Comparison of Psychological Treatments for PTSD After Natural Disasters
Introduction to PTSD and Natural Disasters
A recent study published in JAMA Psychiatry examines two psychological treatment methods for post-traumatic stress disorder (PTSD) following natural disasters. Survivors of such events often face a heightened risk of mental health issues due to disruptions in daily life that can hinder recovery and normalization. Limited access to healthcare services further complicates mental health outcomes, contributing to the persistence of conditions like PTSD.
Treatment Options for Survivors
Currently, two prevalent treatment methods for disaster survivors are Skills for Psychological Recovery (SPR) and Psychological First Aid (PFA). SPR focuses on skill-building to reduce stress and enhance coping mechanisms, while PFA serves as a universal intervention aimed at providing immediate support.
The Stepped Care Model
Stepped care (SC) models propose that the most efficient method for treating PTSD after a natural disaster involves screening and directing individuals to the appropriate level of care, followed by systematic reevaluation. In this model, individuals identified as cases are referred to cognitive behavioral therapy (CBT), an evidence-based approach that addresses symptoms by altering thoughts and behaviors. Conversely, non-cases receive SPR, while those under usual care (UC) are exclusively referred to SPR.
Study Overview and Methods
The JAMA Psychiatry study aimed to assess the effectiveness and cost-effectiveness of a stepped care case-finding intervention compared to a moderate-strength single-level intervention (UC) two years post-natural disaster. The researchers simulated treatment scenarios beginning four weeks after Hurricane Sandy’s landfall on October 29, 2012, and continuing for two years. They modeled 2,642,713 simulated agents residing in various affected areas of New York City, measuring the reach of SC versus UC, the prevalence reduction of PTSD, and the cost-effectiveness over a ten-year period.
Findings on Treatment Effectiveness
The results indicated that the stepped care approach had a wider reach and demonstrated superior treatment effectiveness, along with a favorable cost-effectiveness profile in the impacted areas of New York City compared to usual care. Notably, the absolute benefits became evident at six months and continued to improve beyond one year. Relative benefits of the SC approach were also significant at six months, with sustained gains through 1.75 years.
Cost-Effectiveness of Stepped Care
Despite the stepped care model being more expensive than usual care, the cost per disability-adjusted life year (DALY) saved was significantly lower than conventional benefit thresholds, and the cost per PTSD-free day was well within acceptable limits.
Conclusion and Implications
This study highlights that the stepped care model for the early treatment of PTSD following natural disasters is associated with improved reach, treatment effectiveness, and cost-effectiveness compared to more universally applied interventions. The findings provide a proof of concept for the stepped care approach in addressing PTSD in disaster contexts, warranting further research and real-world application.
Reference
Cohen, G. H., Tamrakar, S., Lowe, S., Sampson, L., Ettman, C., Linas, B., Ruggiero, K., & Galea, S. (2017). Comparison of simulated treatment and cost-effectiveness of a stepped care case-finding intervention vs usual care for posttraumatic stress disorder after a natural disaster. JAMA Psychiatry, 74(12), 1251 – 1258.