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Zerach G, Levinstein Y, Levi-Belz Y. Longitudinal associations between exposure to potentially morally injurious events and suicidal ideation among recently discharged veterans - The mediating roles of depression and loneliness. J Affect Disord 2024; 350:689-697. [PMID: 38224741 DOI: 10.1016/j.jad.2024.01.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Exposure to potentially morally injurious events (PMIEs) during military service is associated with heightened suicidal ideation (SI). However, no longitudinal study has established temporal associations between these variables and examined the possible mediating roles of depression and loneliness in this effect. METHODS Participants were 374 active-duty Israeli combatants who participated in a five-year longitudinal study with four measurement points: T1- one year before enlistment, T2- one month before discharge from army service, and then again six months and twelve months following their discharge (T3 and T4, respectively). Data were assessed through semi-structured interviews and validated self-report questionnaires. RESULTS Above and beyond pre-enlistment personal characteristics (T1) and combat exposure (T2), PMIEs-'betrayal' (T2) predicted more frequent SI over the past twelve months (T4) through the mediation of depression. Moreover, both PMIEs-'betrayal' and 'self' (T2) predicted more frequent SI over the past twelve months (T4) through the mediation of loneliness. LIMITATIONS We used self-report measures to assess PMIEs and SI, which may suffer from various biases. CONCLUSIONS Our findings are the first to provide evidence of longitudinal, temporal associations between exposure to PMIEs and SI. Notably, potential interventions might consider addressing the loneliness experienced following exposure to PMIEs during military service, among recently discharged traumatized veterans.
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Affiliation(s)
- Gadi Zerach
- Dept. of Psychology, Ariel University, Ariel, Israel.
| | - Yoav Levinstein
- Dept. of Health and Well-being, Medical Corps, IDF, School of Social Work, Bar-Ilan University, Ramat-Gan, Israel
| | - Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
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2
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Bhargava A, Knapp JD, Fiehn O, Neylan TC, Inslicht SS. The lipidome of posttraumatic stress disorder. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.23.581833. [PMID: 38464224 PMCID: PMC10925102 DOI: 10.1101/2024.02.23.581833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Posttraumatic stress disorder (PTSD) can develop after trauma exposure. Some studies report that women develop PTSD at twice the rate of men, despite greater trauma exposure in men. Lipids and their metabolites (lipidome) regulate a myriad of key biological processes and pathways such as membrane integrity, oxidative stress, and neuroinflammation in the brain by maintaining neuronal connectivity and homeostasis. In this study, we analyzed the lipidome of 40 individuals with PTSD and 40 trauma-exposed non-PTSD individuals. Plasma samples were analyzed for lipidomics using Quadrupole Time-of-Flight (QToF) mass spectrometry. Additionally, ~ 90 measures were collected, on sleep, mental and physical health indices. Sleep quality worsened as PTSD severity increased in both sexes. The lipidomics analysis identified a total of 348 quantifiable known lipid metabolites and 1951 lipid metabolites that are yet unknown; known metabolites were part of 13 classes of lipids. After adjusting for sleep quality, in women with PTSD, only one lipid subclass, phosphatidylethanolamine (PE) was altered, whereas, in men with PTSD, 9 out of 13 subclasses were altered compared to non-PTSD women and men, respectively. Severe PTSD was associated with 22% and 5% of altered lipid metabolites in men and women, respectively. Of the changed metabolites, only 0.5% measures (2 PEs and cholesterol) were common between women and men with PTSD. Several sphingomyelins, PEs, ceramides, and triglycerides were increased in men with severe PTSD. The triglycerides and ceramide metabolites that were most highly increased were correlated with cholesterol metabolites and systolic blood pressure in men but not always in women with PTSD. Alterations in triglycerides and ceramides are linked with cardiac health and metabolic function in humans. Thus, disturbed sleep and higher weight may have contributed to changes in the lipidome found in PTSD.
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Affiliation(s)
- Aditi Bhargava
- Center for Reproductive Sciences, Department of Obstetrics and Gynecology, University of California San Francisco, CA 94143, USA
- Aseesa Inc., CA 94010, USA
| | | | - Oliver Fiehn
- NIH West Coast Metabolomics Center, University of California Davis Genome Center, Davis, CA 95616, USA
| | - Thomas C. Neylan
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA 94121, USA
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, CA 94143, USA
| | - Sabra S. Inslicht
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA 94121, USA
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, CA 94143, USA
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Murray CD, Havlin H, Molyneaux V. Considering the psychological experience of amputation and rehabilitation for military veterans: a systematic review and metasynthesis of qualitative research. Disabil Rehabil 2024; 46:1053-1072. [PMID: 36856319 DOI: 10.1080/09638288.2023.2182915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 02/09/2023] [Accepted: 02/16/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE Research highlights the differences and unique experiences of military veterans experiencing amputation compared to civilians. This review aimed to synthesise qualitative research exploring the experience of amputation and rehabilitation among existing or previous members of the military. METHODS A systematic search of six databases (PsycINFO, AMED, MEDLINE, CINAHL, Web of Science and Scopus) was undertaken in March 2022. The results of 17 papers reporting 12 studies published between 2009 and 2022 were synthesised using a meta-ethnographic approach to generate new interpretations reflecting the experiences of members of the military who have experienced limb loss. RESULTS Three themes were developed from the data: (1) Making the physical and psychological transition to life after amputation; (2) The role of the military culture in rehabilitation; and (3) The impact of relationships and the gaze of others during rehabilitation and beyond. CONCLUSIONS Military veterans with limb loss experience difficulties in navigating civilian healthcare systems and gaining appropriate support away from the military. Rehabilitation professionals, with psychological training or mentoring, involved in the care of military veterans following amputation could offer psychological support during the transition to civilian life and targeted therapies to veterans experiencing high levels of pain, and facilitate peer support programmes.
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Affiliation(s)
- Craig D Murray
- Faculty of Health and Medicine, Lancaster University, Lancaster, Lancashire, UK
| | - Heather Havlin
- Faculty of Health and Medicine, Lancaster University, Lancaster, Lancashire, UK
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Bryan CJ, Bryan AO, Khazem LR, Aase DM, Moreno JL, Ammendola E, Bauder CR, Hiser J, Daruwala SE, Baker JC. Crisis response planning rapidly reduces suicidal ideation among U.S. military veterans receiving massed cognitive processing therapy for PTSD. J Anxiety Disord 2024; 102:102824. [PMID: 38154445 DOI: 10.1016/j.janxdis.2023.102824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
Posttraumatic stress disorder (PTSD) is common among U.S. military veterans and is associated with increased risk of suicidal thoughts and behaviors. Crisis response planning (CRP), a brief safety planning-type intervention, has been shown to rapidly reduce suicidal ideation and suicide attempts in emergency and acute care settings. CRP's effectiveness when combined with trauma-focused therapies remains unknown. In this randomized pragmatic clinical trial with one-year follow-up, 157 U.S. military personnel and veterans were randomly assigned to receive CRP or self-guided safety planning (SP) prior to beginning massed cognitive processing therapy (CPT) for PTSD. Among 51 (32.5 % of sample) participants endorsing suicidal ideation at baseline, reductions in the severity of suicidal ideation were significantly larger and faster in CRP (F(11,672)= 15.8, p < .001). Among 106 participants denying suicidal ideation at baseline, 8.5 % of CRP participants versus 11.9 % of SP participants (OR=0.69, 95 % CI=0.19-2.52) reported new-onset suicidal ideation during any follow-up assessment. PTSD symptoms significantly reduced over time with no differences between groups. Results support the effectiveness of CRP for rapidly reducing suicidal ideation and managing suicide risk during outpatient treatment for PTSD.
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Affiliation(s)
- Craig J Bryan
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA; VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, NY, USA.
| | - AnnaBelle O Bryan
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Lauren R Khazem
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Darrin M Aase
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Jose L Moreno
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Ennio Ammendola
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Christina Rose Bauder
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Jaryd Hiser
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Samantha E Daruwala
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA; VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, NY, USA
| | - Justin C Baker
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
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5
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Hoopsick RA, Yockey RA. A national examination of suicidal ideation, planning, and attempts among United States adults: Differences by military veteran status, 2008-2019. J Psychiatr Res 2023; 165:34-40. [PMID: 37459776 DOI: 10.1016/j.jpsychires.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 09/03/2023]
Abstract
There is a widening disparity in suicide deaths between United States (U.S.) military veterans and nonveterans. However, it is unclear if there are similar differences in suicidal ideation, planning, and attempts that often precipitate these deaths. A better understanding of trends in suicidal thoughts and behaviors could illuminate opportunities for prevention. We examined pooled cross-sectional data (N = 479,801 adults) from the 2008 to 2019 National Survey on Drug Use and Health. We examined differences in past-year suicidal ideation, suicide planning, and suicide attempts between U.S. veterans (n = 26,508) and nonveterans (n = 453,293). We conducted post hoc analyses to examine for differences in these relationships by race/ethnicity and sex. Lastly, we examined trends in these outcomes over time and tested for differences in trends by veteran status. Overall, veterans had significantly greater odds of past-year suicidal ideation (aOR = 1.33, 95% CI 1.20 to 1.47) and suicide planning (aOR = 1.52, 95% CI 1.30 to 1.78) compared to nonveterans. However, the association between veteran status and past-year suicide attempt was not statistically significant (aOR = 1.29, 95% CI 1.00 to 1.68). These relationships did not differ by race/ethnicity or sex (ps > 0.05). Among all adults, there were significant linear increases in past-year suicidal ideation, planning, and attempts (ps < 0.001). However, these trends did not differ between veterans and nonveterans (ps > 0.05). Veterans may be more likely to experience suicidal thoughts and behaviors than nonveteran adults. Upward trends in suicidal thoughts and behaviors among both veterans and nonveterans from 2008 to 2019 highlight opportunities for intervention.
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Affiliation(s)
- Rachel A Hoopsick
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, 1206 S. Fourth St., 2017 Khan Annex, Huff Hall, Champaign, IL, 61820, USA.
| | - R Andrew Yockey
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, School of Public Health, 709C, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
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6
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DeBeer BB, Mignogna J, Nance M, Bahraini N, Penzenik M, Brenner LA. COVID-19 and Lifetime Experiences of Trauma, Moral Injury, and Institutional Betrayal Among Healthcare Providers. J Occup Environ Med 2023; 65:745-750. [PMID: 37254232 PMCID: PMC10694842 DOI: 10.1097/jom.0000000000002891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The aim of the study is to increase understanding regarding healthcare provider experiences with psychological trauma, moral injury, and institutional betrayal, both over the lifetime and during the COVID-19 pandemic. METHODS The study employed a cross-sectional design to understand traumatic experiences, moral injury, and institutional betrayal among medical and mental health providers. Participants were asked to identify an index trauma, and experiences were coded qualitatively using categories for traumatic events, moral injury, and institutional betrayal. RESULTS Results revealed that experiences of trauma, moral injury, and institutional betrayal were common in relation to the pandemic, as were prepandemic histories of traumatic exposures. Findings indicate that trauma exposure was a work hazard for healthcare providers during the pandemic, which could result in negative long-term mental health outcomes. CONCLUSIONS Future research is needed to explore potential long-term negative outcomes among healthcare providers.
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Affiliation(s)
- Bryann B. DeBeer
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Aurora, CO
- Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, Aurora, CO
| | - Joseph Mignogna
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Aurora, CO
- Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, Aurora, CO
| | - Morgan Nance
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Aurora, CO
- Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, Aurora, CO
| | - Nazanin Bahraini
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Aurora, CO
- Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, Aurora, CO
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado, Aurora, CO
| | - Molly Penzenik
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Aurora, CO
| | - Lisa A. Brenner
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Aurora, CO
- Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, Aurora, CO
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado, Aurora, CO
- Department of Neurology, Anschutz Medical Campus, University of Colorado, Aurora, CO
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7
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Rawat BPS, Reisman J, Pogoda TK, Liu W, Rongali S, Aseltine RH, Chen K, Tsai J, Berlowitz D, Yu H, Carlson KF. Intentional Self-Harm Among US Veterans With Traumatic Brain Injury or Posttraumatic Stress Disorder: Retrospective Cohort Study From 2008 to 2017. JMIR Public Health Surveill 2023; 9:e42803. [PMID: 37486751 PMCID: PMC10407646 DOI: 10.2196/42803] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/06/2023] [Accepted: 04/12/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Veterans with a history of traumatic brain injury (TBI) and/or posttraumatic stress disorder (PTSD) may be at increased risk of suicide attempts and other forms of intentional self-harm as compared to veterans without TBI or PTSD. OBJECTIVE Using administrative data from the US Veterans Health Administration (VHA), we studied associations between TBI and PTSD diagnoses, and subsequent diagnoses of intentional self-harm among US veterans who used VHA health care between 2008 and 2017. METHODS All veterans with encounters or hospitalizations for intentional self-harm were assigned "index dates" corresponding to the date of the first related visit; among those without intentional self-harm, we randomly selected a date from among the veteran's health care encounters to match the distribution of case index dates over the 10-year period. We then examined the prevalence of TBI and PTSD diagnoses within the 5-year period prior to veterans' index dates. TBI, PTSD, and intentional self-harm were identified using International Classification of Diseases diagnosis and external cause of injury codes from inpatient and outpatient VHA encounters. We stratified analyses by veterans' average yearly VHA utilization in the 5-year period before their index date (low, medium, or high). Variations in prevalence and odds of intentional self-harm diagnoses were compared by veterans' prior TBI and PTSD diagnosis status (TBI only, PTSD only, and comorbid TBI/PTSD) for each VHA utilization stratum. Multivariable models adjusted for age, sex, race, ethnicity, marital status, Department of Veterans Affairs service-connection status, and Charlson Comorbidity Index scores. RESULTS About 6.7 million veterans with at least two VHA visits in the 5-year period before their index dates were included in the analyses; 86,644 had at least one intentional self-harm diagnosis during the study period. During the periods prior to veterans' index dates, 93,866 were diagnosed with TBI only; 892,420 with PTSD only; and 102,549 with comorbid TBI/PTSD. Across all three VHA utilization strata, the prevalence of intentional self-harm diagnoses was higher among veterans diagnosed with TBI, PTSD, or TBI/PTSD than among veterans with neither diagnosis. The observed difference was most pronounced among veterans in the high VHA utilization stratum. The prevalence of intentional self-harm was six times higher among those with comorbid TBI/PTSD (6778/58,295, 11.63%) than among veterans with neither TBI nor PTSD (21,979/1,144,991, 1.92%). Adjusted odds ratios suggested that, after accounting for potential confounders, veterans with TBI, PTSD, or comorbid TBI/PTSD had higher odds of self-harm compared to veterans without these diagnoses. Among veterans with high VHA utilization, those with comorbid TBI/PTSD were 4.26 (95% CI 4.15-4.38) times more likely to receive diagnoses for intentional self-harm than veterans with neither diagnosis. This pattern was similar for veterans with low and medium VHA utilization. CONCLUSIONS Veterans with TBI and/or PTSD diagnoses, compared to those with neither diagnosis, were substantially more likely to be subsequently diagnosed with intentional self-harm between 2008 and 2017. These associations were most pronounced among veterans who used VHA health care most frequently. These findings suggest a need for suicide prevention efforts targeted at veterans with these diagnoses.
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Affiliation(s)
- Bhanu Pratap Singh Rawat
- Manning College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | - Joel Reisman
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Bedford, MA, United States
| | - Terri K Pogoda
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, United States
- Boston University School of Public Health, Boston, MA, United States
| | - Weisong Liu
- Center of Biomedical and Health Research in Data Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - Subendhu Rongali
- Manning College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | - Robert H Aseltine
- Division of Behavioral Sciences and Community Health, UConn Health, Farmington, CT, United States
| | - Kun Chen
- Department of Statistics, University of Connecticut, Storrs, CT, United States
| | - Jack Tsai
- Center of Biomedical and Health Research in Data Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - Dan Berlowitz
- Center of Biomedical and Health Research in Data Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - Hong Yu
- Manning College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, United States
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, United States
- Center of Biomedical and Health Research in Data Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - Kathleen F Carlson
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, United States
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A Pilot Study of a Three-Session Heart Rate Variability Biofeedback Intervention for Veterans with Posttraumatic Stress Disorder. Appl Psychophysiol Biofeedback 2023; 48:51-65. [PMID: 36331685 DOI: 10.1007/s10484-022-09565-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
Many veterans do not complete traditional trauma treatments; others may continue to struggle with posttraumatic stress disorder (PTSD) even after completing a full course of therapy (Blasé et al., in Int J Environ Res Public Health 18(7):Article 3329, https://doi.org/10.3390/ijerph18073329 , 2016). Heart rate variability (HRV) biofeedback (HRVB) is a non-invasive, non-pharmacological, breathing-based cardiorespiratory training technique that can reduce trauma symptoms and improve HRV parameters. Prior studies have demonstrated HRVB is well-tolerated by veterans with PTSD symptoms (Tan et al., in Appl Psychophysiol Biofeedback 36(1):27-35, 10.1007/s10484-010-9141-y, 2011; Schuman and Killian, in Appl Psychophysiol Biofeedback 44(1):9-20, https://doi.org/10.1007/s10484-018-9415-3 , 2019). This randomized wait-list controlled pilot study tested a short mobile app-adapted HRVB intervention in combination with treatment as usual for veterans with military-related PTSD to determine if further investigation was warranted. We assessed veterans' military-related PTSD symptoms, depression symptoms, and HRV time and frequency domain measures at baseline, after three clinical sessions, and one month later. This study combined clinical training and home biofeedback with a smartphone app and sensor to reinforce training and validate adherence. In the intervention group, depression and SDNN significantly improved, and we observed marginally significant improvements for PTSD Cluster B (intrusion) symptoms, whereas no significant improvements were observed in the control group. In addition, the brief protocol was acceptable to veterans with PTSD with over 83% of participants completing the study. However, adherence to home practice was low. Findings suggest brief HRVB interventions can decrease comorbid depression and improve overall autonomic function in veterans with PTSD; however, additional research on home biofeedback is necessary to determine the best strategies to increase adherence and which veterans would benefit from brief HRVB interventions.
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Initiating Cognitive Processing Therapy (CPT) in Community Settings: A Qualitative Investigation of Therapist Decision-Making. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:137-150. [PMID: 36370226 PMCID: PMC9832073 DOI: 10.1007/s10488-022-01229-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 11/13/2022]
Abstract
Various organizations have provided treatment guidelines intended to aid therapists in deciding how to treat posttraumatic stress disorder (PTSD). Yet evidence-based psychotherapies (EBPs) for PTSD in the community may be difficult to obtain. Although strides have been made to implement EBPs for PTSD in institutional settings such as the United States Veterans Affairs, community uptake remains low. Factors surrounding clients' decisions to enroll in EBPs have been identified in some settings; however less is known regarding trained therapists' decisions related to offering trauma-focused therapies or alternative treatment options. Thus, the aim of the current study was to examine therapist motivations to initiate CPT in community settings. The present study utilizes data from a larger investigation aiming to support the sustained implementation of Cognitive Processing Therapy (CPT) in community mental health treatment settings. Enrolled therapists participated in phone interviews discussing their opinions of CPT, preferred treatments for PTSD, and process in assessing appropriate PTSD treatments for clients. Semi-structured interviews (N = 29) were transcribed and analyzed using a directed content analysis approach. Several themes emerged regarding therapists' decision-making in selecting PTSD treatments. Therapist motivations to use EBPs for PTSD, primarily CPT, were identified at the client (e.g., perceived compatibility with client-level characteristics), therapist (e.g., time limitations), and clinic levels (e.g., leadership support). The results provide insight into the complex array of factors that affect sustainability of EBPs for PTSD in community settings and inform future dissemination of EBPs, including training efforts in community settings.
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Clark R, Kuffel RL, Neylan TC, Maguen S, Li Y, Boscardin WJ, Byers AL. Posttraumatic stress disorder, suicide, and unintended overdose death in later life: A national cohort study of veterans aged 50 and older. J Am Geriatr Soc 2022; 71:1462-1472. [PMID: 36573640 DOI: 10.1111/jgs.18199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/02/2022] [Accepted: 11/25/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND/OBJECTIVES Although studies have shown posttraumatic stress disorder (PTSD) associated with risk of suicide, the relationship in later life, especially for overdose death, remains unclear. Thus, the aim of the current study was to determine associations between PTSD, suicide, and unintended overdose death in mid- to late-life. METHODS A nationwide cohort study integrating Department of Veterans Affairs' (VA) data, Centers for Medicare & Medicaid Services data, and national cause-specific mortality data. Participants were US veterans aged ≥50 years with PTSD diagnoses at baseline (2012-2013) and were propensity-matched 1:1 with patients without PTSD based on sociodemographics, Charlson Comorbidity Index, and neuropsychiatric disorders (N = 951,018). Information on suicide attempts and unintended death by overdose through December 31, 2017 was provided by the VA's National Suicide Prevention Applications Network (non-fatal attempts) and Mortality Data Repository (death). RESULTS Veterans with PTSD (N = 475,509) had increased risk of suicide attempt (Hazard Ratio [HR], 1.59; 95% CI, 1.54-1.65; p < 0.001), non-fatal attempt (HR, 1.74; 95% CI, 1.67-1.81; p < 0.001), drug overdose death overall (HR, 1.32; 95% CI, 1.22-1.42; p < 0.001), and suicide overdose death (HR, 1.44; 95% CI, 1.15-1.80; p = 0.002), even after adjusting for sociodemographics, Charlson comorbidity index, and neuropsychiatric disorders. We found increased risk for overdose death by narcotics (HR, 1.30; 95% CI, 1.15-1.46; p < 0.001), antiepileptic/sedative-hypnotics (HR, 1.29; 95% CI, 1.02-1.62; p = 0.032), and for other/unspecified drugs (HR, 1.35; 95% CI, 1.20-1.51; p < 0.001), the last category indicative of polydrug. Results remained robust when examined for unintentional, suicide, and undetermined intent for cause-specific death by other/unspecified drugs. CONCLUSIONS PTSD persists throughout mid- to late-life with considerable increased risk for non-fatal suicide attempts and suicide overdose death. These findings suggest the importance of drug-monitoring in preventing late-life suicide.
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Affiliation(s)
- Ryan Clark
- Northern California Institute for Research and Education San Francisco California USA
- San Francisco Veterans Affairs Health Care System San Francisco California USA
| | - Randall L. Kuffel
- Northern California Institute for Research and Education San Francisco California USA
- San Francisco Veterans Affairs Health Care System San Francisco California USA
| | - Thomas C. Neylan
- San Francisco Veterans Affairs Health Care System San Francisco California USA
- Department of Psychiatry and Behavioral Sciences University of California, San Francisco San Francisco California USA
- Department of Neurology University of California, San Francisco San Francisco California USA
| | - Shira Maguen
- San Francisco Veterans Affairs Health Care System San Francisco California USA
- Department of Psychiatry and Behavioral Sciences University of California, San Francisco San Francisco California USA
| | - Yixia Li
- Northern California Institute for Research and Education San Francisco California USA
- San Francisco Veterans Affairs Health Care System San Francisco California USA
| | - W. John Boscardin
- San Francisco Veterans Affairs Health Care System San Francisco California USA
- Department of Medicine, Division of Geriatrics University of California, San Francisco San Francisco California USA
- Department of Epidemiology & Biostatistics University of California, San Francisco San Francisco California USA
| | - Amy L. Byers
- San Francisco Veterans Affairs Health Care System San Francisco California USA
- Department of Psychiatry and Behavioral Sciences University of California, San Francisco San Francisco California USA
- Department of Medicine, Division of Geriatrics University of California, San Francisco San Francisco California USA
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11
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Pease JL, Martin CE, Rowe C, Chard KM. Impact of residential PTSD treatment on suicide risk in veterans. Suicide Life Threat Behav 2022; 53:250-261. [PMID: 36541183 DOI: 10.1111/sltb.12939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 10/27/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION In 2019, 17 veterans died by suicide every day. Various suicide prevention treatments have emerged, yet limited research has explored the impact of Post Traumatic Stress Disorder (PTSD) treatment on suicidal ideation and behaviors. METHODS This study examines the impact of Cognitive Processing Therapy (CPT) on suicidal ideation among veterans in three residential PTSD programs (women's, men's, and PTSD/Traumatic Brain Injury). Interview and self-report data were collected from veterans (n = 446) throughout treatment. RESULTS Over 50% of veterans reported current suicidal ideation and a history of suicide attempts prior to treatment. Variables that predicted change in suicidal ideation included prior suicide attempt (β = 0.21, p = 0.022), change in CAPS-5 total score (β = 0.28, p = 0.038), employment status (β = -0.20, p = 0.035) and history of suicide attempt (β = 0.25, p = 0.009). Those without a previous suicide attempt made greater gains in CPT treatment than those with a previous suicide attempt. CONCLUSION Following 7 weeks of CPT residential treatment, a decrease in PTSD symptoms was significantly associated with a reduction in suicidal ideation. Implications are that CPT can reduce suicide risk in a variety of Veteran cohorts with differing trauma types.
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Affiliation(s)
- James L Pease
- College of Allied Health Sciences, School of Social Work, University of Cincinnati, Cincinnati, Ohio, USA
| | - Colleen E Martin
- Cincinnati VA Medical Center, Trauma Recovery Center, Cincinnati, Ohio, USA
| | - Claire Rowe
- College of Allied Health Sciences, School of Social Work, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kathleen M Chard
- Cincinnati VA Medical Center, Trauma Recovery Center, Cincinnati, Ohio, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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12
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Ingram PB, Morris CS, Golden B, Youngren WA, Fulton JA, Sharpnack J. The Influence of Service Era: Comparing Personality Assessment Inventory (PAI) Scale Scores Within a Posttraumatic Stress Disorder Treatment Clinic (PCT). J Clin Psychol Med Settings 2022; 29:624-635. [PMID: 34427816 DOI: 10.1007/s10880-021-09812-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/27/2022]
Abstract
Research is mixed on the role of service era in symptom endorsement among Veterans, with differences emerging depending on the instrument evaluated. This study compares Personality Assessment Inventory (PAI) scale scores of VA test-takers who served during the Vietnam, Desert Storm, or Post-9/11 service eras. The sample was collected at a VA Posttraumatic Stress Disorder Clinical Team. Associations between gender and combat exposure were also examined as covariates. Results suggest that Veterans' self-report on the PAI is influenced by service era, even after accounting for gender and combat exposure during deployment. The largest differences were between Vietnam or Post-9/11 Veterans and those from the Gulf War era. Symptom differences typically varied across scales commonly associated with symptoms of trauma exposure/posttraumatic stress disorder. Implications for the clinical use of, and research with, the PAI and other broadband personality assessments within the VA healthcare system and trauma treatment settings are discussed.
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Affiliation(s)
- Paul B Ingram
- Department of Psychological Sciences, Texas Tech University, 2810 18th Street, Lubbock, TX, 79424, USA.
- Eastern Kansas Veteran Healthcare System, Topeka, KS, USA.
| | - Cole S Morris
- Department of Psychological Sciences, Texas Tech University, 2810 18th Street, Lubbock, TX, 79424, USA
| | - Brittney Golden
- Department of Psychological Sciences, Texas Tech University, 2810 18th Street, Lubbock, TX, 79424, USA
| | | | - Joe A Fulton
- Department of Psychology, University of Kansas, Lawrence, KS, USA
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13
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Radstaak M, Hüning L, Lamers S, Bohlmeijer ET. Examining well-being in posttraumatic stress disorder treatment: An explorative study. J Trauma Stress 2022; 35:914-925. [PMID: 35182442 PMCID: PMC9306808 DOI: 10.1002/jts.22798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 11/24/2021] [Accepted: 11/28/2021] [Indexed: 11/28/2022]
Abstract
Although the importance of well-being in mental health is widely acknowledged, well-being as a predictor of and outcome in the treatment for posttraumatic stress disorder (PTSD) has received little attention. This naturalistic study aimed to investigate well-being in the context of care-as-usual treatment for PTSD. Patients with PTSD attending a community mental health center (N = 318) completed measures of well-being and PTSD symptoms before and after symptom-focused treatment. Following treatment, well-being increased among patients with PTSD, with emotional, d = -0.25, and psychological well-being, d = -0.24, showing the largest improvements relative to social well-being, d = -0.15. Although levels of well-being improved overall within the sample, participant scores on measures of well-being remained low compared with the general population. Well-being predicted treatment efficiency such that participants with more severe PTSD symptoms benefitted more from care-as-usual treatment when they reported relatively high levels of well-being at the start of treatment. The findings suggest a benefit to including well-being as a pretreatment and outcome variable when evaluating PTSD treatments.
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Affiliation(s)
- Mirjam Radstaak
- Department of PsychologyHealth and TechnologyUniversity of TwenteEnschedethe Netherlands
| | - Laura Hüning
- Mediant, Community Mental Health CenterEnschedethe Netherlands
| | | | - Ernst T. Bohlmeijer
- Department of PsychologyHealth and TechnologyUniversity of TwenteEnschedethe Netherlands
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14
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Carbajal J, Ponder WN. Does Attachment Mediate PTSD and Suicidality in a Sample of Global War on Terrorism (GWOT) Combat Veterans? JOURNAL OF VETERANS STUDIES 2022. [DOI: 10.21061/jvs.v8i1.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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15
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Harper KL, Moshier S, Ellickson-Larew S, Andersen MS, Wisco BE, Mahoney CT, Keane TM, Marx BP. A prospective examination of health care costs associated with posttraumatic stress disorder diagnostic status and symptom severity among veterans. J Trauma Stress 2022; 35:671-681. [PMID: 35030271 DOI: 10.1002/jts.22785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/08/2021] [Accepted: 10/07/2021] [Indexed: 11/07/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with increased health care costs; however, most studies exploring this association use PTSD diagnostic data in administrative records, which can contain inaccurate diagnostic information and be confounded by the quantity of service use. We used a diagnostic interview to determine PTSD diagnostic status and examined associations between PTSD symptom severity and health care costs and utilization, extracted from Veteran Health Administration (VHA) administrative databases. Using a nationwide longitudinal sample of U.S. veterans with and without PTSD (N = 1,377) enrolled in VHA health care, we determined the costs and utilization of mental health and non-mental health outpatient, pharmacy, and inpatient services for 1 year following cohort enrollment. Relative to veterans without PTSD, those with PTSD had higher total health care, B = 0.47; mental health clinic care, B = 0.72; non-mental health clinic care, B = 0.30; and pharmacy costs, B = 0.72, ps < .001. More severe PTSD symptoms were associated with mental health clinic care costs, B = 0.12; non-mental health clinic care costs, B = 0.27; and higher odds of inpatient, B = 0.63, and emergency service use, B = 0.39, p < .001-p = .012. These findings indicate that veterans' PTSD status, determined by a clinician-administered semistructured diagnostic interview, was associated with higher health care costs and increased use of mental health and non-mental health clinic services. The findings also suggest that more severe PTSD is associated with increased costs and utilization, including costly emergency and inpatient utilization.
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Affiliation(s)
- Kelly L Harper
- National Center for PTSD at VA Boston Health care System, Boston, Massachusetts, USA
| | | | - Stephanie Ellickson-Larew
- National Center for PTSD at VA Boston Health care System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Massachusetts, USA
| | - Martin S Andersen
- Department of Economics, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Blair E Wisco
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Colin T Mahoney
- Deparment of Psychology, Western New England University, Springfield, Massachusetts, USA
| | - Terence M Keane
- National Center for PTSD at VA Boston Health care System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Massachusetts, USA
| | - Brian P Marx
- National Center for PTSD at VA Boston Health care System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Massachusetts, USA
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16
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Niles BL, Reid KF, Whitworth JW, Alligood E, Williston SK, Grossman DH, McQuade MM, Mori DL. Tai Chi and Qigong for trauma exposed populations: A systematic review. Ment Health Phys Act 2022; 22:10.1016/j.mhpa.2022.100449. [PMID: 37885833 PMCID: PMC10601358 DOI: 10.1016/j.mhpa.2022.100449] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Trauma exposure and posttraumatic stress are highly prevalent and comorbid with health problems. Despite the apparent systemic nature of post-traumatic stress, recommended treatments neglect trauma's deleterious effects on health. Integrative mind-body treatments for posttraumatic stress, such as Tai Chi and Qigong (TCQ), may offer a promising adjunct to first-line treatments. Method A systematic search was conducted to identify trials that examined Tai Chi and/or Qigong as treatments for trauma-exposed populations. Studies were examined for rigor; design, sample and intervention characteristics, dropout, attendance, satisfaction, acceptability, and key findings were systematically extracted. Results The 6 studies included are all pilot or feasibility trials with descriptive or mixed-methods outcomes. No randomized trials or rigorous studies were identified. Dropout rates ranged widely, and adverse reactions were not evident. Reported satisfaction was high and benefits of relaxation, reductions in mental health symptoms, and improvements in pain and physical and cognitive functioning were noted. Limitations All the studies were non-rigorous and relatively small, with no comparison groups, or follow-up assessments; in many cases, posttraumatic stress symptoms were not formally assessed. Conclusions The paucity and lack of rigor of the studies identified for this review highlights the need for larger, methodologically sound clinical trials. The reviewed studies suggest that TCQ practices have the potential to reduce symptoms and improve functioning for individuals exposed to trauma and provide evidence that TCQ is feasible, acceptable, and low risk in these populations. Possible mechanistic pathways supporting TCQ as a treatment for posttraumatic stress are considered.
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Affiliation(s)
- Barbara L. Niles
- National Center for PTSD – Behavioral Science Division 150 S Huntington Ave, Boston, MA, 02130, USA
- VA Boston Healthcare System, 150 S Huntington Ave, Boston, 02130, MA, USA
- Boston University School of Medicine, 72 E Concord St, Boston, 02118, MA, USA
| | - Kieran F. Reid
- Laboratory of Exercise Physiology and Physical Performance, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, 02115, MA, USA
| | - James W. Whitworth
- National Center for PTSD – Behavioral Science Division 150 S Huntington Ave, Boston, MA, 02130, USA
- VA Boston Healthcare System, 150 S Huntington Ave, Boston, 02130, MA, USA
- Boston University School of Medicine, 72 E Concord St, Boston, 02118, MA, USA
| | - Elaine Alligood
- VA Boston Healthcare System, 150 S Huntington Ave, Boston, 02130, MA, USA
| | - Sarah Krill Williston
- National Center for PTSD – Behavioral Science Division 150 S Huntington Ave, Boston, MA, 02130, USA
- VA Boston Healthcare System, 150 S Huntington Ave, Boston, 02130, MA, USA
- Boston University School of Medicine, 72 E Concord St, Boston, 02118, MA, USA
| | - Daniel H. Grossman
- National Center for PTSD – Behavioral Science Division 150 S Huntington Ave, Boston, MA, 02130, USA
- VA Boston Healthcare System, 150 S Huntington Ave, Boston, 02130, MA, USA
| | - Maria M. McQuade
- National Center for PTSD – Behavioral Science Division 150 S Huntington Ave, Boston, MA, 02130, USA
- VA Boston Healthcare System, 150 S Huntington Ave, Boston, 02130, MA, USA
| | - DeAnna L. Mori
- VA Boston Healthcare System, 150 S Huntington Ave, Boston, 02130, MA, USA
- Boston University School of Medicine, 72 E Concord St, Boston, 02118, MA, USA
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17
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Auth NM, Booker MJ, Wild J, Riley R. Mental health and help seeking among trauma-exposed emergency service staff: a qualitative evidence synthesis. BMJ Open 2022; 12:e047814. [PMID: 35110304 PMCID: PMC8811562 DOI: 10.1136/bmjopen-2020-047814] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To identify factors and contexts that may contribute to mental health and recovery from psychological difficulties for emergency service workers (ESWs) exposed to occupational trauma, and barriers and facilitators to help-seeking behaviour among trauma-exposed ESWs. BACKGROUND ESWs are at greater risk of stressor-related psychopathology than the general population. Exposure to occupational stressors and trauma contribute to the observed rates of post-trauma psychopathology in this occupational group with implications for workforce sustainability. Types of organisational interventions offered to trauma-exposed ESWs are inconsistent across the UK, with uncertainty around how to engage staff. DESIGN Four databases (OVID MEDLINE, EMBASE, PsycINFO and SCOPUS) were systematically searched from 1 January 1980 to March 2020, with citation tracking and reference chaining. A modified Critical Appraisal Skills Programme tool and quality appraisal prompts were used to identify fatally flawed studies. Qualitative studies of trauma-exposure in front-line ESWs were included, and data were extracted using a customised extraction table. Included studies were analysed using thematic synthesis. RESULTS A qualitative evidence synthesis was conducted with 24 qualitative studies meeting inclusion criteria, as defined by the PerSPEcTiF framework. Fourteen descriptive themes emerged from this review, categorised into two overarching constructs: (1) factors contributing to mental health (such as the need for downtime, peer support and reassurance) and (2) factors influencing help-seeking behaviour (such as stigma, the content/form/mandatory nature of interventions, and mental health literacy issues including emotional awareness and education). CONCLUSION ESWs reported disconnect between the organisations' cultural positioning on trauma-related mental health, the reality of undertaking the role and the perceived applicability and usefulness of trauma interventions. Following traumatic exposure, ESWs identify benefitting from recovery time and informal support from trusted colleagues. A culture which encourages help seeking and open dialogue around mental health may reduce stigma and improve recovery from mental ill health associated with trauma exposure.
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Affiliation(s)
| | | | - Jennifer Wild
- Experimental Psychology, University of Oxford, Oxford, UK
| | - Ruth Riley
- Social and Community Medicine, University of Bristol, Bristol, UK
- Department of Applied Health Research, University of Birmingham, Birmingham, UK
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18
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Soumoff AA, Clark NG, Spinks EA, Kemezis PA, Raiciulescu S, Driscoll MY, Kim SY, Benedek DM, Choi KH. Somatic Symptom Severity, Not Injury Severity, Predicts Probable Posttraumatic Stress Disorder and Major Depressive Disorder in Wounded Service Members. J Trauma Stress 2022; 35:210-221. [PMID: 34374129 DOI: 10.1002/jts.22722] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 05/21/2021] [Accepted: 05/31/2021] [Indexed: 12/24/2022]
Abstract
Although previous studies have reported an association between patient-reported somatic symptom severity and the development of posttraumatic stress disorder (PTSD) or major depressive disorder (MDD) in injured military service members (SMs), conclusions from other studies regarding the association between clinician-determined injury severity and PTSD or MDD remain unclear. The present study investigated whether somatic symptoms or injury severity predict the development of probable PTSD or MDD in wounded SMs medically evacuated from combat areas. Data including SM demographic characteristics, clinician-determined injury severity (i.e., Injury Severity Score [ISS] and Abbreviated Injury Scale [AIS] values), and self-report assessments of PTSD (PTSD Checklist-Civilian Version), MDD (Patient Health Questionnaire [PHQ]-9), and somatic symptoms (PHQ-15) were analyzed. A total of 2,217 SMs completed at least one self-assessment between 2003 and 2014, with 425 having completed assessments at each assessment period (AP), conducted 1-75 (AP1), 76-165 (AP2), and 166-255 (AP3) days postinjury. Between AP1 and AP3, the rates of probable PTSD and MDD increased from 3.0% to 11.7% and from 2.8% to 9.2%, respectively. Somatic symptom severity at AP1 predicted probable PTSD and MDD at all three APs, odds ratios (ORs) = 3.5-11.5; however, ISS values did not predict probable PTSD or MDD at any AP, ORs = 0.6-0.9. This suggests that the initial severity of self-reported somatic symptoms rather than clinician-determined injury severity predicts the development of probable PTSD and MDD in wounded SMs.
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Affiliation(s)
- Alyssa A Soumoff
- Behavioral Health Directorate, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA
| | - Neil G Clark
- Behavioral Health Directorate, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Elizabeth A Spinks
- Behavioral Health Directorate, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Patricia A Kemezis
- Behavioral Health Directorate, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Sorana Raiciulescu
- Department of Preventive Medicine and Biostatistics, Biostatistics Consulting Center, Uniformed Services University, Bethesda, Maryland, USA
| | - Mercedes Y Driscoll
- Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA
| | - Sharon Y Kim
- Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA.,Program in Neuroscience, Uniformed Services University, Bethesda, Maryland, USA
| | - David M Benedek
- Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA.,Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA.,Program in Neuroscience, Uniformed Services University, Bethesda, Maryland, USA
| | - Kwang H Choi
- Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA.,Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA.,Program in Neuroscience, Uniformed Services University, Bethesda, Maryland, USA
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19
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Schafer KM, Clancy KJ, Joiner T. An investigation into the bidirectional relationship between post-traumatic stress disorder and suicidal ideation: A nine year study. J Anxiety Disord 2022; 85:102510. [PMID: 34864539 PMCID: PMC10423636 DOI: 10.1016/j.janxdis.2021.102510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 11/03/2021] [Accepted: 11/21/2021] [Indexed: 11/20/2022]
Abstract
Suicide is the second leading cause of death in adolescents; a frequent precursor of suicide is suicidal ideation (SI). Literature indicates that Post-Traumatic Stress Disorder (PTSD) and SI are robust cross-sectional correlates of one another, with PTSD often being conceptualized as a risk factor (i.e., conferring risk) for SI. Indeed, PTSD is a well-established risk factor for SI; however, SI is an understudied risk factor for PTSD. It is possible that, yet unknown if, PTSD and SI promote each other over time in a bidirectional fashion. We investigated the bidirectional longitudinal associations between PTSD and SI in a large, diverse sample, who at baseline were adolescents. Participants were interviewed between 1995 and 1998 and again between 2004 and 2008. We hypothesized that PTSD and SI would be cross-sectionally, longitudinally, and bidirectionally related and that the number of traumas endorsed at baseline would be positively associated with PTSD and SI at baseline and follow-up. Indeed, PTSD and SI were cross-sectionally correlated at baseline, but not follow-up. PTSD predicted SI over nine years; however, SI during adolescence did not predict PTSD in adulthood. Finally, poly-trauma endorsed at baseline was associated with increased risk of SI, but not PTSD, over nine years.
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20
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Levi-Belz Y, Dichter N, Zerach G. Moral Injury and Suicide Ideation Among Israeli Combat Veterans: The Contribution of Self-Forgiveness and Perceived Social Support. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP1031-NP1057. [PMID: 32410491 DOI: 10.1177/0886260520920865] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Modern warfare within a civilian setting may expose combatants to severe moral challenges. Whereas most of these challenges are handled effectively, some potentially morally injurious events (PMIEs) may have deleterious psychological, spiritual, and interpersonal effects among them, which may increase the risk for suicide ideation and behaviors (SIB). In this study, we aimed to examine the protective role of self-forgiveness and perceived social support on the relationship between exposure to PMIEs and SIB among combat veterans. A sample of 191 Israeli combat veterans completed validated self-report questionnaires in a cross-sectional design study, tapping moral injury, SIB, perceived social support, and self-forgiveness. Veterans with a history of SIB revealed higher levels of exposure to PMIEs and lower levels of self-forgiveness and perceived social support than veterans with no SIB history. Moreover, beyond the contributions of the PMIE dimensions, significant contributions of self-forgiveness and perceived social support to current suicide ideation (SI) were found. Importantly, the moderating model indicated that higher social support moderated the link between PMIEs and current SI. Based on the current findings, it can be suggested that self-forgiveness and perceived social support are important contributors to lower SI levels among veterans with PMIEs. It can be further suggested that interpersonal support may help veterans develop a sense of belongingness and bonding, which is a plausible basis for diminishing the risk of SI following PMIE exposure.
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Affiliation(s)
- Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Neta Dichter
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
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21
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Mendoza NB, Mordeno IG, Nalipay MJN. The Transdiagnostic Role of Rumination in the Comorbidity of PTSD and Depression. JOURNAL OF LOSS & TRAUMA 2021. [DOI: 10.1080/15325024.2021.2018197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Imelu G. Mordeno
- Mindanao State University–Iligan Institute of Technology, Iligan, Philippines
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22
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Allard CB, Norman SB, Straus E, Kim HM, Stein MB, Simon NM, Rauch SAM. Reductions in guilt cognitions following prolonged exposure and/or sertraline predict subsequent improvements in PTSD and depression. J Behav Ther Exp Psychiatry 2021; 73:101666. [PMID: 34147766 DOI: 10.1016/j.jbtep.2021.101666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 04/27/2021] [Accepted: 05/28/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Reduction of trauma related negative cognitions, such as guilt, is thought to be a mechanism of change within PTSD treatments like prolonged exposure (PE). Research suggests PE can directly address guilt cognitions. However, whether pharmacotherapies for PTSD can remains unclear. METHODS Data from a randomized controlled trial of PE plus placebo (PE + PLB), sertraline plus enhanced medication management (SERT + EMM), and their combination (PE + SERT) in 195 Veterans from recent wars was analyzed. RESULTS The unadjusted means and mixed-effects model showed guilt decreased significantly over the follow-up time as expected; however, contrary to our hypothesis, PE conditions were not associated with greater reductions in guilt than the SERT + EMM condition. As hypothesized, week 12 reduction in guilt predicted post-treatment (weeks 24-52) reduction in PTSD and depression, but not impairments in function. LIMITATIONS Generalizability of findings is limited by the sample being comprised of combat Veterans who were predominantly male, not on SSRI at study entry, willing to be randomized to therapy or medication, and reporting low levels of guilt. To reduce differences in provider attention, SERT + EMM was administered over 30 min to include psychoeducation and active listening; it is unknown if this contributed to effects on guilt. CONCLUSIONS PE + PLB, SERT + EMM, and PE + SERT were equally associated with reduction in trauma related guilt. Reducing trauma related guilt may be a pathway to reducing PTSD and posttraumatic depression symptoms. Further study is needed to determine how best to treat trauma related guilt and to understand the mechanisms by which guilt improves across different treatments for PTSD.
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Affiliation(s)
- Carolyn B Allard
- VA San Diego Healthcare System, 3350 Villa La Jolla Drive, San Diego, CA, 92161, USA; California School of Professional Psychology, Alliant International University, Daley Hall, 10455 Pomerado Rd, San Diego, CA, 92131, USA.
| | - Sonya B Norman
- VA San Diego Healthcare System, 3350 Villa La Jolla Drive, San Diego, CA, 92161, USA; National Center for PTSD, VA Medical Center, 215 North Main st, White River Junction, VT, 05009, USA; University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA; VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, MC116B, San Diego, CA, 92161, USA.
| | - Elizabeth Straus
- VA San Diego Healthcare System, 3350 Villa La Jolla Drive, San Diego, CA, 92161, USA; University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - H Myra Kim
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA; University of Michigan, Consulting for Statistics, Computing and Analytics Research, 3550 Rackham, 950 E. Washington Street, Ann Arbor, MI, 48109, USA.
| | - Murray B Stein
- VA San Diego Healthcare System, 3350 Villa La Jolla Drive, San Diego, CA, 92161, USA; University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Naomi M Simon
- Massachusetts General Hospital, Department of Psychiatry, One Bowdoin Square, 6th Floor, Boston, MA, 02114, USA; New York University Grossman School of Medicine, Department of Psychiatry, One Park Avenue 8th Floor, New York, NY, 10016, USA.
| | - Sheila A M Rauch
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA; Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA; Emory University School of Medicine, 12 Executive Park, 3rd Floor, Atlanta, GA, 30029, USA.
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23
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Rozek DC, Crawford JN, LoSavio ST, Myers US, Dabovich P, Warnecke A, Smith NB, Bryan CJ. The protective role of reasons for living on suicidal cognitions for military affiliated individuals with a positive PTSD screen in primary care settings. J Affect Disord 2021; 292:424-429. [PMID: 34144367 DOI: 10.1016/j.jad.2021.05.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/31/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Identifying and enhancing protective beliefs is essential in reducing suicide risk among military-affiliated individuals. The goal of this study was to examine if specific reasons for living impact the relationship between PTSD and suicidal cognitions among military-affiliated individuals in primary care settings. METHODS Participants included 2,685 U.S. military personnel and their adult beneficiaries recruited from primary care clinics. Participants completed the Primary Care Posttraumatic Stress Disorder Screen, Suicide Cognitions Scale, and Brief Reasons for Living Inventory. RESULTS Responsibility to family and survival and coping beliefs-were related to suicidal cognitions with higher levels associated with less suicidal cognitions and a weaker relationship between PTSD and suicidal cognitions. By contrast, fear of suicide and fear of social disapproval were associated with more suicidal cognitions, and the link between positive PTSD screen and suicidal cognitions was stronger for individuals with higher levels of fear of social disapproval. Moral objection did not predict suicidal cognitions and did not moderate the relationship between PTSD and suicidal cognitions. LIMITATIONS The limitations of the study include that measures were done in primary care and brief screeners were often used. Additionally, the study is cross-sectional in nature, whereas some of the symptoms and outcome variables likely fluctuate over time. CONCLUSIONS Findings suggest not all reasons for living are not equally influential and, among military-affiliated individuals with a positive PTSD screen, bolstering reasons for living related to responsibility to family and survival and coping skills could be particularly impactful in reducing suicide cognitions.
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Affiliation(s)
- David C Rozek
- UCF RESTORES & Department of Psychology, University of Central Florida, Orlando, FL, USA.
| | - Jennifer N Crawford
- Department of Psychiatry & Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Stefanie T LoSavio
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Ursula S Myers
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Paula Dabovich
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, SA, Australia
| | - Ashlee Warnecke
- Battle Creek Veterans Affairs Medical Center, Battle Creek, MI, USA
| | - Noelle B Smith
- Northeast Program Evaluation Center, Department of Veterans Affairs, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Craig J Bryan
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Graziano RC, Aunon FM, LoSavio ST, Elbogen EB, Beckham JC, Dillon KH. A network analysis of risk factors for suicide in Iraq/Afghanistan-era veterans. J Psychiatr Res 2021; 138:264-271. [PMID: 33872963 PMCID: PMC8192445 DOI: 10.1016/j.jpsychires.2021.03.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 01/19/2023]
Abstract
Suicidal ideation (SI) is a prevalent issue in the veteran population. A number of factors have been identified as risk factors for suicidal ideation (SI) in veterans, including suicide attempts, depression, posttraumatic stress disorder (PTSD), and drug use. However, clinicians' ability to predict suicide is poor, particularly given the interplay between various factors such as previous suicide attempts. As such, there is a gap in our knowledge of which factors most saliently predict suicide risk and which should be targets for interventions designed to lower SI. Network analysis, a method allowing for an examination of how variables relate within the context of a network of factors, may bridge this gap by simultaneously evaluating the interrelationships between risk factors for suicide in veterans. Current study used network analysis and data from 2268 Iraq/Afghanistan-era military veterans to examine the relationships between suicidal ideation and several factors related to suicide risk, such as past suicide attempts, PTSD symptoms, depression, drug use, trauma exposure. Partial correlation network results showed suicidal ideation to be strongly related to depression, with smaller connections to past suicide attempts and anger. Additionally, past suicide attempts was strongly related to history of childhood trauma and weakly related to problematic drug use and PTSD symptoms. These results offer valuable information for both predicting suicide risk and differentiating targets for interventions lowering suicide risk in veterans.
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Affiliation(s)
| | | | - Stefanie T. LoSavio
- Durham VA Health Care System, Durham, NC,Duke University Medical Center, Durham, NC
| | - Eric B. Elbogen
- Duke University Medical Center, Durham, NC,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC,National Center on Homelessness Among Veterans, Washington, DC
| | - Jean C. Beckham
- Durham VA Health Care System, Durham, NC,Duke University Medical Center, Durham, NC,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC
| | | | - Kirsten H. Dillon
- Durham VA Health Care System, Durham, NC,Duke University Medical Center, Durham, NC,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC,Correspondence concerning this article should be sent to: Kirsten H. Dillon, PhD, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705,
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25
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Tannahill HS, Fargo JD, Barrett TS, Blais RK. Gender as a moderator of the association of military sexual trauma and posttraumatic stress symptoms. J Clin Psychol 2021; 77:2262-2287. [PMID: 33991354 DOI: 10.1002/jclp.23162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The current study examined the moderating role of gender on the association of military sexual trauma (MST) type (harassment-only vs. assault) and posttraumatic stress symptoms (PTSS) using the 6-factor Anhedonia Model. METHODS Participants were 1321 service members/veterans. Two-part hurdle models assessed the moderating role of gender on the association of MST type with the presence (at least "moderate" symptoms endorsed within each cluster) or severity of PTSS and symptom clusters. RESULTS Among those who experienced assault MST, women were at higher risk for the presence of intrusive, avoidance, negative affect, and anhedonia symptoms, and higher risk for more severe negative affect symptoms. Among those who experienced harassment-only MST, men were at higher risk of more severe PTSS symptoms overall and in the intrusive and dysphoric arousal symptom clusters. No other significant differences were observed. CONCLUSIONS Gathering information on MST type may be helpful in treatment planning.
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Affiliation(s)
| | - Jamison D Fargo
- Department of Psychology, Utah State University, Logan, Utah, USA
| | - Tyson S Barrett
- Department of Psychology, Utah State University, Logan, Utah, USA
| | - Rebecca K Blais
- Department of Psychology, Utah State University, Logan, Utah, USA
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Abstract
This review examines the role of trauma in psychiatric morbidity and analogous psychoneurobiological changes. Trauma is a necessary criterion for Post-Traumatic Stress Disorder (PTSD), however, trauma history is highly correlated with a variety of psychiatric conditions. Some evidence suggests that Major Depressive Disorder (MDD) is the most common psychiatric condition that arises following trauma. Approximately 50% of PTSD cases present with co-morbid MDD. Overlapping symptomatology and neurobiology between these conditions underlie the debate over whether these phenomena result from problematic nosology or whether comorbid MDD + PTSD is a distinct phenotype of trauma-related psychopathology. Regardless, similar treatment approaches have been employed historically, with varying success. The drug-assisted psychotherapy treatment model, which combines pharmacological and psychotherapeutic approaches, is currently being trialled as a novel treatment approach in psychiatry. Both psilocybin- and 3,4-Methylenedioxymethamphetamine (MDMA)-assisted psychotherapy have received Food and Drug Administration 'breakthrough therapy' designation for the treatment of resistant MDD and PTSD, respectively. This paper reviews the therapeutic rationale of both psilocybin and MDMA for treating both trauma-related MDD and PTSD.
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Affiliation(s)
- Catherine I V Bird
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nadav L Modlin
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - James J H Rucker
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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27
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Pittman JOE, Lindamer L, Afari N, Depp C, Villodas M, Hamilton A, Kim B, Mor MK, Almklov E, Gault J, Rabin B. Implementing eScreening for suicide prevention in VA post-9/11 transition programs using a stepped-wedge, mixed-method, hybrid type-II implementation trial: a study protocol. Implement Sci Commun 2021; 2:46. [PMID: 33926577 PMCID: PMC8082763 DOI: 10.1186/s43058-021-00142-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/25/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Post-9/11 veterans who enroll in VA health care frequently present with suicidal ideation and/or recent suicidal behavior. Most of these veterans are not screened on their day of enrollment and their risk goes undetected. Screening for suicide risk, and associated mental health factors, can lead to early detection and referral to effective treatment, thereby decreasing suicide risk. eScreening is an innovative Gold Standard Practice with evidence to support its effectiveness and implementation potential in transition and care management (TCM) programs. We will evaluate the impact of eScreening to improve the rate and speed of suicide risk screening and referral to mental health care compared to current screening methods used by transition care managers. We will also evaluate the impact of an innovative, multicomponent implementation strategy (MCIS) on the reach, adoption, implementation, and sustained use of eScreening. METHODS This is an eight-site 4-year, stepped-wedge, mixed-method, hybrid type-II implementation trial comparing eScreening to screening as usual while also evaluating the potential impact of the MCIS focusing on external facilitation and Lean/SixSigma rapid process improvement workshops in TCM. The aims will address: 1) whether using eScreening compared to oral and/or paper-based methods in TCM programs is associated with improved rates and speed of PTSD, depression, alcohol, and suicide screening & evaluation, and increased referral to mental health treatment; 2) whether and to what degree our MCIS is feasible, acceptable, and has the potential to impact adoption, implementation, and maintenance of eScreening; and 3) how contextual factors influence the implementation of eScreening between high- and low-eScreening adopting sites. We will use a mixed methods approach guided by the RE-AIM outcomes of the Practical Robust Implementation and Sustainability Model (PRISM). Data to address Aim 1 will be collected via medical record query while data for Aims 2 and 3 will be collected from TCM staff questionnaires and qualitative interviews. DISCUSSION The results of this study will help identify best practices for screening in suicide prevention for Post-9/11 veterans enrolling in VA health care and will provide information on how best to implement technology-based screening into real-world clinical care programs. TRIAL REGISTRATION ClinicalTrials.gov : NCT04506164; date registered: August 20, 2020; retrospectively registered.
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Affiliation(s)
- James O E Pittman
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA.
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA.
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA.
| | - Laurie Lindamer
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA
| | - Niloofar Afari
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA
| | - Colin Depp
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA
| | - Miguel Villodas
- San Diego State University, 5500 Campanile Dr, San Diego, CA, USA
| | - Alison Hamilton
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, USA
| | - Bo Kim
- HSR&D Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, USA
| | - Maria K Mor
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- VA Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erin Almklov
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA
| | - John Gault
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA
| | - Borsika Rabin
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA
- UC San Diego Dissemination and Implementation Science Center, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA
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28
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Park CL, Sacco SJ, Finkelstein-Fox L, Sinnott SM, Scoglio AAJ, Lee SY, Gnall KE, Mazure C, Shirk SD, Hoff RA, Kraus SW. Post-9/11 military veterans' adjustment to civilian life over time following separation from service. J Clin Psychol 2021; 77:2077-2095. [PMID: 33871869 DOI: 10.1002/jclp.23144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/18/2021] [Accepted: 03/25/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVES US military veterans face many challenges in transitioning to civilian life; little information is available regarding veterans' reintegration experiences over time. The current study characterized veterans' postdeployment stressful life events and concurrent psychosocial wellbeing over one year and determined how stressors and wellbeing differ by demographic factors. METHODS Recent Post-911 veterans (n = 402) were assessed approximately every three months for 1 year. Participants were 60% men, primarily White (78%), and 12% Latinx; the average age was 36 years. RESULTS The frequency of stressful events decreased over time but was higher for men and minority-race veterans (independent of time since separation). Veterans reported high mean levels of posttraumatic stress disorder, anxiety, and insomnia symptoms, which improved slightly over time. Minority-race and Latinx veterans had higher symptom levels and slower rates of symptom reduction. CONCLUSION Veterans remain distressed in their overall transition to civilian life. Interventions to promote resilience and help veterans manage readjustment to civilian life appear urgently needed.
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Affiliation(s)
- Crystal L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Shane J Sacco
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Lucy Finkelstein-Fox
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Sinead M Sinnott
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Arielle A J Scoglio
- Institute for Health Equity and Social Justice Research, Northeastern University, Boston, Massachusetts, USA
| | - Sharon Y Lee
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Katherine E Gnall
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Carolyn Mazure
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Steven D Shirk
- Division of Addiction, VISN1 New England MIRECC, Edith Nourse Rogers Memorial Veterans Hospital and University of Massachusetts Medical School, Bedford, Massachusetts, USA
| | - Rani A Hoff
- Northeast Program Evaluation Center (NEPEC), VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Shane W Kraus
- Department of Psychology, University of Nevada, Las Vegas, Nevada, USA
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29
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Arenson M, Bernat E, De Los Reyes A, Neylan TC, Cohen BE. Social support, social network size, and suicidal ideation: A nine-year longitudinal analysis from the Mind Your Heart Study. J Psychiatr Res 2021; 135:318-324. [PMID: 33545566 DOI: 10.1016/j.jpsychires.2021.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/04/2021] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
Substantial research has investigated the impact of social support on the development and course of suicidal thoughts and behaviors. However, its measurement has been inconsistent, and different facets of social support may have differential effects on suicidal ideation (SI). The present study used data from 743 veterans recruited between 2008 and 2010 as part of the Mind Your Heart Study to investigate the relationship between two aspects of social support (social network size and perceived social support) and SI over 9 years. Using the 9th item of the PHQ-9, we created two composite scores: (1, chronicity) the proportion of years the participant endorsed SI and (2, severity) the severity of SI across the follow-up period. We found that, when modeled individually, both larger social network size and greater perceived social support predicted lower SI chronicity (β=-.16, β = -0.19 respectively; ps < .001) and lower SI severity (β=-0.15 and β = -0.19, respectively; ps < .001). However, when modeled together and controlling for PTSD and depression symptoms, increased social network size but not perceived social support predicted lower SI chronicity (β=-0.09, p = .01 and β = 0.02, p = .48, respectively) and SI severity (β=-0.07, p = .045 and β = 0.01, p = .71, respectively). These findings suggest that social network size may be an important target for intervention, and that future work is needed to better delineate the effect of different features of social support on risk for suicide.
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Affiliation(s)
- Melanie Arenson
- University of Maryland, College Park, 4094 Campus Drive, Campus Park, MD, 20742, USA; San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA, 94121, USA.
| | - Edward Bernat
- University of Maryland, College Park, 4094 Campus Drive, Campus Park, MD, 20742, USA
| | - Andres De Los Reyes
- University of Maryland, College Park, 4094 Campus Drive, Campus Park, MD, 20742, USA
| | - Thomas C Neylan
- San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA, 94121, USA; University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Beth E Cohen
- San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA, 94121, USA; University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
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McNett S, Lind MJ, Brown RC, Hawn S, Berenz EC, Brown E, McDonald SD, Pickett T, Danielson CK, Thomas S, Amstadter AB. Sleep Quality Moderates the Relationship between Anxiety Sensitivity and PTSD Symptoms in Combat-exposed Veterans. Behav Sleep Med 2021; 19:208-220. [PMID: 32063030 DOI: 10.1080/15402002.2020.1726749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective/Background: Posttraumatic stress disorder (PTSD) and related conditions (e.g., depression) are common in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) veterans. High anxiety sensitivity (AS), defined as fear of anxiety and anxiety-related consequences, is related to greater PTSD and depressive symptoms; however, few studies have identified possible modifiers of these associations. The current study examined the moderating role of sleep quality in the associations between AS and PTSD and depressive symptoms. Participants: Participants were 155 OEF/OIF/OND community veterans ages 21-40 (12.3% women). Methods: Participants completed a semi-structured clinical interview for DSM-IV PTSD symptoms (Clinician Administered PTSD Scale; CAPS) and self-report measures of anxiety sensitivity (Anxiety Sensitivity Index), sleep quality (Pittsburgh Sleep Quality Index global score; PSQI), and depressive symptoms (Beck Depression Inventory-II; BDI-II). Results: Results of hierarchical linear regression models indicated that the main effects of AS and global PSQI score were significantly associated with greater PTSD and depressive symptoms (both with sleep items removed), above and beyond the covariates of trauma load and military rank. Sleep quality moderated the relationship between AS and PTSD symptoms (but not depressive symptoms), such that greater AS was associated with greater PTSD symptoms for individuals with good sleep quality, but not poor sleep quality. Conclusions: Sleep quality and AS account for unique variance in PTSD and depressive symptoms in combat-exposed veterans. AS may be less relevant to understanding risk for PTSD among combat-exposed veterans experiencing poor sleep quality.
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Affiliation(s)
- Sage McNett
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University , Richmond, Virginia
| | - Mackenzie J Lind
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University , Richmond, Virginia
| | - Ruth C Brown
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University , Richmond, Virginia
| | - Sage Hawn
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University , Richmond, Virginia.,Department of Psychology, Virginia Commonwealth University , Richmond, Virginia
| | - Erin C Berenz
- Department of Psychology, University of Illinois at Chicago , Illinois
| | - Emily Brown
- Dornsife School of Public Health, Drexel University , Philadelphia, Pennsylvania
| | - Scott D McDonald
- Department of Psychology, Virginia Commonwealth University , Richmond, Virginia.,Hunter Holmes McGuire VA Medical Center , Richmond, Virginia.,Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University , Richmond, Virginia
| | - Treven Pickett
- Department of Psychology, Virginia Commonwealth University , Richmond, Virginia.,Hunter Holmes McGuire VA Medical Center , Richmond, Virginia.,Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University , Richmond, Virginia
| | - Carla Kmett Danielson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina , Charleston, South Carolina
| | - Suzanne Thomas
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina , Charleston, South Carolina
| | - Ananda B Amstadter
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University , Richmond, Virginia.,Department of Psychology, Virginia Commonwealth University , Richmond, Virginia
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31
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Mahoney CT, Moshier SJ, Keane TM, Marx BP. Heightened healthcare utilization & risk of mental disorders among Veterans with comorbid opioid use disorder & posttraumatic stress disorder. Addict Behav 2021; 112:106572. [PMID: 32861102 DOI: 10.1016/j.addbeh.2020.106572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/24/2020] [Accepted: 07/21/2020] [Indexed: 12/01/2022]
Abstract
Although Veterans with posttraumatic stress disorder (PTSD) are vulnerable to opioid misuse, there is limited research evaluating the psychosocial and medical sequalae experienced by Veterans with comorbid PTSD and opioid use disorder (OUD). Using data from a nationwide, longitudinal registry of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Veterans oversampled for PTSD with a 1:1 ratio of men to women, we identified Veterans with lifetime diagnoses of comorbid PTSD and OUD (n = 40), PTSD and non-opioid substance use disorder (SUD; n = 386), PTSD only (n = 901), and non-opioid SUD only (n = 52) using medical record data. We then compared these groups on Veterans Affairs emergency, urgent care, and inpatient healthcare utilization, suicide risk, functional impairment, and the presence of comorbid mental conditions in the following 1-2 years. Relative to all other groups, Veterans with comorbid OUD and PTSD had increased likelihood of emergency room and inpatient care, probable somatoform and major depressive disorders, and greater functional impairment. Both the PTSD/OUD group and PTSD/non-opioid SUD group demonstrated increased suicidality, urgent care utilization, and probable generalized anxiety disorder relative to Veterans with PTSD only or non-opioid SUD only. Results suggest that comorbid OUD and PTSD are associated with greater likelihood of negative psychiatric and healthcare related outcomes, even relative to PTSD comorbid with other types of SUDs. Findings support the importance of concentrated and sustained efforts to improve prevention and intervention strategies for Veterans struggling with PTSD symptoms and opioid misuse.
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Affiliation(s)
- Colin T Mahoney
- VA Boston Healthcare System, Boston, MA, United States; National Center for PTSD, Behavioral Science Division, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | | | - Terence M Keane
- VA Boston Healthcare System, Boston, MA, United States; National Center for PTSD, Behavioral Science Division, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Brian P Marx
- VA Boston Healthcare System, Boston, MA, United States; National Center for PTSD, Behavioral Science Division, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States.
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32
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Decker SE, Hoff R, Martino S, Mazure CM, Park CL, Porter E, Kraus SW. Is Emotion Dysregulation Associated With Suicidal Ideation in Post 9/11 Veterans? Arch Suicide Res 2021; 25:126-140. [PMID: 31556798 DOI: 10.1080/13811118.2019.1661895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Emotion dysregulation, a risk factor for suicide ideation and attempts, has not been studied in U.S. veterans of Operations Enduring and Iraqi Freedom and New Dawn (OEF/OIF/OND). Data were collected through standardized telephone interviews and computer-based surveys from 278 OEF/OIF/OND veterans (70.6% male, 29.4% female). Bivariate analyses indicated that emotion dysregulation was associated with suicidal ideation during the past-three-months (r = 0.30, p < 0.05) and lifetime suicide attempts (r = 0.21, p < 0.05). When PTSD and depression symptoms were added to a sequential logistic regression model, emotion dysregulation was no longer significantly associated with ideation or attempt. Emotion dysregulation was associated with suicidal ideation and attempt; however, current distress had greater associations. Dysregulation is one of several factors in veteran suicide risk.
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33
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Tai YM, Chang FS, Chou HY, Yang SN. Depression, posttraumatic stress, and suicidal ideation: A linkage study in Taiwanese army. TAIWANESE JOURNAL OF PSYCHIATRY 2021. [DOI: 10.4103/tpsy.tpsy_36_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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34
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Lawrence KA, Vogt D, Nigam S, Dugan AJ, Slade E, Smith BN. Temporal Sequencing of Mental Health Symptom Severity and Suicidal Ideation in Post-9/11 Men and Women Veterans Who Recently Separated from the Military. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2021; 5:24705470211061347. [PMID: 34870056 PMCID: PMC8637689 DOI: 10.1177/24705470211061347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/03/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite some evidence for gender differences in associations between military veterans' mental health and suicidal ideation (SI), gender-specific prospective studies are lacking. The aims of this prospective study were to: (1) examine gender differences in veterans' initial status and trajectories of mental health severity and SI status and (2) identify temporal sequencing of mental health predictors of SI. METHODS Surveys of 1035 US veterans were administered at 3 time-points (T1, T2, T3) over a 7-year period following military separation, with an initial assessment within 2 years of military separation. RESULTS Men reported higher baseline PTSD and alcohol misuse severity than women. No baseline gender difference in SI prevalence was detected. Baseline gender differences in mental health severity were maintained over time. For both men and women, remittance of SI was more likely from T1 to T2 than from T2 to T3 while chronic SI was more likely from T2 to T3. The strongest predictors of T3 SI were prior SI followed by alcohol misuse, depression, and PTSD severity with stronger effects for T2 predictors than T1. CONCLUSION The maintenance of baseline gender differences throughout trajectories of mental health predictors of SI supports the need for ongoing gender-specific mental health services. Current governmental interorganizational efforts are focused on suicide prevention during the first year after military service completion. Our findings indicate a need to extend mental health screening and treatment beyond the early post-military period to reduce risk and recurrence of SI for both men and women.
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Affiliation(s)
| | - Dawne Vogt
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Boston University School of
Medicine, Boston, MA, USA
| | | | | | | | - Brian N. Smith
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Boston University School of
Medicine, Boston, MA, USA
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35
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Latour C, O'Byrne L, McCarthy M, Chacko R, Russell E, Price RK. Improving mental health in U.S. Veterans using mHealth tools: A pilot study. Health Informatics J 2020; 26:3201-3214. [PMID: 32972313 PMCID: PMC8112186 DOI: 10.1177/1460458220954613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Rates of PTSD remain elevated among U.S. Veterans, highlighting a need for innovative management tools. Previous studies have shown mobile apps to have positive effects on PTSD symptoms, but few apps have been examined systematically. This pilot study evaluated the perceived effectiveness and usability of Mindset, a novel mobile app that monitors user stress level via heart rate to encourage e-therapy use. The study sample included 30 community-residing Veterans who completed baseline assessments. They used the Mindset app and associated smartwatch until their approximate 1-month follow-up. Self-reported assessments included pre- and post-deployment experiences; experience with Mindset; and standard screeners for PTSD (PCL-M), anxiety (GAD-7), depression (PHQ-9), and alcohol use problems (AUDIT). Among the 24 participants who completed follow-up interviews, a significant decrease (p < 0.05) was found in PCL-M, PHQ-9, and modified AUDIT scores. Respondents reported moderate to high acceptance and satisfaction with Mindset features, though considerable frustration with the associated smartwatch. These findings highlight mHealth apps such as Mindset as potentially useful tools for PTSD and depression symptom management. These findings are also encouraging in the context of the current COVID-19 pandemic, which may accelerate further innovation and implementation of mHealth technologies to improve mental health self-care.
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Affiliation(s)
- Chase Latour
- Washington University in St. Louis, USA
- University of North Carolina at Chapel Hill
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Adapting Cognitive Processing Therapy for PTSD for People With Disabilities: A Case Study With a U.S. Veteran. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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37
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Fisher LB, Bomyea J, Thomas G, Cheung JC, He F, Jain S, Flashman LA, Andaluz N, Coimbra R, George MS, Grant GA, Marx CE, McAllister TW, Shutter L, Lang AJ, Stein MB, Zafonte RD. Contributions of posttraumatic stress disorder (PTSD) and mild TBI (mTBI) history to suicidality in the INTRuST consortium. Brain Inj 2020; 34:1339-1349. [PMID: 32811203 DOI: 10.1080/02699052.2020.1807054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Mild TBI (mTBI) and posttraumatic stress disorder (PTSD) are independent risk factors for suicidal behaviour (SB). Further, co-occurring mTBI and PTSD increase one's risk for negative health and psychiatric outcomes. However, little research has examined the role of comorbid mTBI and PTSD on suicide risk. METHODS The present study utilized data from the Injury and TRaUmatic STress (INTRuST) Consortium to examine the prevalence of suicidal ideation (SI) and behaviours among four groups: 1) comorbid mTBI+PTSD, 2) PTSD only, 3) mTBI only, and 4) healthy controls. RESULTS Prevalence of lifetime SI, current SI, and lifetime SB for individuals with mTBI+PTSD was 40%, 25%, and 19%, respectively. Prevalence of lifetime SI, current SI, and lifetime SB for individuals with PTSD only was 29%, 11%, and 11%, respectively. Prevalence of lifetime SI, current SI, and lifetime SB for individuals with mTBI only was 14%, 1%, and 2%, respectively. Group comparisons showed that individuals with mTBI alone experienced elevated rates of lifetime SI compared to healthy controls. History of mTBI did not add significantly to risk for suicidal ideation and behaviour beyond what is accounted for by PTSD. CONCLUSION Findings suggest that PTSD seems to be driving risk for suicidal behaviour.
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Affiliation(s)
- Lauren B Fisher
- Department of Psychiatry, Harvard Medical School , Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital , Boston, Massachusetts, USA
| | - Jessica Bomyea
- VA San Diego Center of Excellence for Stress and Mental Health , San Diego, California, USA.,Department of Psychiatry, University of California San Diego , La Jolla, California, USA
| | - Garrett Thomas
- Department of Psychiatry, Massachusetts General Hospital , Boston, Massachusetts, USA
| | - Joey C Cheung
- Department of Psychiatry, Massachusetts General Hospital , Boston, Massachusetts, USA
| | - Feng He
- Biostatistics Research Center, Department of Family Medicine and Public Health, University of California San Diego , La Jolla, California, USA
| | - Sonia Jain
- Biostatistics Research Center, Department of Family Medicine and Public Health, University of California San Diego , La Jolla, California, USA
| | - Laura A Flashman
- Dartmouth-Hitchcock Medical Center, Department of Psychiatry, Dartmouth Geisel School of Medicine at Dartmouth , Hanover, New Hampshire, USA
| | - Norberto Andaluz
- Department of Neurological Surgery, University of Louisville , Louisville, Kentucky, USA
| | - Raul Coimbra
- Department of Surgery, Riverside University Health System , Moreno Valley, California, USA
| | - Mark S George
- Psychiatry Division, Ralph H. Johnson VA Medical Center , Charleston, South Carolina, USA.,Department of Psychiatry and Behavioral Sciences, The Medical University of South Carolina , Charleston, South Carolina, USA
| | - Gerald A Grant
- Department of Neurology and Neurosciences, Stanford University Medical Center , Stanford, California, USA
| | - Christine E Marx
- Durham VA Medical Center , Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Duke University , Durham, North Carolina, USA
| | - Thomas W McAllister
- Dartmouth-Hitchcock Medical Center, Department of Psychiatry, Dartmouth Geisel School of Medicine at Dartmouth , Hanover, New Hampshire, USA.,Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana, USA
| | - Lori Shutter
- Department of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh , Pittsburgh, Pennsylvania, USA
| | - Ariel J Lang
- VA San Diego Center of Excellence for Stress and Mental Health , San Diego, California, USA.,Department of Psychiatry, University of California San Diego , La Jolla, California, USA.,Department of Family Medicine and Public Health, University of California San Diego , La Jolla, California, USA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego , La Jolla, California, USA.,Department of Family Medicine and Public Health, University of California San Diego , La Jolla, California, USA
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Brigham and Women's Hospital, Massachusetts General Hospital, and Harvard Medical School , Boston, Massachusetts, USA.,Massachusetts General Hospital for Children Sports Concussion Program , Boston, Massachusetts, USA.,MGH Red Sox Foundation Home Base Program , Boston, Massachusetts, USA
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Kwon A, Min D, Kim Y, Jin MJ, Lee SH. Interaction between catechol-O-methyltransferase polymorphism and childhood trauma in suicidal ideation of patients with post-traumatic stress disorder. Brain Behav 2020; 10:e01733. [PMID: 32618128 PMCID: PMC7428489 DOI: 10.1002/brb3.1733] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/16/2019] [Accepted: 06/06/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Suicidal behavior of post-traumatic stress disorder (PTSD) patients is influenced by genetic and environmental factors. The catechol-O-methyltransferase (COMT) gene has been known to be associated with suicidal ideation. The present study aimed to explore the relationship of COMT polymorphism, childhood trauma, and suicidal ideation in patients with PTSD. METHODS Fifty patients with PTSD and 62 healthy controls (HCs) were recruited, and COMT variants rs4680 and rs4633 were genotyped through peripheral blood. Psychological assessments such as the childhood trauma questionnaire (CTQ), the scale for suicidal ideation, the clinician-administered PTSD scale for DSM-5, and a PTSD checklist were administered. A regression analysis, the Johnson-Neyman technique, and a two-way analysis of covariance were conducted. RESULTS Interaction of COMT polymorphism (rs4680, rs4633) and childhood emotional abuse (subscale of CTQ) predicted suicidal ideation in patients with PTSD. Patients with the rs4680 Val/Val genotype, compared to Met carriers genotype, showed higher suicidal ideation when childhood emotional abuse was high. Patients with the rs4633 CC genotype, compared to T carriers genotype, showed higher suicidal ideation when childhood emotional abuse was high. CONCLUSION Our results suggest that vulnerability to suicide could be increased in the Val/Val genotype of COMT rs4680 and the CC genotype of rs4633 in patients with PTSD. Moreover, PTSD group with high childhood emotional abuse demonstrated a significantly higher suicidal ideation than did those with low childhood emotional abuse.
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Affiliation(s)
- Aeran Kwon
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Korea
| | - Dongil Min
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Korea
| | - Yourim Kim
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Korea
| | - Min Jin Jin
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Korea
| | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Korea.,Department of Psychiatry, Inje University, Ilsan Paik Hospital, Goyang, Korea
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Khalifian CE, Knopp K, Wilks CR, Wooldridge J, Sohn MJ, Thomas D, Morland LA. The Association Between Sexual Functioning and Suicide Risk in U.S. Military Veteran Couples Seeking Treatment for Post-Traumatic Stress Disorder. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1601-1613. [PMID: 31915971 DOI: 10.1007/s10508-019-01577-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/07/2019] [Accepted: 10/28/2019] [Indexed: 06/10/2023]
Abstract
Intimate relationship distress has been identified as one of the most common precipitants of suicidal thoughts for U.S. military populations. Sexual functioning is associated with relationship distress and has recently been identified as a predictor of suicidal ideation with female military personnel; however, no studies have examined this association among a treatment-seeking sample of male and female veterans and their partners. Couples (N = 138) completed baseline assessments of sexual functioning, relationship functioning, suicidal ideation, and mental health prior to evaluation for engagement in a couples-based PTSD treatment study. Analyses revealed that decreased sexual pleasure and decreased frequency of sexual intercourse were associated with more recent suicidal ideation for male veterans, whereas increased sexual frequency was marginally associated with increased suicidal ideation for female veterans, controlling for PTSD and depression symptoms, relationship satisfaction, and medications. These findings stress the importance of assessing sexual functioning as a risk factor for suicide and taking into consideration the possibility that sexual functioning may be protective or predictive of suicidality depending on the person and context.
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Affiliation(s)
- Chandra E Khalifian
- Veterans Affairs Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
| | - Kayla Knopp
- Veterans Affairs Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
- Department of Psychology, University of Denver, Denver, CO, USA
| | - Chelsey R Wilks
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Jennalee Wooldridge
- Veterans Affairs Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Min Ji Sohn
- Veterans Affairs Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
| | - Derek Thomas
- Veterans Affairs Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Leslie A Morland
- Veterans Affairs Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- National Center for PTSD -Pacific Islands Division, Honolulu, HI, USA
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Jung YE, Kim MD. Prevalence and correlates of comorbid PTSD with depression among older people exposed to the Jeju April 3 incident. J Affect Disord 2020; 272:8-14. [PMID: 32379624 DOI: 10.1016/j.jad.2020.03.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 01/21/2020] [Accepted: 03/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The psychological consequences of the Jeju April 3 incident, which occurred almost 70 years ago, may be long-lasting. Thus, the present study investigated the prevalence and impact of comorbid post-traumatic stress disorder (PTSD) and depression among older people exposed to this incident. METHODS A total of 110 survivors and 1,011 immediate family members of the victims of the Jeju April 3 incident completed a questionnaire that collected demographic information, the Center for Epidemiologic Studies Depression Scale (CES-D), and the PTSD Checklist-Civilian Version (PCL-C). Comorbidity was defined as a combination of CES-D positivity and PCL-C positivity. To identify trends among clinical characteristics according to the severity of the comorbid PTSD and depression condition, linear-by-linear association tests were conducted. RESULTS Of the 1,121 older people included in the present study, 10.8% met the criteria for comorbid PTSD and depression, 3.0% had PTSD only, and 24.3% had depression only. Additionally, as the severity of the comorbid condition increased, there were trends for lower levels of socioeconomic status and perceived family support and higher suicidality. Compared to either disorder alone, individuals with the comorbid condition were 2.04 times more likely to have a higher suicidal risk. LIMITATIONS Standardized diagnostic tools for assessing the case findings were not employed in the present study. CONCLUSION Comorbid PTSD and depression was prevalent among older people exposed to the Jeju April 3 incident. Additionally, this comorbid condition was related to a serious clinical phenomenology, including a higher suicidal risk.
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Affiliation(s)
- Young-Eun Jung
- Department of Psychiatry, School of Medicine, Jeju National University, Jeju, South Korea
| | - Moon-Doo Kim
- Department of Psychiatry, School of Medicine, Jeju National University, Jeju, South Korea.
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Hausman C, Meffert BN, Mosich MK, Heinz AJ. Impulsivity and Cognitive Flexibility as Neuropsychological Markers for Suicidality: A Multi-Modal Investigation Among Military Veterans with Alcohol Use Disorder and PTSD. Arch Suicide Res 2020; 24:313-326. [PMID: 31248349 PMCID: PMC6954988 DOI: 10.1080/13811118.2019.1635930] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To examine relations between self-report and behavioral measures of impulsivity and cognitive flexibility with suicidal ideation and self-harm and suicide attempt history. Methods: Eighty-seven military veterans who met DSM-5 diagnostic criteria for alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) were evaluated for current suicidal ideation and self-harm, suicide attempt history, impulsivity, and cognitive flexibility. Results: Higher levels of self-reported impulsivity were associated with greater suicidal ideation and self-harm and lower behavioral inhibition was associated with greater likelihood of endorsing a suicide attempt. Conclusion: Use of multi-modal assessment of impulsivity and cognitive flexibility may aid in suicide screening and intervention among vulnerable and high-risk populations.
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Brown LA, Chen S, Narine K, Contractor AA, Oslin D. DSM-5 PTSD symptom clusters and suicidal ideation in veterans. Psychiatry Res 2020; 288:112942. [PMID: 32315877 DOI: 10.1016/j.psychres.2020.112942] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/16/2020] [Accepted: 03/23/2020] [Indexed: 12/23/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with significantly greater risk for suicidal ideation (SI). In civilians, the negative alterations in cognitions and mood (NACM) and alterations in arousal and reactivity (AAR) clusters are most strongly associated with SI. This study sought to examine the association between PTSD symptom clusters and SI in a large sample of veterans. Veterans (n = 1,789) completed the PTSD Checklist for DSM-5 and the Patient Health Questionnaire (PHQ) during primary care visits. Wald chi-square tests of parameter constraints were computed to test hypothesized relations between PTSD factors and the PHQ-9 suicidal ideation item. Each of the PTSD symptom clusters were significantly associated with SI. The NACM cluster was more strongly associated with SI than AAR and marginally more strongly associated with SI than the avoidance symptom clusters. In a restricted sample of only veterans with PTSD, NACM remained more strongly associated with SI than avoidance. Each of the NACM symptoms were significantly associated with SI. Changes in cognitions and mood were most strongly associated with SI in this large sample of veterans. These findings suggest that directly targeting the NACM symptom cluster may be an important goal for suicide prevention efforts among veterans with PTSD.
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Affiliation(s)
- Lily A Brown
- University of Pennsylvania, Department of Psychiatry, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA.
| | - Shirley Chen
- Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center and Center of Excellence for Substance Abuse Treatment and Evaluation Corporal Michael J. Crescenz VA Medical Center, 21 S University Ave, Philadelphia, PA 19104, Philadelphia, PA, USA
| | - Kevin Narine
- University of Pennsylvania, Department of Psychiatry, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA
| | - Ateka A Contractor
- University of North Texas, 1155 Union Cir, Denton, TX 76203, Denton, TX, USA
| | - David Oslin
- University of Pennsylvania, Department of Psychiatry, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA; Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center and Center of Excellence for Substance Abuse Treatment and Evaluation Corporal Michael J. Crescenz VA Medical Center, 21 S University Ave, Philadelphia, PA 19104, Philadelphia, PA, USA
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Ingram PB, Tarescavage AM, Ben-Porath YS, Oehlert ME. Comparing MMPI-2-Restructured Form Scores by Service Era for Veterans Assessed Within the Veteran Affairs Healthcare System. J Clin Psychol Med Settings 2020; 27:366-375. [PMID: 31471846 PMCID: PMC7223335 DOI: 10.1007/s10880-019-09650-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study compares profiles of Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) scale scores from 1492 VA test-takers who served during the Vietnam or Gulf War service eras. The sample includes all such cases collected at any VA posttraumatic stress disorder Clinical Teams across the United States between January 1, 2008 and May 31, 2015 using the MMPI-2 or MMPI-2-RF (via the VA Mental Health Assistant suite). Associations between gender and score differences were also examined. In contrast to past research using the MMPI-2, results of this study suggest that veterans are generally homogeneous in their MMPI-2-RF profiles across different periods of service. Specifically, the magnitudes of mean differences are small and not clinically significant. Thus, responses on the MMPI-2-RF do not appear influenced by service era. Implications for the clinical use of, and research with, the MMPI-2-RF are discussed within the VA healthcare system.
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Affiliation(s)
- Paul B Ingram
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA.
- Dwight D. Eisenhower VAMC, Eastern Kansas Veteran Healthcare System, Leavenworth, KS, USA.
| | | | | | - Mary E Oehlert
- Dwight D. Eisenhower VAMC, Eastern Kansas Veteran Healthcare System, Leavenworth, KS, USA
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Dillon KH, Van Voorhees EE, Dennis PA, Glenn JJ, Wilks CR, Morland LA, Beckham JC, Elbogen EB. Anger mediates the relationship between posttraumatic stress disorder and suicidal ideation in veterans. J Affect Disord 2020; 269:117-124. [PMID: 32250864 PMCID: PMC7234813 DOI: 10.1016/j.jad.2020.03.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 01/17/2020] [Accepted: 03/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Theoretical models and cross-sectional empirical studies of suicide indicate that anger is a factor that may help explain the association between posttraumatic stress disorder (PTSD) and suicide, but to date no longitudinal studies have examined this relationship. The current study used longitudinal data to examine whether changes in anger mediated the association between changes in PTSD symptomatology and suicidal ideation (SI). METHODS Post 9/11-era veterans (N = 298) were assessed at baseline, 6-months, and 12-month time points on PTSD symptoms, anger, and SI. Analyses covaried for age, sex, and depressive symptoms. Multilevel structural equation modeling was used to examine the three waves of data. RESULTS The effect of change in PTSD symptoms on SI was reduced from B = 0.02 (p = .008) to B = -0.01 (p = .67) when change in anger was added to the model. Moreover, the indirect effect of changes in PTSD symptoms on suicidal ideation via changes in anger was significant, B = 0.02, p = .034. The model explained 31.1% of the within-person variance in SI. LIMITATIONS Focus on predicting SI rather than suicidal behavior. Sample was primarily male. CONCLUSIONS Findings suggest that the association between PTSD and SI is accounted for, in part, by anger. This study further highlights the importance of anger as a risk factor for veteran suicide. Additional research on clinical interventions to reduce anger among veterans with PTSD may be useful in reducing suicide risk.
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Affiliation(s)
- Kirsten H Dillon
- Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, United States.
| | - Elizabeth E Van Voorhees
- Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, United States; Duke University Medical Center, Durham, NC, United States
| | - Paul A Dennis
- Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, United States; Duke University Medical Center, Durham, NC, United States
| | - Jeffrey J Glenn
- Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, United States
| | | | - Leslie A Morland
- University of California, San Diego, La Jolla, CA, United States; National Center for PTSD, Pacific Islands Division, Honolulu, HI, United States
| | - Jean C Beckham
- Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, United States; Duke University Medical Center, Durham, NC, United States
| | - Eric B Elbogen
- Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, United States; Duke University Medical Center, Durham, NC, United States
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Abstract
OBJECTIVES Examine the effect of different types of firearms on readmission due to acute stress disorder (ASD) and/or post-traumatic stress disorder (PTSD) in firearm-injury victims. BACKGROUND Survivors of firearm-related injuries suffer long-term sequelae such as disability, work loss, and deterioration in the quality of life. There is a paucity of data describing the long-term mental health outcomes in these patients. METHODS We performed a 5-year (2011-2015) analysis of the Nationwide Readmission Database. All adult patients with firearm injuries were stratified into 3 groups by firearm type: handgun, shotgun, and semiautomatic rifle. Outcome measures were the incidence and predictors of ASD/PTSD. RESULTS A total of 100,704 victims of firearm-related injuries were identified, of which 13.3% (n = 13,393) were readmitted within 6 months of index hospitalization, 6.7% (n = 8970) of these due to ASD/PTSD. Mean age was 34 ± 14 years, 88% were men. Of those readmitted due to ASD/PTSD, 24% (n = 2153) sustained a handgun-related injury on index hospitalization, 12% (n = 1076) shotgun, and 64% (n = 5741) semiautomatic gun (P = 0.039). On regression analysis, semiautomatic gun and shotgun victims had higher odds of developing ASD/PTSD upon readmission [odds ratio (OR): 2.05 (1.10-4.12) and OR: 1.41 (1.08-2.11)] compared to handgun. Female sex [OR: 1.79 (1.05-3.05)] and younger age representing those younger than 25 years [OR: 4.66 (1.12-6.74)] were also independently associated with higher odds of ASD/PTSD. CONCLUSIONS Apart from the lives lost, survivors of semiautomatic rifle- and shotgun-related injuries suffer long-term mental health sequalae. These secondary and debilitating mental health outcomes are important considerations for capturing the overall burden of the disease.
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Smith NB, Sippel LM, Rozek DC, Spangler PT, Traber D, Straud C, Hoff R, Harpaz-Rotem I. Courses of suicidal ideation among military veterans in residential treatment for posttraumatic stress disorder. Depress Anxiety 2020; 37:273-284. [PMID: 31951318 PMCID: PMC7054126 DOI: 10.1002/da.22993] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 12/06/2019] [Accepted: 12/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicidal thoughts are common among veterans with posttraumatic stress disorder (PTSD). The aim of this study was to examine the prevalence and correlates of four courses of suicidal (SI) among veterans receiving residential PTSD treatment. METHODS A total of 1,807 veterans receiving residential PTSD treatment at Department of Veterans Affairs medical facilities who completed self-report measures at admission and discharge were included. RESULTS The prevalence of SI courses were No SI (33.6%), Remitted SI (23.0%), SI onset (6.0%), and Chronic SI (37.4%). There were group differences between the four SI courses in PTSD symptoms at baseline, magnitude of PTSD symptom change during treatment, race/ethnicity and baseline depression, substance use, physical functioning, and pain. Chronic SI was associated with highest baseline PTSD, depression, substance use, pain and worse physical functioning. Remitted SI course was associated with greatest pre-posttreatment PTSD improvement, followed by No SI, Chronic SI, and SI Onset. Multinomial logistic regressions revealed that PTSD symptom improvement and baseline PTSD symptoms most consistently related to symptomatic SI courses compared to less symptomatic or No SI courses. Receipt of trauma-focused psychotherapy (none, some, or adequate) and length of stay were not related to SI courses and did not differ between groups. CONCLUSIONS Findings indicate that treating PTSD symptoms could be impactful for reducing suicidal thoughts. Although many veterans had remitted or reduced severity of SI at discharge, a significant proportion of veterans reported SI at discharge (43.4%), potentially highlighting the need for suicide specific treatment interventions within the context of PTSD treatment.
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Affiliation(s)
- Noelle B. Smith
- VA Northeast Program Evaluation Center, West Haven, CT, USA
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Lauren M. Sippel
- National Center for PTSD Executive Division, White River Junction, VT, USA
- Geisel School of Medicine at Dartmouth, Department of Psychiatry, Hanover, NH, USA
| | - David C. Rozek
- UCF RESTORES & Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Patricia T. Spangler
- Center for the Study of Traumatic Stress, Uniformed Service University, Bethesda, MD, USA
| | - Delphine Traber
- Université Grenoble Alpes, Université Savoie Mont Blanc, LIP/PC2S, Grenoble, France
| | - Casey Straud
- University of Texas Health Science Center San Antonio, Department of Psychiatry, San Antonio, TX, USA
| | - Rani Hoff
- VA Northeast Program Evaluation Center, West Haven, CT, USA
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ilan Harpaz-Rotem
- VA Northeast Program Evaluation Center, West Haven, CT, USA
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
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47
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Ge F, Yuan M, Li Y, Zhang W. Posttraumatic Stress Disorder and Alterations in Resting Heart Rate Variability: A Systematic Review and Meta-Analysis. Psychiatry Investig 2020; 17:9-20. [PMID: 31995968 PMCID: PMC6992856 DOI: 10.30773/pi.2019.0112] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 10/14/2019] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE The functions of both the central and peripheral autonomic nervous system, indexed by heart rate variability (HRV), are affected by psychology and physiology. This review summarizes the results of studies comparing the evaluation of HRV parameters between individuals with posttraumatic stress disorder (PTSD) and healthy controls. METHODS Eligible studies (n=499) were identified through literature searches of the EMBASE, Medline, PubMed and Web of Science databases. Nineteen studies met our inclusion criteria. A random effects model was used, and standardized mean differences for highfrequency HRV(HF-HRV), low-frequency HRV(LF-HRV) and the root mean square of successive R-R interval differences (RMSSD) were calculated. RESULTS Significant effects were found for HF-HRV [p<0.0001, Z=4.18; Hedges'g=-1.58, 95% confidence interval (CI) (-2.32, -0.84); k=14] and RMSSD [p<0.00001, Z=4.80; Hedges'g=-1.96, 95% CI (-2.76, -1.16); k=9] relative to healthy controls. Considerable heterogeneity was revealed, but the main effects for HF-HRV and RMSSD were robust in subsequent meta-regression and subgroup analyses. CONCLUSION Given the relationships among low vagal state, inflammation, and alterations in brain structure and function, including executive function and emotion regulation, reduced HRV may be regarded as an endophenotype in PTSD research.
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Affiliation(s)
- Fenfen Ge
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China
| | - Minlan Yuan
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China
| | - Ying Li
- Embedded System and Intelligent Computing Laboratory, University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Zhang
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China
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48
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Zhang J, Xue R, Li YF, Zhang YZ, Wei HW. Anxiolytic-like effects of treadmill exercise on an animal model of post-traumatic stress disorder and its mechanism. J Sports Med Phys Fitness 2020; 60:172-179. [DOI: 10.23736/s0022-4707.20.10120-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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49
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Weber FC, Norra C, Wetter TC. Sleep Disturbances and Suicidality in Posttraumatic Stress Disorder: An Overview of the Literature. Front Psychiatry 2020; 11:167. [PMID: 32210854 PMCID: PMC7076084 DOI: 10.3389/fpsyt.2020.00167] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/21/2020] [Indexed: 12/11/2022] Open
Abstract
A causal relationship between sleep disturbances and suicidal behavior has been previously reported. Insomnia and nightmares are considered as hallmarks of posttraumatic stress disorder (PTSD). In addition, patients with PTSD have an increased risk for suicidality. The present article gives an overview about the existing literature on the relationship between sleep disturbances and suicidality in the context of PTSD. It aims to demonstrate that diagnosing and treating sleep problems as still underestimated target symptoms may provide preventive strategies with respect to suicidality. However, heterogeneous study designs, different samples and diverse outcome parameters hinder a direct comparison of studies and a causal relationship cannot be shown. More research is necessary to clarify this complex relationship and to tackle the value of treatment of sleep disturbances for suicide prevention in PTSD.
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Affiliation(s)
- Franziska C Weber
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Christine Norra
- LWL Hospital Paderborn, Psychiatry-Psychotherapy-Psychosomatics, Ruhr University of Bochum, Bochum, Germany
| | - Thomas C Wetter
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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50
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Tsegay A, Damte A, Kiros A. Determinants of suicidal ideation among patients with mental disorders visiting psychiatry outpatient unit in Mekelle town, psychiatric clinics, Tigray, Northern Ethiopia: a case-control study. Ann Gen Psychiatry 2020; 19:20. [PMID: 32190099 PMCID: PMC7066829 DOI: 10.1186/s12991-020-00270-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/23/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Globally, more than 450 million people suffer from a mental or behavioral disorder. Psychiatric disorder and its duration, physical illness, family history of mental illness, previous suicidal attempt, unemployment, poor social support, and psychotic symptoms are of the main reasons enabling patients to be suicidal ideates. The purpose of this study is to identify the determinants of suicidal ideation among patients with mental disorders in Mekelle, Ethiopia. METHODS Case-control study design was employed with a total of 221 study subjects (74 cases and 147 controls) in Mekelle, Ethiopia. Suicidal ideation was measured by the Suicidal Behavior Questionnaire-Revised (SBQ-R) scale. Bivariate and multiple logistic regression analyses were performed to determine between the independent and dependent variables. RESULTS This study revealed that family suicide history (AOR = 6.87, 95% CI [1.138-41.531, P = 0.036), previous attempts history (AOR = 27.457, 95% CI 10.417-72.368, P = 0.0001), family mental illness history (AOR = 3.029, 95% CI 1.088-8.431, P = 0.034), major depressive disorders (AOR = 11.182, 95% CI 2.382-52.501, P = 0.002), and psychiatric comorbid disorders (AOR = 12.245, 95% CI 1.898-78.986, P = 0.008) were significant factors of suicidal ideation. CONCLUSION Family mental illness history, family suicide history, previous suicide attempt history, major depressive disorders, and psychiatric comorbid disorders were significant factors of suicidal ideation.
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Affiliation(s)
- Abreha Tsegay
- Department of Psychiatric Nursing, School of Nursing, College of Health Sciences, Mekelle University, Mekelle, Tigray Ethiopia
| | - Ashenafi Damte
- Department of Psychiatric Nursing, School of Nursing, College of Health Sciences, Mekelle University, Mekelle, Tigray Ethiopia
| | - Adam Kiros
- Department of Psychiatric Nursing, School of Nursing, College of Health Sciences, Mekelle University, Mekelle, Tigray Ethiopia
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