Delivery of self training and education for stressful situations (DESTRESS-PC): a randomized trial of nurse assisted online self-management for PTSD in primary care.
OBJECTIVE
This randomized controlled trial examined the effectiveness of a nurse assisted online cognitive-behavioral self-management intervention for war-related posttraumatic stress disorder (PTSD), compared to optimized usual primary care PTSD Treatment (OUC) to reduce PTSD symptoms.


METHODS
Participants were 80 veterans of recent military conflicts with PTSD as assessed by the PTSD Checklist (PCL) seeking primary care treatment at one of three Veterans Affairs (VA) and four Army clinics. DESTRESS-PC consisted of logins to a secure website three times per week for 6 weeks with monitoring by a study nurse. All participants received nurse care management in the form of phone check-ins every two weeks and feedback to their primary care providers. Blinded raters assessed outcomes 6, 12, and 18 weeks post-randomization.


RESULTS
DESTRESS-PC was associated with a significantly greater decrease in PTSD symptoms compared to OUC (F(3, 186)=3.72, p=.012). The effect was largest at the 12-week assessment (∆PCL=12.6±16.6 versus 5.7±12.5, p<0.05) with the treatment effect disappearing by the 18-week follow-up. Notably, there was a dose effect; number of logins correlated significantly with PTSD outcomes, with more logins associated with greater PTSD symptom improvement. None of the secondary outcomes (depression, anxiety, somatic symptoms, and functional status) showed statistically significant improvement; however, the treatment effect on depression approached significance (F(3, 186)=2.17, p=.093).


CONCLUSIONS
DESTRESS-PC shows promise as a means of delivering effective, early PTSD treatment in primary care. Larger trials are needed.
Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, USA. Electronic address: cengel@rand.org.
Charles C
CC
Engel
Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, 150 S. Huntington Ave, Jamaica Plain, MA, USA; Department of Psychiatry, Boston University, 715 Albany St., M-8th Floor, Boston, MA, USA.
Brett
B
Litz
Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC, USA; Department of Psychiatry, Medical University of South Carolina, 67 President Street, Charleston, SC, USA.
Kathryn M
KM
Magruder
Deployment Health Clinical Center, Walter Reed National Military Medical Center, Building 8, 2nd Floor, Room 2220, 8901 Wisconsin Avenue, Bethesda, MD, USA.
Elizabeth
E
Harper
Deployment Health Clinical Center, Walter Reed National Military Medical Center, Building 8, 2nd Floor, Room 2220, 8901 Wisconsin Avenue, Bethesda, MD, USA.
Kristie
K
Gore
Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, 150 S. Huntington Ave, Jamaica Plain, MA, USA; Department of Psychiatry, Boston University, 715 Albany St., M-8th Floor, Boston, MA, USA.
Nathan
N
Stein
Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC, USA; Department of Psychiatry, Medical University of South Carolina, 67 President Street, Charleston, SC, USA.
Derik
D
Yeager
Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, USA; Deployment Health Clinical Center, Walter Reed National Military Medical Center, Building 8, 2nd Floor, Room 2220, 8901 Wisconsin Avenue, Bethesda, MD, USA; Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Department of Psychiatry, 4301 Jones Bridge Road, Bethesda, MD, USA.
Xian
X
Liu
Womack Army Medical Center, 2817 Reilly Rd, Fort Bragg, NC, USA.
T Ray
TR
Coe
D000328:Adult; D001007:Anxiety / Q000523:psychology / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D057184:Practice Patterns, Nurses'; D011320:Primary Health Care; D012648:Self Care / Q000379:methods*; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy*; D014728:Veterans / Q000523:psychology*
Depression; Military mental health; Posttraumatic Stress Disorder; Primary care; Telehealth