Active-duty military personnel face deterrents to seeking outpatient mental health treatment despite the high prevalence of posttraumatic stress disorder (PTSD) in this population. The Behavioral Health Consultation (BHC) model moo, be the answer for those presenting subthreshold PTSD symptoms, at high risk for PTSD due to their occupation, not interested in outpatient mental health treatment, or unable to seek such treatment due to occupational limitations. Three empirically based interventions that have been effective in managing symptoms of PTSD are summarized and then integrated into the established BHC model as suggested treatments for managing PTSD symptoms in an integrated primary care setting. Pilot data and recommendations for future research and practice are provided.
WHY PRIMARY CARE SETTINGS?
Symptoms of posttraumatic stress disorder (PTSD) among U.S. military veterans deployed during Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) have been detected at rates as high as 17%. PTSD prevalence rates were determined to be as high as 52% in veterans who were seen in primary care and diagnosed with at least one mental health disorder (Seal, Bertenthal, Miner, Sen, & Marmar, 2007). Unfortunately, only 10% of male and 26% of female active-duty personnel reporting mental health symptoms will pursue treatment (Visco, 2008). The wide-ranging reasons for their low help-seeking behaviors include such factors as avoidant coping strategies associated with PTSD, frequent redeployments that destabilize living arrangements, and fears that seeking treatment will negatively impact their careers (e.g., security clearance, weapons-bearing status, time away from the duty section when staffing is scarce). Clearly, these obstacles decrease the likelihood that active-duty members will seek treatment for mental health symptoms like those of PTSD.
Assuming that the obstacles can be surmounted, effective treatment protocols are rigorous and time-consuming--as much as 12 weeks of weekly 60-90 minute sessions (Foa et al., 1999; Foa et al., 2005; Foa, Rothbaum, Riggs, & Murdock, 1991; Resick, Nishith, Weaver, Astin, & Feurer, 2002; Rothbaum, Astin, Millie, & Marsteller, 2005; Rothbaum et al., 2006; Schnurr et al., 2007). It is vital to better manage disorders like PTSD and to formulate innovative approaches to manage them and subthreshold levels of PTSD (presenting symptoms that do not meet full diagnostic criteria).
The primary care setting is where military members' PTSD symptoms are most likely to be identified, due to the population-based approach the military uses to detect health problems resulting from deployments. Like civilians, those in the military have more frequent and feasible contact with medical providers in primary care clinics than in mental health clinics, so it makes sense to address PTSD symptoms in primary care. To do so, assessment and intervention must be tailored to meet that delivery model.
Randomized clinical trials (RCTs) have previously targeted PTSD in civilians or in discharged military veterans treated long after their combat exposure. It appears that a large proportion of patients with non-combat-related PTSD can be brought to remission with early cognitive-behavioral interventions (Bryant, Sackville, Dang, Moulds, & Guthrie, 1999; Litz, Gray, Bryant, & Adler, 2002).
A few studies have evaluated the efficacy of PTSD screening and the adaptation of interventions for primary care (Clum, Chrestman, & Resick, 2004; Samson, Bensen, Beck, Price, & Nimmer, 1999; U.S. Dept. of Veteran Affairs/Department of Defense [VA/DOD], 2004). One model for integrating mental health into primary care, Behavioral Health Consultation (BHC), may be an effective way to address PTSD for those who are (1) unable or unwilling to participate in specialized mental health treatment; (2) at chronic risk for PTSD due to frequent deployment; or (3) experiencing subthreshold levels of PTSD. …