Systematic Review and Ptsd

Post-Traumatic Stress Disorder (PTSD) is a commonly occurring mental health problem facing military personnel and veterans. The constant problems that plague those with PTSD can cause them to lead a lower quality of life with potential development of depression and anxiety commonly prevalent in those with the mental disorder. This qualitative study aims to research ways to provide positive pathways to care for members of the UK Armed Forces receiving treatment for PTSD by examining United States PTSD programs and studies performed on efficacy of these programs. This study will show what has worked in American PTSD programs under the Department of Veterans Affairs and what can be applied for the UK Armed Forces.

Research Hypothesis

The U.S. Department of Veterans Affairs has various programs available to help military personnel and veterans cope with PTSD. Information collected from studies assessing these programs' effectiveness will be used to provide more effective treatment options for the UK Armed Forces suffering from PTSD.

Literature Review

This brief literature review will provide a basic understanding of the need for a systematic review of U.S. based PTSD programs by showing strategies and programs that have proven successful in treating PTSD and a qualitative study demonstrating the problems experienced by UK military personnel that experience PTSD. This qualitative study serves as the basis for an exploration in understanding what treatment modalities are effective for the treatment of PTSD.

The qualitative study selected for this literature review covers several aspects of why those in the military may seek or not seek treatment for their PTSD. An interesting and noteworthy finding was the perception of importance of having someone there to witness their difficulties. "Participants perceived the importance of having a trusted witness to their difficulties who could point out something was seriously wrong. These supported participants to accept that their difficulties were serious and that they needed to seek help" (Murphy, Hunt, Luzon, & Greenberg, 2014, p. 5). Participants in the study also noted the need for a 'safe space' to allow them the chance to realize something was wrong. This would then provide them the motivation to get help.

A final key aspect of the study showed the need for participants to experience normalization "Participants spoke about the positive experience of learning that the difficulties they were experiencing were similar to those experienced by other people" (Murphy, Hunt, Luzon, & Greenberg, 2014, p. 5). There were other aspects of treatment or assessment that led to participants seeking treatment for their PTSD. However, these are the most important in relation to understanding what is being done in the United States to help military personnel and veterans with this disorder.

The next article plays into the themes or sub-themes discovered in the previous study. Meaning, the researchers identified a model that associated personal resources with PTSD severity.

The SEM model indicated that (1) a robust latent variable named personal resources (indicated by social support, unit cohesion, and trait resilience) was negatively associated with PTSD severity; (2) personal resources were negatively associated with negative posttraumatic cognitions; (3) negative posttraumatic cognitions fully mediated the association between personal resources and PTSD severity (Zang et al., 2017, p. 18).

The last article covers effective treatments found in PTSD programs run under the Department of Veterans Affairs. Researchers found adjunctive mindfulness-based cognitive therapy provided the most relief regarding decrease of symptom severity when participants experienced a depressive episode. Additionally, it lessened relapse rate. " . . . reducing relapse rate in recovered patients during maintenance phase of depression management. Adjunctive mindfulness-based stress reduction is effective for improving symptoms, mental health-related quality of life, and mindfulness in veterans with combat post-traumatic stress disorder (PTSD) (SOR B)" (Khusid & Vythilingam, 2016, p. 961).

Methods

Design

The study will use a qualitative systematic review approach via gathering data on patients within the United States who were or are part of the military and were diagnosed with PTSD. The quality criteria were based on Post Traumatic Stress Disorder guidelines, definitions, and recommendations part of a PTSD service or program that server veterans under the U.S. Department of Veterans Affairs. A systematic review offers a qualitative synthesis of research, providing an easy to digest form of information analysis that answers questions concerning topics like: treatment modality, efficacy, and outcomes for affected populations.

Participants

Because the study will be a systematic review, it will not have any participants. This is because the objective is to understand PTSD among military service personnel in the United States to aid researchers in the United Kingdom regarding appropriate treatment and program options. The United States has a robust program pool for PTSD treatment for veterans and military personnel. Using pre-existing studies to collect and analyze information seems like the best solution.

Procedures/Measures

The data analysis will come from the systematic review. " . . . qualitative synthesis can provide information about contextual factors to consider in developing systematic review protocol, including issues related to theory of change, choice of outcomes to be used in the analysis, choosing moderator variables, and finding issues relevant to implementation" (Saini & Shlonsky, 2012, p. 85). The systematic review has three phases: the beginning phase, the middle phase, and the end phase.

Data Analysis

In the beginning phase, the researcher must look at what the contextual factors are that must be considered to start a systematic review. For this study, it would be military personnel with PTSD in the United States and the programs and treatment options offered to them. The middle phase entails learning about the heterogeneity of the evidence presented from the findings. For example, if the Department of Veterans Affairs offers PTSD treatment programs for veterans and current military personnel, and the programs have been found to be ineffective, or effective in some locations, what is causing the discrepancies in service?

Lastly, the end phase brings an examination and discussion of application and relevance of findings. If treatment options exist for military personnel, and some are effective, the programs that are effective can be researched further to see if their operating guidelines could be standardized and applied to negatively-performing PTSD programs. The relevance of this understanding and assessment of information is to provide a sound and effective strategy towards establishing proper care for military personnel and veterans suffering from PTSD.

In terms of analyzing information within a system review, meta-analysis can be used in order to correct any fallibilities of an author-based approach. A meta-analysis is a statistical procedure that allows the researcher to combine data derived from multiple studies. Meta-analysis can be used to identify a common effect consistent within every study examined. Meta-analysis can also be used to identify reasons for any variation.

Because a single study will not yield the information needed to answer any underlying hypotheses or perceived themes, it is important to use several studies and analyze them accordingly. Meta-analysis allows for this and is not limited by the number of studies examined. Although the project is qualitative, meta-analysis is one of several techniques used in a systematic review. "Though sometimes misappropriated, the term 'meta-analysis' is now used in a circumscribed way to describe the quantitative pooling of study findings. Meta-analysis is just one of the techniques used in a systematic review . . . " (Silverman, 2016, p. 382).

Ethical Issues

Regarding ethical issues, because information will be taken from already performed studies, and not from interviews or conducted surveys, there is no risk of personal and identifiable information from leaking. The review will not have any participants and will use the data from programs and from research studies where the information has undergone ethical consideration. The only potential ethical considerations would pertain to legitimacy of the studies and accurate analysis and synthesis of the information. The selection criteria must take from studies that have been established and verified to avoid problems.