Effects of treatment, choice, and preference on health-related quality-of-life outcomes in patients with posttraumatic stress disorder (PTSD)
Health outcomes may depend on which treatment is received, whether choice of treatment is given, and whether a received treatment is the preferred therapy. We examined the effects of these key factors on the EuroQol-5D (EQ-5D-3L) in patients with PTSD.
Two hundred patients aged 18–65 years with PTSD diagnosis enrolled in a doubly randomized preference trial (DRPT) examining treatment, choice of treatment, and treatment-preference effects of prolonged exposure therapy (PE) and pharmacotherapy with sertraline (SER) (clinicaltrials.gov Identifier: NCT00127673). We performed difference-in-difference analysis to estimate the treatment effects of prolonged exposure therapy (PE) as compared to pharmacotherapy with sertraline (SER), receipt of choice versus no-choice of treatment, and receipt of preferred versus non-preferred treatment on health-related quality-of-life (HRQOL) outcome using the EQ-5D-3L completed at baseline and 10-week post-treatment.
The treatment effects of PE on the EQ-5D scores in overall patients and subgroup of patients who preferred PE were 0.150 (p = 0.025) and 0.223 (p < 0.001), respectively. The effects of treatment choice were 0.088 (p = 0.050) and 0.156 (p = 0.043) in overall patients and subgroup of patients received SER, respectively. The effects of treatment preference were 0.101 (p = 0.038) and 0.249 (p = 0.004) in overall patients and subgroup of patients SER, respectively.
Overall, PE is associated with better improved HRQOL, especially in patients who prefer it. Independently, allowing patients to choose their preferred treatment resulted in better HRQOL than either assigning them a treatment or giving them a treatment that is not preferred.
KeywordsTreatment preference Treatment choice Prolonged exposure therapy Sertraline Posttraumatic stress disorder EQ-5D-3L
This research was supported by Grants R01MH066347 and R01MH066348 from the National Institute of Mental Health (“Effectiveness of PTSD Treatment: Prolonged Exposure Therapy vs. Zoloft”).
Compliance with ethical standards
Conflict of interest
The authors declare that they do not have conflicts of interest.
The study was approved by the Institutional Review Boards (IRB) of the Case Western Reserve University/University Hospital of Cleveland and University of Washington. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 2.Eibner, C., Ringel, J. S., Kilmer, B., Pacula, R. L., & Diaz, C. (2008). The cost of post-deployment mental health and cognitive conditions. In T. Tanielian & L. H. Jaycox (Eds.), Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica: RAND.Google Scholar
- 4.Resick, P. A., Nishith, P., Weaver, T. L., Astin, M. C., & Feuer, C. A. (2002). A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Consulting and Clinical Psychology, 70(4), 867–879.CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Mitchell-Jones, N., Farren, J. A., Tobias, A., Bourne, T., & Bottomley, C. (2017). Ambulatory versus inpatient management of severe nausea and vomiting of pregnancy: A randomised control trial with patient preference arm. British Medical Journal Open, 7(12), e017566.Google Scholar
- 13.Hubacher, D., Spector, H., Monteith, C., Chen, P. L., & Hart, C. (2017). Long-acting reversible contraceptive acceptability and unintended pregnancy among women presenting for short-acting methods: A randomized patient preference trial. American Journal of Obstetrics and Gynecology, 216(2), 101–109.CrossRefPubMedGoogle Scholar
- 14.Elmagied, A. M., Vaughan, L. E., Weaver, A. L., et al. (2016). Fibroid interventions: Reducing symptoms today and tomorrow: Extending generalizability by using a comprehensive cohort design with a randomized controlled trial. American Journal of Obstetrics and Gynecology, 215, 338.e1–338.e18.CrossRefGoogle Scholar
- 18.Yancy, W. S. Jr., Mayer, S. B., Coffman, C. J., Smith, V. A., Kolotkin, R. L., Geiselman, P. J., McVay, M. A., Oddone, E. Z., & Voils, C. I. (2015). Effect of allowing choice of diet on weight loss: A randomized trial. Annals of Internal Medicine, 162(12), 805–814.CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Feeny, N. C., & Zoellner, L. A. Talk presented at: 2010 American Psychiatric Association Annual Meeting (Symposium 12: Anxiety Treatment—New Research Findings for the Clinician); May 22, 2010; New Orleans, LA.Google Scholar
- 27.Youngstrom, E. A., Feeny, N. C., Zoellner, L. A., Mavissakalian, M., & Roy-Byrne, P. Doubly Randomized Preference Trial in PTSD—Prolonged Exposure versus Sertraline (Symposium 5032). Talk presented at: American Psychological Association Annual Convention; August 3, 2013; Honolulu, HI.Google Scholar
- 28.Le, Q. A., Doctor, J. N., Zoellner, L. A., & Feeny, N. C. (2014). Cost-effectiveness of prolonged exposure therapy versus pharmacotherapy and treatment choice in posttraumatic stress disorder (the Optimizing PTSD Treatment Trial): A doubly randomized preference trial. The Journal of Clinical Psychiatry, 75(3), 222–230.CrossRefPubMedGoogle Scholar
- 33.Stoll, C., Schelling, G., Goetz, A. E., Kilger, E., Bayer, A., et al. (2000). Health-related quality of life and post-traumatic stress disorder in patients after cardiac surgery and intensive care treatment. The Journal of Thoracic and Cardiovascular Surgery, 120(3), 505–512.CrossRefPubMedGoogle Scholar
- 34.Schnurr, P. P., Hayes, A. F., Lunney, C. A., McFall, M., & Uddo, M. (2006). Longitudinal analysis of the relationship between symptoms and quality of life in veterans treated for posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 74(4), 707–713.CrossRefPubMedGoogle Scholar
- 40.Johansen, V. A., Wahl, A. K., Eilertsen, D. E., Weisaeth, L., & Hanestad, B. R. (2007). The predictive value of post-traumatic stress disorder symptoms for quality of life: A longitudinal study of physically injured victims of non-domestic violence. Health Qual Life Outcomes, 5, 26.CrossRefPubMedPubMedCentralGoogle Scholar
- 41.Le, Q. A., Doctor, J. N., Zoellner, L. A., & Feeny, N. C. (2013). Minimal clinically important differences for the EQ-5D and QWB-SA in post-traumatic stress disorder (PTSD): Results from a Doubly Randomized Preference Trial (DRPT). Health Qual Life Outcomes, 11, 59.CrossRefPubMedPubMedCentralGoogle Scholar
- 43.Williams, M., Cahill, S., & Foa, E. Psychotherapy for post-traumatic stress disorder. D. Stein & E. Hollander, B. Rothbaum (Eds.), Textbook of anxiety disorders (2nd edn.) Washington:American Psychiatric Publishing, 2010.Google Scholar