Stepped care is more effective than usual care in reducing the prevalence of posttraumatic stress disorder (PTSD) in the aftermath of hurricanes, according to a new study led by a Boston University School of Public Health (BUSPH).
The study, published in JAMA Psychiatry, suggests that the stepped care (SC) approach would have a greater population impact than previously applied interventions for early treatment of individuals with PTSD. The findings are also consistent with previous studies examining stepped care approaches to treating other mental health disorders.
The researchers used an agent-based model to simulate the stepped care approach for 2,642,713 agents using the sociodemographic characteristics derived from the American Community Survey estimates for New York City. They then simulated treatment scenarios starting four weeks following the landfall of Hurricane Sandy and ending two years later. Under the stepped care approach, individuals identified as PTSD cases were referred to cognitive behavioral therapists and non-cases were referred to SRP, while those receiving usual care were all referred to SRP.
The study found that three to six months after the hurricane, stepped care delivered greater reach, treatment effectiveness, and cost-effectiveness than usual care when it came to hurricane-related PTSD. The authors cautioned that the SC model would still require substantial resources for deployment: $50.94 million to $101.87 million in the simulated scenario after Hurricane Sandy.
In the absence of randomized trials, the authors wrote, the simulation results present the best evidence for establishing stepped care in the treatment of PTSD following large-scale disasters.
“These results provide further proof of concept for the SC approach to treating PTSD after a disaster, and they warrant further study and application in real-world settings,” the authors wrote.