PREDICTING CLINICAL OUTCOMES IN OEF/OIF/OND VETERANS WITH THE POLYTRAUMA CLINICAL TRIAD

Abstract

Since 2001, well over 2.1 million U.S. military personnel have served during Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) (Elder, 2015). During the OEF/OIF/OND era, traumatic brain injuries (TBI) have become a hallmark injury of returning veterans in addition to posttraumatic stress disorder (PTSD) and chronic pain (Mott, Mondragon, Hundt, Beason-Smith, Grady, & Teng, 2014). Approximately 20% of OEF/OIF/OND veterans meet the criteria for having polytrauma and estimates of 6-8% have what is known as the polytrauma clinical triad (PCT) which is co-occurring PTSD, TBI, and chronic pain (Cifu, Taylor, Carne, Bidelspach, Sayer, Scholten, & Campbell, 2013). Numerous randomized clinical trials have shown that cognitive processing therapy (CPT) and prolonged exposure (PE), two evidence-based treatments for posttraumatic stress disorder (PTSD), are equally effective at improving PTSD symptoms. The present study aims to shed light on predicting clinical outcomes for OEF/OIF/OND veterans with PCT who have engaged in CPT or PE. Whether or not CPT and PE are effective treatments, for veterans with PCT, at reducing self-reported PTSD, depression, anxiety, alcohol use, and pain symptoms is measured using changes in total scores on the PTSD Checklist Military Version (PCL-M), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Alcohol Use Disorders Identification Test (AUDIT-C), and the Defense and Veterans Pain Rating Scale (DVPRS) scores. This study was completed via retrospective review of approximately 2,100 electronic medical record charts. The final cohort included in this study was comprised of 140 veterans in individual therapy utilizing CPT or PE through the Veterans Health Administration. Two-way RM-ANOVAs and RM-MANOVA were used to analyze the data in SPSS. Consistent with previous findings, this study found that both CPT and PE are effective treatments for PTSD although treatment outcomes varied within and between groups when race/ethnicity were considered. The findings of the current study were consistent with previous literature and provide some initial data for understanding PTSD treatment outcomes with veterans with PCT.