Examining the Impact of Behavioral Health Encounter Dose and Frequency on Posttraumatic Stress Symptoms Among Active Duty Service Members
Objective: Several factors may influence the standardized delivery and frequency of behavioral health encounters for posttraumatic stress disorder (PTSD) in active duty military settings, potentially impacting the effectiveness of care. This retrospective analysis evaluated the course of treatment among 884 active duty Army service members in routine outpatient care. Method: Patients were included in the analysis based on a screening score of 50 or higher on the PTSD Checklist (PCL-C) at intake. Patients subsequently completed the PCL-C at periodic intervals during behavioral health encounters. A multilevel model predicting PCL-C score was constructed with the number of encounters and days between encounters as predictor variables, controlling for intake PCL-C scores. Results: A higher number of total encounters during the entire study period predicted lower scores on the PCL-C. Quadratic effects showed that encounter frequency of less than 3 weeks and treatment during the first 8 encounters was associated with lower symptoms. A curvilinear effect showed that long breaks in care are associated with greater PTSD symptoms, but also that very-frequent care (e.g., twice weekly) would be associated with greater symptoms. Conclusion: These results suggest the need to carefully monitor the frequency and overall dose of behavioral health encounters for PTSD among active duty military patients, suggesting that the greatest treatment gains occur early in treatment and that there is a need for idiographic treatment planning that addresses both the needs of the patient and the mission needs of the military command.