort of Department of Veterans Affairs (VA) users, and compared outcomes in a subgroup who completed patient-reported outcome measurement (PROM) as part of routine practice. We added progressively stringent measurement requirements. Prescribing quality for PTSD in the VA was stable over time. Use of PROM was rare in the case of antidepressant treatment, limiting our assessment of outcomes.

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The opinions expressed herein are those of the authors and do not necessarily reflect the positions of the United States Department of Veterans Affairs or the United States Department of Defense.

Funding

A VA Health Services Research and Development Career Development Award to Dr. Shiner (CDA11-263) funded the development of this cohort. A DoD Peer Reviewed Medical Research Program Award to Dr. Shiner (PR160206) funded the development of our strategy to leverage patient-reported outcomes data.

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Authors and Affiliations

  1. White River Junction VA Medical Center, 215 North Main Street, White River Junction, VT, 05009, USA

    Brian Shiner, Christine Leonard & Sarah Cornelius

  2. Geisel School of Medicine at Dartmouth, Hanover, NH, USA

    Brian Shiner, Jiang Gui, Paula P. Schnurr & Bradley V. Watts

  3. National Center for PTSD Executive Division, White River Junction, VT, USA

    Brian Shiner & Paula P. Schnurr

  4. VA Office of Systems Redesign and Improvement, Washington, DC, USA

    Bradley V. Watts

  5. Boston University School of Public Health, Boston, MA, USA

    Jaimie L. Gradus

Authors
  1. Brian Shiner
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  2. Christine Leonard
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  3. Jiang Gui
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  4. Sarah Cornelius
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  5. Jaimie L. Gradus
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  6. Paula P. Schnurr
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  7. Bradley V. Watts
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Corresponding author

Correspondence to Brian Shiner.

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Conflict of interest

All authors declares that they have not conflicts of interest.

Ethical Approval

The Veterans IRB of Northern New England, the White River Junction VA Medical Center Research and Development Committee, and VA National Data Systems approved this study. All procedures performed in studies involving human participants were in accordance with the Ethical Standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

The Veterans IRB of Northern New England granted a waiver of informed consent for this entirely retrospective medical records-based study.

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Appendices

Appendix 1

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Table 6 Antidepressant medication initiation in the year following initial PTSD diagnosis among patients with no antidepressant prescriptions in the 2 years prior to index PTSD diagnosis, by punitive quality standards
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6.

Appendix 2

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Table 7 Covariates for comparisons of quality standards, 2008–2013 (unweighted)
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7.

Appendix 3

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Table 8 Covariates for comparisons of quality standards, 2008–2013 (weighted)
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8.

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Shiner, B., Leonard, C., Gui, J. et al. Measurement Strategies for Evidence-Based Antidepressants for Posttraumatic Stress Disorder Delivery: Trends and Associations with Patient-Reported Outcomes. Adm Policy Ment Health 48, 70–87 (2021). https://doi.org/10.1007/s10488-020-01047-w

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