By the end of May 2007, 14 bombing survivors had been referred for treatment by their family doctors to the participating treatment centers using standard referral procedures in place before the Trauma Response Programme, and a further 19 referrals to other nonparticipating centers or private psychologists had been recorded. In the same period, the Trauma Response Programme identified 906 named individuals of whom to date 596 individuals have completed the initial screening with the two-page questionnaire. Of these 596 individuals, 370 were invited for a detailed assessment, of whom 24 (6%) did not attend. Of the 346 receiving detailed assessment, 91 (26%) were judged as requiring monitoring only, whereas 255 (74%) were referred for treatment. Among the 255 referred by the screening team, their primary diagnoses were: 184 (72%) DSM-IV or ICD-10 PTSD (with or without comorbid disorders), 20 (8%) travel phobia, 22 (9%) adjustment disorder, 10 (4%) complicated grief, 7 (3%) generalized anxiety disorder, 5 (2%) major depressive disorder, and 7 (3%) other diagnoses.
Preliminary outcome data are available on 60 individuals with DSM-IV
PTSD and 22 individuals with ICD-10
PTSD who were referred to the specialist trauma centers. There were 28 men and 54 women with an average age of 35.2 years (range 19–57 years). Of this group, six never attended, one was referred on to another service, and 75 started treatment; 72 completed treatment and 3 dropped out after two sessions each. All patients receiving treatment within the program, including two of the dropouts, completed the Posttraumatic Diagnostic Scale (PDS: Foa et al., 1997
) and the Beck Depression Inventory (BDI: Beck, Ward, Mendelson, Mock, & Erbaugh, 1961
) at each session. This was done to ensure completeness of data in case patients did not attend the last treatment sessions. Thus, the outcome data are intent-to-treat.
Because the diagnostic criteria for PTSD in the DSM-IV are more stringent than in ICD-10, the analyses distinguished between people who would meet full DSM-IV criteria and those would meet ICD-10, but not DSM-IV criteria. At the first treatment session, those with DSM-IV PTSD had a mean PDS score of 33.76 (SD = 9.37) and a mean BDI score of 25.16 (SD = 9.30), whereas those with ICD-10 PTSD had a PDS score of 21.62 (SD = 10.01) and a BDI score of 14.09 (SD = 10.59). The modal number of treatment sessions was nine (range = 1–29).
At the final treatment session, those with DSM-IV
PTSD had a mean PDS score of 9.58 (SD
= 9.78) and a mean BDI score of 8.72 (SD
= 8.03), whereas those with ICD-10
PTSD had a PDS score of 6.10 (SD
= 5.57) and a BDI score of 5.00 (SD
= 6.96). A mixed model ANOVA on the PDS scores with group (DSM-IV
as a between-subjects factor and time (first vs. last treatment session) as a within-subjects factor yielded significant effects of group, F
(1, 72) = 18.40, p
< .001, and time, F
(1, 72) = 161.41, p
< .001, and a significant Group x Time interaction, F
(1, 72) = 7.45, p
< .01. The pretreatment and posttreatment effect size d
(calculated as the difference between the pretreatment and posttreatment means divided by their common standard deviation) was 2.53 for DSM-IV
PTSD and 1.99 for ICD-10
PTSD. Following Jacobson and Truax (1991)
, clinically significant change was defined as a posttherapy PDS score closer to the mean of a functional trauma-exposed population than to the mean of a population with PTSD. Mean PDS scores for functional and PTSD populations were taken from Foa et al. (1997)
, yielding a cutoff value of 24. In Foa et al.'s study, the mean PDS score for the PTSD sample was almost identical to our group with DSM-IV
PTSD. Forty-six out of 53 (87%) of our DSM-IV
PTSD cases for whom data were available showed clinically significant change.
A similar mixed model ANOVA on the BDI scores yielded significant effects of Group, F
(1, 72) = 14.78, p
< .001, and Time, F
(1, 72) = 102.39, p
< .001, and a significant Group × Time interaction, F
(1, 72) = 8.12, p
< .01. The pretreatment and post-treatment effect size was 1.90 for DSM-IV
PTSD and 1.04 for ICD-10
PTSD. Mean BDI scores for functional and depressed populations were taken from Seggar, Lambert, and Hansen (2002)
, who suggest that they can be discriminated by a cutoff value of 15. In their study, the mean BDI score for the depressed sample was almost identical to our group with DSM-IV
PTSD. Forty-two out of 53 (79%) of our DSM-IV
PTSD cases for whom data were available showed clinically significant change at posttreatment.