Effect of a Behavioral Intervention on Outcomes for Caregivers of Veterans with PTSD
Abstract: Caregivers of the approximately 9 million individuals in the US with Posttraumatic Stress Disorder (PTSD) face burdens that may seem overwhelming. In 2017, VA implemented the first national clinical program for caregivers of veterans with PTSD. Previous interventions have focused on caregivers more as adjuncts of persons with PTSD or included PTSD caregivers with other types of military/veteran caregivers. The REACH VA behavioral intervention, 4 one-hour sessions during 2 to 3 months, focusing on caregiver coping and managing PTSD-related concerns, was delivered centrally by telephone. In a pre/post intervention design, the 161 caregivers experienced statistically significant improvement in burden, depression, anxiety, frustrations, general stress, time providing care, number of and bother about troubling behaviors, and safety risks. Pre and post intervention improvements in burden and anxiety were also clinically significant. Reducing caregivers’ psychological distress can improve ability to provide care and positively affect health and safety of persons with PTSD. With REACH, VA has made major steps to support caregivers of veterans. The positive results of this implementation may also serve as a model to support PTSD caregivers in the general population.
Abstract: IMPORTANCE: Veterans with occupational performance (e.g., activities of daily living [ADL]) limitations who are receiving inpatient psychiatric care may benefit from outpatient occupational therapy upon discharge, but access disparities have not been investigated. OBJECTIVE: To investigate whether ADL limitations, an indicator of need, are associated with outpatient occupational therapy utilization after inpatient psychiatric hospitalization in the Veterans Health Administration (VHA) and whether this relationship differs by facility characteristics. DESIGN: Secondary analysis of VHA medical record data. Modified Poisson regression was used to model outpatient occupational therapy utilization (yes or no) as a function of ADL limitations, facility characteristics, and sociodemographic and clinical characteristics. Interactions were used to estimate whether the relationship between ADL limitations and outpatient occupational therapy utilization differs across facility characteristics. SETTING: VHA outpatient setting. PARTICIPANTS: Veterans who received VHA inpatient psychiatric care from 2015 to 2020 and lived