J. Med. Internet Res. - Internet-based early intervention to prevent posttraumatic stress disorder in injury patients: randomized controlled trial.


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CKGROUND: Posttraumatic stress disorder (PTSD) develops in 10-20% of injury patients. We developed a novel, self-guided Internet-based intervention (called Trauma TIPS) based on techniques from cognitive behavioral therapy (CBT) to prevent the onset of PTSD symptoms.OBJECTIVE: To determine whether Trauma TIPS is effective in preventing the onset of PTSD symptoms in injury patients.METHODS: Adult, level 1 trauma center patients were randomly assigned to receive the fully automated Trauma TIPS Internet intervention (n=151) or to receive no early intervention (n=149). Trauma TIPS consisted of psychoeducation, in vivo exposure, and stress management techniques. Both groups were free to use care as usual (nonprotocolized talks with hospital staff). PTSD symptom severity was assessed at 1, 3, 6, and 12 months post injury with a clinical interview (Clinician-Administered PTSD Scale) by blinded trained interviewers and self-report instrument (Impact of Event Scale-Revised). Secondary outcomes were acute anxiety and arousal (assessed online), self-reported depressive and anxiety symptoms (Hospital Anxiety and Depression Scale), and mental health care utilization. Intervention usage was documented.RESULTS: The mean number of intervention logins was 1.7, SD 2.5, median 1, interquartile range (IQR) 1-2. Thirty-four patients in the intervention group did not log in (22.5%), 63 (41.7%) logged in once, and 54 (35.8%) logged in multiple times (mean 3.6, SD 3.5, median 3, IQR 2-4). On clinician-assessed and self-reported PTSD symptoms, both the intervention and control group showed a significant decrease over time (P<.001) without significant differences in trend. PTSD at 12 months was diagnosed in 4.7% of controls and 4.4% of intervention group patients. There were no group differences on anxiety or depressive symptoms over time. Post hoc analyses using latent growth mixture modeling showed a significant decrease in PTSD symptoms in a subgroup of patients with severe initial symptoms (n=20) (P<.001).CONCLUSIONS: Our results do not support the efficacy of the Trauma TIPS Internet-based early intervention in the prevention of PTSD symptoms for an unselected population of injury patients. Moreover, uptake was relatively low since one-fifth of individuals did not log in to the intervention. Future research should therefore focus on innovative strategies to increase intervention usage, for example, adding gameplay, embedding it in a blended care context, and targeting high-risk individuals who are more likely to benefit from the intervention.TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 57754429; http://www.controlled-trials.com/ISRCTN57754429 (Archived by WebCite at http://webcitation.org/6FeJtJJyD).

Resumo Limpo

ckground posttraumat stress disord ptsd develop injuri patient develop novel selfguid internetbas intervent call trauma tip base techniqu cognit behavior therapi cbt prevent onset ptsd symptomsobject determin whether trauma tip effect prevent onset ptsd symptom injuri patientsmethod adult level trauma center patient random assign receiv fulli autom trauma tip internet intervent n receiv earli intervent n trauma tip consist psychoeduc vivo exposur stress manag techniqu group free use care usual nonprotocol talk hospit staff ptsd symptom sever assess month post injuri clinic interview clinicianadminist ptsd scale blind train interview selfreport instrument impact event scalerevis secondari outcom acut anxieti arous assess onlin selfreport depress anxieti symptom hospit anxieti depress scale mental health care util intervent usag documentedresult mean number intervent login sd median interquartil rang iqr thirtyfour patient intervent group log log log multipl time mean sd median iqr clinicianassess selfreport ptsd symptom intervent control group show signific decreas time p without signific differ trend ptsd month diagnos control intervent group patient group differ anxieti depress symptom time post hoc analys use latent growth mixtur model show signific decreas ptsd symptom subgroup patient sever initi symptom n pconclus result support efficaci trauma tip internetbas earli intervent prevent ptsd symptom unselect popul injuri patient moreov uptak relat low sinc onefifth individu log intervent futur research therefor focus innov strategi increas intervent usag exampl ad gameplay embed blend care context target highrisk individu like benefit interventiontri registr intern standard random control trial number isrctn httpwwwcontrolledtrialscomisrctn archiv webcit httpwebcitationorgfejtjjyd

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