1
|
Argyriou E, Gros D, Hernandez Tejada MA, Muzzy WA, Acierno R. A machine learning personalized treatment rule to optimize assignment to psychotherapies for grief among veterans. J Affect Disord 2024; 358:466-473. [PMID: 38718947 DOI: 10.1016/j.jad.2024.05.028] [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: 02/14/2024] [Revised: 04/03/2024] [Accepted: 05/02/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Complex grief patterns are associated with significant suffering, functional impairments, health and mental health problems, and increased healthcare use. This burden may be even more pronounced among veterans. Behavioral Activation and Therapeutic Exposure (BATE-G) and Cognitive Therapy for Grief (CT-G) are two evidence-based interventions for grief. The goal of this study was to use a precision medicine approach to develop a personalized treatment rule to optimize assignment among these psychotherapies. METHODS We analyzed data (N = 155) from a randomized clinical trial comparing BATE-G and CT-G. Outcome weighted learning was used to estimate an optimal personalized treatment rule. Baseline characteristics including demographics, social support, variables related to the death, and psychopathology dimensions were used as prescriptive factors of treatment assignment. RESULTS The estimated rule assigned 72 veterans to CT-G and 56 to BATE-G. Assigning participants according to this rule was estimated to lead to markedly lower mean grief level following 6 months from treatment compared to assigning everyone to either BATE-G (Vdopt - VBATE-G = -18.57 [95 % CI: -29.41, -7.72]) or CT-G (Vdopt - VBATE-G = -20.89 [95 % CI: -30.7, -11.07]) regardless of their characteristics. LIMITATIONS Participants were primarily male veterans, and identified with Black or White race. The estimated rule was not externally validated. CONCLUSION The estimated rule used relatively simple, easily accessible, client characteristics to personalize assignment to treatment using a precision medicine approach based on machine learning and causal inference. Upon further validation, such a rule can be easily implemented in clinical practice to prescriptively maximize treatment benefits.
Collapse
Affiliation(s)
- Evangelia Argyriou
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, United States; Department of Psychology, Indiana University Indianapolis, United States
| | - Daniel Gros
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, United States; Mental Health Service, Ralph H. Johnson VA Healthcare System, United States.
| | - Melba A Hernandez Tejada
- Faillace Department of Psychiatry, University of Texas Health Science Center at Houston, United States
| | - Wendy A Muzzy
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, United States; Mental Health Service, Ralph H. Johnson VA Healthcare System, United States
| | - Ronald Acierno
- Faillace Department of Psychiatry, University of Texas Health Science Center at Houston, United States
| |
Collapse
|
2
|
Fernandez A, Askenazy F, Zeghari R, Auby P, Robert P, Thümmler S, Gindt M. Somatic and Posttraumatic Stress Symptoms in Children and Adolescents in France. JAMA Netw Open 2024; 7:e247193. [PMID: 38635269 DOI: 10.1001/jamanetworkopen.2024.7193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Importance Somatic symptoms are a major concern among the pediatric population because of frequency and burden. The association between adverse childhood experiences and somatic symptoms in adults is well established but less is known concerning somatic symptoms in young people. Objective To explore the frequency and intensity of somatic symptoms in children and adolescents exposed to traumatic events. Design, Setting, and Participants This cross-sectional study was conducted from January 1 to December 31, 2021, at the Nice Pediatric Psychotrauma Referral Center in Nice, France. Participants included pediatric outpatients, aged 7 to 17 years, who were referred to the center. Statistical analysis was performed in January 2022. Exposure All participants experienced at least 1 traumatic event during life. Main Outcome and Measure Somatic and posttraumatic stress symptoms were assessed using the Patient Health Questionnaire-13 (PHQ-13) and Child PTSD Checklist (CPC). Posttraumatic stress disorder (PTSD) and non-PTSD groups were defined based on CPC symptoms severity score. In the hypothesized association between somatic symptoms and posttraumatic stress symptoms (PTSS), PTSD and non-PTSD groups were compared, correlations between PTSS and severity of CPC were analyzed, and a regression model was performed. Results There were 363 participants included (mean [SD] age, 13.58 [0.25] years; 174 [47.9%] female, 189 [52.1%] male). Compared with the non-PTSD group, the PTSD group presented with a higher mean (SD) number of somatic symptoms (7.0 [2.5] vs 4.0 [2.5] symptoms; t360 = 11.7; P < .001), and higher mean (SD) intensity (10.4 [4.6] vs 4.8 [3.7] points; t360 = 12.6; P < .001). Most of the explored somatic symptoms positively correlated with the intensity of PTSS and their functional alterations (eg, PTSS intensity correlated with stomach pain symptoms [r = .30; P < .001]; and with headaches symptoms [r = .44; P < .001]). In the regression model, the combination of migraines, palpitation, nausea, tiredness, and sleep disorders explained 6.5% of the variance in the PTSD group. (F1,341 = 22.651; P < .001). Conclusions and Relevance In this cross-sectional study, somatic symptoms were positively correlated with PTSS both in frequency and intensity among youths. These results suggest that the systematic screening for somatic symptoms in youths with traumatic exposure should be a routine evaluation procedure.
Collapse
Affiliation(s)
- Arnaud Fernandez
- Nice Pediatric Psychotrauma Center, University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France
- CoBTek, Université Côte d'Azur, Nice, France
- Centre Régional du Psychotraumatisme PACA, Nice, France
| | - Florence Askenazy
- Nice Pediatric Psychotrauma Center, University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France
- CoBTek, Université Côte d'Azur, Nice, France
- Centre Régional du Psychotraumatisme PACA, Nice, France
| | - Radia Zeghari
- Nice Pediatric Psychotrauma Center, University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France
- CoBTek, Université Côte d'Azur, Nice, France
| | - Philippe Auby
- Nice Pediatric Psychotrauma Center, University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France
- CoBTek, Université Côte d'Azur, Nice, France
| | - Philippe Robert
- Nice Pediatric Psychotrauma Center, University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France
- CoBTek, Université Côte d'Azur, Nice, France
| | - Susanne Thümmler
- Nice Pediatric Psychotrauma Center, University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France
- CoBTek, Université Côte d'Azur, Nice, France
| | - Morgane Gindt
- Nice Pediatric Psychotrauma Center, University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France
- CoBTek, Université Côte d'Azur, Nice, France
- Centre Régional du Psychotraumatisme PACA, Nice, France
| |
Collapse
|
3
|
Caycho-Rodríguez T, Lee SA, Vilca LW, Lobos-Rivera ME, Flores-Monterrosa AN, Tejada Rodríguez JC, Chacón-Andrade ER, Marroquín-Carpio WC, Carbajal-León C, Reyes-Bossio M, Delgado-Campusano M, Torales J. A Psychometric Analysis of the Spanish Version of the Grief Impairment Scale: A Screening Tool of Biopsychosocial Grief-Related Functional Impairment in a Salvadoran Sample. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231175383. [PMID: 37154932 DOI: 10.1177/00302228231175383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The objective of this study was to translate and psychometrically evaluate a Spanish version of the Grief Impairment Scale (GIS) using a sample of bereaved adults from El Salvador (N = 579). The results confirm the unidimensional structure of the GIS, and solid reliability, item characteristics, and criterion-related validity, where the GIS scale significantly and positively predicts depression. However, this instrument only showed evidence of configural and metric invariance between different sex groups. Overall, these results support the Spanish version of the GIS as a psychometrically sound screening tool for health professionals and researchers to use in their clinical work.
Collapse
Affiliation(s)
| | | | - Lindsey W Vilca
- South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima, Peru
| | | | | | | | | | | | - Carlos Carbajal-León
- South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima, Peru
| | | | | | - Julio Torales
- Universidad Nacional de Asunción, San Lorenzo, Paraguay
| |
Collapse
|
4
|
Lee SA, Neimeyer RA. Grief Impairment Scale: A biopsychosocial measure of grief-related functional impairment. DEATH STUDIES 2022; 47:519-530. [PMID: 36006100 DOI: 10.1080/07481187.2022.2113605] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Though most mourners are resilient, a minority of the bereaved experience disabling grief accompanied by clinically significant impairment in important areas of functioning. Although impairment measures exist, they have notable limitations in the context of bereavement. Therefore, the objective of this study was to develop and evaluate the Grief Impairment Scale (GIS), which was designed to identify the impact of grief on biopsychosocial functioning. The resulting 5-item scale, which was based on 363 adults who are struggling with grief, demonstrated solid reliability, factorial validity, and convergent and divergent validity with correlations with measures of impairment, prolonged grief, and psychological distress. The GIS also measures grief-related functioning equivalently across demographic groups and satisfactorily discriminates between persons with and without impairment using an optimized cut score of ≥ 9 (79% sensitivity and 74% specificity). These results provide preliminary support for the GIS as a flexible tool for clinical research and practice.
Collapse
Affiliation(s)
- Sherman A Lee
- Christopher Newport University, Newport News, VA, USA
| | - Robert A Neimeyer
- University of Memphis, Memphis, TN, USA
- Portland Institute for Loss and Transition, Portland, OR, USA
| |
Collapse
|
5
|
Yehene E, Martin Y, Goldzweig G. An Analysis of Factors Predicting Post-Traumatic Stress Disorder and Grief Following Comrade Loss. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221113616. [PMID: 35837840 DOI: 10.1177/00302228221113616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This study explored how "inhibiting factors" associated with military-bereavement impact combatants' psychological sequelae following comrade loss. One hundred six eligible Israeli combat male-soldiers completed the Texas-Revised-Inventory of Grief, the post-traumatic-stress-disorder symptoms scale (PSS), the Male Role Norms Scale, the Social Acknowledgment Questionnaire, and a scale assessing Military Encouragement to Grieve (MEG-8). Time since loss had no impact on soldiers' levels of PSS or prolonged grief. Regression analysis indicated that higher masculinity-perception and disapproval from the family predicated higher PSS, above and beyond grief. Conversely, lower disapproval from the family, and higher disapproval from the general community, predicted higher grief, above and beyond PSS. Also, military encouragement significantly mediated the positive relationship between masculinity and sense of social-recognition. The results show how inhibiting factors contribute differently to the perpetuation of PSS and grief. This interplay sheds light on soldiers' "external" and "internal" loss processes of traumatic bereavement. The practical implications to treatment are also discussed.
Collapse
Affiliation(s)
- Einat Yehene
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel-Aviv Yaffo, Israel
| | - Yossi Martin
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel-Aviv Yaffo, Israel
| | - Gil Goldzweig
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel-Aviv Yaffo, Israel
| |
Collapse
|
6
|
Yehene E, Eitam T. "Crying in My Uniform, For Sure": A Qualitative Thematic Analysis of Loss and Grief Among Soldiers After Losing a Comrade in Combat. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221090749. [PMID: 35452335 DOI: 10.1177/00302228221090749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent studies investigate grief among soldiers who experienced combat loss, but little research exists on the qualitative lived experience of such an event. In this study, semi-structured interviews were conducted with soldiers (n = 19) who lost a comrade (3-21 years ago) to delve into their bereavement process. The reflexive thematic analysis of soldiers' accounts identified six main themes: (1) an unexpected and shattering experience; (2) emotional dissociation; (3) detachment from the outside world; (4) group formation; (5) accommodating the bereaved family; and (6) life-long impact. These themes were positioned on four distinct circles relating to the self and the surrounding social systems, indicating how soldiers' grief unfolds and remains encapsulated and disenfranchised. The findings emphasize the value of peer support groups that should be facilitated and encouraged by official bodies-even years after-as part of providing social recognition.
Collapse
Affiliation(s)
- Einat Yehene
- School of Behavioral Sciences, 42716The Academic College of Tel Aviv - Yaffo, Tel Aviv-Yaffo, Israel
| | - Talya Eitam
- School of Behavioral Sciences, 42716The Academic College of Tel Aviv - Yaffo, Tel Aviv-Yaffo, Israel
| |
Collapse
|
7
|
Bader C, Flynn D, Buckenmaier C, McDonald C, Meghani S, Calilung C, Polomano R. Comparative Analysis of Health Domains for Neuropathic Pain Patients. Clin Nurs Res 2021; 31:89-99. [PMID: 34291679 DOI: 10.1177/10547738211030640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Active duty military members have significant service-related risks for developing pain from injury. Although estimates for neuropathic pain (NP) are available for civilian populations, the incidence and prevalence for NP in military members is less clear. Understanding correlates of pain in military members is vital to improving their physical, mental, and social health. Using a comparative design, a secondary analysis was conducted on longitudinal PASTOR data from 190 pain management center patients. The objectives were to compare trends in patient-reported outcomes over time between those screening positive and negative for NP (NP+, NP-, respectively) based on PROMIS Neuropathic Pain Scale T-scores. Findings showed improvements in fatigue, sleep-related impairment, and anger over time. There was a difference between those screening NP+ and NP- for sleep-related impairment, and the cross-level interaction effect showed sleep-related impairment worsening over time. These results emphasize the need to identify NP and implement and evaluate targeted therapies.
Collapse
Affiliation(s)
- Christine Bader
- University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Diane Flynn
- Madigan Army Medical Center, Tacoma, WA, USA
| | - Chester Buckenmaier
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Defense and Veterans Center for Integrative Pain Management, Rockville, MD, USA
| | | | - Salimah Meghani
- University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Christian Calilung
- Defense and Veterans Center for Integrative Pain Management, Rockville, MD, USA
| | | |
Collapse
|
8
|
Cooper AD, Kolaja CA, Markwald RR, Jacobson IG, Chinoy ED. Longitudinal associations of military-related factors on self-reported sleep among U.S. service members. Sleep 2021; 44:6314292. [PMID: 34216467 DOI: 10.1093/sleep/zsab168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 06/24/2021] [Indexed: 11/15/2022] Open
Abstract
STUDY OBJECTIVES Sleep loss is common in the military, which can negatively affect health and readiness; however, it is largely unknown how sleep varies over a military career. This study sought to examine the relationships between military-related factors and the new onset and reoccurrence of short sleep duration and insomnia symptoms. METHODS Millennium Cohort Study data were used to track U.S. military service members over time to examine longitudinal changes in sleep. Outcomes were self-reported average sleep duration (categorized as ≤5 hours, 6 hours, or 7-9 hours [recommended]) and/or insomnia symptoms (having trouble falling or staying asleep). Associations between military-related factors and the new onset and reoccurrence of these sleep characteristics were determined, after controlling for multiple health and behavioral factors. RESULTS Military-related factors consistently associated with an increased risk for new onset and/or reoccurrence of short sleep duration and insomnia symptoms included active duty component, Army or Marine Corps service, combat deployment, and longer than average deployment lengths. Military officers and noncombat deployers had decreased risk for either sleep characteristic. Time-in-service and separation from the military were complex factors; they lowered risk for ≤5 hours sleep but increased risk for insomnia symptoms. CONCLUSIONS Various military-related factors contribute to risk of short sleep duration and/or insomnia symptoms over time, although some factors affect these sleep characteristics differently. Also, even when these sleep characteristics remit, some military personnel have an increased risk of reoccurrence. Efforts to improve sleep prioritization and implement interventions targeting at-risk military populations, behaviors, and other significant factors are warranted.
Collapse
Affiliation(s)
- Adam D Cooper
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA.,Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA.,Innovative Employee Solutions, San Diego, CA, USA
| | - Claire A Kolaja
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA.,Leidos, Inc., San Diego, CA, USA
| | - Rachel R Markwald
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
| | - Isabel G Jacobson
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA.,Leidos, Inc., San Diego, CA, USA
| | - Evan D Chinoy
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA.,Leidos, Inc., San Diego, CA, USA
| |
Collapse
|
9
|
Acierno R, Kauffman B, Muzzy W, Tejada MH, Lejuez C. Behavioral Activation and Therapeutic Exposure vs. Cognitive Therapy for Grief Among Combat Veterans: A Randomized Clinical Trial of Bereavement Interventions. Am J Hosp Palliat Care 2021; 38:1470-1478. [DOI: 10.1177/1049909121989021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Approximately two-thirds of Operations Enduring Freedom, Iraqi Freedom, and New Veterans reported knowing someone who was killed or seriously injured, lost someone in their immediate unit, or personally saw dead or seriously injured Americans (Hoge et al., 2004; Thomas et al., 2010; Toblin et al., 2012). Thus, it is not surprising that prevalence of Persistent Complex Bereavement Disorder (PCBD) is high in these groups. Importantly, PCBD impact appears to be independent of both Post-Traumatic Stress Disorder (PTSD) and Major Depressive Disorder (Bonnano, 2007), 2 disorders that are also highly prevalent in these groups, thus tailored treatments for grief are indicated. The Department of Veterans Affairs suggests Cognitive Therapy for Grief as a first line psychotherapy, however treatments relatively more focused on behavior change and exposure to grief cues also may be useful for this population. To address this question, the present study used a randomized controlled trial to compare a 7-session program of Behavioral Activation and Therapeutic Exposure for Grief vs. Cognitive Therapy for Grief among 155 OIF/OEF/OND veterans. Both treatments produced significant treatment gains over baseline, and these improvements were maintained over 6-month followup; however no differences were observed between groups. Given equal efficacy, implications for matching treatment to patient characteristics are discussed.
Collapse
Affiliation(s)
- Ron Acierno
- Faillace Department of Psychiatry, University of Texas Health Sciences Center Houston, TX, USA
- Department of Veterans Affairs Medical Center, Charleston, SC, USA
| | - Brooke Kauffman
- Faillace Department of Psychiatry, University of Texas Health Sciences Center Houston, TX, USA
- Department of Psychology, University of Houston, TX, USA
| | - Wendy Muzzy
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Melba Hernandez Tejada
- Faillace Department of Psychiatry, University of Texas Health Sciences Center Houston, TX, USA
| | - Carl Lejuez
- Office of the Provost, University of Connecticut, Storrs, CT, USA
| |
Collapse
|
10
|
Thimm JC, Kristoffersen AE, Ringberg U. The prevalence of severe grief reactions after bereavement and their associations with mental health, physical health, and health service utilization: a population-based study. Eur J Psychotraumatol 2020; 11:1844440. [PMID: 33408813 PMCID: PMC7748058 DOI: 10.1080/20008198.2020.1844440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Previous research has shown that bereaved individuals are at risk of developing physical and mental health problems. However, knowledge is scarce about the associations between severe grief reactions after bereavement and physical and mental health problems and the use of health services. Objectives: The present study sought to investigate the prevalence of severe grief reactions and to study the associations of severe grief reactions with mental and physical health and health care utilization. Method: The sample comprised 20,453 adults aged 40 and above (mean age = 57.2 years, SD = 11.3 years, 52.4% female) who participated in the seventh wave of the Tromsø study. Severe grief was assessed with one question asking whether the respondent has experienced the death of a loved one and currently has difficulty accepting the loss, yearns for the deceased, and experiences intense emotional pain related to the loss. Furthermore, participants answered questions about their current physical health, mental health (Hopkins Symptom Checklist - 10), and the use of health services in the past year. Results: Overall, 5.2% of the participants reported severe grief after a loss in childhood, 25.9% after bereavement in adulthood and 4.1% after bereavement in the previous year. Female gender, higher age, living without a partner, non-Norwegian ethnicity, and lower socio-economic status were associated with severe grief. Severe grief reactions were negatively related to self-reported health, predicted positively current levels of depression and anxiety, and were positively associated with the use of health services. Effect sizes were small. Gender differences in the use of health services were observed. Conclusion: Severe grief reactions are common in individuals aged 40 and older and associated with self-reported physical and mental health problems as well as increased use of health services. Health service providers should be attentive to possible severe grief in connection with health complaints.
Collapse
Affiliation(s)
- Jens C Thimm
- Center for Crisis Psychology, University of Bergen, Bergen, Norway.,Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Agnete Egilsdatter Kristoffersen
- The National Research Center in Complementary and Alternative Medicine, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Unni Ringberg
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
11
|
Lancel M, Stroebe M, Eisma MC. Sleep disturbances in bereavement: A systematic review. Sleep Med Rev 2020; 53:101331. [PMID: 32505968 DOI: 10.1016/j.smrv.2020.101331] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 12/16/2022]
Abstract
Severe, persistent and disabling grief occurs among a sizable minority experiencing bereavement, with diagnostic manuals newly including complicated grief (CG) disorders. Sleep disturbances/disorders have been established as worsening affective and stress-related conditions. However, the role of sleep difficulties in bereavement and CG has not received similar scientific attention. We therefore conducted a systematic review with narrative syntheses on this topic to clarify the role of sleep in bereavement (PROSPERO: CRD42018093145). We searched PubMed, Web of Science and PsychInfo for peer-reviewed English-language articles including (at least one) bereaved sample and sleep disturbance measure. We identified 85 articles on 12.294 participants. We answered seven pre-defined research questions demonstrating: high prevalence of sleep disturbances in bereavement; positive associations of grief intensity with sleep difficulties; preliminary indications of risk factors of post-loss sleep disturbance; higher prevalence of sleep disturbances in CG, enhanced by psychiatric comorbidity (i.e., depression); and initial evidence of causal relationships between (complicated) grief and sleep. Grief therapy partly improves sleep difficulties, yet no intervention studies have specifically targeted sleep problems in bereaved persons. Causal relationships between sleep and grief require further examination in intensive longitudinal investigations, including randomized trials, thereby clarifying whether treating sleep problems enhances CG treatment effects.
Collapse
Affiliation(s)
- Marike Lancel
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands; Psychiatric Sleep Center Assen, Mental Health Services Drenthe, the Netherlands.
| | - Margaret Stroebe
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands; Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Maarten C Eisma
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| |
Collapse
|
12
|
Mahat-Shamir M, Lebowitz K, Hamama-Raz Y. "You did not desert me my brothers in arms": The continuing bond experience of men who have lost a brother in arms. DEATH STUDIES 2020; 46:415-424. [PMID: 32163014 DOI: 10.1080/07481187.2020.1737275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This qualitative study provides an in-depth account of the continuing bond experience of bereaved Israeli men who have lost a comrade with whom they served in mandatory military service (a brother in arms). Our study findings indicate that bereaved men experienced continuing bond relationships with their deceased brothers in arms on two axes-an internal axis and an external axis. Together, the two axes connected the bereaved to the deceased. Furthermore, the bereaved constantly (re)negotiated these connecting axes vis-a-vis Israeli social norms and expectations. Implications for practice are outlined.
Collapse
Affiliation(s)
- Michal Mahat-Shamir
- Department of Social Work, School of Social Work, Ariel University, Ariel, Israel
| | - Keshet Lebowitz
- Department of Social Work, School of Social Work, Ariel University, Ariel, Israel
| | - Yaira Hamama-Raz
- Department of Social Work, School of Social Work, Ariel University, Ariel, Israel
| |
Collapse
|
13
|
Sessoms PH, Gobrecht M, Niederberger BA, Sturdy JT, Collins JD, Dominguez JA, Jaworski RL, Kelly KR. Effect of a load distribution system on mobility and performance during simulated and field hiking while under load. ERGONOMICS 2020; 63:133-144. [PMID: 31709928 DOI: 10.1080/00140139.2019.1690710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/31/2019] [Indexed: 06/10/2023]
Abstract
This study was conducted to test a modular scalable vest-load distribution system (MSV-LDS) against the plate carrier system (PC) currently used by the United States Marine Corps. Ten Marines engaged in 1.6 km load carriage trials in seven experimental conditions in a laboratory study. Kinematic, kinetic, and spatiotemporal gait parameters, muscle activity (electromyography), heart rate, caloric expenditure, shooting reaction times, and subjective responses were recorded. There was lower mean trapezius recruitment for the PC compared with the MSV-LDS for all conditions, and muscle activity was similar to baseline for the MSV-LDS. Twenty-seven Marines carrying the highest load were evaluated in the field, which measured an increase in energy expenditure with MSV-LDS; however, back discomfort was reduced. The field evaluation showed significantly reduced estimated ground reaction force on flat-ground segments with the MSV-LDS, and the data suggest both systems were comparable with respect to mobility and energy cost. Practitioner summary: This study found that a novel load distribution system appears to redistribute load for improved comfort as well as reduce estimated ground reaction force when engaged in hiking activities. Further, hiking with a load distribution system enables more neutral walking posture. Implications of load differences in loads carried are examined. Abbreviations: AGRF: anterior-posterior ground reaction forces; CAREN: Computer Assisted Rehabilitation Environment; GRF: ground reaction forces; HR: heart rate; ML-GRF: mediolateral ground reaction forces; MOLLE: Modular Lightweight Load-carrying Equipment; MSV-LDS: modular scalable vest-load distribution system; NHRC: Naval Health Research Center; PC: plate carrier; PPE: personal protective equipment; RPE: rating of perceived exertion; SAPI: small arms protective insert; sEMG: surface electromyography; USMC: United States Marine Corps; VGRF: Ground reaction forces in the vertical.
Collapse
Affiliation(s)
- Pinata H Sessoms
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Marcus Gobrecht
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | | | | | | | - Jose A Dominguez
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
| | - Rebecca L Jaworski
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
| | - Karen R Kelly
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
| |
Collapse
|
14
|
Simon NM, Hoeppner SS, Lubin RE, Robinaugh DJ, Malgaroli M, Norman SB, Acierno R, Goetter EM, Hellberg SN, Charney ME, Bui E, Baker AW, Smith E, Kim HM, Rauch SA. Understanding the impact of complicated grief on combat related posttraumatic stress disorder, guilt, suicide, and functional impairment in a clinical trial of post-9/11 service members and veterans. Depress Anxiety 2020; 37:63-72. [PMID: 31916660 PMCID: PMC7433022 DOI: 10.1002/da.22911] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/18/2019] [Accepted: 04/22/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Complicated grief (CG) is a bereavement-specific syndrome distinct from but commonly comorbid with posttraumatic stress disorder (PTSD). While bereavement is common among military personnel (Simon et al., 2018), there is little research on the impact of CG comorbidity on PTSD treatment outcomes. METHODS To evaluate the impact of comorbid CG on PTSD treatment outcomes we analyzed data from a randomized trial comparing prolonged exposure, sertraline, and their combination in veterans with a primary diagnosis of combat-related PTSD (n = 194). Assessment of PTSD, trauma-related guilt, functional impairment, and suicidal ideation and behavior occurred at baseline and weeks 6, 12, and 24 during the 24-week trial. RESULTS CG was associated with lower PTSD treatment response (odds ratio (OR) = 0.29, 95% confidence interval (CI) [0.12, 0.69], p = 0.005) and remission (OR = 0.28, 95% CI [0.11, 0.71], p = 0.007). Those with CG had greater severity of PTSD (p = 0.005) and trauma-related guilt (<0.001) at baseline and endpoint. In addition, those with CG were more likely to experience suicidal ideation during the study (CG: 35%, 14/40 vs. no CG 15%, 20/130; OR = 3.01, 95% CI [1.29, 7.02], p = 0.011). CONCLUSIONS Comorbid CG is associated with elevated PTSD severity and independently associated with poorer endpoint treatment outcomes in veterans with combat-related PTSD, suggesting that screening and additional intervention for CG may be needed.
Collapse
Affiliation(s)
- Naomi M. Simon
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, New York University School of Medicine, New York, NY
| | - Susanne S. Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Rebecca E. Lubin
- Department of Psychiatry, New York University School of Medicine, New York, NY
| | - Donald J. Robinaugh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Matteo Malgaroli
- Department of Psychiatry, New York University School of Medicine, New York, NY
| | - Sonya B. Norman
- National Center for PTSD, White River Junction, VT,Mental Health Service Line, Veterans Affairs San Diego Healthcare System, San Diego, CA,School of Medicine, University of California, San Diego, La Jolla,Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, CA
| | - Ron Acierno
- Mental Health Service Line, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC,College of Nursing, Medical University of South Carolina, Charleston, SC
| | - Elizabeth M. Goetter
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | | | - Meredith E. Charney
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Amanda W. Baker
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Erin Smith
- VA Ann Arbor Healthcare System, Ann Arbor, MI,Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - H. Myra Kim
- VA Ann Arbor Healthcare System, Ann Arbor, MI,Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor, MI
| | - Sheila A.M. Rauch
- Mental Health Service Line, Veterans Affairs Atlanta Healthcare System, Decatur, GA,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| |
Collapse
|
15
|
Lubens P, Silver RC. U.S. combat veterans' responses to suicide and combat deaths: A mixed-methods study. Soc Sci Med 2019; 236:112341. [PMID: 31374437 DOI: 10.1016/j.socscimed.2019.05.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 03/15/2019] [Accepted: 05/27/2019] [Indexed: 11/26/2022]
Abstract
RATIONALE Limited research has examined how combat veterans experience deaths of comrades to combat or suicide. We sought to investigate the process and identify factors that predict the level of grief among post-9/11 U.S. veterans. METHODS Using a mixed-methods study design during 2016-2017, U.S. combat veterans of the Iraq and Afghanistan conflicts who lost comrades to both combat and suicide (N = 28) participated in semi-structured interviews, and veterans who lost a comrade in combat or to suicide (N = 178) completed online surveys that assessed grief, combat exposure, unit cohesion, anger, posttraumatic stress symptoms (PTSS), and past diagnoses of PTSD and depression. RESULTS Text analyses of interview transcripts revealed seven themes: 1) Suicide death is unexpected and can make acceptance of loss harder; 2) Combat death is expected and can ease acceptance of loss; 3) Combat death is heroic and can make acceptance of loss easier; 4) Brotherhood forged in combat intensifies the emotional response; 5) Guilt over the inability to prevent a comrade's death makes acceptance harder; 6) Attribution of blame for a death creates anger; and 7) Detachment from the civilian world may make it more difficult to cope with comrades' deaths. Regression analyses of survey data indicated: 1) suicide loss predicted non-acceptance of the loss; 2) mode of death moderated the association between unit cohesion and grief; 3) combat exposure, anger, closeness to the deceased, and having a past diagnosis of depression predicted the level of grief; and 4) combat exposure is a similarly strong predictor of grief and PTSS. Results highlight how veterans' grief further delineates war's toll. CONCLUSION The mixed-methods design tells a rich story about a previously unexplored consequence of war. These findings have important public health implications because outcomes impact not only veterans but also their families and communities.
Collapse
Affiliation(s)
- Pauline Lubens
- Program in Public Health, University of California, Irvine, Irvine, CA, 92697-3957, USA.
| | - Roxane Cohen Silver
- Department of Psychological Science, Program in Public Health, and Department of Medicine, University of California, Irvine, Irvine, CA, 92697-7085, USA.
| |
Collapse
|
16
|
Carr DC, Taylor MG, Meyer A, Sachs-Ericsson NJ. The Role of Maternal Relationship in the Persisting Effect of Combat Exposure. Innov Aging 2019; 3:igz007. [PMID: 30972373 PMCID: PMC6450661 DOI: 10.1093/geroni/igz007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Indexed: 01/07/2023] Open
Abstract
Background and Objectives The veteran population is aging. Combat exposure is associated with negative health and psychological outcomes in some, but not all veterans; others even appear to experience gains. One mechanism driving these varied responses might be early life relationships. This study investigated the extent to which the quality of early maternal relationships influences the association between combat exposures and life satisfaction (LS) among older male veterans. Research Design and Methods Data were drawn from a pooled sample of male veterans in the Health and Retirement Study who completed the 2013 Veteran Mail Survey (N = 1,160). We used ordinary least squares regression to examine the association between combat exposures (with and without exposure to death) and LS, and the moderating effect of maternal relationship quality on this association. Results We found a significant positive association between maternal relationship quality and LS, and a significant association of combat that was dependent on maternal relationship quality. Specifically, combat-exposed veterans with poor maternal relationship quality reported lower LS, whereas combat-exposed veterans with high relationship quality reported higher LS—relative to their noncombat-exposed counterparts. The effects of exposure to death of hazardous toxins did not mediate or moderate this relationship. Discussion and Implications Findings indicate that maternal relationships had a lasting influence on whether combat contributed to a positive, negative, or neutral long-term effect on wellbeing. Findings support previous studies that suggest early life factors may play an important role in the fostering of resilient health outcomes over the life course. Implications for preventative strategies in soldiers are discussed.
Collapse
Affiliation(s)
- Dawn C Carr
- Department of Sociology, Pepper Institute on Aging and Social Policy, Tallahassee
- Address correspondence to: Dawn C. Carr, PhD, Department of Sociology, Florida State University, Tallahassee, FL 32306-1121. E-mail:
| | - Miles G Taylor
- Department of Sociology, Pepper Institute on Aging and Social Policy, Tallahassee
| | - Alex Meyer
- Department of Psychology, Florida State University, Tallahassee
| | | |
Collapse
|
17
|
James L, Smart D, Odom-Maryon T, Honn KA, Rowan S. Sleep deprivation in Air National Guard medical personnel responding to simulated disaster-training exercises. MILITARY PSYCHOLOGY 2019. [DOI: 10.1080/08995605.2019.1565909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Lois James
- College of Nursing, Washington State University, Spokane, Washington
| | - Denise Smart
- College of Nursing, Washington State University, Spokane, Washington
| | | | - Kimberly A. Honn
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - Stephanie Rowan
- Dental School, University of Texas Health Science Center, San Antonio, Texas
| |
Collapse
|
18
|
Danker-Hopfe H, Sauter C, Kowalski JT, Kropp S, Ströhle A, Wesemann U, Zimmermann PL. Effect of deployment related experiences on sleep quality of German soldiers after return from an International Security Assistance Force (ISAF) mission to Afghanistan. Psychiatry Res 2018; 270:560-567. [PMID: 30343242 DOI: 10.1016/j.psychres.2018.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 10/08/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022]
Abstract
The aim of the present study was to investigate the effect of experiencing potentially traumatic events during deployment on post-deployment sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI) and the Addendum for Post-Traumatic Stress Disorder (PTSD) of the Pittsburgh Sleep Quality Index (PSQI-A). Deployment related experiences were quantified on a standardised list of the Mental Health Advisory Team of the U.S. armed forces. The original sample consisted of 118 soldiers of the German armed forces who were deployed to Afghanistan for six months. The present analyses focused on data assessed after deployment (n = 70) and in a three-month follow-up (n = 51). Results indicate that immediately after return experiences during deployment had an independent significant effect on sleep quality but not three months later. Immediately after return depressive and stress symptoms significantly affected sleep quality while three months later somatic symptoms were significant. At both time points sleep prior to deployment was a significant predictor of sleep quality following deployment. Given the importance of sleep quality prior to deployment as a known independent risk factor for newly occurring mental disorders after deployment, these results underline the need to improve sleep quality already at an early stage.
Collapse
Affiliation(s)
- Heidi Danker-Hopfe
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Competence Centre of Sleep Medicine at Campus Benjamin Franklin, Berlin, Germany.
| | - Cornelia Sauter
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Competence Centre of Sleep Medicine at Campus Benjamin Franklin, Berlin, Germany
| | - Jens T Kowalski
- German Armed Forces Office, Applied Military Psychology and Research Division, c/o University of the Federal Armed Forces Hamburg, Hamburg, Germany
| | - Stefan Kropp
- Asklepios Fachklinikum Teupitz, Department of Psychiatry and Psychotherapy, Teupitz, Germany; Asklepios Fachklinikum Lübben, Department of Psychiatry and Psychotherapy, Lübben, Germany
| | - Andreas Ströhle
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany
| | - Ulrich Wesemann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Peter L Zimmermann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
| |
Collapse
|
19
|
Litz BT, Contractor AA, Rhodes C, Dondanville KA, Jordan AH, Resick PA, Foa EB, Young-McCaughan S, Mintz J, Yarvis JS, Peterson AL. Distinct Trauma Types in Military Service Members Seeking Treatment for Posttraumatic Stress Disorder. J Trauma Stress 2018; 31:286-295. [PMID: 29669185 DOI: 10.1002/jts.22276] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 12/16/2017] [Accepted: 12/18/2017] [Indexed: 11/07/2022]
Abstract
We examined the frequency of trauma types reported in a cohort of service members seeking treatment for posttraumatic stress disorder (PTSD) and compared symptom profiles between types. In this observational study, 999 service members (9.2% women; Mage = 32.91 years; 55.6% White) were evaluated using a standardized assessment procedure to determine eligibility for clinical trials. Participants were evaluated for DSM-IV-TR-defined PTSD using the PTSD Symptom Scale-Interview; all participants reported a Criterion A event. Independent evaluators rated descriptions of Criterion A events as belonging to trauma types at a high degree of reliability, κ = 0.80. Aggregated non-life-threat primary trauma types were more frequently endorsed than aggregated life-threat types, 95% CI [17.10%, 29.20%]. Participants who endorsed moral injury-self traumas had a higher level of reexperiencing (d = 0.39), guilt (hindsight bias, d = 1.06; wrongdoing, d = 0.93), and self-blame (d = 0.58) symptoms, relative to those who reported life threat-self. Participants who experienced traumatic loss had greater reexperiencing (d = 0.39), avoidance (d = 0.22), guilt (responsibility, d = 0.39), and greater peri- and posttraumatic sadness (d = 0.84 and d = 0.70, respectively) symptoms, relative to those who endorsed life threat-self. Relative to life threat-self, moral injury-others was associated with greater peri- (d = 0.36) and posttraumatic (d = 0.33) betrayal/humiliation symptoms, and endorsement of aftermath of violence was associated with greater peri- (d = 0.84) and posttraumatic sadness (d = 0.57) symptoms. War zone traumas were heterogeneous, and non-life-threat traumas were associated with distinct symptoms and problems.
Collapse
Affiliation(s)
- Brett T Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ateka A Contractor
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Charla Rhodes
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Katherine A Dondanville
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Alexander H Jordan
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Edna B Foa
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Jim Mintz
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Jeffrey S Yarvis
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Alan L Peterson
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, Texas, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| |
Collapse
|
20
|
Beyond war and PTSD: The crucial role of transition stress in the lives of military veterans. Clin Psychol Rev 2018; 59:137-144. [DOI: 10.1016/j.cpr.2017.11.007] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 10/31/2017] [Accepted: 11/18/2017] [Indexed: 11/24/2022]
|
21
|
Charney ME, Bui E, Sager JC, Ohye BY, Goetter EM, Simon NM. Complicated Grief Among Military Service Members and Veterans Who Served After September 11, 2001. J Trauma Stress 2018; 31:157-162. [PMID: 29384232 DOI: 10.1002/jts.22254] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 10/04/2017] [Accepted: 10/14/2017] [Indexed: 11/06/2022]
Abstract
Minimal research is available on the prevalence and impact of complicated grief (CG) in military service members and veterans, despite high reported rates of loss in this population. The present study aimed to examine prevalence rates of CG in a sample of treatment-seeking military service and members and veterans who served after September 11, 2001. Additionally, the study aimed to examine characteristics associated with CG as well as the association between CG and quality of life. In a sample of 622 military service members and veterans who served after September 11, 2001, 502 reported a significant loss (80.7%). Usable data were available for a total of 468 participants. Of these 468 participants, 30.3% (n = 142) met diagnostic criteria for CG, as defined by a score of 30 or more on the Inventory of Complicated Grief (ICG; Prigerson et al., 1995). We conducted a series of t tests and chi-square tests to examine the differences between individuals who met criteria for CG and those who did not. The presence of CG was associated with worse PTSD, d = 0.68, p < .001; depression, d = -1.10, p < .001; anxiety, d = -1.02, p < .001; stress, d = 0.99, p < .001; and quality of life, d = 0.76, p < .001. Multiple regression analyses examined the independent impact of CG on quality of life. Complicated grief was associated with poorer quality of life above and beyond PTSD, β = -.12, p = .017. In addition, in a separate regression, CG was associated with poorer quality of life above and beyond depression, β = -.13, p < .001. Overall, our findings highlight the impact of CG on this population, and have implications for assessment and treatment.
Collapse
Affiliation(s)
- Meredith E Charney
- The Home Base Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Eric Bui
- The Home Base Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Julia C Sager
- The Home Base Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bonnie Y Ohye
- The Home Base Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth M Goetter
- The Home Base Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Naomi M Simon
- The Home Base Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, New York University School of Medicine, New York, New York, USA
| |
Collapse
|
22
|
Umberson D. Black Deaths Matter: Race, Relationship Loss, and Effects on Survivors. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2017; 58:405-420. [PMID: 29172766 PMCID: PMC6309550 DOI: 10.1177/0022146517739317] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Close relationships are a resource for mental and physical health that, like other social resources, is unequally distributed in the population. This article focuses on racial disparities in the loss of relationships across the life course. Racial disparities in life expectancy in the United States mean that black Americans experience the deaths of more friends and family members than do white Americans from childhood through later life. I argue that these losses are a unique type of stress and adversity that, through interconnected biopsychosocial pathways, contribute to disadvantage in health over the life course. I focus particularly on how the interconnected pathways associated with loss undermine opportunities for and increase risks to social ties throughout life, adding to disadvantage in health. I call on social scientists and policy makers to draw greater attention to this unique source of disadvantage for black children, adults, and families.
Collapse
|
23
|
Walker MS, Kaimal G, Gonzaga AML, Myers-Coffman KA, DeGraba TJ. Active-duty military service members' visual representations of PTSD and TBI in masks. Int J Qual Stud Health Well-being 2017; 12:1267317. [PMID: 28452610 PMCID: PMC5328376 DOI: 10.1080/17482631.2016.1267317] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Active-duty military service members have a significant risk of sustaining physical and psychological trauma resulting in traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). Within an interdisciplinary treatment approach at the National Intrepid Center of Excellence, service members participated in mask making during art therapy sessions. This study presents an analysis of the mask-making experiences of service members (n = 370) with persistent symptoms from combat- and mission-related TBI, PTSD, and other concurrent mood issues. Data sources included mask images and therapist notes collected over a five-year period. The data were coded and analyzed using grounded theory methods. Findings indicated that mask making offered visual representations of the self related to individual personhood, relationships, community, and society. Imagery themes referenced the injury, relational supports/losses, identity transitions/questions, cultural metaphors, existential reflections, and conflicted sense of self. These visual insights provided an increased understanding of the experiences of service members, facilitating their recovery.
Collapse
Affiliation(s)
- Melissa S Walker
- a National Intrepid Center of Excellence , Walter Reed National Military Medical Center , Bethesda , MD , USA
| | - Girija Kaimal
- b College of Nursing and Health Professions , Drexel University , Philadelphia , PA , USA
| | - Adele M L Gonzaga
- b College of Nursing and Health Professions , Drexel University , Philadelphia , PA , USA
| | | | - Thomas J DeGraba
- a National Intrepid Center of Excellence , Walter Reed National Military Medical Center , Bethesda , MD , USA
| |
Collapse
|
24
|
Ursano RJ, Kessler RC, Naifeh JA, Herberman Mash H, Fullerton CS, Bliese PD, Zaslavsky AM, Ng THH, Aliaga PA, Wynn GH, Dinh HM, McCarroll JE, Sampson NA, Kao TC, Schoenbaum M, Heeringa SG, Stein MB. Risk of Suicide Attempt Among Soldiers in Army Units With a History of Suicide Attempts. JAMA Psychiatry 2017; 74:924-931. [PMID: 28746705 PMCID: PMC5674988 DOI: 10.1001/jamapsychiatry.2017.1925] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
IMPORTANCE Mental health of soldiers is adversely affected by the death and injury of other unit members, but whether risk of suicide attempt is influenced by previous suicide attempts in a soldier's unit is unknown. OBJECTIVE To examine whether a soldier's risk of suicide attempt is influenced by previous suicide attempts in that soldier's unit. DESIGN, SETTING, AND PARTICIPANTS Using administrative data from the Army Study to Assess Risk and Resilience in Servicemembers (STARRS), this study identified person-month records for all active-duty, regular US Army, enlisted soldiers who attempted suicide from January 1, 2004, through December 31, 2009 (n = 9650), and an equal-probability sample of control person-months (n = 153 528). Data analysis was performed from August 8, 2016, to April 10, 2017. MAIN OUTCOMES AND MEASURES Logistic regression analyses examined the number of past-year suicide attempts in a soldier's unit as a predictor of subsequent suicide attempt, controlling for sociodemographic features, service-related characteristics, prior mental health diagnosis, and other unit variables, including suicide-, combat-, and unintentional injury-related unit deaths. The study also examined whether the influence of previous unit suicide attempts varied by military occupational specialty (MOS) and unit size. RESULTS Of the final analytic sample of 9512 enlisted soldiers who attempted suicide and 151 526 control person-months, most were male (86.4%), 29 years or younger (68.4%), younger than 21 years when entering the army (62.2%), white (59.8%), high school educated (76.6%), and currently married (54.8%). In adjusted models, soldiers were more likely to attempt suicide if 1 or more suicide attempts occurred in their unit during the past year (odds ratios [ORs], 1.4-2.3; P < .001), with odds increasing as the number of unit attempts increased. The odds of suicide attempt among soldiers in a unit with 5 or more past-year attempts was more than twice that of soldiers in a unit with no previous attempts (OR, 2.3; 95% CI, 2.1-2.6). The association of previous unit suicide attempts with subsequent risk was significant whether soldiers had a combat arms MOS or other MOS (ORs, 1.4-2.3; P < .001) and regardless of unit size, with the highest risk among those in smaller units (1-40 soldiers) (ORs, 2.1-5.9; P < .001). The population-attributable risk proportion for 1 or more unit suicide attempts in the past year indicated that, if this risk could be reduced to no unit attempts, 18.2% of attempts would not occur. CONCLUSIONS AND RELEVANCE Risk of suicide attempt among soldiers increased as the number of past-year suicide attempts within their unit increased for combat arms and other MOSs and for units of any size but particularly for smaller units. Units with a history of suicide attempts may be important targets for preventive interventions.
Collapse
Affiliation(s)
- Robert J Ursano
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - James A Naifeh
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Holly Herberman Mash
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Carol S Fullerton
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Paul D Bliese
- Darla School of Business, University of South Carolina, Columbia
| | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Tsz Hin Hinz Ng
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Pablo A Aliaga
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Gary H Wynn
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Hieu M Dinh
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - James E McCarroll
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Tzu-Cheg Kao
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | | | - Murray B Stein
- Department of Psychiatry, University of California, San Diego, La Jolla.,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla.,Veterans Affairs San Diego Healthcare System, San Diego, California
| | | |
Collapse
|
25
|
Simon NM, O'Day EB, Hellberg SN, Hoeppner SS, Charney ME, Robinaugh DJ, Bui E, Goetter EM, Baker AW, Rogers AH, Nadal-Vicens M, Venners MR, Kim HM, Rauch SAM. The loss of a fellow service member: Complicated grief in post-9/11 service members and veterans with combat-related posttraumatic stress disorder. J Neurosci Res 2017; 96:5-15. [PMID: 28609578 DOI: 10.1002/jnr.24094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/01/2017] [Accepted: 05/09/2017] [Indexed: 11/10/2022]
Abstract
Bereavement is a potent and highly prevalent stressor among service members and veterans. However, the psychological consequences of bereavement, including complicated grief (CG), have been minimally examined. Loss was assessed in 204 post-9/11, when service members and veterans with combat-related posttraumatic stress disorder (PTSD) took part in a multicenter treatment study. Those who reported the loss of an important person completed the inventory of complicated grief (ICG; n = 160). Over three quarters (79.41%) of the sample reported an important lifetime loss, with close to half (47.06%) reporting the loss of a fellow service member (FSM). The prevalence of CG was 24.75% overall, and nearly one third (31.25%) among the bereaved. CG was more prevalent among veterans who lost a fellow service member (FSM) (41.05%, n = 39) compared to those bereaved who did not (16.92%, n = 11; OR = 3.41, 95% CI: 1.59, 7.36). CG was associated with significantly greater PTSD severity, functional impairment, trauma-related guilt, and lifetime suicide attempts. Complicated grief was prevalent and associated with adverse psychosocial outcomes in veterans and service members with combat-related PTSD. Clinicians working with this population should inquire about bereavement, including loss of a FSM, and screen for CG. Additional research examining CG in this population is needed.
Collapse
Affiliation(s)
- Naomi M Simon
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Emily B O'Day
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Samantha N Hellberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Susanne S Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Meredith E Charney
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Donald J Robinaugh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Elizabeth M Goetter
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Amanda W Baker
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Andrew H Rogers
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Mireya Nadal-Vicens
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Margaret R Venners
- VA Ann Arbor Healthcare System, 2215 Fuller Road 116c, Ann Arbor, MI, 48105, USA.,University of Michigan, Department of Psychiatry, 4250 Plymouth Rd., Ann Arbor, MI, 48109
| | - Hyungjin M Kim
- VA Ann Arbor Healthcare System, 2215 Fuller Road 116c, Ann Arbor, MI, 48105, USA
| | - Sheila A M Rauch
- VA Ann Arbor Healthcare System, 2215 Fuller Road 116c, Ann Arbor, MI, 48105, USA.,University of Michigan, Department of Psychiatry, 4250 Plymouth Rd., Ann Arbor, MI, 48109.,Emory University, School of Medicine, 12 Executive Park, 3rd Floor, Atlanta, GA, 30329, USA.,Atlanta VA Medical Center, 1670 Clairmont Road 116c, Atlanta, GA, 30033, USA
| |
Collapse
|
26
|
McCutchan PK, Liu X, LeardMann CA, Smith TC, Boyko EJ, Gore KL, Freed MC, Engel CC. Deployment, combat, and risk of multiple physical symptoms in the US military: a prospective cohort study. Ann Epidemiol 2016; 26:122-128. [DOI: 10.1016/j.annepidem.2015.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 11/29/2015] [Accepted: 12/04/2015] [Indexed: 11/28/2022]
|
27
|
Zhang Y, Zhang J, Zhu S, Du C, Zhang W. Prevalence and Predictors of Somatic Symptoms among Child and Adolescents with Probable Posttraumatic Stress Disorder: A Cross-Sectional Study Conducted in 21 Primary and Secondary Schools after an Earthquake. PLoS One 2015; 10:e0137101. [PMID: 26327455 PMCID: PMC4556626 DOI: 10.1371/journal.pone.0137101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 08/12/2015] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To explore the prevalence rates and predictors of somatic symptoms among child and adolescent survivors with probable posttraumatic stress disorder (PTSD) after an earthquake. METHODS A total of 3053 students from 21 primary and secondary schools in Baoxing County were administered the Patient Health Questionnaire-13 (PHQ-13), a short version of PHQ-15 without the two items about sexuality and menstruation, the Children's Revised Impact of Event Scale (CRIES), and the self-made Earthquake-Related Experience Questionnaire 3 months after the Lushan earthquake. RESULTS Among child and adolescent survivors, the prevalence rates of all somatic symptoms were higher in the probable PTSD group compared with the controls. The most frequent somatic symptoms were trouble sleeping (83.2%), feeling tired or having low energy (74.4%), stomach pain (63.2%), dizziness (58.1%), and headache (57.7%) in the probable PTSD group. Older age, having lost family members, having witnessed someone get seriously injured, and having witnessed someone get buried were predictors for somatic symptoms among child and adolescent survivors with probable PTSD. CONCLUSIONS Somatic symptoms among child and adolescent earthquake survivors with probable PTSD in schools were common, and predictors of these somatic symptoms were identified. These findings may help those providing psychological health programs to find the child and adolescent students with probable PTSD who are at high risk of somatic symptoms in schools after an earthquake in China.
Collapse
Affiliation(s)
- Ye Zhang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jun Zhang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- * E-mail: (JZ); (WZ)
| | - Shenyue Zhu
- Education Supervision Department, Baoxing County Education Bureau, Yaan, Sichuan, China
| | - Changhui Du
- Science and Education Information Department, Chengdu Center of Disease Control, Chengdu, Sichuan, China
| | - Wei Zhang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- * E-mail: (JZ); (WZ)
| |
Collapse
|
28
|
Zhang J, Zhu S, Du C, Zhang Y. Posttraumatic stress disorder and somatic symptoms among child and adolescent survivors following the Lushan earthquake in China: A six-month longitudinal study. J Psychosom Res 2015; 79:100-6. [PMID: 26080620 DOI: 10.1016/j.jpsychores.2015.06.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 06/01/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To explore somatic conditions in a sample of 2299 child and adolescent survivors of an earthquake and their relationship to posttraumatic stress disorder (PTSD) symptoms. METHODS The Children's Revised Impact of Event Scale, the Patient Health Questionnaire (PHQ)-13 scale, a short version of PHQ-15 scale that omits two items involving sexual pain/problems and menstrual problems, and a project-developed questionnaire were administered to participants three and six months after the earthquake. RESULTS Among child and adolescent survivors, the prevalence rates of probable PTSD were 37.4 and 24.2% three and six months, respectively, after the earthquake. The most common somatic symptoms were trouble sleeping (58.4 and 48.4%), feeling tired or having low energy (52.0 and 46.1%), and stomach pain (45.8 and 45.4%) after three and six months, respectively. Several specific somatic symptoms evaluated three months after the earthquake including trouble sleeping, headache, and shortness of breath were predictors of the overall PTSD symptoms evaluated six months after the earthquake. Additionally, the symptom of hyperarousal evaluated after three months could predict the overall somatic symptoms evaluated after six months. CONCLUSIONS PTSD and somatic symptoms were common after the earthquake, and a longitudinal association between PTSD and somatic symptoms was detected among child and adolescent survivors. These findings have implications in China and possibly elsewhere.
Collapse
Affiliation(s)
- Jun Zhang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Shenyue Zhu
- Baoxing County Education Bureau, Yaan 625700, China.
| | - Changhui Du
- Chengdu Center of Disease Control, Chengdu 610041, China.
| | - Ye Zhang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, China.
| |
Collapse
|
29
|
Klyce DW, Bombardier CH, Davis TJ, Hartoonian N, Hoffman JM, Fann JR, Kalpakjian CZ. Distinguishing Grief From Depression During Acute Recovery From Spinal Cord Injury. Arch Phys Med Rehabil 2015; 96:1419-25. [DOI: 10.1016/j.apmr.2015.02.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/29/2015] [Accepted: 02/18/2015] [Indexed: 11/29/2022]
|
30
|
Sachs-Ericsson N, Joiner TE, Cougle JR, Stanley IH, Sheffler JL. Combat Exposure in Early Adulthood Interacts with Recent Stressors to Predict PTSD in Aging Male Veterans. THE GERONTOLOGIST 2015. [DOI: 10.1093/geront/gnv036] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
31
|
Quartana PJ, Wilk JE, Balkin TJ, Hoge CW. Indirect associations of combat exposure with post-deployment physical symptoms in U.S. soldiers: roles of post-traumatic stress disorder, depression and insomnia. J Psychosom Res 2015; 78:478-483. [PMID: 25499887 DOI: 10.1016/j.jpsychores.2014.11.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 11/17/2014] [Accepted: 11/20/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To characterize the indirect associations of combat exposure with post-deployment physical symptoms through shared associations with post-traumatic stress disorder (PTSD), depression and insomnia symptoms. METHODS Surveys were administered to a sample of U.S. soldiers (N = 587) three months after a 15-month deployment to Iraq. A multiple indirect effects model was used to characterize direct and indirect associations between combat exposure and physical symptoms. RESULTS Despite a zero-order correlation between combat exposure and physical symptoms, the multiple indirect effects analysis did not provide evidence of a direct association between these variables. Evidence for a significant indirect association of combat exposure and physical symptoms was observed through PTSD, depression, and insomnia symptoms. In fact, 92% of the total effect of combat exposure on physical symptoms scores was indirect. These findings were evident even after adjusting for the physical injury and relevant demographics. CONCLUSION This is the first empirical study to suggest that PTSD, depression and insomnia collectively and independently contribute to the association between combat exposure and post-deployment physical symptoms. Limitations, future research directions, and potential policy implications are discussed.
Collapse
Affiliation(s)
- Phillip J Quartana
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, United States.
| | - Joshua E Wilk
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, United States
| | - Thomas J Balkin
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, United States
| | - Charles W Hoge
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, United States
| |
Collapse
|
32
|
Saban KL, Mathews HL, Collins EG, Hogan NS, Tell D, Bryant FB, Pape TLB, Griffin JM, Janusek LW. The Man I Once Knew. Biol Res Nurs 2015; 18:50-9. [DOI: 10.1177/1099800414568661] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Grief, although traditionally conceptualized as a bereavement-related reaction, is also experienced by significant others in response to the profound cognitive and personality changes associated with a traumatic brain injury (TBI) in a loved one. Grief associated with the death of a loved one is related to increases in proinflammatory cytokines, yet it is not clear whether this is the case for grief experienced by individuals caring for a significant other with TBI. The purpose of this cross-sectional, exploratory study was to examine grief and its association with a proinflammatory cytokine, tumor necrosis factor α (TNF-α), in wives/partners caring for veterans with TBI. Participants completed written measures of grief, perceived stress, and depressive symptoms and provided morning saliva samples for TNF-α analysis. Participants reported levels of grief comparable to those reported in studies evaluating individuals grieving the death of a loved one. Path analysis revealed that grief was not associated with TNF-α; however, participants reporting high levels of blame/anger, a subscale of the grief scale, had higher levels of TNF-α. In addition, both grief and blame/anger were related to increased perceived stress and depressive symptoms; however, path analysis demonstrated that perceived stress and depressive symptoms did not mediate the influence of blame/anger on TNF-α. These findings suggest that blame/anger associated with grief may be related to the elevations in TNF-α exhibited by individuals caring for a loved one with TBI.
Collapse
Affiliation(s)
- Karen L. Saban
- Edward Hines Jr. VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, IL, USA
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA
| | | | - Eileen G. Collins
- Edward Hines Jr. VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, IL, USA
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Nancy S. Hogan
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA
| | - Dina Tell
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA
| | - Fred B. Bryant
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Theresa Louise Bender Pape
- Edward Hines Jr. VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, IL, USA
- Department of Physical Medicine & Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Joan M. Griffin
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Linda Witek Janusek
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA
| |
Collapse
|
33
|
Pedersen ER, Troxel WM, Shih RA, Pinder E, Lee D, Geyer L. Increasing resilience through promotion of healthy sleep among service members. Mil Med 2015; 180:4-6. [PMID: 25562849 PMCID: PMC4356633 DOI: 10.7205/milmed-d-14-00264] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - Wendy M Troxel
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213
| | - Regina A Shih
- RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202-5050
| | - Evette Pinder
- Deployment Health Clinical Center (DHCC)/Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE), 1335 East West Highway 9-605D, Silver Spring, MD 20910
| | - Dana Lee
- Deployment Health Clinical Center (DHCC)/Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE), 1335 East West Highway 9-605D, Silver Spring, MD 20910
| | - Lily Geyer
- RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202-5050
| |
Collapse
|
34
|
Kulkarni P, Kulkarni P, Anavkar V, Ghooi R. Preference of the place of death among people of pune. Indian J Palliat Care 2014; 20:101-6. [PMID: 25125864 PMCID: PMC4129995 DOI: 10.4103/0973-1075.132620] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim: Provision of end-of-life care requires that we have adequate information about the preferred place of death in the population. Since no such study is reported in India, this study was taken up in and around Pune, a large cosmopolitan city. Setting and Design: A questionnaire was designed in three parts and distributed among the people above the age of 18 in and around Pune. Materials and Methods: The questionnaire had three parts the first being a consent form, followed by one for collection of personal information and lastly questions specific to the subject matter. Filled forms were screened for inconsistencies, gaps of information and errors. Results: The population survey was mixed, both urban and rural, men and women, educated and uneducated, young and old. Despite this heterogeneity, the results were consistent to the point that most of the people surveyed preferred home as the place of death. This preference cuts across all barriers, the only difference being that women had a stronger preference for home death compared to men. Conclusions: Helping people to die at their preferred place is a part of end-of-life care. Majority of people surveyed by us, prefer to die at home, where they are relatively more comfortable. Public and governmental policies should be directed toward facilitating home deaths.
Collapse
Affiliation(s)
- Priyadarshini Kulkarni
- Departments of Research and Training, Cipla Palliative Care and Training Centre, Pune, Maharashtra, India
| | - Pradeep Kulkarni
- Departments of Research and Training, Cipla Palliative Care and Training Centre, Pune, Maharashtra, India
| | - Vrushali Anavkar
- Departments of Research and Training, Cipla Palliative Care and Training Centre, Pune, Maharashtra, India
| | - Ravindra Ghooi
- Departments of Research and Training, Cipla Palliative Care and Training Centre, Pune, Maharashtra, India
| |
Collapse
|
35
|
George EO, Roys S, Sours C, Rosenberg J, Zhuo J, Shanmuganathan K, Gullapalli RP. Longitudinal and Prognostic Evaluation of Mild Traumatic Brain Injury: A 1H-Magnetic Resonance Spectroscopy Study. J Neurotrauma 2014; 31:1018-28. [DOI: 10.1089/neu.2013.3224] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Elijah O. George
- Magnetic Resonance Research Center, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
| | - Steve Roys
- Magnetic Resonance Research Center, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Chandler Sours
- Magnetic Resonance Research Center, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland
| | - Joseph Rosenberg
- Magnetic Resonance Research Center, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jiachen Zhuo
- Magnetic Resonance Research Center, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kathirkamanthan Shanmuganathan
- Magnetic Resonance Research Center, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rao P. Gullapalli
- Magnetic Resonance Research Center, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
- Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland
| |
Collapse
|
36
|
O'Neil ME, Carlson KF, Storzbach D, Brenner LA, Freeman M, Quiñones AR, Motu'apuaka M, Kansagara D. Factors Associated with Mild Traumatic Brain Injury in Veterans and Military Personnel: A Systematic Review. J Int Neuropsychol Soc 2014; 20:1-13. [PMID: 24499707 DOI: 10.1017/s135561771300146x] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A history of mild traumatic brain injury (mTBI) is common among military members who served in Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND). We completed a systematic review to describe the cognitive, mental health, physical health, functional, social, and cost consequences of mTBI in Veteran and military personnel. Of 2668 reviewed abstracts, the 31 included studies provided very low strength evidence for the questions of interest. Cognitive, physical, and mental health symptoms were commonly reported by Veterans/military members with a history of mTBI. On average, these symptoms were not significantly more common in those with a history of mTBI than in those without, although a lack of significant mean differences does not preclude the possibility that some individuals could experience substantial effects related to mTBI history. Evidence of potential risk or protective factors moderating mTBI outcomes was unclear. Although the overall strength of evidence is very low due to methodological limitations of included studies, our findings are consistent with civilian studies. Appropriate re-integration services are needed to address common comorbid conditions, such as treatment for post-traumatic stress disorder, substance use disorders, headaches, and other difficulties that Veterans and members of the military may experience after deployment regardless of mTBI history. (JINS, 2014, 20, 1-13).
Collapse
Affiliation(s)
| | | | | | - Lisa A Brenner
- 5 Denver VA Medical Center, VISN 19 MIRECC, Denver, Colorado
| | | | | | | | | |
Collapse
|
37
|
McCaslin SE, Leach B, Herbst E, Armstrong K. Guest editorial: Overcoming barriers to care for returning veterans: expanding services to college campuses. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2014; 50:vii-xiv. [PMID: 24458904 DOI: 10.1682/jrrd.2013.09.0204] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
38
|
Ruan L, Lau BWM, Wang J, Huang L, Zhuge Q, Wang B, Jin K, So KF. Neurogenesis in neurological and psychiatric diseases and brain injury: from bench to bedside. Prog Neurobiol 2013; 115:116-37. [PMID: 24384539 DOI: 10.1016/j.pneurobio.2013.12.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 12/08/2013] [Accepted: 12/12/2013] [Indexed: 02/08/2023]
Abstract
Researchers who have uncovered the presence of stem cells in an adult's central nervous system have not only challenged the dogma that new neurons cannot be generated during adulthood, but also shed light on the etiology and disease mechanisms underlying many neurological and psychiatric disorders. Brain trauma, neurodegenerative diseases, and psychiatric disorders pose enormous burdens at both personal and societal levels. Although medications for these disorders are widely used, the treatment mechanisms underlying the illnesses remain largely elusive. In the past decade, an increasing amount of evidence indicate that adult neurogenesis (i.e. generating new CNS neurons during adulthood) may be involved in the pathology of different CNS disorders, and thus neurogenesis may be a potential target area for treatments. Although new neurons were shown to be a major player in mediating treatment efficacy of neurological and psychotropic drugs on cognitive functions, it is still debatable if the altered production of new neurons can cause the disorders. This review hence seeks to discuss pre and current clinical studies that demonstrate the functional impact adult neurogenesis have on neurological and psychiatric illnesses while examining the related underlying disease mechanisms.
Collapse
Affiliation(s)
- Linhui Ruan
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China; Department of Pharmacology and Neuroscience, University of North Texas Health Science Center at Fort Worth, TX 76107, USA.
| | - Benson Wui-Man Lau
- Department of Rehabilitation Science, The Hong Kong Polytechnic University, Hong Kong, PR China
| | - Jixian Wang
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center at Fort Worth, TX 76107, USA
| | - Lijie Huang
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China; Department of Pharmacology and Neuroscience, University of North Texas Health Science Center at Fort Worth, TX 76107, USA
| | - Qichuan Zhuge
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Brian Wang
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center at Fort Worth, TX 76107, USA
| | - Kunlin Jin
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China; Department of Pharmacology and Neuroscience, University of North Texas Health Science Center at Fort Worth, TX 76107, USA.
| | - Kwok-Fai So
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, PR China; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, PR China; Research Centre of Heart, Brain, Hormone and Healthy Aging, Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, PR China; GMH Institute of CNS Regeneration, Jinan University, Guangzhou, PR China.
| |
Collapse
|
39
|
|
40
|
Abstract
STUDY DESIGN Feasibility study on the acquisition of lumbar spine kinematic data from upright magnetic resonance images obtained under heavy load carrying conditions. OBJECTIVE To characterize the effect of the load on spinal kinematics of active Marines under typical load carrying conditions from a macroscopic and lumbar-level approach in active-duty US Marines. SUMMARY OF BACKGROUND DATA Military personnel carry heavy loads of up to 68 kg depending on duty position and nature of the mission or training; these loads are in excess of the recommended assault loads. Performance and injury associated with load carriage have been studied; however, knowledge of lumbar spine kinematic changes is still not incorporated into training. These data would provide guidance for setting load and duration limits and a tool to investigate the potential contribution of heavy load carrying on lumbar spine pathologies. METHODS Sagittal T2 magnetic resonance images of the lumbar spine were acquired on a 0.6-T upright magnetic resonance imaging scanner for 10 active-duty Marines. Each Marine was scanned without load (UN1), immediately after donning load (LO2), after 45 minutes of standing (LO3) and walking (LO4) with load, and after 45 minutes of side-lying recovery (UN5). Custom-made software was used to measure whole spine angles, intervertebral angles, and regional disc heights (L1-S1). Repeated measurements analysis of variance and post hoc Sidak tests were used to identify significant differences between tasks (α = 0.05). RESULTS The position of the spine was significantly (P < 0.0001) more horizontal relative to the external reference frame and lordosis was reduced during all tasks with load. Superior levels became more lordotic, whereas inferior levels became more kyphotic. Heavy load induced lumbar spine flexion and only anterior disc and posterior intervertebral disc height changes were observed. All kinematic variables returned to baseline levels after 45 minutes of side-lying recovery. CONCLUSION Superior and inferior lumbar levels showed different kinematic behaviors under heavy load carrying conditions. These findings suggest a postural, lumbar flexion strategy aimed at centralizing a heavy posterior load over the base of support.
Collapse
|
41
|
|
42
|
The effects of positive patient testimonials on PTSD treatment choice. Behav Res Ther 2012; 50:805-13. [PMID: 23103234 DOI: 10.1016/j.brat.2012.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 09/10/2012] [Accepted: 09/12/2012] [Indexed: 11/24/2022]
Abstract
Despite the existence of effective treatment options for PTSD, these treatments are failing to reach those that stand to benefit from PTSD treatment. Understanding the processes underlying an individual's treatment seeking behavior holds the potential for reducing treatment-seeking barriers. The current study investigates the effects that positive treatment testimonials have on decisions regarding PTSD treatment. An undergraduate (N = 439) and a trauma-exposed community (N = 203) sample were provided with videotaped treatment rationales for prolonged exposure (PE) and sertraline treatments of PTSD. Half of each sample also viewed testimonials, detailing a fictional patient's treatment experience. All participants then chose among treatment options and rated the credibility of - and personal reactions toward - those options. Among treatment naïve undergraduates, testimonials increased the proportion choosing PE alone; and among treatment naïve members of the trauma-exposed community sample, testimonials increased the proportion choosing a combined PE plus sertraline treatment. These effects were not observed for those with prior history of either psychotherapeutic or pharmacological treatment. Major barriers exist that prevent individuals with PTSD from seeking treatment. For a critical unreached treatment sample, those who are treatment naïve, positive patient testimonials offer a mechanism in which to make effective treatments more appealing and accessible.
Collapse
|
43
|
Dretsch MN, Thiel KJ, Athy JR, Irvin CR, Sirmon‐Fjordbak B, Salvatore A. Mood symptoms contribute to working memory decrement in active-duty soldiers being treated for posttraumatic stress disorder. Brain Behav 2012; 2:357-64. [PMID: 22950039 PMCID: PMC3432958 DOI: 10.1002/brb3.53] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 02/02/2012] [Accepted: 03/05/2012] [Indexed: 11/08/2022] Open
Abstract
A significant proportion of military veterans of operations in Afghanistan and Iraq have been diagnosed with posttraumatic stress disorder (PTSD). Growing evidence suggests that neuropsychological deficits are a symptom of PTSD. The current study investigated neurocognitive functioning among soldiers diagnosed with PTSD. Specifically, active-duty soldiers with and without a diagnosis of PTSD were assessed for performance on tests of attention and working memory. In addition, factors such as combat experience, depression, anxiety, PTSD symptom severity, and alcohol consumption were explored as possible mediators of group differences in neurocognitive functioning. Twenty-three active-duty soldiers diagnosed with PTSD were matched with 23 healthy Soldier controls; all were administered the Attention Network Task (ANT), Backward Digit Span (BDS) task, Beck Depression Inventory, Beck Anxiety Inventory, PTSD Checklist-Military Version, Combat Exposure Scale, and Modified Drinking Behavior Questionnaire. Soldiers diagnosed with PTSD performed significantly worse on the working memory task (BDS) than healthy controls, and reported greater levels of PTSD symptoms, combat exposure, depression, and anxiety. However, after controlling for depression and anxiety symptoms, the relationship between PTSD and working memory was no longer present. The results indicate that PTSD is accompanied by deficits in working memory, which appear to be partially attributed to anxiety and depression symptoms.
Collapse
Affiliation(s)
- Michael N. Dretsch
- U.S. Army Aeromedical Research Laboratory, Fort Rucker, Alabama 36362‐0577
| | - Kenneth J. Thiel
- U.S. Army Aeromedical Research Laboratory, Fort Rucker, Alabama 36362‐0577
| | - Jeremy R. Athy
- U.S. Army Aeromedical Research Laboratory, Fort Rucker, Alabama 36362‐0577
| | - Clinton R. Irvin
- U.S. Army Aeromedical Research Laboratory, Fort Rucker, Alabama 36362‐0577
| | | | | |
Collapse
|