{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T10:57:21Z","timestamp":1790679441953,"version":"4.1.0"},"reference-count":27,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PCN Reports"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Trauma\u2010focused psychotherapies are recommended as first\u2010line treatments for post\u2010traumatic stress disorder (PTSD); however, treatment discontinuation remains a major challenge in routine clinical practice. This study examined treatment discontinuation and structured psychotherapy implementation among patients with PTSD and complex PTSD (CPTSD) in a post\u2010disaster outpatient setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort study analyzed anonymized clinical records from April 2016 to March 2021 at a psychiatric outpatient clinic in Minamisoma City, Fukushima, Japan. Patients with ICD\u201011 PTSD or CPTSD as a primary or secondary diagnosis were included (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009170), with an analytic cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009144, excluding transfers, deaths, and undetermined outcomes) for structured psychotherapy analyses. To address immortal time bias arising from delayed trauma\u2010focused psychotherapy initiation (median 327 days from initial visit), structured psychotherapy was modeled as a time\u2010varying covariate in Cox regression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Treatment discontinuation occurred in 33.5% (57\/170) of patients within 1 year, with 64.9% of events occurring within the first 90 days. Structured psychotherapy was delivered to 17.6% (30\/170) of patients. Although crude discontinuation rates differed markedly by trauma\u2010focused psychotherapy receipt (7.1% vs. 47.4%), the association was substantially attenuated and non\u2010significant in the time\u2010varying analysis (hazard ratio = 0.482, 95% CI 0.113\u20132.050), indicating that the crude association largely reflected immortal time bias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this post\u2010disaster outpatient setting, discontinuation was concentrated in the early phase of care that precedes structured psychotherapy, and most patients never reached trauma\u2010focused treatment. Early treatment engagement, rather than structured psychotherapy delivery alone, may represent the critical bottleneck in real\u2010world PTSD care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pcn5.70416","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T10:35:08Z","timestamp":1790159708000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Treatment discontinuation in a post\u2010disaster outpatient clinic: A retrospective cohort study of post\u2010traumatic stress disorder and complex post\u2010traumatic stress disorder in Fukushima, Japan"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7216-0255","authenticated-orcid":false,"given":"Arinobu","family":"Hori","sequence":"first","affiliation":[{"name":"Department of Psychiatry Hori Mental Clinic Minamisoma Fukushima Japan"},{"name":"Department of Neuropsychiatry Fukushima Medical University School of Medicine Fukushima Fukushima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emiko","family":"Ando","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Hori Mental Clinic Minamisoma Fukushima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Radiation Health Management Fukushima Medical University School of Medicine, Fukushima Fukushima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michio","family":"Murakami","sequence":"additional","affiliation":[{"name":"Center for Infectious Disease Education and Research (CiDER) The University of Osaka Suita Osaka Japan"},{"name":"EIPM Center The University of Osaka Suita Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaharu","family":"Tsubokura","sequence":"additional","affiliation":[{"name":"Department of Radiation Health 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