A Study of Dog Adoption in Veterans With Posttraumatic Stress Disorder (PTSD)

Study Overview
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Brief Summary
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The purpose of this study is to provide preliminary data on the feasibility and impact of adopting a dog from an animal shelter as a supplement to usual care in Veterans with Posttraumatic Stress Disorder (PTSD) who desire to get such a pet.

Detailed Description
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Posttraumatic Stress Disorder, a common mental disorder among Veterans, is marked by painful re-experiencing of a traumatic event, often together with depression, fearfulness, and social isolation. Despite major advances in rehabilitation, many Veterans continue to be disabled by PTSD. One possible new approach involves the use of shelter dogs, which might relieve symptoms and aid reintegration into society by providing emotional support and a greater sense of security. In this randomized controlled trial of 48 Veterans with chronic PTSD, we will evaluate whether the half who adopt a dog from the San Antonio Humane Society show greater improvement in their PTSD symptoms over the first three months than the half who are assigned to a waiting list.

Official Title
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A Study of Dog Adoption in Veterans With Posttraumatic Stress Disorder

Conditions
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Posttraumatic Stress Disorder (PTSD)

Intervention / Treatment
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* Other: Shelter Dog Adoption


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Meets Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) criteria for current PTSD as determined by the Clinician-Administered PTSD Scale for DSM-5 (CAPS) Scores 39 or greater on the PTSD Checklist for DSM-5 (PCL-5) Feels able to afford to care for a dog after the anticipated annual costs of approximately $750 are outlined If married or cohabiting, spouse or significant other agrees with the decision to adopt a dog If not a homeowner, landlady or landlord agrees to allow the dog to reside on the property Agrees to keep the dog inside most of the time Agrees to be the primary caretaker for the dog Had a dog previously as a child or adult Served during the Vietnam era or more recently In active therapy for at least 1 month, with plans to remain in active therapy Has been in a stable housing situation for the last 3 months Case manager for any Veteran who is in the Housing and Urban Development/VA Subsidized Housing (HUD/VASH) program has been consulted prior to study enrollment Has a plan for someone else to take care of the dog if she or he can't Exclusion Criteria: Has had a dog or other companion animal within the past 12 months Has current alcohol or drug abuse or dependence Has a primary psychiatric diagnosis other than PTSD Has had significant suicide/homicide risk in the past 3 months Has had psychosis or mania in the past 3 months Has had a psychiatric admission during the past 3 months Has mental or physical impairments that would interfere with caring for the dog or self Has a history of moderate to severe traumatic brain injury (TBI) (subjects with moderate TBI will be allowed to participate in the study if a Physical Medicine and Rehabilitation physician determines it is acceptable) Requires a puppy Requires a breed that is uncommonly available for adoption at the San Antonio Humane Society Requires a pit bull or other fierce dog Veteran's mental health clinician or Physical Medicine and Rehabilitation physician reports a past history of animal cruelty or abuse or expresses concern about the potential for such behavior

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Shelter Dog Adoption<br>Veterans will choose a dog from the San Antonio Humane Society with the help of a Humane Society adoption counselor and study staff and take it home to live with them. The dog will be a pet and not a service dog. Following adoption, Veterans and their dogs will receive eight weeks of free obedience training provided by a veterinarian. | Other: Shelter Dog Adoption<br>* Veterans will choose a dog from the San Antonio Humane Society with the help a Humane Society adoption counselor and study staff and take it home to live with them. The dog will be a pet and not a service dog. Following adoption, Veterans and their dogs will receive eight weeks of free obedience training provided by a veterinarian.<br>|
| Active Comparator: Wait-list, Then Adoption after 3 Months<br>After 3 months on a wait-list, Veterans will choose a dog from the San Antonio Humane Society with the help of a Humane Society adoption counselor and study staff and take it home to live with them. The dog will be a pet and not a service dog. Following adoption, Veterans and their dogs will receive eight weeks of free obedience training provided by a veterinarian. | Other: Shelter Dog Adoption<br>* Veterans will choose a dog from the San Antonio Humane Society with the help a Humane Society adoption counselor and study staff and take it home to live with them. The dog will be a pet and not a service dog. Following adoption, Veterans and their dogs will receive eight weeks of free obedience training provided by a veterinarian.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in PTSD Checklist (PCL-5) Score Between Baseline and 3-month Follow-up | The PCL-5 is a self-rating scale based on the DSM-5 diagnostic criteria for Posttraumatic Stress Disorder. The range of the scale is from 0 (no symptoms) to 80 (maximal symptoms). | Baseline and 3-month follow-up visit. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Total Score on the Clinician-Administered PTSD Scale for DSM-5 (CAPS) | The Clinician-Administered PTSD Scale for DSM-5 (CAPS) is a semi-structured interview that assesses the severity of current symptoms for Posttraumatic Stress Disorder (PTSD). The total score ranges from 0 (no symptoms) to 80 (maximal symptoms). | Baseline and 3-month follow-up | 
| Change in Alcohol Use Disorders Identification Test (AUDIT-C) Total Score | Self-rating scale that assesses the frequency and extent of hazardous drinking. The range of the scale is from 0 (no hazardous drinking) to 12 (extremely hazardous drinking). | Baseline and 3-month follow-up | 
| Change in Beck Depression Inventory - II (BDI-II) Score | The Beck Depression Inventory - II is a self rating scale that assesses the severity of depressive symptoms. The range of the scale is from 0 (no symptoms) to 63 (maximal symptoms). | Baseline and 3-month follow-up | 
| Change in Community Integration Questionnaire (CIQ) Total Score | Self-rating scale that assesses the extent of a subject's integration into her or his community. The range of the scale is from 0 (minimal integration) to 29 (maximal integration). A positive change indicates an improvement in integration. | Baseline and 3-month follow-up visit | 
| Change in Patient Health Questionnaire-9 (PHQ-9) Score | The Patient Health Questionnaire-9 (PHQ-9) is a self-rating scale that assesses the severity of the symptoms of a major depressive episode. Scores range from 0 (no symptoms) to 27 (maximal symptoms). | Baseline and 3-month follow-up | 
| Percent of Subjects Reporting More Frequent Physical Activity Sessions on the Physical Activity Questionnaire (PAQ) | The PAQ is a self-rating scale that assesses the frequency and intensity of various types of physical activity over the previous 3 months. The percent reporting increased frequency of physical activity sessions can range from 0 to 100. | Baseline and 3-month follow-up | 
| Change in the Global Score on the Pittsburgh Sleep Quality Inventory With PTSD Addendum (PSQI-A) | Self-rating scale that assesses the frequency and severity of various sleep-related problems, including problems that frequently occur in persons with PTSD. Scores range from 0 (excellent sleep quality) to 42 (very poor sleep quality). | Baseline and 3-month follow-up | 
| Number of Participants With Improvement in Quality of Life After Dog Adoption | Interview that asks open-ended questions to assess the subject's symptoms, quality of life, and experiences related to having a dog | Baseline and 1-month, 3-month, 4-month, and 6-month follow-up visits, as well as 2-week, 2-month, and 4.5-month phone calls | 
| Change in Scores on the UCLA Loneliness Scale, Version 3 | The UCLA Loneliness Scale, Version 3 is a self-rating scale that measures the severity of symptoms of loneliness. The range of the scale if from 20 (no symptoms) to 80 (maximal symptoms). | Baseline and 3-month follow-up | 
| Changes in the Mental Component Score of the Veterans RAND 12-item Health Survey (VR-12) | The VR-12 is a12-item self-rating scale that assess health-related quality of life. The results are expressed as two scores, a Mental Component Score and a Physical Component Score. The Mental Component Score measures mental aspects of quality of life and ranges from 0 (extremely poor mental health) to 100 (extremely good mental health), while the Physical Component Score measures physical aspects of quality of life and also ranges from 0 (extremely poor physical health) to 100 (extremely good physical health). | Baseline and 3-month Follow-up | 
| Changes in Current Pain Ratings on the Numeric Rating Scale for Pain Intensity (NPS) | The NPS asks patients to rate their pain intensity on a scale from 0 (no pain) to 10 (worst possible pain) | Baseline and 3-month follow-up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Veterans, Posttraumatic Stress Disorder, dog adoption, companion animal