Post-traumatic stress disorder (PTSD) is a complex somatic, affective, and behavioral effect of psychosocial trauma, characterized by intrusive thoughts, nightmares and flashbacks of past traumatic events, hypervigilance, sleep disturbances leading to considerable social, and interpersonal dysfunction. Over 76% of Canadians have reported exposure to a significant stress event; the lifetime prevalence of PTSD in Canada has been estimated to be 9.2%. The 2013 Canadian Forces Mental Health Survey provides an estimate for the presence of PTSD in serving personnel; of 8200 Canadian Armed Forces personnel surveyed, 11.1% of Regular Forces personnel met criteria for PTSD at some point in their life, with 5.3% having met the diagnostic criteria in the time of the survey or over the previous year.

Patients can be treated for PTSD in numerous services, programs, and settings, for varying durations. There are usually four levels of care for patients with mental illness: inpatient hospitalization (24-hour care in a structured setting, usually for patients who are severely depressed, traumatized, or suicidal), residential treatment (similar to inpatient hospitalization but in a more home-like environment, medical staff not available on a 24-hour basis, for residents who are declared medically stable), partial hospitalization (day treatment, for patients who need structured treatment program but do not need 24-hour supervision), or outpatient treatment.

There remains uncertainty about the effective durations for treatment, and benefits of more resource-intensive inpatient treatment versus outpatient programs. This Rapid Response report aims to review the comparative clinical effectiveness of long- (over 90 days) versus short-term (28 to 45 days) inpatient treatment programs, and the comparative clinical effectiveness of inpatient versus outpatient treatment programs for patients with PTSD. Evidence-based guidelines regarding inpatient treatment programs for patients with PTSD will also be examined.

Contents

• CONTEXT AND POLICY ISSUES
• RESEARCH QUESTIONS
• KEY FINDINGS
• METHODS
  • Literature Search Strategy
  • Selection Criteria and Methods
  • Exclusion Criteria
  • Critical Appraisal of Individual Studies
• SUMMARY OF EVIDENCE
  • Quantity of Research Available
  • Summary of Study Characteristics
  • Summary of Critical Appraisal
  • Summary of Findings
  • Limitations
• CONCLUSIONS AND IMPLICATIONS FOR DECISION OR POLICY MAKING
• REFERENCES
• Appendix 1 Selection of Included Studies
• Appendix 2 Characteristics of Included Studies
• Appendix 3 Summary of Critical Appraisal of Included Study
• Appendix 4 Main Study Findings and Authors’ Conclusions

Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.