Person:

Bui, Eric

Objective: Posttraumatic stress disorder and Prolonged Grief Disorder (PGD) arise following major life stressors, and may share some overlapping symptomatology. This study aimed to examine the presence and response to treatment of post-traumatic stress symptoms (PTSS) in bereaved adults with a primary diagnosis of PGD. Methods: A randomized controlled trial of 395 adults with PGD (defined as >30 on the Inventory of Complicated Grief plus confirmation on structured clinical interview) randomized participants to complicated grief treatment (CGT) with citalopram, CGT plus placebo, citalopram, or placebo between March 2010 and September 2014. We examined the presence of PTSS (Davidson Trauma Scale) at baseline and change in PTSS with treatment using longitudinal mixed effects regression, and examined the role of violent compared to non-violent deaths (loss type). Results: High levels of PTSS were present at baseline, regardless of loss type, and were associated with increased functional impairment (p<0.01). CGT with placebo demonstrated efficacy for PTSS compared to placebo in both threshold (OR=2.71, 95%CI [1.13-2.17], p=0.026) and continuous (p<0.001; effect size d=0.47) analyses, and analyses were suggestive of a greater effect for CGT plus citalopram compared to citalopram alone (threshold analysis OR=2.84, 95%CI [1.20-6.70], p=0.017; continuous p=0.053; d=0.25). In contrast, citalopram did not differ from placebo and CGT plus citalopram did not differ from CGT plus placebo. Conclusion: Bereavement-related PTSS are common in bereaved adults with PGD in the context of both violent and non-violent death, and are associated with poorer functioning. CGT shows efficacy for PTSS, while the antidepressant citalopram does not.

Objective: The current study is an analysis of predictors of PTSD treatment response in a clinical trial comparing: 1) prolonged exposure plus placebo (PE + PLB); 2) PE + sertraline (PE + SERT); and 3) SERT + enhanced medication management (SERT + EMM) with predictors including time since trauma (TST), self-report of pain, alcohol use, baseline symptoms, and demographics. Methods: Participants (N = 196) were veterans with combat-related PTSD of at least three months duration recruited between 2011 and 2016 from 4 sites in the 24-week PROlonGed ExpoSure and Sertraline (PROGrESS) clinical trial [assessments at weeks 0 (intake), 6, 12, 24, 36, and 52] Results: Across treatment conditions – (i) Longer TST was predictive of greater week 24 PTSD symptom improvement after adjusting for baseline; (ii) Higher baseline pain severity was predictive of smaller symptom improvement and; (iii) Hispanics showed greater improvement than non-Hispanics. No other baseline characteristics, including alcohol consumption, were significantly predictive of week 24 improvement. Comparison of TST by treatment condition revealed a significant relationship only in those randomized to PE+SERT condition. Longitudinal analyses showed similar results. Conclusions: The finding that longer TST shows larger symptom reductions is promising for PTSD patients who might not seek help for years following trauma. Higher baseline pain severity robustly predicted attenuated and slower response to all treatment conditions suggesting a common neuropathological substrate. Finally, in the current study alcohol use did not impede the effectiveness pharmacotherapy for PTSD. Trial Registration: ClinicalTrials.gov: NCT01524133