Optimizing Allocation to Telehealth and In-Person Prolonged Exposure for Women Veterans with Military Sexual Trauma: A Precision Medicine Approach.

Authors

• Evangelia Argyriou
• Daniel F Gros
• Melba A Hernandez Tejada
• Wendy A Muzzy
• Ron Acierno

Language

English

Publication Date

10-24-2024

Journal

Behavioral Sciences

DOI

10.3390/bs14110993

PMID

39594293

PMCID

PMC11591394

PubMedCentral® Posted Date

10-24-2024

PubMedCentral® Full Text Version

Post-print

Abstract

Military sexual trauma-related post-traumatic stress disorder (PTSD) is highly prevalent and costly among women veterans, making the need for effective and accessible treatment of critical importance. Access to care is a key mechanism of mental health disparities and might affect differential response to treatment. The goal of this study was to estimate an individualized treatment rule based on readily available individual characteristics related to access to care to optimize allocation to in-person vs. telehealth delivery of prolonged exposure for PTSD in military sexual trauma survivors. The following variables were used as prescriptive factors: age, race, disability status, socioeconomic status, rural vs. urban status, and baseline PTSD level. The rule was estimated using a machine-learning approach, Outcome Weighted Learning. The estimated optimal rule outperformed a one-size-fits-all rule where everyone is universally assigned to telehealth; it led to markedly lower mean PTSD levels following 6 months from treatment (𝑉dopt − 𝑉Telehealth = −14.55, 95% CI: −27.24, −1.86). However, the rule did not significantly discriminate for in-person therapy (𝑉dopt − 𝑉In-person = −11.86, 95% CI: −25.83, 2.12). Upon further validation with larger and more diverse samples, such a rule may be applied in practice settings to aid clinical decision-making and personalization of treatment assignment.

Keywords

precision medicine, individualized treatment rule, PTSD, military sexual trauma, prolonged exposure, telehealth

Published Open-Access

yes

Recommended Citation

Argyriou, Evangelia; Gros, Daniel F; Hernandez Tejada, Melba A; et al., "Optimizing Allocation to Telehealth and In-Person Prolonged Exposure for Women Veterans with Military Sexual Trauma: A Precision Medicine Approach." (2024). Faculty, Staff and Student Publications. 4331.
https://digitalcommons.library.tmc.edu/uthmed_docs/4331