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Interventions to PTSD: Additional Commentary

April 2, 2013
Gap in a bridge

Photo courtesy of Ewen and Donabel

Our systematic review and meta-analysis’s most resonant finding is the glaring gap in reliable evidence to inform what we know about most interventions considered for preventing post-traumatic stress disorder. This is in part due to the relative youth of the formal PTSD diagnosis, compared to other prevalent psychiatric disorders such as major depressive disorder. In other words, the clinical community has not had the same amount of experience exploring the etiology of PTSD or approaches to intervene before the condition can be diagnosed as a clinically significant problem for the traumatized patient. However, the most fundamental reason for the literature dearth problem might be the sheer difficulty in delivering clinical interventions to recently traumatized populations, who can develop chronic PTSD as soon as 3 months after the traumatic event(s).

Let us surmise that most people experiencing early symptoms of PTSD seek help first from their primary care providers, who can screen their patients to evaluate symptom severity and make referrals linking the most at risk to specialty mental health providers. How do our findings guide the mental health specialist in providing care during this crucial window of time? We can say with a fair degree of confidence that psychological debriefing lacks support for its use. Our review may also provide potentially usable information for providers treating patients with acute stress disorder, but how this diagnosis will change in the upcoming fifth revision to the DSM scheduled for release in May 2013 is unclear. Perhaps even more applicable is our finding that collaborative care involving different treatment modalities as needed could best serve patients with severe PTSD symptoms before they are diagnosed. We should emphasize, though, that the single study of collaborative care that we found was based in a Level 1 trauma center equipped and prepared to offer a blend of medical care, specialty mental health services, and care management that was tailored to each patient’s needs.

— Manny Coker-Schwimmer, MPH

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