Research Article
Treatment outcome in Australian veterans with combat-related posttraumatic stress disorder: A cause for cautious optimism?
Mark Creamer,
Philip Morris,
Dirk Biddle, Peter Elliott,
Corresponding Author
Mark Creamer
National Centre for PTSD and Department of Psychiatry, University of Melbourne, Australia
National Centre for PTSD, Locked Bag 1, West Heidelberg, Victoria 3081, AustraliaSearch for more papers by this authorPhilip Morris
Mental Health Services, Gold Coast, Queensland, Australia
Search for more papers by this authorPeter Elliott
Department of Psychology, University of Melbourne, Australia
Search for more papers by this authorMark Creamer,
Philip Morris,
Dirk Biddle, Peter Elliott,
Corresponding Author
Mark Creamer
National Centre for PTSD and Department of Psychiatry, University of Melbourne, Australia
National Centre for PTSD, Locked Bag 1, West Heidelberg, Victoria 3081, AustraliaSearch for more papers by this authorPhilip Morris
Mental Health Services, Gold Coast, Queensland, Australia
Search for more papers by this authorPeter Elliott
Department of Psychology, University of Melbourne, Australia
Search for more papers by this authorAbstract
This study investigated treatment outcome in combat-related posttraumatic stress disorder (PTSD). Participants were 419 Australian Vietnam veterans who completed a 12-week hospital-based program. A comprehensive protocol assessed PTSD, comorbidity, and social functioning at admission and at 3 and 9 months posttreatment. Overall, the group showed significant improvements in core PTSD symptoms, anxiety, depression, alcohol abuse, social dysfunction, and anger. Changes occurred mostly between admission and 3 months posttreatment, with gains maintained at 9 months. Ratings by patients and their partners indicated perceived improvement and strong satisfaction with treatment. Nevertheless, treatment gains were variable and, for most veterans, considerable pathology remained following the programs. The current study provides grounds for cautious optimism in the treatment of combat-related PTSD.
References
- Babor, T. F., de la Fuente, J. R., Saunders, J., & Grant, M. (1989). AUDIT—The Alcohol Use Disorders Indentification Test: Guidelines for use in primary health care. Geneva: World Health Organization.
- Blake, D. D., Weathers, F., Nagy, L. M., Kaloupek, D. G., Klauminzer, G., Charney, D. S., & Keane, T. M. (1995). The development of a clinician administered PTSD scale. Journal of Traumatic Stress, 8, 75–90.
- Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy, 34, 669–673.
- Busuttil, W., Turnbull, G. J., Neal, L. A., Rollins, J., West, A. G., Blanch, N., & Herepath, R. (1995). Incorporating psychological debriefing techniques within a brief group psychotherapy programme for the treatment of posttraumatic stress disorder. British Journal of Psychiatry, 167, 495–502.
- Creamer, M., Jackson, A., & Ball, R. (1996). A profile of help-seeking Australian veterans. Journal of Traumatic Stress, 9, 569–575.
- Epstein, N. B., Baldwin, L. M., & Bishop, D. S. (1983). The McMaster Family Assessment Device. Journal of Marital and Family Therapy, 9, 171–180.
- Foa, E. B., & Meadows, E. A. (1997). Psychosocial treatments for posttraumatic stress disorder. A critical review. Annual Review of Psychology, 48, 449–480.
- Foa, E. B., Rothbaum, B. O., Riggs, D. S., & Murdock, T. B. (1991). Treatment of posttraumatic stress disorder in rape victims: A comparison between cognitive-behavioral procedures and counseling. Journal of Consulting and Clinical Psychology, 59, 715–723.
- Fontana, A., & Rosenheck, R. (1997). Effectiveness and cost of the inpatient treatment of PTSD: Comparison of three models of treatment. American Journal of Psychiatry, 154, 758–765.
- Fontana, A., Rosenheck, R., & Spencer, H. (1991). The long journey home II: The second progress report on the PTSD Clinical Teams program. West Haven, CT: Department of Veterans Affairs Medical Center.
- Goldberg, D. P. (1972). The detection of psychiatric illness by questionnaire. London: Oxford University Press.
- Hammarberg, M., & Silver, S. M. (1994). Outcome of treatment for posttraumatic stress disorder in a primary care unit serving Vietnam veterans. Journal of Traumatic Stress, 7, 195–216.
- Hedeker, D. (1993). MIXREG: A FORTRAN program for mixed-effects linear regression with auto-correlated errors. Chicago: Prevention Research Center, University of Illinois.
- Jacobson, N. S., & Traux, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.
- Johnson, D. R., Rosenheck, R., Fontana, A., Lubin, H., Charney, D., & Southwick, S. (1996). Outcome of intensive inpatient treatment for combat-related posttraumatic stress disorder. American Journal of Psychiatry, 153, 771–777.
-
Keane, T. M.,
Fairbank, J. A.,
Caddell, J. M.,
Zimering, R. T.,
Taylor, K. L., &
Mora, C. A.
(1989).
Clinical evaluation of a measure to assess combat exposure.
Psychological Assessment,
1,
53–55.
10.1037/1040-3590.1.1.53 Google Scholar
- Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048–1060.
- Kulka, R. A., Schlenger, W. E., Fairbank, J. A., Hough, R. L., Jordan, B. K., Marmar, C. R., & Weiss, D. S. (1990). Trauma and the Vietnam generation: Report of findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel.
- O'Toole, B. I., Marshall, R. P., Grayson, D. A., Schureck, R. J., Dobson, M., Ffrench, M., Pulvertaft, B., Meldrum, L., Bolton, J., & Vennard, J. (1996). The Australian Vietnam veterans health study: III. Psychological health of Australian Vietnam veterans and its relationship to combat. International Journal of Epidemiology, 25, 331–339.
-
Perconte, S. T.
(1989).
Stability of positive treatment outcome and symptom relapse in posttraumatic stress disorder.
Journal of Traumatic Stress,
2,
127–135.
10.1002/jts.2490020202 Google Scholar
- Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption—II. Addiction, 88, 791–804.
-
Scurfield, R. M.,
Kenderdine, S. K., &
Pollard, R. J.
(1990).
Impatient treatment for war-related posttraumatic stress disorder: Initial findings on a longer-term outcome study.
Journal of Traumatic Stress,
3,
185–201.
10.1002/jts.2490030203 Google Scholar
- Shalev, A. Y. (1997). Discussion: Treatment of prolonged posttraumatic stress disorder—learning from experience. Journal of Traumatic Stress, 10, 415–422.
- Solomon, Z., Bleich, A., Shoham, S., Nardi, C., & Kotler, M. (1992). The “Koach” project for treatment of combat-related PTSD: Rationale, aims, and methodology. Journal of Traumatic Stress, 5, 175–193.
- Solomon, Z., Shalev, A., Spiro, S. E., Dolev, A., Bleich, A., Waysman, M., & Cooper, S. (1992). Negative psychometric outcomes: Self-report measures and a follow-up telephone survey. Journal of Traumatic Stress, 5, 225–246.
- Ware, J. E., Kosinski, M., & Keller, S. D. (1995). SF-12: How to score the SF-12 physical and mental health summary scales. Boston, MA: New England Medical Centre, The Health Institute.
- Ware, J. E., Snow, K. K., Kosinski, M., & Gandek, B. (1993). SF-36 Health Survey manual and interpretation guide. Boston: New England Medical Center.
- Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at 9th Annual Conference of the International Society for Traumatic Stress Studies, San Antonio, TX.
- Zigmond, A., & Snaith, R. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavia, 67, 361–370.
