title: Prevention of posttraumatic stress disorder by early treatment: results from the Jerusalem Trauma Outreach And Prevention study.
abstract: BACKGROUND
  Preventing posttraumatic stress disorder (PTSD) is a pressing public health need.
  
  
  OBJECTIVE
  To compare early and delayed exposure-based, cognitive, and pharmacological interventions for preventing PTSD.
  
  
  METHODS
  Equipoise-stratified randomized controlled study.
  
  
  METHODS
  Hadassah Hospital unselectively receives trauma survivors from Jerusalem and vicinity.
  
  
  METHODS
  Consecutively admitted survivors of traumatic events were assessed by use of structured telephone interviews a mean (SD) 9.61 (3.91) days after the traumatic event. Survivors with symptoms of acute stress disorder were referred for clinical assessment. Survivors who met PTSD symptom criteria during the clinical assessment were invited to receive treatment.
  
  
  METHODS
  Twelve weekly sessions of prolonged exposure (PE; n = 63), or cognitive therapy (CT; n = 40), or double blind treatment with 2 daily tablets of either escitalopram (10 mg) or placebo (selective serotonin reuptake inhibitor/placebo; n = 46), or 12 weeks in a waiting list group (n = 93). Treatment started a mean (SD) 29.8 (5.7) days after the traumatic event. Waiting list participants with PTSD after 12 weeks received PE a mean (SD) 151.8 (42.4) days after the traumatic event (delayed PE).
  
  
  METHODS
  Proportion of participants with PTSD after treatment, as determined by the use of the Clinician-Administered PTSD Scale (CAPS) 5 and 9 months after the traumatic event. Treatment assignment and attendance were concealed from the clinicians who used the CAPS.
  
  
  RESULTS
  At 5 months, 21.6% of participants who received PE and 57.1% of comparable participants on the waiting list had PTSD (odds ratio [OR], 0.21 [95% CI, 0.09-0.46]). At 5 months, 20.0% of participants who received CT and 58.7% of comparable participants on the waiting list had PTSD (OR, 0.18 [CI, 0.06-0.48]). The PE group did not differ from the CT group with regard to PTSD outcome (OR, 0.87 [95% CI, 0.29-2.62]). The PTSD prevalence rates did not differ between the escitalopram and placebo subgroups (61.9% vs 55.6%; OR, 0.77 [95% CI, 0.21-2.77]). At 9 months, 20.8% of participants who received PE and 21.4% of participants on the waiting list had PTSD (OR, 1.04 [95% CI, 0.40-2.67]). Participants with partial PTSD before treatment onset did similarly well with and without treatment.
  
  
  CONCLUSIONS
  Prolonged exposure, CT, and delayed PE effectively prevent chronic PTSD in recent survivors. The lack of improvement from treatment with escitalopram requires further evaluation. Trauma-focused clinical interventions have no added benefit to survivors with subthreshold PTSD symptoms. Trial Registration clinicaltrials.gov Identifier: NCT00146900.
authors.affiliation: Department of Psychiatry, Hadassah University Hospital, Kiriat Hadassah-Ein Kerem, Jerusalem, Israel. ashalev@cc.huji.ac.il
authors.forename: Arieh Y
authors.initials: AY
authors.lastname: Shalev
authors.forename: Yael
authors.initials: Y
authors.lastname: Ankri
authors.forename: Yossi
authors.initials: Y
authors.lastname: Israeli-Shalev
authors.forename: Tamar
authors.initials: T
authors.lastname: Peleg
authors.forename: Rhonda
authors.initials: R
authors.lastname: Adessky
authors.forename: Sara
authors.initials: S
authors.lastname: Freedman
mesh_terms: D000328:Adult; D015283:Citalopram / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D004311:Double-Blind Method; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007171:Implosive Therapy; D007406:Interview, Psychological; D007557:Israel; D008297:Male; D010349:Patient Compliance; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors