Ensaio clínico randomizado controlado comparativo com mulheres com diagnóstico de Transtorno de Estresse Pós-traumático após abuso sexual entre terapia interpessoal e sertralina

• Ano de defesa: 2024
• Autor(a) principal: Proença, Cecília Roberti [UNIFESP]
• Orientador(a): Mello, Andrea Feijó de [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• dARK ID: ark:/48912/00130000218h1
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo
• Palavras-chave em Português: Psicoterapia interpessoal; Farmacoterapia; Violência sexual; Transtorno de estresse pós-traumático; Preditor de resposta; Abuso sexual na infância
• Palavras-chave em Inglês: Interpersonal psychotherapy; Pharmacotherapy; Sexual assault; Posttraumatic stress disorder; Response predictor; Childhood sexual abuse
• Link de acesso: https://hdl.handle.net/11600/72031

Introduction: Sexual violence is one of the traumatic events most commonly associated with post-traumatic stress disorder (PTSD), a clinical condition that can become chronic and debilitating if not treated early and effectively. While most guidelines recommend selective serotonin reuptake inhibitors and trauma-focused psychotherapies as treatment options, not all patients respond to these approaches, and many do not tolerate being exposed to traumatic memories. Literature suggests the effectiveness of non-trauma-focused therapies, such as Interpersonal Psychotherapy (IPT), which focuses on interpersonal consequences rather than trauma itself. Objective: This study aims to compare the efficacy of Interpersonal Psychotherapy Adapted for PTSD (IPT-PTSD) with sertraline in women who have experienced recent sexual violence, in a randomized clinical trial, exploring therapeutic response trajectories and investigating the role of childhood sexual abuse as a response predictor. Method: This study consisted of a 14-week randomized and controlled clinical trial involving women diagnosed with PTSD resulting from sexual violence, experienced up to six months before inclusion. Participants were randomized assigned to receive either sertraline or IPT-PTSD. Following the intervention period, participants were monitored until one year after inclusion. PTSD, anxiety, and depressive symptoms were evaluated with assessment tools. The Clinician-Administered PTSD Scale-5 (CAPS-5) served as the primary outcome measure. Additionally, latent class trajectory analysis was used to assess predictors of treatment response at the end of the clinical trial and after one year of follow-up. Results: 74 women were included, with 39 allocated to IPT-PTSD and 35 to sertraline group. Both treatments significantly reduced PTSD, anxiety, and depression symptoms, with no differences between groups. CAPS-5 mean scores decreased from 42.5 (SD = 9.4) to 27.1 (SD = 15.9) with sertraline and from 42.6 (SD = 9.1) to 29.1 (SD = 15.5) with IPT-PTSD. Attrition rate in the clinical trial was high, 37,8%, without significant difference between groups (p = 0.40). The unconditional two-class model, “response and non-response”, best explained patient trajectories throughout the study. Childhood sexual abuse was identified as a predictor, negatively associated with therapeutic response. Conclusions: This trial found significant improvement in PTSD symptoms, regardless of time, in both study arms, with no differences between IPT-PTSD and sertraline treatment, suggesting that non-exposure-based psychotherapies may benefit PTSD patients. Identifying childhood sexual abuse as a predictor of therapeutic response, regardless of the therapeutic approach, alert clinicians to assess patients individually, personalizing treatment options.