Although posttraumatic stress disorder (PTSD) and alcohol abuse frequently
occur among acutely injured trauma survivors, few real-world interventions
have targeted these disorders.
We tested the effectiveness of a multifaceted collaborative care (CC)
intervention for PTSD and alcohol abuse.
Randomized effectiveness trial.
We recruited a population-based sample of 120 male and female injured
surgical inpatients 18 or older at a level I trauma center.
Patients were randomly assigned to the CC intervention (n = 59) or the
usual care (UC) control condition (n = 61). The CC patients received stepped
care that consisted of (1) continuous postinjury case management, (2) motivational
interviews targeting alcohol abuse/dependence, and (3) evidence-based pharmacotherapy
and/or cognitive behavioral therapy for patients with persistent PTSD at 3
months after injury.
Main Outcome Measures
We used the PTSD symptomatic criteria (PTSD Checklist) at baseline and
1, 3, 6, and 12 months after injury, and alcohol abuse/dependence (Composite
International Diagnostic Interview) at baseline and 6 and 12 months after
Random-coefficient regression analyses demonstrated that over time,
CC patients were significantly less symptomatic compared with UC patients
with regard to PTSD (P = .01) and alcohol abuse/dependence
(P = .048). The CC group demonstrated no difference
(−0.07%; 95% confidence interval [CI], −4.2% to 4.3%) in the adjusted
rates of change in PTSD from baseline to 12 months, whereas the UC group had
a 6% increase (95% CI, 3.1%-9.3%) during the year. The CC group showed on
average a decrease in the rate of alcohol abuse/dependence of −24.2%
(95% CI, −19.9% to −28.6%), whereas the UC group had on average
a 12.9% increase (95% CI, 8.2%-17.7%) during the year.
Early mental health care interventions can be feasibly and effectively
delivered from trauma centers. Future investigations that refine routine acute
care treatment procedures may improve the quality of mental health care for
Americans injured in the wake of individual and mass trauma.