Informing the Future of Psychological Health Care in the Military: The STRONG STAR-CAP Longitudinal Outcomes Project

While the U.S. Department of Defense (DoD) has invested almost $2 billion in research on psychological health and traumatic brain injury (TBI) over the past 15 years, most has been for individual research projects. Unfortunately, this does not allow data from multiple studies to easily be merged to address questions that require large data sets of well-characterized cohorts of military service members, nor does it permit participants to be recontacted for follow-up assessments years later.

Consequently, there is a dearth of information on symptoms, diagnoses, health-care utilization, employment, disability, and health functioning of military personnel who (1) participated in previous DoD-funded psychological health clinical trials, and (2) participated in psychiatric epidemiological studies that evaluated large cohorts of service members pre- and post-deployment. There also is a research gap in our understanding of the complex relationships between multiple psychological health comorbidities and the degree to which individuals differ in terms of clinical outcomes and how they change.

STRONG STAR Director Alan Peterson, PhD, of The University of Texas at San Antonio Long School of Medicine and his team of collaborating investigators aim to address these research gaps through a DoD-funded Focused Program award. The group will conduct four separate but interrelated projects that are expected to help chart future evidence-based psychological health treatments.

Project 1 is a prospective observational study led by Stacey Young-McCaughan, PhD, also of the UT San Antonio Long School of Medicine. Its aim is to understand the long-term health, functioning, and resilience of 3,360 service members and veterans who participated in psychological treatment clinical trials conducted by the STRONG STAR Consortium and the Consortium to Alleviate PTSD (CAP) to treat posttraumatic stress disorder (PTSD), sleep disturbance, and chronic pain. Researchers will recontact these individuals for follow-up assessments of psychological health and daily life functioning. Findings will provide an unprecedented window into the long-term impact of psychological health treatments for service members and help guide patients and providers in the future as they collaborate to design optimal treatment plans with the greatest chances of success.

Project 2, led by Douglas Williamson, PhD, of Duke University School of Medicine, is a prospective, longitudinal, quantitative follow-up of 4,112 combat soldiers previously assessed before and after deployment in support of Operation Enduring Freedom or Operation Iraqi Freedom. Researchers will conducted a 10-year follow-up assessment to learn about (1) the long-term psychosocial and psychological health effects associated with deployment to a combat zone and how these effects change over time; (2) the extent to which physical injuries, particularly mild TBI, sustained during and since deployment impact soldiers’ current health and well-being; and (3) which predeployment psychological and biological variables predict the likelihood and severity of psychological and physical health long-term outcomes among soldiers following their deployment. Findings will increase understanding of combat stress’s multifaceted impact on service members’ short-term and long-term health. This should lead to more effective interventions, policies, and support systems to mitigate adverse effects and promote overall well-being.

Project 3 is led by Brett Litz, PhD, with the VA Boston Healthcare System and Boston University School of Medicine. This project will examine the long-term status of service members treated with evidence-based treatments for PTSD and assess their lived experiences being treated with these interventions. Investigators will also generate a profile of the personal, social, and occupational resources that facilitate engagement and successful outcomes and barriers that lead to non-response and dropout. The goal is to provide this information to the Defense Health Agency for wide dissemination and to Military Health System behavioral health care providers and service members seeking behavioral health care to consider when planning treatment in a shared decision-making framework. This deliverable is designed to help service members and providers be more confident about the use of evidence-based treatments by matching the needs of military personnel and their circumstances to initiation of treatment. It will also help personalize treatment plans for service members who are at risk for not engaging with an evidence-based treatment or when a treatment is less likely to meet their complex needs.

Finally, Project 4 is led by Willie Hale, PhD, with The University of Texas at San Antonio. This project will examine how polymorbid conditions (e.g., TBI, depression, chronic pain, sleep disorders, substance use, etc.) make PTSD treatment more difficult. They will first look for distinct patterns of pretreatment psychological health polymorbidity among various primary and secondary psychological health indicators as well as a variety of demographic factors. Then they will try to determine the degree to which individuals within various profiles differ in terms of short-term specific outcomes, in trajectories of change over time, and in enduring gains, lack of response to treatment, and dropout.

The end goal

Through these combined efforts, investigators aim to advance the assessment, diagnosis, treatment, and prevention of psychological health conditions and TBI in military personnel and veterans and to inform a personalized medicine approach with data to match patients to treatments to optimize outcomes.