title: Long-term outcome of early interventions to prevent posttraumatic stress disorder.
abstract: BACKGROUND
  Failing to prevent posttraumatic stress disorder (PTSD) has major clinical and public health consequences. This work evaluates the 3-year outcome of offering early interventions to survivors with acute PTSD.
  
  
  METHODS
  Adults admitted consecutively to the hospital with acute DSM-IV PTSD were randomized, between June 2003 and October 2007, to 12 weeks of prolonged exposure (n = 63) or cognitive therapy (n = 40) or concealed SSRI (escitalopram; n = 23) versus placebo (n = 23). Eighty-two participants who declined treatment were followed as well. Treatment started 1 month after the traumatic event, and participants were reassessed 5 and 36 months later. Assessors were blinded to treatment allocation and acceptance. The Clinician-Administered PTSD Scale (CAPS) evaluated PTSD and PTSD symptoms. Self-reported symptoms, general functioning, and employment status were secondary outcomes. Participants lost to follow-up were missing completely at random.
  
  
  RESULTS
  Prolonged exposure and cognitive therapy significantly reduced PTSD and PTSD symptoms between 1 and 5 months (mean CAPS total scores [95% CI] at 1 month: prolonged exposure = 73.59 [68.21-78.96] and cognitive therapy = 71.78 [66.92-78.93]; mean CAPS total scores [95% CI] at 5 months: prolonged exposure = 28.59 [21.89-35.29] and cognitive therapy = 29.48 [21.32-37.95], P < .001), and their results remained stable. At 3 years, however, the study groups had similar levels of PTSD symptoms (mean CAPS total scores [95% CI]: prolonged exposure = 31.51 [20.25-42.78]; cognitive therapy = 32.08 [20.74-43.42]; SSRI = 34.31 [16.54-52.07]; placebo = 32.13 [20.15-44.12]; and no intervention = 30.59 [19.40-41.78]), similar prevalence of PTSD (28.6%-46.2%), and similar secondary outcomes.
  
  
  CONCLUSIONS
  Early prolonged exposure and cognitive therapy accelerated the recovery from acute PTSD. Their effect remained stable, however, without reducing the 3-year prevalence of the disorder. The lingering prevalence of PTSD, despite efficient interventions, illustrates a nonremitting, treatment-refractory subset of survivors and outlines a major clinical and public health challenge.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT00146900.
authors.affiliation: Department of Psychiatry, NYU Langone Medical Center, One Park Ave, 8-221, New York, NY 10016 Arieh.shalev@nyumc.org.
authors.forename: Arieh Y
authors.initials: AY
authors.lastname: Shalev
authors.forename: Yael
authors.initials: Y
authors.lastname: Ankri
authors.forename: Moran
authors.initials: M
authors.lastname: Gilad
authors.forename: Yossi
authors.initials: Y
authors.lastname: Israeli-Shalev
authors.forename: Rhonda
authors.initials: R
authors.lastname: Adessky
authors.forename: Meng
authors.initials: M
authors.lastname: Qian
authors.forename: Sara
authors.initials: S
authors.lastname: Freedman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015283:Citalopram / Q000009:adverse effects / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003430:Cross-Sectional Studies; D004311:Double-Blind Method; D061345:Early Medical Intervention; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007171:Implosive Therapy; D007557:Israel; D008016:Life Change Events; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D016037:Single-Blind Method; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D055815:Young Adult
chemical_list: D015283:Citalopram