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The Behavioral Health Data Portal (BHDP) is widely used to track PTSD, depression, and anxiety symptoms within Army BH care, but there are opportunities to expand symptom tracking

• Soldiers had more symptom scores the longer they were in treatment, suggesting that BHDP has been widely implemented and that soldiers routinely received scores during BH visits.
• Some soldiers had BH visits after their last symptom measure score. Thus, a soldier's last score was not necessarily a measure of symptoms at the last visit.

Stronger patient-reported therapeutic alliance was associated with improved PTSD, depression, and anxiety outcomes

• Even when controlling for other treatment factors, a perceived strong working relationship between soldiers and their providers was associated with decreased PTSD, depression, and anxiety symptoms.
• No pretreatment variables, such as demographic or risk variables, were consistently associated with outcomes.

Increased supply of benzodiazepines was associated with worse PTSD, depression, and anxiety outcomes

• Soldiers with more than a 30-day supply of benzodiazepines experienced poorer outcomes.

Many soldiers' trajectories of symptom change did not demonstrate improvement

• Rates of achieving either response to treatment (i.e., symptom improvement) or remission within one to six months were 35 percent for PTSD, 45 percent for depression, and 41 percent for anxiety.
• The authors identified trajectories of symptom change for each sample. The majority of soldiers with PTSD (83 percent) were included in a trajectory that did not demonstrate improvement in their symptoms.
• Among patients with depression, 34 percent were included in a trajectory that showed no improvement, and 45 percent showed a small improvement.
• Forty-five percent of the anxiety sample were in a trajectory that showed no improvement.

This report identifies factors associated with changes in outcomes for soldiers who received Army behavioral health (BH) specialty care and provides recommendations to improve BH care and outcomes. RAND researchers identified three samples of soldiers who received Army BH care with diagnoses of posttraumatic stress disorder (PTSD), depression, or anxiety and whose symptoms were assessed during their care. Multivariate analyses included 141 patient and treatment variables to identify factors associated with symptom improvement. Analyses also examined patterns in how the symptoms changed over time.

Analyses suggest that the Behavioral Health Data Portal, an online system that allows for collection of multiple patient- and clinician-reported measures, is widely used to track symptoms of PTSD, depression, and anxiety, but there are opportunities to expand symptom tracking. Two treatment factors—therapeutic alliance and receipt of benzodiazepines—were associated with treatment outcomes. Specifically, a stronger therapeutic relationship or alliance with providers, as reported by soldiers, was associated with improved PTSD, depression, and anxiety outcomes. Further, receipt of more than a 30-day supply of benzodiazepines was associated with poorer PTSD, depression, and anxiety outcomes. Many soldiers' trajectories of symptom change did not demonstrate improvement.

Recommendations include providing feedback and guidance to providers on how to strengthen alliance with their patients, expanding tracking and feedback on benzodiazepine prescribing, and increasing provider use of measurement-based BH care.

• Chapter One

  Introduction

• Chapter Two

  Methods

• Chapter Three

  Implementation of Treatment Outcome Monitoring and the Army's Outcome Measures

• Chapter Four

  Characteristics and Representativeness of Soldiers in the Multivariate Analysis Samples

• Chapter Five

  Identifying Pretreatment and Treatment Predictors of PTSD, Depression, and Anxiety Outcomes

• Chapter Six

  Trajectories of PTSD, Depression, and Anxiety Symptom Change

• Chapter Seven

  Summary and Recommendations

• Appendix A

  Variables Used in the Multivariate Models

• Appendix B

  PTSD, Depression, and Anxiety Outcome Models: Full Model Results