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PCN reports : psychiatry and clinical neurosciences
By Hori A, Ando E, Ito N and 2 others.
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Trauma-focused psychotherapies are recommended as first-line treatments for post-traumatic stress disorder (PTSD); however, treatment discontinuation remains a major challenge in routine clinical practice. This study examined treatment discontinuation and structured psychotherapy implementation among patients with PTSD and complex PTSD (CPTSD) in a post-disaster outpatient setting.
This retrospective cohort study analyzed anonymized clinical records from April 2016 to March 2021 at a psychiatric outpatient clinic in Minamisoma City, Fukushima, Japan. Patients with ICD-11 PTSD or CPTSD as a primary or secondary diagnosis were included (n = 170), with an analytic cohort (n = 144, excluding transfers, deaths, and undetermined outcomes) for structured psychotherapy analyses. To address immortal time bias arising from delayed trauma-focused psychotherapy initiation (median 327 days from initial visit), structured psychotherapy was modeled as a time-varying covariate in Cox regression.
Treatment discontinuation occurred in 33.5% (57/170) of patients within 1 year, with 64.9% of events occurring within the first 90 days. Structured psychotherapy was delivered to 17.6% (30/170) of patients. Although crude discontinuation rates differed markedly by trauma-focused psychotherapy receipt (7.1% vs. 47.4%), the association was substantially attenuated and non-significant in the time-varying analysis (hazard ratio = 0.482, 95% CI 0.113-2.050), indicating that the crude association largely reflected immortal time bias.
In this post-disaster outpatient setting, discontinuation was concentrated in the early phase of care that precedes structured psychotherapy, and most patients never reached trauma-focused treatment. Early treatment engagement, rather than structured psychotherapy delivery alone, may represent the critical bottleneck in real-world PTSD care.
Published in PCN reports : psychiatry and clinical neurosciences. The abstract is shown as published and remains the work of its authors; read the full article at the source.
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