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Kihas I, Barrett EL, Teesson M, Touyz SW, Newton NC, Mills KL. Co-occurring experiences of traumatic events and substance use among young people. CHILD ABUSE & NEGLECT 2024; 156:107003. [PMID: 39208535 DOI: 10.1016/j.chiabu.2024.107003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 08/12/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Harmful substance use among young people is concerningly prevalent. Substance use disorder (SUD) and post-traumatic stress disorder (PTSD) frequently co-occur in treatment settings and are well researched among adults but lacking among young community cohorts. The aim of this study was to explore the prevalence and relationship between substance use, SUD, trauma, and PTSD among a community sample of young people in Australia. METHOD A cross-sectional examination of data collected from participants (n = 1007, 48.9 % male) aged 18-22 years (M = 20 years, SD = 0.44), who took part in the 7-year follow-up of a cluster RCT of school-based substance use prevention interventions: The Climate and Preventure (CAP) study. A series of regressions were conducted to examine the relationship between trauma-related variables and substance use outcomes. RESULTS 48.3 % experienced a traumatic event (median = 2, range = 1-11) and of those 10.9 % met a probable PTSD diagnosis. Median age of first trauma exposure was 14 years (range = 0-21). 89.9 % used substances; 73.1 % reported binge drinking, and 35.6 % met a probable diagnosis of SUD (alcohol/cannabis). Those who experienced any traumatic event had almost 1.5 times greater odds of binge drinking. Cannabis use was significantly associated with most trauma-related variables. Sexual trauma exposure was the only trauma type significantly associated with all substance use variables. CONCLUSIONS This study demonstrated that substance use/SUD and experiences of trauma/PTSD are prevalent among a community sample of young people. Importantly, substance use among young people is associated with experiencing a traumatic event, particularly sexual and physical types of traumatic events, and developing PTSD.
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Affiliation(s)
- Ivana Kihas
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia.
| | - Emma L Barrett
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia.
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia.
| | - Stephen W Touyz
- School of Psychology and Inside Out Institute, The University of Sydney, NSW, Australia.
| | - Nicola C Newton
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia.
| | - Katherine L Mills
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia.
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Sullivan MD, Wilson L, Amick M, Miller-Matero LR, Chrusciel T, Salas J, Zabel C, Lustman PJ, Ahmedani B, Carpenter RW, Scherrer JF. Social support and the association between post-traumatic stress disorder and risk for long-term prescription opioid use. Pain 2024; 165:2379-2386. [PMID: 38833573 PMCID: PMC11408094 DOI: 10.1097/j.pain.0000000000003286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/15/2024] [Indexed: 06/06/2024]
Abstract
ABSTRACT Post-traumatic stress disorder (PTSD) is common in patients with chronic pain, adversely affects chronic pain outcomes, and is associated with opioid use and adverse opioid outcomes. Social support is a robust predictor of PTSD incidence and course as well as chronic pain outcome. We determined whether the association between PTSD and persistent opioid use was modified by emotional support in a cohort of patients receiving opioids for noncancer pain. Eligible participants were ≥18 years and had completed a new period of prescription opioid use lasting 30 to 90 days. Bivariate associations between cohort characteristics and each key variable was assessed using χ 2 tests for categorical variables and t -tests for continuous variables. Interaction between PTSD and emotional support was assessed by a priori stratification on low vs high emotional support. Participants (n = 808) were 53.6 (SD ± 11.6) years of age, 69.8% female, 69.6% White, and 26.4% African American. Overall, 17.2% had probable PTSD. High emotional support was significantly ( P < 0.0001) more common among those without probable PTSD. Prescription opioid use at 6-month follow-up was significantly ( P = 0.0368) more common among patients with vs without probable PTSD. In fully adjusted models, PTSD was no longer associated with opioid use at 6-month follow-up among participants with high emotional support. Among those with lower emotional support, PTSD was significantly associated with opioid use at 6-month follow-up in unadjusted (odds ratio = 2.40; 95% confidence interval: 1.24-4.64) and adjusted models (odds ratio = 2.39; 95% confidence interval: 1.14-4.99). Results point to the hypothesis that improvement of emotional support in vulnerable patients with chronic pain and PTSD may help reduce sustained opioid use.
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Affiliation(s)
- Mark D Sullivan
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, WA, United States
| | - Lauren Wilson
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Matthew Amick
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Lisa R Miller-Matero
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI, United States
| | - Timothy Chrusciel
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, United States
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Celeste Zabel
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI, United States
| | - Patrick J Lustman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Brian Ahmedani
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI, United States
| | - Ryan W Carpenter
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, United States
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, United States
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO, United States
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3
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Lathan EC, Petri JM, Haynes T, Sonu SC, Mekawi Y, Michopoulos V, Powers A. Evaluating the Performance of the Primary Care Posttraumatic Stress Disorder Screen for DSM-5 (PC-PTSD-5) in a Trauma-Exposed, Socioeconomically Vulnerable Patient Population. J Clin Psychol Med Settings 2023; 30:791-803. [PMID: 36715813 PMCID: PMC9885055 DOI: 10.1007/s10880-023-09941-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 01/31/2023]
Abstract
The properties and utility of the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) remain unstudied in community-based populations. This study evaluates the performance of the PC-PTSD-5 to determine whether it can be used as a brief alternative to the PTSD Checklist for DSM-5 (PCL-5) in a large public hospital in the southeastern United States. Participants (N = 422; 92.7% Black; 85.8% female; Mage = 42.0 years, SDage = 13.4 years) completed the PCL-5 and PC-PTSD-5 after recruitment from medical clinic waiting rooms and admission lists. Using chance-corrected test quality indices and item response theory (IRT) analyses, we determined optimal cut-scores for screening and examined item performance. Approximately 45.0% of the sample screened positive for probable DSM-5 PTSD using the PCL-5. The PC-PTSD-5 demonstrated high internal consistency and strong associations with PCL-5 scores (total, r = .79; items, rs = .51-.61). A cut-score of one was optimally sensitive for screening (κ[1] = .96), and a cut-score of four had the highest quality of probable efficiency (κ[.5] = .66) for detecting self-reported DSM-5 PTSD on the PCL-5. IRT analyses indicated Item 1 (nightmares, intrusive memories) provided the most information, and other items may not be incrementally useful for this sample. Findings provide preliminary support for the use of the PC-PTSD-5 as a brief alternative to the PCL-5 among chronically trauma-exposed patients in the public healthcare setting.
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Affiliation(s)
- Emma C Lathan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA, 30303, USA.
| | - Jessica M Petri
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA, 30303, USA
| | - Tamara Haynes
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA, 30303, USA
- Department of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Stan C Sonu
- Department of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA
- Department of General Pediatrics and Adolescent Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Yara Mekawi
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA, 30303, USA
- Emory National Primate Research Center, Atlanta, GA, USA
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA, 30303, USA
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Willis F, Buck L, Musa J, Hinz U, Mechtersheimer G, Seidensaal K, Fröhling S, Büchler MW, Schneider M. Long-term quality of life after resection of retroperitoneal soft tissue sarcoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106977. [PMID: 37481390 DOI: 10.1016/j.ejso.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/27/2023] [Accepted: 07/03/2023] [Indexed: 07/24/2023]
Abstract
INTRODUCTION Retroperitoneal soft tissue sarcoma (RPS) is characterized by high recurrence rates. Since complete tumor resection, often necessitating multivisceral resection, enables long-term survival in both primary and recurrent disease, health related quality of life (QoL) after RPS resection has attracted increasing interest. However, data regarding this topic is limited. Here, we multidimensionally assessed long-term QoL after RPS resection. METHODS Five previously validated (1. EORTC QLQ-C30, 2. WEMWBS, 3. FoP-Q-SF, 4. PC-PTSD, 5. Pro-CTCAE) were sent to patients having undergone resection of primary, recurrent and metastasized RPS at Heidelberg University Hospital between 10/2001 and 12/2020. Multivariable linear regression models were used to test associations between clinical/demographic variables and patient reported outcomes (PROs). RESULTS Questionnaires were answered by 127 patients (71% response rate). The median interval between RPS diagnosis and assessment of PROs was 80 months. The overall Global Health score was 64.1 and comparable to the general German population. RPS patients reported deficits regarding emotional and social functioning, whereas physical limitations were less pronounced. Besides diarrhea, abdominal symptoms were comparable to the overall population. Tumor recurrences, the number of surgeries, multivisceral resections or postoperative complications did not significantly affect long-term QoL ratings. CONCLUSION RPS patients rate their QoL relatively high, even after multiple and multivisceral resections. Psychosocial well-being should be monitored in follow-up sessions to offer tailored support if necessary, thus improving postoperative care.
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Affiliation(s)
- Franziska Willis
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Lena Buck
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Julian Musa
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany; Division of Translational Pediatric Sarcoma Research (B410), German Cancer Research Center (DKFZ), Heidelberg, Germany; Hopp-Children's Cancer Center (KiTZ), Heidelberg, Germany
| | - Ulf Hinz
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Katharina Seidensaal
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Fröhling
- Division of Translational Medical Oncology, National Center for Tumor Diseases Heidelberg and German Cancer Research Center, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Schneider
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.
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Powers A, Lathan EC, Dixon HD, Mekawi Y, Hinrichs R, Carter S, Bradley B, Kaslow NJ. Primary care-based mindfulness intervention for posttraumatic stress disorder and depression symptoms among Black adults: A pilot feasibility and acceptability randomized controlled trial. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2023; 15:858-867. [PMID: 36265048 PMCID: PMC10227868 DOI: 10.1037/tra0001390] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
OBJECTIVE There is support for the use of mindfulness-based approaches with trauma-exposed adults. However, limited data are available on feasibility and acceptability of group-based mindfulness interventions in urban medical clinics serving primarily Black adults with low socioeconomic resources, where rates of trauma exposure are high. The present randomized pilot study evaluated the feasibility and acceptability of an 8-week adapted mindfulness-based cognitive therapy (MBCT) group for trauma-exposed Black adults who screened positive for posttraumatic stress disorder (PTSD) and depression in an urban primary care clinic setting. METHOD Participants were randomized to waitlist control (WLC) or MBCT. Feasibility and acceptability were assessed through examination of retention rates, measures of group satisfaction and treatment barriers, and qualitative interview. Forty-two Black adults (85% women) were consented; of those, 34 (81%) completed preassessment and randomization. RESULTS Feasibility of study design was shown, with > 75% (n = 26) of randomized participants completing the study through postassessment. Twenty-four individuals (70.5%) completed through 1-month follow-up. Results showed high levels of group acceptability across quantitative and qualitative measures. Perceived barriers to psychological treatment were high, with an average of > 6 barriers present. CONCLUSIONS The findings indicate feasibility and acceptability of MBCT group interventions in urban primary care settings with trauma-exposed patients with significant psychopathology. However, substantial barriers to treatment engagement were endorsed and to improve numbers for successful engagement in the intervention, continued efforts to reduce treatment barriers and increase access to mindfulness-based interventions in underresourced communities are needed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta GA
| | - Emma C. Lathan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta GA
| | - H. Drew Dixon
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta GA
| | - Yara Mekawi
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY
| | - Rebecca Hinrichs
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta GA
| | - Sierra Carter
- Department of Psychology, Georgia State University, Atlanta, GA
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta GA
| | - Nadine J. Kaslow
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta GA
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Hong JH, de Dios C, Badawi JC, Tonkin SS, Schmitz JM, Walss-Bass C, Meyer TD. Types of Traumatic Experiences in Drug Overdose-Related Deaths: An Exploratory Latent Class Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.30.23289256. [PMID: 37205511 PMCID: PMC10187323 DOI: 10.1101/2023.04.30.23289256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Aim Drug overdose related-deaths in the US are increasing, with over 100,000 deaths occurring in 2020, an increase of 30% from the previous year and the highest number recorded in a single year. It is widely known that experiences of trauma and substance use very often co-occur, but little is known about the role of trauma in the context of drug overdose-related deaths. Latent class analysis (LCA) was used to classify drug overdose-related deaths based on type of traumatic experiences and individual, social, and substance use characteristics. Methods Psychological autopsy data were obtained from the University of Texas Health Science Center at Houston (UTHealth) Brain Collection. A total of 31 drug overdose-related deaths collected from January 2016 through March 2022 were included in this study. LCA was used to identify latent factors via experience of four trauma categories (illness/accidents, sexual/interpersonal violence, death/trauma to another, other situations where life was in danger). Generalized linear modeling (GLM) was used to explore differences on demographic, social, substance use, and psychiatric variables between the latent classes in separate models. Results LCA identified 2 classes: C1 ( n =12; 39%) was characterized by higher incidence of overall trauma exposure as well as variation in trauma type; C2 ( n =19; 61%) had lower levels of overall trauma exposure with sexual/interpersonal violence as the most frequent. GLMs indicated that C1 membership was associated with higher incidence of polysubstance use, being married, and having suicidal ideation compared to C2 membership ( p s<0.05). Conclusion Among individuals who died by drug overdose, the exploratory LCA identified two distinct subgroups that differed in type of trauma experienced and substance use pattern, the first group having more "typical" characteristics of drug overdoses cases, the other group less typical. This suggests that those at risk of drug overdose may not always exhibit high-risk characteristics.
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7
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Patton SC, Hinojosa CA, Lathan EC, Welsh JW, Powers A. Validating the primary care posttraumatic stress disorder screen for DSM-5 (PC-PTSD-5) in a substance misusing, trauma-exposed, socioeconomically vulnerable population. Addict Behav 2023; 139:107592. [PMID: 36584543 PMCID: PMC9993036 DOI: 10.1016/j.addbeh.2022.107592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
The co-occurrence of substance use disorder (SUD) and posttraumatic stress disorder (PTSD) is common, and is associated with greater severity of symptoms, poorer treatment prognosis, and increased risk of return to substance use following treatment. Screening for PTSD is not routinely implemented in substance use treatment programs, despite clinical relevance. Identifying screening tools that minimize patient burden and allow for comprehensive treatment in this patient population is critical. The current study examined the utility of the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) in identifying probable PTSD in a predominantly Black sample of 81 socioeconomically disadvantaged substance misusing hospital patients. The majority of the sample (75.3 %; n = 61) were found to meet criteria for probable PTSD using a suggested clinical cut score of 33 on the PTSD Checklist for DSM-5 (PCL-5). Diagnostic utility analyses were completed and determined a cut-score of 5 for the PC-PTSD-5 to demonstrate the best performance (SE = 0.62, κ(1) = 0.22; SP =.80, κ(0) = 0.61; EEF = 0.67, κ(0.5) = 0.32) in this sample. Results provide preliminary support for the use of the PC-PTSD-5 as a brief screening tool for probable PTSD in substance misusing patient populations. Routine use of the PC-PTSD-5 during assessment may be beneficial when treatment planning with those undergoing treatment for SUD because comprehensive assessment and treatment will provide a better chance of long-term recovery.
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Affiliation(s)
- Samantha C Patton
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, United States
| | - Cecilia A Hinojosa
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, United States
| | - Emma C Lathan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, United States
| | - Justine W Welsh
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, United States
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, United States.
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Goodman ML, Molldrem S, Elliott A, Robertson D, Keiser P. Long COVID and mental health correlates: a new chronic condition fits existing patterns. Health Psychol Behav Med 2023; 11:2164498. [PMID: 36643576 PMCID: PMC9833408 DOI: 10.1080/21642850.2022.2164498] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Emerging Long COVID research indicates the condition has major population health consequence. Other chronic conditions have previously been associated with functional and mental health challenges - including depression, anxiety, post-traumatic stress disorder (PTSD), suicide ideation, substance use and lower life satisfaction. Methods This study explores correlations between self-reported Long COVID, functional and mental health challenges among a random community-based sample of people (n = 655) aged 20-50 years who contracted COVID-19 prior to vaccination in a Texas county. A random sample of eligible participants was mailed a link to participate in a semi-structured questionnaire. Participant responses, including open-ended responses regarding their experience following COVID-19, were paired with health system data. Results Long COVID was associated with increased presence of depression (13% increase), anxiety (28% increase), suicide ideation (10% increase), PTSD (20% increase), and decreased life satisfaction and daily functioning. Structural equation modeling, controlling for sociodemographic variables and imposing a theoretical framework from existing chronic disease research, demonstrated correlations between Long COVID and higher PTSD, suicide ideation and lower life satisfaction were mediated by higher daily functional challenges and common mental disorders. Conclusions Basic and applied, interdisciplinary research is urgently needed to characterize the population-based response to the new challenge of Long COVID.
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Affiliation(s)
- Michael L. Goodman
- Deparment of Internal Medicine, University of Texas Medical Branch, USA, Michael L. Goodman
| | - Stephen Molldrem
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, USA
| | - Aleisha Elliott
- Area Health Education Center, University of Texas Medical Branch, USA
| | | | - Philip Keiser
- Deparment of Internal Medicine, University of Texas Medical Branch, USA,Galveston County Health District, USA
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Quinn CA, Walter ZC, de Andrade D, Dingle G, Haslam C, Hides L. Controlled Trial Examining the Strength-Based Grit Wellbeing and Self-Regulation Program for Young People in Residential Settings for Substance Use. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13835. [PMID: 36360714 PMCID: PMC9657698 DOI: 10.3390/ijerph192113835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
This cohort-controlled trial examined whether the 12-session Grit Wellbeing and Self-regulation Program enhanced the treatment outcomes of young people accessing residential alcohol and other drug (AOD) treatment. Grit focuses on increasing wellbeing and reducing substance use and mental health problems by building self-regulation skills, strengths, social connections, and health behaviours. Participants were 194 (66% male, Mage 27.40) young people (aged 18-35 years) accessing a six-week residential treatment program for substance use. Participants received standard treatment, or standard treatment plus Grit (two sessions/week for six weeks). The primary outcome was substance use, measured as: (i) global substance use and (ii) alcohol, methamphetamine, and cannabis use involvement. Secondary outcomes included wellbeing, depression, anxiety, and vocational engagement. Participants were assessed at baseline, and 6-weeks (secondary outcomes only), 3-months, 6-months, and 12-months post-program enrolment. Results revealed that both groups showed a significant improvement in all outcomes at three months, and improvements were maintained at 6- and 12-month follow-ups. The Grit group had a larger reduction in methamphetamine and cannabis use involvement compared to the control group. This study presents promising evidence that a six-week residential program can achieve improvements in AOD use, depression, anxiety, wellbeing and vocational engagement. Further, targeting self-regulation may enhance such programs.
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Affiliation(s)
- Catherine A. Quinn
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane 4072, Australia
- School of Psychology, The University of Queensland, Brisbane 4072, Australia
| | - Zoe C. Walter
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane 4072, Australia
- School of Psychology, The University of Queensland, Brisbane 4072, Australia
| | - Dominique de Andrade
- School of Psychology, The University of Queensland, Brisbane 4072, Australia
- School of Psychology, Deakin University, Melbourne 3125, Australia
| | - Genevieve Dingle
- School of Psychology, The University of Queensland, Brisbane 4072, Australia
| | - Catherine Haslam
- School of Psychology, The University of Queensland, Brisbane 4072, Australia
| | - Leanne Hides
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane 4072, Australia
- School of Psychology, The University of Queensland, Brisbane 4072, Australia
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10
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Hawn SE, Cusack SE, George B, Sheerin CM, Dick D, Amstadter AB. Diagnostic validity of the PC-PTSD screen in college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1909-1919. [PMID: 33253061 PMCID: PMC8164645 DOI: 10.1080/07448481.2020.1841768] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/19/2020] [Accepted: 10/18/2020] [Indexed: 06/12/2023]
Abstract
Objective: The purpose of this study was to test the diagnostic validity of the Primary Care PTSD screen (PC-PTSD) in a generalizable college sample and to examine potential differences in its predictive efficacy according to sex and racial/ethnic identity. An exploratory aim was to determine whether PC-PTSD symptom items differentially predicted PTSD diagnostic status. Participants: Data from 475 undergraduates were analyzed. Methods: Logistic regressions were conducted to examine the relationship between different PC-PTSD endorsement thresholds and probable PTSD among various subsamples. Follow-up tests of diagnostic accuracy were performed. Results: Results of this study indicated that the PC-PTSD identified PTSD among college students with poor accuracy. Furthermore, the PC-PTSD did not demonstrate equal predictive validity across neither sex nor racial/ethnic identity. Endorsement of reexperiencing symptoms appeared to be the strongest predictor of PTSD. Conclusions: Results highlight the clear need for a validated PTSD screener effective for a diverse college population.
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Affiliation(s)
- Sage E. Hawn
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Shannon E. Cusack
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Brianna George
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Christina M. Sheerin
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Danielle Dick
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ananda B. Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, Virginia, USA
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11
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Jackson TN, Wheeler TP, Truitt MS, Nelson P, Kempe K. Recruitment & Retainment of Vascular Surgeons: Prophylactic measures to improve the current workforce crisis. Ann Vasc Surg 2022; 85:219-227. [PMID: 35271962 DOI: 10.1016/j.avsg.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/05/2022] [Accepted: 02/06/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The vascular surgery workforce is in jeopardy with current and increasing shortages. This study explores target populations for recruitment and aims to identify potential modifiable and nonmodifiable risk factors associated with reduced job satisfaction among practicing vascular surgeons to improve retention and prevent early retirement. MATERIALS AND METHODS A cross-sectional national survey of surgeons (n=1043) was conducted from September 2016 to May 2017. Data included demographic and occupational characteristics, as well as psychological, work-life balance, work-environment, and job-satisfaction variables. Surgeons were grouped into general surgery (n=507), obstetrics and gynecology (n=272), surgical subspecialties (n=212), and vascular surgery (n=52). Vascular surgeons were recategorized as more satisfied and less satisfied, and potential risk factors for job dissatisfaction were identified. RESULTS As compared with general surgeons, obstetrics and gynecology, as well as other surgical subspecialties, vascular surgery tended to be male-dominated with higher rates of non-white, minority groups (p<0.05). Less vascular surgery respondents were found in the Midwest (p<0.001). Vascular surgeons worked more hours on average than other surgical fields and were less satisfied with work (p<0.05). Potential job dissatisfaction risk factors among vascular surgeons include: unhealthy work-life balance, poor camaraderie/coworker dissatisfaction, insufficient hospital support, hostile hospital culture, discontent with supervision, minimal patient diversity, dissatisfaction with work in general, and unhappiness with career choice (p<0.05). CONCLUSIONS Recruiting new vascular surgery trainees while simultaneously preventing early retirement and attrition is critical to combatting the current workforce crisis. Potential interventions include (1) re-branding of the field with prioritization of work-life balance, (2) increasing hospital administration's support, (3) creating a collaborative work environment, and (4) facilitating personal accomplishment in work.
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Affiliation(s)
- Theresa N Jackson
- University of Oklahoma Tulsa, Department of General Surgery, 1802 E. 19(th) St, Kravis Building, Tulsa, Oklahoma, United States.
| | - Tiffany P Wheeler
- University of Oklahoma Tulsa, Department of General Surgery, 1802 E. 19th St, Kravis Building, Tulsa, Oklahoma, United States
| | - Michael S Truitt
- Methodist Dallas Medical Center, Department of Trauma Surgery, 1414 N. Beckley Ave, Dallas, Texas, United States
| | - Peter Nelson
- University of Oklahoma Tulsa, Department of Vascular Surgery, 1919 S. Wheeling Ave #600, Tulsa, Oklahoma, United States
| | - Kelly Kempe
- University of Oklahoma Tulsa, Department of Vascular Surgery, 1919 S. Wheeling Ave #600, Tulsa, Oklahoma, United States
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12
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Chander G, Hutton HE, Xu X, Canan CE, Gaver J, Finkelstein J, Lesko CR, McCaul ME, Lau B. Computer delivered intervention for alcohol and sexual risk reduction among women attending an urban sexually transmitted infection clinic: A randomized controlled trial. Addict Behav Rep 2021; 14:100367. [PMID: 34938828 PMCID: PMC8664779 DOI: 10.1016/j.abrep.2021.100367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/09/2021] [Accepted: 06/28/2021] [Indexed: 12/18/2022] Open
Abstract
Unhealthy alcohol use is prevalent among women attending STI clinics. We tested whether CBI or CBI-IVR-TM, reduced alcohol use among women in this setting. Neither CBI nor CBI-IVR-TM reduced alcohol use more than control. 2/3 of women had an alcohol use disorder, 65% substance use, 28% depressive symptoms. CBI is insufficient for alcohol reduction in this high severity, high comorbidity setting.
Objective We sought to determine if a computer delivered brief alcohol intervention (CBI) with or without interactive voice response counseling and text messages (CBI-IVR-TM), reduced alcohol use and sexual risk behaviors compared to attention control. Methods We conducted a 3-arm RCT among women (n = 439) recruited from Baltimore City Sexually Transmitted Infection (STI) Clinics. Eligibility included: 1) consumption of >7 drinks per week or 2) ≥2 episodes of heavy episodic drinking or ≥2 episodes of sex under the influence of alcohol in the prior three months. Research assessments conducted at baseline, 3, 6 and 12 months included a 30-day Timeline Followback querying daily alcohol use, drug use, and sexual activity. We used the MINI International Neuropsychiatric Interview-DSM-IV to ascertain drinking severity. Primary alcohol outcomes included: drinking days, heavy drinking days, drinks per drinking day. Secondary sexual risk outcomes included number of sexual partners, days of condomless sex, and days of condomless sex under the influence of drugs and alcohol. Results Median age was 31 (IQR 25–44 years), 88% were African American, 65% reported current recreational drug use, and 26% endorsed depressive symptoms. On the MINI 66% met criteria for alcohol use disorder (49% alcohol dependence, 18% abuse). At follow-up, all three groups reduced drinking days, heavy drinking days, drinks per drinking day and drinks per week with no significant differences between study arms. There was no difference in sexual risk outcomes among the groups. Conclusions Among women attending an urban STI clinic single session CBI with or without IVR and text message boosters was insufficient to reduce unhealthy alcohol use or sexual risk behaviors beyond control. The high severity of alcohol use and the prevalence of mental health symptoms and other substance use comorbidity underscores the importance of developing programs that address not only alcohol use but other determinants of STI risk among women.
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Affiliation(s)
- Geetanjali Chander
- Johns Hopkins University School of Medicine, Department of Medicine, 1830 E. Monument Street, Baltimore, MD 21287, United States
| | - Heidi E Hutton
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 550 N. Broadway, Baltimore, MD 21205, United States
| | - Xiaoqiang Xu
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 550 N. Broadway, Baltimore, MD 21205, United States
| | - Chelsea E Canan
- Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe Street, Baltimore, MD 21287, United States
| | - Jennifer Gaver
- Johns Hopkins University School of Medicine, Department of Medicine, 1830 E. Monument Street, Baltimore, MD 21287, United States
| | - Joseph Finkelstein
- Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, New York, NY 10029, United States
| | - Catherine R Lesko
- Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe Street, Baltimore, MD 21287, United States
| | - Mary E McCaul
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 550 N. Broadway, Baltimore, MD 21205, United States
| | - Bryan Lau
- Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe Street, Baltimore, MD 21287, United States
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13
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Huang RW, Shen T, Ge LM, Cao L, Luo JF, Wu SY. Psychometric Properties of the Chinese Version of the Primary Care Post-Traumatic Stress Disorder Screen-5 for Medical Staff Exposed to the COVID-19 Pandemic. Psychol Res Behav Manag 2021; 14:1371-1378. [PMID: 34512047 PMCID: PMC8421668 DOI: 10.2147/prbm.s329380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/20/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose The COVID-19 pandemic may increase the development of psychiatric disorders, such as posttraumatic stress disorder (PTSD) among medical staff. A brief validated screening tool is essential for the early diagnosis of PTSD. The purpose of the present study was to evaluate the validation of a Chinese version of the Primary Care-PTSD-5 (C-PC-PTSD-5) and determine an appropriate cutoff score with optimal sensitivity and specificity for medical staff in China during the COVID-19 pandemic. Participants and Methods An online cross-sectional survey was conducted on medical staff (n = 1104) from 17 medical institutions in Shanghai. Questionnaires comprising general information, medical-related traumatic event experiences, the PTSD Checklist (PCL-5), and C-PC-PTSD-5 were distributed to participants using the online Questionnaire Star electronic system. Internal consistency, convergent validity, and test–retest reliability were calculated. Receiver operating characteristic (ROC) analysis was performed to determine diagnostic accuracy and the optimal cutoff score of the C-PC-PTSD-5 for medical staff. Results We included 1062 valid questionnaires for the analysis. Data of 838 traumatic experiences were analyzed. Internal consistency of the C-PC-PTSD-5 was satisfied (Cronbach’s α = 0.756). The total score of the C-PC-PTSD-5 showed good test–retest reliability (r = 0.746). We found a strong correlation between the C-PC-PTSD-5 score and PCL-5 total score (r = 0.669, p < 0.001), which indicated good convergent validity. The ROC analysis showed an area under the curve of 0.81 ± 0.016. A cutoff score of 2 provided optimal sensitivity and specificity for the C-PC-PTSD-5 (sensitivity = 0.632, specificity = 0.871, Youden index = 0.503, and overall efficiency = 0.768). Conclusion Our results indicated that the C-PC-PTSD-5 can be employed as a brief and efficient screening instrument for medical staff exposed to the COVID-19 pandemic. A score of 2 was identified as the optimal threshold for probable clinical PTSD symptoms.
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Affiliation(s)
- Rui-Wen Huang
- Department of Science and Education, RuiJin Hospital LuWan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Tao Shen
- Department of Psychiatry, Shanghai Huangpu District Mental Health Center, Shanghai, People's Republic of China
| | - Lei-Ming Ge
- Department of General practice, Changfeng Community Health Service Center of Putuo, Shanghai, People's Republic of China
| | - Lu Cao
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jian-Feng Luo
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, People's Republic of China.,NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, People's Republic of China
| | - Shi-Yu Wu
- Department of Science and Education, RuiJin Hospital LuWan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China
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14
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Kimber J, Sullivan N, Anastasides N, Slotkin S, McAndrew LM. Understanding Veterans' Causal Attributions of Physical Symptoms. Int J Behav Med 2021; 28:299-307. [PMID: 32691396 PMCID: PMC7855405 DOI: 10.1007/s12529-020-09918-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Illness beliefs are significant contributors to health outcomes. Beliefs about the cause of physical symptoms are considered particularly important among those with medically unexplained symptoms and illnesses (MUS); yet little is known about causal beliefs among those with the most severe MUS (i.e., Veterans). The goal of the current study was to examine Veteran's causal attributions of their physical symptoms. METHOD A total of 91 combat Veterans with MUS were surveyed using a mixed-methods design about the cause of their physical symptoms, physical symptom severity, and PTSD symptoms. Causal attributions of physical symptoms were analyzed through thematic response analysis and grouped into categories. Chi-square analysis was used to assess the distribution of causal attribution types across Veterans with varying physical symptom severity and PTSD symptom severity. RESULTS Veterans with MUS reported an average of 7.9 physical symptoms, and attributed the cause of their symptoms to seven different categories ("Do not Know," "Stress/Mental Health," "Deployment/Environment," "Functional/Symptom," "Medically Explained," "Medically Unexplained Syndrome," and "Lifestyle"). Exploratory chi-square analysis revealed significant differences in causal attributions across physical symptom severity and severity of PTSD symptoms. Veterans with more severe PTSD and Veterans with more severe physical symptoms were more likely to attribute their MUS to stress/mental health or to a medically unexplained syndrome compared with those with low/no PTSD symptoms and physical symptom severity. Veterans with minimal PTSD and Veterans with minimal physical symptom severity were more likely to attribute the cause of their MUS to lifestyle choices (e.g., exercise/diet) compared with those with high PTSD and physical symptom severity. CONCLUSION Veterans with MUS endorse multiple, varied causal attributions for their physical symptoms, suggesting more complex causal beliefs than typically assumed. This has important implications for patient-provider communication and development of concordance around MUS treatment.
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Affiliation(s)
- Justin Kimber
- Department of Educational and Counseling Psychology, University at Albany, State University of New York, 1400 Washington Ave Ext, Albany, 12222, NY, USA.
| | - Nicole Sullivan
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, 07018, NJ, USA
| | - Nicole Anastasides
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, 07018, NJ, USA
| | - Sarah Slotkin
- Department of Educational and Counseling Psychology, University at Albany, State University of New York, 1400 Washington Ave Ext, Albany, 12222, NY, USA
| | - Lisa M McAndrew
- Department of Educational and Counseling Psychology, University at Albany, State University of New York, 1400 Washington Ave Ext, Albany, 12222, NY, USA
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15
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Traumatized attendings - When the doctor has the disease. Am J Surg 2021; 223:626-632. [PMID: 34116794 DOI: 10.1016/j.amjsurg.2021.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/29/2021] [Accepted: 05/13/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study aims to compare PTSD prevalence between seven medical specialties and to identify potential risk factors for PTSD. METHODS A cross-sectional national survey of attending physicians (n = 2216) was conducted and screened for PTSD using the Primary Care PTSD Screen. Stepwise multivariable regression analysis with backward elimination identified potential risk factors. RESULTS Overall prevalence of PTSD was 14% and ranged from 7% to 18% for psychiatrists and OBGYNs, respectively (p = 0.004). Six potential risk factors for PTSD included: emotional exhaustion, job dissatisfaction, lack of autonomy, working >60 h per week, poor camaraderie, and female gender (p < 0.05). CONCLUSIONS The prevalence of PTSD in attending physicians is more than double that of the general population. Higher risk specialties include OBGYN and general surgery. Specialty-specific interventions targeted at reducing physician burnout and improving the physician work-environment are needed to improve physician wellness and reduce PTSD.
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16
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Supporting the Mental Health and Well-Being of First Responders from Career to Retirement: A Scoping Review. Prehosp Disaster Med 2021; 36:475-480. [PMID: 33928892 DOI: 10.1017/s1049023x21000431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION First responders are at greater risk of mental ill health and compromised well-being compared to the general population. It is important to identify strategies that will be effective in supporting mental health, both during and after the first responder's career. METHODS A scoping review was conducted using the PubMed database (1966 to October 1, 2020) and the Google Scholar database (October 1, 2020) using relevant search terms, truncation symbols, and Boolean combination functions. The reference lists of all relevant publications were also reviewed to identify further publications. RESULTS A total of 172 publications were retrieved by the combined search strategies. Of these, 56 met the inclusion criteria and informed the results of this overview paper. These publications identified that strategies supporting first responder mental health and well-being need to break down stigma and build resilience. Normalizing conversations around mental health is integral for increasing help-seeking behaviors, both during a first responder's career and in retirement. Organizations should consider the implementation of both pre-retirement and post-retirement support strategies to improve mental health and well-being. CONCLUSION Strategies for supporting mental health and well-being need to be implemented early in the first responder career and reinforced throughout and into retirement. They should utilize holistic approaches which encourage "reaching in" rather than placing an onus on first responders to "reach out" when they are in crisis.
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17
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Quality of life among people who use drugs living in poor urban communities in the Philippines. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 93:103160. [PMID: 33721576 DOI: 10.1016/j.drugpo.2021.103160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/08/2021] [Accepted: 02/03/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The quality of life (QOL) and mental health of people who use drugs (PWUD) in the Philippines, especially those living in poor urban communities, are highly concerning due to the situations surrounding drug use and the ongoing hard-line antidrug policy. This study aimed to investigate the QOL and mental health status of PWUD, compare them with a comparison group with no history of drug use, and identify factors associated with QOL among Filipino PWUD. METHODS A cross-sectional study was conducted with recruitment from a community-based rehabilitation programme and poor urban communities in Muntinlupa in 2018. QOL was measured using the WHOQOL-BREF, while psychological distress and posttraumatic stress disorder (PTSD) were measured using the Kessler Psychological Distress Scale (K-6) and the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), respectively. Multivariable linear regressions with each WHOQOL-BREF domain as a dependent factor were conducted to establish three predictions: age- and gender-adjusted QOL means, factors associated with QOL among PWUD, and interaction of lifetime drug use with each covariate. RESULTS In total, 272 PWUD and 402 comparison participants were recruited. Most PWUD were current drug users (53%), primarily of methamphetamine (70%). Among PWUD, the prevalence of moderate to severe psychological distress was 70%, and probable PTSD was 28%-both rates higher than those among the comparison group. All four QOL domain scores (physical, psychological, social, and environmental) of PWUD were lower than those of the comparison group. Multivariable regressions showed that psychological distress, current drug use, selling drugs, experiencing discrimination, and being never-married were associated with lower QOL. Higher individual income, household resources, social activity participation, and service use for drug use problems were associated with higher QOL among PWUD. Stratified and interaction analyses revealed that the QOL of PWUD was more sensitive to changes in individual income relative to the QOL of comparison group. CONCLUSION A comprehensive intervention addressing psychological distress reduction, economic empowerment, and social inclusion-complementary to abstinence-oriented programmes-may improve the well-being of Filipino PWUD.
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18
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Bovin MJ, Kimerling R, Weathers FW, Prins A, Marx BP, Post EP, Schnurr PP. Diagnostic Accuracy and Acceptability of the Primary Care Posttraumatic Stress Disorder Screen for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) Among US Veterans. JAMA Netw Open 2021; 4:e2036733. [PMID: 33538826 PMCID: PMC7862990 DOI: 10.1001/jamanetworkopen.2020.36733] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/20/2020] [Indexed: 11/14/2022] Open
Abstract
Importance Posttraumatic stress disorder (PTSD) is a serious mental health disorder that can be effectively treated with empirically based practices. PTSD screening is essential for identifying undetected cases and providing patients with appropriate care. Objective To determine whether the Primary Care PTSD screen for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PC-PTSD-5) is a diagnostically accurate and acceptable measure for use in Veterans Affairs (VA) primary care clinics. Design, Setting, and Participants This cross-sectional, diagnostic accuracy study enrolled participants from May 19, 2017, to September 26, 2018. Participants were recruited from primary care clinics across 2 VA Medical Centers. Session 1 was conducted in person, and session 2 was completed within 30 days via telephone. A consecutive sample of 1594 veterans, aged 18 years or older, who were scheduled for a primary care visit was recruited. Data analysis was performed from March 2019 to August 2020. Exposures In session 1, participants completed a battery of questionnaires. In session 2, a research assistant administered the PC-PTSD-5 to participants, and then a clinician assessor blind to PC-PTSD-5 results conducted a structured diagnostic interview for PTSD. Main Outcomes and Measures The range of PC-PTSD-5 cut points overall and across gender was assessed, and diagnostic performance was evaluated by calculating weighted κ values. Results In total, 495 of 1594 veterans (31%) participated, and 396 completed all measures and were included in the analyses. Participants were demographically similar to the VA primary care population (mean [SD] age, 61.4 [15.5] years; age range, 21-93 years) and were predominantly male (333 participants [84.1%]) and White (296 of 394 participants [75.1%]). The PC-PTSD-5 had high levels of diagnostic accuracy for the overall sample (area under the receiver operating characteristic curve [AUC], 0.927; 95% CI, 0.896-0.959), men (AUC, 0.932; 95% CI, 0.894-0.969), and women (AUC, 0.899, 95% CI, 0.824-0.974). A cut point of 4 ideally balanced false negatives and false positives for the overall sample and for men. However, for women, this cut point resulted in high numbers of false negatives (6 veterans [33.3%]). A cut point of 3 fit better for women, despite increasing the number of false positives. Participants rated the PC-PTSD-5 as highly acceptable. Conclusions and Relevance The PC-PTSD-5 is an accurate and acceptable screening tool for use in VA primary care settings. Because performance parameters will change according to sample, clinicians should consider sample characteristics and screening purposes when selecting a cut point.
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Affiliation(s)
- Michelle J. Bovin
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Rachel Kimerling
- National Center for PTSD, VA Palo Alto Healthcare System, Palo Alto, California
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California
| | | | - Annabel Prins
- National Center for PTSD, VA Palo Alto Healthcare System, Palo Alto, California
- Department of Psychology, San Jose State University, San Jose, California
| | - Brian P. Marx
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Edward P. Post
- Veterans Affairs Central Office, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan
- University of Michigan Medical School, Ann Arbor
| | - Paula P. Schnurr
- National Center for PTSD, White River Junction, Vermont
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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The Prevalence of Post-Traumatic Stress Disorder among People Living with HIV/AIDS: a Systematic Review and Meta-Analysis. Psychiatr Q 2020; 91:1317-1332. [PMID: 32981021 DOI: 10.1007/s11126-020-09849-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 01/26/2023]
Abstract
Numerous studies have reported that the prevalence estimates of post-traumatic stress disorder (PTSD) might be substantially high among people with HIV/AIDS (PLWHA) when compared to the general population. However, there are no previous systematic reviews and meta-analysis studies that reported the pooled prevalence of PTSD among PLWHA. To fill this gap in research, this study aims to analyze data from observational studies concerning the prevalence of PTSD among PLWHA and formulate a recommendation for future research and clinical practice. Three electronic databases (PubMed, EMBASE, and SCOPUS) were searched to identify relevant studies that reported the prevalence of PTSD among PLWHA. A comprehensive meta-analysis software was used to conduct the meta-analysis. Subgroup and sensitivity analysis was conducted the I2 test was utilized to evaluate heterogeneity. Publication bias was assessed by using Egger's test and visual inspection of the symmetry in funnel plots. Nineteen-studies with 9094 participants were included in this systematic review and meta-analysis. The pooled prevalence estimate of PTSD among PLWHA was found to be 32.67% (95% CI; 25.29-41.01). The prevalence of PTSD was 25.17% (95% CI; 19.72-31.55) for studies that used diagnostic instrument to assess PTSD and it was 34.68% (95% CI; 25.42-45.26) for studies that used screening instruments. Furthermore, the prevalence of PTSD among PLWHA was comparable between high-income (31.19%) and low, and middle-income countries (34.87%). We also found that the pooled prevalence of PTSD was remarkably higher for moderate and low-quality studies (42.64%) than for high-quality studies (24.84%). The prevalence of PTSD among PLWHA in the current study showed a significant variation by the location of the studies, the instruments used to measure PTSD as well as the quality of the included studies. The present review demonstrated that the prevalence estimates of PTSD among PLWHA (32.67%) was notably high and requires clinical attention. The estimated prevalence of PTSD was found to be comparable between high income and low, and middle-income countries. In addition, we found that the prevalence of PTSD was notably lower when measured by the diagnostic instrument than the screening instrument, although the variation was not statistically significant. Early screening and treatment of PTSD among PLWHA is needed to alleviate suffering.
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Thompson J, Drew JM. Warr;or21: A 21-Day Program to Enhance First Responder Resilience and Mental Health. Front Psychol 2020; 11:2078. [PMID: 33013529 PMCID: PMC7505768 DOI: 10.3389/fpsyg.2020.02078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022] Open
Abstract
First responders face multiple stressors on a daily basis. They have experienced higher rates of anxiety disorders, depression, burnout, post-traumatic stress disorder (PTSD), suicide (Asmundson and Stapleton, 2008), alcohol and substance abuse (Ballenger et al., 2010), and deficient sleep hygiene (Pearsall, 2012) compared to the general population. Existing resilience research can be utilized and adapted to help first responders cope in a positive manner as a form of prevention and also as part of their recovery. New resiliency programs continue to emerge and this paper details one – warr;or21. The warr;or21 program is explained and based on an evaluation of the program’s preliminary data, the results are promising with how the program can assist first responders (and the general public) increase their resiliency and mental health.
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Affiliation(s)
- Jeff Thompson
- Molecular Imaging and Neuropathology Division, Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Jacqueline M Drew
- Griffith Criminology Institute, Griffith University, Mt Gravatt, QLD, Australia
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21
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Hawn SE, Aggen SH, Cusack SE, Dick D, Amstadter AB. Examination of a novel measure of trauma-related drinking to cope. J Clin Psychol 2020; 76:1938-1964. [PMID: 32478444 DOI: 10.1002/jclp.22972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/19/2020] [Accepted: 04/25/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The present study sought to fill a gap in the current literature by developing a concise self-report questionnaire assessing drinking motives specific to coping with symptoms of posttraumatic stress disorder (PTSD). This new four-item questionnaire is called the Trauma Related Drinking questionnaire (TRD). METHOD Using structural equation modeling, the latent structure of the TRD items and how they relate to other variables of interest were explored among a sample of 1,896 college undergraduates from a large public university. RESULTS Broadly, we found evidence to suggest that TRD is a more specific measure of drinking to cope motives compared to the commonly used Drinking Motives Questionnaire coping subscale. Additionally, findings demonstrate support for the external validation of TRD, both with regard to PTSD and alcohol consumption and related problems. CONCLUSIONS Results support the use of TRD in future self-medication research and as a clinically useful screening tool.
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Affiliation(s)
- Sage E Hawn
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia.,Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Steven H Aggen
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Shannon E Cusack
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia.,Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | | | - Danielle Dick
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia
| | - Ananda B Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia.,Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, Virginia
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Cochran G, Chen Q, Field C, Seybert AL, Hruschak V, Jaber A, Gordon AJ, Tarter R. A community pharmacy-led intervention for opioid medication misuse: A small-scale randomized clinical trial. Drug Alcohol Depend 2019; 205:107570. [PMID: 31689641 PMCID: PMC6933550 DOI: 10.1016/j.drugalcdep.2019.107570] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Stemming the opioid epidemic requires testing novel interventions. Toward this goal, feasibility and acceptability of a Brief Motivational Intervention-Medication Therapy Management (BMI-MTM) intervention was examined along with its impact on medication misuse and concomitant health conditions. METHODS We conducted a two-group randomized trial in 2 community pharmacies. We screened patients for prescription opioid misuse at point-of-service using the Prescription Opioid Misuse Index. Participants were assigned to standard medication counseling (SMC) or SMC + BMI-MTM (referred to as BMI-MTM herein). BMI-MTM consists of a pharmacist-led medication counseling/brief motivational session and 8-weekly patient navigation sessions. Assessments were at baseline, 2-, and 3-months. Primary outcomes included feasibility, acceptability, and mitigation of opioid medication misuse. Secondary outcomes included pain and depression. Outcomes were analyzed with descriptive and multivariable statistics (intent-to-treat [ITT] and adjusted for number of sessions completed [NUMSESS]). RESULTS Thirty-two participants provided informed consent (74.4% consent rate; SMC n = 17, BMI-MTM n = 15; 3-month assessment retention ≥93%). Feasibility was demonstrated by all BMI-MTM recipients completing the pharmacist session and an average of 7 navigation sessions. BMI-MTM recipients indicated ≥4.2 (5 maximum) level of satisfaction with the pharmacist-led session, and 92.4% were satisfied with navigation sessions. Compared to SMC at 3-months, BMI-MTM recipients reported greater improvements in misuse (ITT: Adjusted Odds Ratio [AOR] = 0.13; 95% CI = 0.05, 0.35, p < 0.001. NUMSESS AOR = 0.05; 95% CI = 0.01, 0.25; p < 0.001), pain (ITT: В = 8.8, 95% CI=-0.95, 18.5, p = 0.08; NUMSESS: В = 14.0, 95% CI = 3.28, 24.8, p = 0.01), and depression (ITT: B= -0.44; 95% CI=-0.65, -0.22; p < 0.001. NUMSESS B= -0.64; 95% CI=-0.82, -0.46; p < 0.001). CONCLUSIONS BMI-MTM is a feasible misuse intervention associated with superior satisfaction and outcomes than SMC. Future research should test BMI-MTM in a large-scale, fully-powered trial.
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Affiliation(s)
- Gerald Cochran
- University of Utah, School of Medicine, Department of Internal Medicine, 30 N 1900 E, Room 4C104, Salt Lake City, Utah, 84132, USA; University of Pittsburgh, School of Social Work 2117 Cathedral of Learning, 4200 Fifth Avenue, Pittsburgh, PA, 15260, USA.
| | - Qi Chen
- University of Pittsburgh, School of Social Work 2117 Cathedral of Learning, 4200 Fifth Avenue, Pittsburgh, PA, 15260, USA.
| | - Craig Field
- University of Texas, El Paso, Department of Psychology, Psychology Building, Room 112 500 W University, El Paso, Texas, 79902, USA.
| | - Amy L Seybert
- University of Pittsburgh, School of Pharmacy, Department of Pharmacy and Therapeutics, 3501 Terrace St, Pittsburgh, PA, 15261, USA.
| | - Valerie Hruschak
- University of Pittsburgh, School of Social Work 2117 Cathedral of Learning, 4200 Fifth Avenue, Pittsburgh, PA, 15260, USA.
| | - Amanda Jaber
- Falk Pharmacy, UPMC 3601 Fifth Ave, Pittsburgh, PA 15213, USA.
| | - Adam J Gordon
- University of Utah, School of Medicine, Department of Internal Medicine, 30 N 1900 E, Room 4C104, Salt Lake City, Utah, 84132, USA.
| | - Ralph Tarter
- University of Pittsburgh, School of Pharmacy, Department of Pharmaceutical Sciences, 3501 Terrace St, Pittsburgh, PA, 15261, USA.
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Jackson T, Zhou C, Khorgami Z, Jackson D, Agrawal V, Taubman K, Nelson P, Truitt MS. Traumatized Residents - It's Not Surgery. It's Medicine. JOURNAL OF SURGICAL EDUCATION 2019; 76:e30-e40. [PMID: 31477549 DOI: 10.1016/j.jsurg.2019.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/23/2019] [Accepted: 08/03/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) has been shown to be more common in surgical residents than the general population. This may be due to the rigors of a surgical residency. This study aims to compare the prevalence of screening positive for PTSD (PTSD+) among 7 medical specialties. Further, we intend to identify independent risk factors for the development of PTSD. METHODS A cross-sectional national survey of residents (n = 1904) was conducted from September 2016 to May 2017. Residents were screened for PTSD. Traumatic stressors were identified in those who reported symptoms of PTSD. Potential risk factors for PTSD were assessed using multivariate regression analysis with stepwise backward elimination against 30 demographic, occupational, psychological, work-life balance, and work-environment variables. RESULTS Residents from anesthesiology (n = 180), emergency medicine (n = 222), internal medicine (n = 473), general surgery (n = 464), obstetrics and gynecology (n = 226), psychiatry (n = 208), and surgical subspecialties (n = 131) were surveyed. No statistical difference was found in the prevalence of PTSD between specialties. Prevalence ranged from 14% to 23%. Eight independent risk factors for the development of PTSD+ were identified: higher postgraduate year, female gender, public embarrassment, emotional exhaustion, feeling unhealthy, job dissatisfaction, hostile hospital culture, and unsafe patient load. CONCLUSIONS The prevalence of PTSD in surgery residents was not statistically different when compared to those in other medical specialties. However, the overall prevalence of PTSD (20%) remains more than 3 times that of the general population. Overall, 8 risk factors for PTSD were identified. These risk factors varied by specialty. This may highlight the unique challenges of training in each discipline. Specialty specific interventions to improve resident wellness should be emphasized in the development of our young physicians.
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Affiliation(s)
- Theresa Jackson
- University of Oklahoma Tulsa, Department of Surgery, Tulsa, Oklahoma.
| | - Cici Zhou
- University of Oklahoma College of Medicine, Department of Graduate Medical Education, Oklahoma City, Oklahoma
| | - Zhamak Khorgami
- University of Oklahoma Tulsa, Department of Surgery, Tulsa, Oklahoma
| | | | - Vaidehi Agrawal
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kevin Taubman
- University of Oklahoma Tulsa, Department of Surgery, Tulsa, Oklahoma
| | - Peter Nelson
- University of Oklahoma Tulsa, Department of Surgery, Tulsa, Oklahoma
| | - Michael S Truitt
- Methodist Dallas Medical Center, Department of Graduate Medical Education, Dallas, Texas
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Abstract
Background: Injured patients are at risk for prolonged opioid use after discharge from care. Limited evidence exists regarding how continued opioid use may be related to opioid medication misuse and opioid use disorder (OUD) following injury. This pilot study characterized opioid consumption patterns, health characteristics, and substance use among patients with active prescriptions for opioid medications following injury care. Methods: This study was a cross-sectional screening survey combined with medical record review from February 2017 to March 2018 conducted among outpatient trauma and orthopedic surgery clinic patients. Eligible patients were 18-64 years of age, admitted/discharged for an injury or trauma-related orthopedic surgery, returning for clinic follow-up ≤6 months post hospital discharge after the index injury, prescribed opioid pain medication at discharge, and currently taking an opioid medication (from discharge or a separate prescription post discharge). Data collected included demographic, substance use, mental health, and physical health information. Descriptive and univariate statistics were calculated to characterize the population and opioid-related risks. Results: Seventy-one participants completed the survey (92% response). Most individuals (≥75%) who screened positive for misuse or OUD reported no nonmedical/illicit opioid use in the year before the index injury. A positive depression screen was associated with a 3.88 times increased likelihood for misuse or OUD (95% confidence interval [CI] = 1.1-13.5). Nonopioid illicit drug use (odds ratio [OR] = 1.89, 95% CI = 1.1-3.4) and opioid craving (OR = 1.29, 95% CI = 1.1-1.5) were also associated with increased likelihood for misuse or OUD. Number of emergency department visits in the 3 years previous to the index injury was associated with a 22% likelihood of being misuse or OUD positive (95% CI = 1.0-1.5). Conclusions: Patients with behavioral health concerns and greater emergency department utilization may have heightened risk for experiencing adverse opioid-related outcomes. Future research must further establish these findings and possibly develop protocols to identify patients at risk prior to pain management planning.
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Li J, Zhang W, Chen W, Yuan H, Zhang S, Tian M, Qu Z. Applications of the Chinese version of the primary care PTSD screen for DSM-5 (PC-PTSD-5) for children. J Affect Disord 2019; 254:109-114. [PMID: 31158781 DOI: 10.1016/j.jad.2019.05.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/11/2019] [Accepted: 05/12/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Effective screening is important for public mental health services. Although the primary care PTSD screen for DSM-5 (PC-PTSD-5) is useful in screening for post-traumatic stress disorder (PTSD) in adults, its reliability and validity for use in children remain unclear. This study aimed to examine the performance characteristics of the Chinese PC-PTSD-5 for children in children aged 8 to 16 years. METHODS 4,022 rural children from Grades 4 to 9 in China were included in this study. All participants were assessed for PTSD using the Chinese PC-PTSD-5 for children and the PTSD Checklist for DSM-5 (PCL-5), and assessed for anxiety using the Chinese version of the State Anxiety Scale for Children (CSAS-C), and for depression using the Children's Depression Inventory - Short Form (CDI-S). The performance characteristics of the PC-PTSD-5 for children were evaluated using receiver operating characteristic analyses. RESULTS The mean scores on the PCL-5 and the PC-PTSD-5 were 17.45 (SD = 14.78) and 1.78 (SD = 1.33), respectively. There was a significant correlation between the PC-PTSD-5 and PCL-5 (r = 0.54, p < 0.001), and small but significant correlations of the PC-PTSD-5 with the CSAS-C (r = 0.31, p < 0.001) and CDI-S (r = 0.27, p < 0.001). In this study, 2 and 3 were both found to be acceptable cutoff values. A cutoff value of 2 yielded a sensitivity of 0.87 and a specificity of 0.52, while a cutoff of 3 had sensitivity = 0.57, and specificity = 0.77. LIMITATIONS A clinical interview was not used to validated diagnostic findings. CONCLUSIONS The reliability and validity of the Chinese PC-PTSD-5 were statistically acceptable for screening for probable PTSD in children. Additionally, the Chinese PC-PTSD-5 had a favorable sensitivity at a cut off 2 and a favorable specificity at a cut off 3, based on PCL-5 results.
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Affiliation(s)
- Jina Li
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, No. 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Weijun Zhang
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, No. 19, Xinjiekou Wai Street, Beijing 100875, China.
| | - Wenrui Chen
- The India China Institute, The New School, New York, NY 10011, United States.
| | - Hui Yuan
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, No. 19, Xinjiekou Wai Street, Beijing 100875, China.
| | - Shengfa Zhang
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, No. 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Meng Tian
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, No. 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Zhiyong Qu
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, No. 19, Xinjiekou Wai Street, Beijing 100875, China.
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McAndrew LM, Slotkin S, Kimber J, Maestro K, Phillips LA, Martin JL, Credé M, Eklund A. Cultural incongruity predicts adjustment to college for student veterans. J Couns Psychol 2019; 66:678-689. [PMID: 31204835 DOI: 10.1037/cou0000363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Little is known about what predicts student service members' and veterans' (SSM/V) adjustment to college. In qualitative research, SSM/V report feeling they do not belong and are misunderstood by college communities, a phenomenon that counseling psychologists call cultural incongruity. The goal of the current study was to quantitatively examine the relationship between cultural incongruity and adjustment to college. We surveyed 814 SSM/V about their adjustment to college using the Student Adaptation to College Questionnaire. Cultural incongruity was operationalized in two ways: feelings of not belonging were measured via direct report and the association with adjustment to college assessed with regression. Feelings of being misunderstood about academic barriers were assessed by comparing SSM/V's perceptions of academic barriers and SSM/V's perceptions of how others view the SSM/V's academic barriers and the association with adjustment was assessed using polynomial regression and response surface analysis. Cultural incongruity predicted adjustment to college. After controlling for other known predictors, feelings of not belonging accounted for 18% of the variance in adjustment to college. Polynomial regression showed that feeling understood about academic barriers protected against the negative impact of the barrier on adjustment to college. Cultural incongruity predicts adjustment to college for SSM/V. Helping SSM/V feel their unique barriers to college adjustment are understood may blunt the impact of these barriers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Do screening and a randomized brief intervention at a Level 1 trauma center impact acute stress reactions to prevent later development of posttraumatic stress disorder? J Trauma Acute Care Surg 2019; 85:466-475. [PMID: 29787532 DOI: 10.1097/ta.0000000000001977] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Approximately 20% to 40% of trauma survivors experience posttraumatic stress disorder (PTSD). The American College of Surgeons Committee on Trauma reports that early screening and referral has the potential to improve outcomes and that further study of screening and intervention for PTSD would be beneficial. This prospective randomized study screened hospitalized patients for traumatic stress reactions and assessed the effect of a brief intervention in reducing later development of PTSD. METHODS The Primary Care PTSD (PC-PTSD) screen was administered to admitted patients. Patients with symptoms were randomized to an intervention or control group. The brief intervention focused on symptom education and normalization, coping strategies, and utilizing supports. The control group received a 3-minute educational brochure review. Both groups completed in-hospital interviews, then 45- and 90-day telephone interviews. Follow-up collected the PTSD checklist-civilian (PCL-C) assessment and qualitative data on treatment-seeking barriers. RESULTS The PC-PTSD screen was successful in predicting later PTSD symptoms at both 45 days (β = 0.43, p < 0.001) and 90 days (β = 0.37, p < 0.001) even after accounting for depression. Correlations of the intervention with the PCL-C scores and factor score estimates did not reach statistical significance at either time point (p = 0.827; p = 0.838), indicating that the brief intervention did not decrease PTSD symptoms over time. Of those at or above the PCL-C cutoff at follow-ups, a minority had sought treatment for their symptoms (43.2%). Primary barriers included focusing on their injury or ongoing rehabilitation, financial concerns, or location of residence. CONCLUSION The PC-PTSD screen identified patients who later assess positive for PTSD using the PCL-C. The brief intervention did not reduce 45- and 90-day PTSD development. Follow-up interviews revealed lack of treatment infrastructure in the community. It will be important for trauma centers to align with community resources to address the treatment needs of at-risk patients. LEVEL OF EVIDENCE Prospective randomized controlled trial, level II.
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Jackson TN, Morgan JP, Jackson DL, Cook TR, McLean K, Agrawal V, Taubman KE, Truitt MS. The Crossroads of Posttraumatic Stress Disorder and Physician Burnout: A National Review of United States Trauma and Nontrauma Surgeons. Am Surg 2019. [DOI: 10.1177/000313481908500217] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Posttraumatic stress disorder (PTSD) among trauma surgeons is three times that of the general population, and physician burnout (PBO) among surgeons is rising. Given that PTSD and PBO are both stress-based syndromes, we aim to identify the prevalence and risk factors for PTSD among trauma and nontrauma surgeons, and determine if a relationship exists. A cross-sectional survey of surgeons was conducted between September 2016 and May 2017. Respondents were screened for PTSD and PBO. Traumatic stressors were identified, and 20 potential risk factors were assessed. The respondents (n = 1026) were grouped into trauma (n = 350) and nontrauma (n = 676). Between the cohorts, there was no significant difference in prevalence of screening positive for PTSD (17% vs 15%) or PBO (30% vs 25%). A relationship was found between PTSD and PBO (P < 0.001). The most common traumatic stressor was overwhelming work responsibilities. Potential risk factors for PTSD differed, but overlapping risk factors included hospital culture, hospital support, and salary (P < 0.05). Our findings of an association between PTSD and PBO is concerning. Interventions to reduce rates of PTSD should target changing the existing culture of surgery, improving hospital support, and ensuring equitable pay.
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Affiliation(s)
| | - Jake P. Morgan
- Department of Graduate Medical Education, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | | | - Taylor R. Cook
- Department of Graduate Medical Education, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Kevin McLean
- Department of Graduate Medical Education, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Vaidehi Agrawal
- Department of Graduate Medical Education, Methodist Dallas Medical Center, Dallas, Texas
| | - Kevin E. Taubman
- Department of Surgery, University of Oklahoma Tulsa, Tulsa, Oklahoma
| | - Michael S. Truitt
- Department of Graduate Medical Education, Methodist Dallas Medical Center, Dallas, Texas
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Patanwala M, Tieu L, Ponath C, Guzman D, Ritchie CS, Kushel M. Physical, Psychological, Social, and Existential Symptoms in Older Homeless-Experienced Adults: An Observational Study of the Hope Home Cohort. J Gen Intern Med 2018; 33:635-643. [PMID: 29185174 PMCID: PMC5910332 DOI: 10.1007/s11606-017-4229-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 09/14/2017] [Accepted: 11/03/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND The homeless population in the United States is aging. Aging-associated comorbidities are associated with increased symptoms. OBJECTIVE To describe the prevalence of symptoms among older homeless-experienced adults, analyze factors associated with moderate-high physical symptom burden, and identify symptom clusters. DESIGN Cross-sectional analysis within longitudinal cohort study. PARTICIPANTS Using population-based sampling from shelters, meal programs, encampments, and a recycling center in Oakland, CA, we recruited homeless adults aged ≥ 50 for a longitudinal cohort. This study includes participants who participated in the 18-month follow-up visit. MAIN MEASURES We assessed physical symptoms using the Patient Health Questionnaire-15 (PHQ-15); psychological symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D), Primary Care PTSD Screen (PC-PTSD), and psychiatric section of the Addiction Severity Index (ASI); loneliness using the Three-Item Loneliness Scale; and regret using a six-item regret scale. KEY RESULTS Two hundred eighty-three participants (75.6% men and 82.3% African-Americans) completed symptoms interviews. Over a third (34.0%) had moderate-high physical symptom burden. The most prevalent physical symptoms were joint pain, fatigue, back pain, and sleep trouble. Over half (57.6%) had psychological symptoms; 39.6% exhibited loneliness and 26.5% had high regret. In a multivariate model, being a woman (AOR 2.54, 95% CI 1.28-5.03), childhood abuse (AOR 1.88, 95% CI 1.00-3.50), cannabis use (AOR 2.59, 95% CI 1.38-4.89), multimorbidity (AOR 2.50, 95% CI 1.36-4.58), anxiety (AOR 4.30, 95% CI 2.24-8.26), hallucinations (AOR 3.77, 95% CI 1.36-10.43), and loneliness (AOR 2.32, 95% CI 1.26-4.28) were associated with moderate-high physical symptom burden. We identified four symptom clusters: minimal overall (n = 129), moderate overall (n = 68), high physical and high psychological (n = 67), and high physical and low psychological (n = 17). CONCLUSIONS Older homeless-experienced adults exhibit a high prevalence of symptoms across multiple dimensions. To reduce suffering, clinicians should recognize the interaction between symptoms and address multiple symptom dimensions.
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Affiliation(s)
- M Patanwala
- UCSF School of Medicine, San Francisco, CA, USA
| | - L Tieu
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
- UCSF Center for Vulnerable Populations, San Francisco, CA, USA
| | - C Ponath
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - D Guzman
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
- UCSF Center for Vulnerable Populations, San Francisco, CA, USA
| | - C S Ritchie
- UCSF Division of Geriatrics, Department of Medicine, San Francisco, CA, USA
| | - Margot Kushel
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
- UCSF Center for Vulnerable Populations, San Francisco, CA, USA.
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Cochran GT, Engel RJ, Hruschak VJ, Tarter RE. Prescription Opioid Misuse Among Rural Community Pharmacy Patients: Pilot Study for Screening and Implications for Future Practice and Research. J Pharm Pract 2017; 30:498-505. [PMID: 27402634 PMCID: PMC5219955 DOI: 10.1177/0897190016656673] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Opioid misuse imposes a disproportionately heavy burden on individuals living in rural areas. Community pharmacy has the potential to expand and coordinate with health professionals to identify and intervene with those who misuse opioids. OBJECTIVE Rural and urban community pharmacy patients were recruited in this pilot project to describe and compare patterns of opioid misuse. METHODS We administered a health screening survey in 4 community pharmacies among patients filling opioid medications. Univariate statistics were used to assess differences in health characteristics and opioid medication misuse behaviors between rural and urban respondents. Multivariable statistics were used to identify risk factors associated with rural and urban opioid misuse. RESULTS A total of 333 participants completed the survey. Participants in rural settings had poorer overall health, higher pain levels, lower education, and a higher rate of unemployment compared to patients in urban pharmacies. Rural respondents with illicit drug use (adjustable odds ratio [aOR]: 14.34, 95% confidence interval [CI] = 2.16-95.38), posttraumatic stress disorder (aOR: 5.44, 95% CI = 1.52-19.50), and ≤high school education (aOR: 6.68, 95% CI = 1.06-42.21) had increased risk for opioid misuse. CONCLUSIONS Community pharmacy represents a promising resource for potential identification of opioid misuse, particularly in rural communities. Continued research must extend these findings and work to establish collaborative services in rural settings.
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Affiliation(s)
- Gerald T Cochran
- 1 Department of Psychiatry, School of Medicine, University of Pittsburgh School of Social Work, Pittsburgh, PA, USA
| | - Rafael J Engel
- 2 University of Pittsburgh School of Social Work, Pittsburgh, PA, USA
| | | | - Ralph E Tarter
- 3 University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
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Cochran G, McCarthy R, Gordon AJ, Tarter RE. Opioid medication misuse among unhealthy drinkers. Drug Alcohol Depend 2017; 179:13-17. [PMID: 28735077 PMCID: PMC5815165 DOI: 10.1016/j.drugalcdep.2017.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/17/2017] [Accepted: 06/10/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Combining opioid medications and alcohol has serious implications for patient health, including overdose. Information regarding those who use/misuse opioid medications and engage in unhealthy alcohol use is limited to pharmacological and epidemiological descriptions. This study presents opioid medication misuse and behavioral, mental, and physical health characteristics of persons filling opioid medications that are engaged in unhealthy alcohol use. METHODS We conducted a cross-sectional survey at 5 community pharmacies in Southwestern, Pennsylvania among patients filling opioid medications. Respondents completed validated opioid medication misuse, alcohol use, illicit drug use, depression, posttraumatic stress disorder (PTSD), and physical health functioning assessments. We present univariate and multivariate statistics describing opioid medication misuse and health risks among those positive for unhealthy alcohol use. RESULTS A total of 344 patients completed the survey (75.8% response). A total of 15.9% of respondents screened positive for opioid medication misuse, of whom 20.3% reported unhealthy alcohol use. Taking opioid medications too often was reported among a larger proportion of the sample with unhealthy alcohol use (34.3%) compared to those without (22.1%, p=0.04). Further, among respondents with unhealthy alcohol use, illicit drug use (Adjusted odds ratio [AOR]=12.14, 95% Confidence Interval [CI]=1.64-89.72) and PTSD (AOR=9.77, 95% CI=1.70-56.11) were associated with increased odds for opioid medication misuse. CONCLUSION Results suggest respondents with unhealthy alcohol use had distinct health profiles, which may place them at risk for opioid misuse and adverse events, such as overdose. Continued research must work to further understand these relationships and identify intervention and treatment strategies.
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Affiliation(s)
- Gerald Cochran
- University of Pittsburgh, School of Social Work, 4200 Forbes Ave. #2006, Pittsburgh, PA, 15260, USA; University of Pittsburgh, School of Medicine, M240 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261, USA.
| | - Rebecca McCarthy
- VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA 15224, USA.
| | - Adam J. Gordon
- University of Pittsburgh, School of Medicine, M240 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261, USA,VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA 15224, USA
| | - Ralph E. Tarter
- University of Pittsburgh, School of Pharmacy, 3501 Terrace St, Pittsburgh, PA 15213, USA
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Flatt JD, Williams BA, Barnes D, Goldenson J, Ahalt C. Post-traumatic stress disorder symptoms and associated health and social vulnerabilities in older jail inmates. Aging Ment Health 2017; 21:1106-1112. [PMID: 27367335 PMCID: PMC5580931 DOI: 10.1080/13607863.2016.1201042] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To examine post-traumatic stress disorder (PTSD) symptoms in older jail inmates, and to determine whether adverse social and health-related characteristics were associated with having PTSD symptoms. METHOD We performed an exploratory cross-sectional study of 238 older (age ≥55 years) jail inmates from a county jail. PTSD symptoms were determined using the Primary Care PTSD (PC-PTSD) screen. Reporting three or more PTSD symptoms was defined as a positive screen. Descriptive statistics and multiple regression analyses were used to examine the prevalence of a positive PTSD screen and associations with social and health-related characteristics. RESULTS The mean age was 59 years, 64% were Black, and 82% reported an annual income ≤$15,000. Nearly 40% of older jail inmates had a positive PTSD screen and 10% reported a prior PTSD diagnosis by a physician. Older jail inmates with a positive PTSD screen were significantly more likely than those with a negative PTSD screen to report medication insecurity in the past year, impairment in two or more activities of daily living, traumatic brain injury, pain in the past week, and poor self-rated health. CONCLUSION Over one in three of the older jail inmates in this study had a positive PTSD screen, though only one in five of those with a positive screen reported a prior PTSD diagnosis. Screening for PTSD in jails may help identify older inmates who would benefit from additional mental health treatment and reentry planning to improve health in this population.
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Affiliation(s)
- Jason D. Flatt
- Institute for Health & Aging, University of California, San Francisco, CA, USA,San Francisco Veteran Affairs Medical Center, San Francisco, CA, USA
| | - Brie A. Williams
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA,San Francisco Veteran Affairs Medical Center, San Francisco, CA, USA
| | - Deborah Barnes
- San Francisco Veteran Affairs Medical Center, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Joe Goldenson
- Jail Health Services, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Cyrus Ahalt
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
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Landefeld JC, Miaskowski C, Tieu L, Ponath C, Lee CT, Guzman D, Kushel M. Characteristics and Factors Associated With Pain in Older Homeless Individuals: Results From the Health Outcomes in People Experiencing Homelessness in Older Middle Age (HOPE HOME) Study. THE JOURNAL OF PAIN 2017; 18:1036-1045. [PMID: 28412229 PMCID: PMC5581208 DOI: 10.1016/j.jpain.2017.03.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/16/2017] [Accepted: 03/28/2017] [Indexed: 12/22/2022]
Abstract
Individuals experiencing homelessness in the United States are aging; little is known about chronic pain in this population. In a cross-sectional, population-based study, we interviewed 350 homeless individuals aged 50 years and older to describe pain experienced by older persons experiencing homelessness and to assess factors associated with chronic moderate to severe pain, defined as pain lasting ≥3 months, with a past week average severity score of 5 to 10 (scale 0-10). The median age of participants was 58 years. Participants were predominantly African American (79.6%) and male (77.3%). Overall, 46.8% reported chronic moderate to severe pain. Almost half of participants reported a diagnosis of arthritis (44.3%) and one-third reported symptoms consistent with post-traumatic stress disorder (PTSD; 32.8%). Three-quarters (75.3%) endorsed a personal history of abuse. In multivariate analyses, PTSD (adjusted odds ratio [AOR]: 2.2, 95% confidence interval [CI], 1.4-3.7), arthritis (AOR: 4.8, 95% CI, 3.0-7.8), and history of experiencing abuse (AOR: 2.4, 95% CI, 1.3-4.3) were associated with chronic moderate to severe pain. HIV status, diabetes, depressive symptoms, and substance use were not associated with pain. Clinicians should consider the management of associated mental health conditions and the sequelae of experiencing abuse in the treatment of chronic pain in older adults experiencing homelessness. PERSPECTIVE This article describes the prevalence and factors associated with chronic pain in older homeless adults. Almost half report chronic pain, which was associated with PTSD, arthritis, and personal history of abuse. Clinicians should address chronic pain, trauma, and the associated mental health conditions in this high-risk population.
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Affiliation(s)
- John C Landefeld
- Division of General Internal Medicine, University of California, San Francisco, California; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, California
| | - Lina Tieu
- Division of General Internal Medicine, University of California, San Francisco, California; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Claudia Ponath
- Division of General Internal Medicine, University of California, San Francisco, California; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Christopher T Lee
- Division of General Internal Medicine, University of California, San Francisco, California; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - David Guzman
- Division of General Internal Medicine, University of California, San Francisco, California; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Margot Kushel
- Division of General Internal Medicine, University of California, San Francisco, California; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.
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Hiratsuka VY, Moore L, Dillard DA, Avey JP, Dirks LG, Beach B, Novins D. Development of a Screening and Brief Intervention Process for Symptoms of Psychological Trauma Among Primary Care Patients of Two American Indian and Alaska Native Health Systems. J Behav Health Serv Res 2017; 44:224-241. [PMID: 27328846 PMCID: PMC5177536 DOI: 10.1007/s11414-016-9519-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
American Indian and Alaska Native (AI/AN) people experience high rates of acute, chronic, and intergenerational trauma. Traumatic experiences often increase the risk of both medical and behavioral health problems making primary care settings opportune places to screen for trauma exposure or symptomology. The objective of this study was to determine considerations and recommendations provided by patients, health care providers, health care administrators, and tribal leaders in the development of an adult trauma screening, brief intervention, and referral for treatment process to pilot at two large AI/AN primary care systems. A qualitative and iterative data collection and analysis process was undertaken using a community-based participatory research approach guided by a cross-site steering committee. Twenty-four leaders and providers participated in individual interviews, and 13 patients participated in four focus groups. Data were thematically analyzed to select a trauma screening instrument, develop a screening process, and develop brief intervention materials. The nature of traumas experienced in the AI/AN community, the need to develop trusting patient-provider relationships, and the human resources available at each site drove the screening, brief intervention, and referral process decisions for a future trauma screening pilot in these health systems.
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Affiliation(s)
- Vanessa Y Hiratsuka
- Southcentral Foundation Research Department, 4085 Tudor Centre Drive, Anchorage, AK, 99508, USA.
| | - Laurie Moore
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, 13055 E. 17th Avenue, Aurora, CO, 80045, USA
| | - Denise A Dillard
- Southcentral Foundation Research Department, 4085 Tudor Centre Drive, Anchorage, AK, 99508, USA
| | - Jaedon P Avey
- Southcentral Foundation Research Department, 4085 Tudor Centre Drive, Anchorage, AK, 99508, USA
| | - Lisa G Dirks
- Southcentral Foundation Research Department, 4085 Tudor Centre Drive, Anchorage, AK, 99508, USA
| | - Barbara Beach
- Cherokee Nation Behavioral Health, 1277 Skill Center Circle, Tahlequah, OK, 74464, USA
| | - Douglas Novins
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, 13055 E. 17th Avenue, Aurora, CO, 80045, USA
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Fait K, Vilchinsky N, Dekel R, Levi N, Hod H, Matetzky S. Cardiac Disease-Induced Post-traumatic Stress Symptoms (CDI-PTSS) Among Patients' Partners. Stress Health 2017; 33:169-176. [PMID: 27256207 DOI: 10.1002/smi.2686] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 04/10/2016] [Accepted: 04/10/2016] [Indexed: 11/06/2022]
Abstract
It is well established that a patient's partner can be deeply affected by the traumatizing nature of the patient's illness. Yet, no study to date has focused on post-traumatic stress symptoms (PTSS) among partners of patients coping with an acute coronary syndrome (ACS). The current study's main aims were to address this gap and to evaluate cardiac disease-induced (CDI) PTSS prevalence in partners of patients who experienced ACS. Patients who experienced ACS and their partners were interviewed by telephone 2 to 6 months after patients' hospitalization. All patients and partners were screened for CDI-PTSS. Demographic and medical variables as well as partners' level of exposure to the cardiac event were assessed. Prevalence of CDI-PTSS was higher among partners than among patients. Partners' number of CDI-PTSS was not significantly associated with patients' number of CDI-PTSS or with any of the other explanatory factors measured, except for education level. The preliminary results that arose from the current study point to the vast number of individuals who must act as caregivers for their ill partners while having to cope with their own PTSS. Much effort should be channelled into integrating partners into cardiac recovery programmes. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Keren Fait
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Noa Vilchinsky
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Rachel Dekel
- The Louis & Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat-Gan, Israel
| | - Nitza Levi
- Leviev Heart Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Hanoch Hod
- Leviev Heart Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shlomi Matetzky
- Leviev Heart Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Cochran G, Hruschak V, Bacci JL, Hohmeier KC, Tarter R. Behavioral, mental, and physical health characteristics and opioid medication misuse among community pharmacy patients: A latent class analysis. Res Social Adm Pharm 2016; 13:1055-1061. [PMID: 27876595 DOI: 10.1016/j.sapharm.2016.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/14/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Community pharmacists are well-positioned to address the US opioid medication crisis, which has created a need to detect misuse risk in order to provide optimal patient care. OBJECTIVES This study sought to identify community pharmacy patient subgroups at risk for opioid medication misuse. METHODS This study was a cross-sectional survey that examined behavioral, mental, and physical health characteristics among patients filling opioid pain medications. A convenience sample of adult patients filling opioid pain medications who were not receiving cancer treatment were screened in 2 urban and 2 rural community pharmacies in southwestern Pennsylvania. Patient subgroups were identified using latent class analysis. Latent class regression analysis was used to examine the association between subgroup membership and misuse. RESULTS A total of 333 patients completed the survey (response rate 71.4%). Latent class analysis results showed that a 3-class solution best fit the data, which were labeled: mental health (8.4%, n = 28), poor health (79.6%, n = 265), and hazardous alcohol use (12%, n = 40). Individuals within the mental health subgroup had an increased risk for opioid medication misuse (Odds Ratio = 6.23, 95% CI = 5.13-7.33). CONCLUSION These findings demonstrate heterogeneity of this population receiving prescribed opioids and the potential to identify subgroups with high misuse risk. These findings also support routine screening of patients filling opioid medications and suggest the need for evidence-based patient-centered intervention development.
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Affiliation(s)
- Gerald Cochran
- University of Pittsburgh, School of Social Work, 4200 Forbes Ave. #2006, Pittsburgh, PA 15260, USA; University of Pittsburgh, School of Medicine, Department of Psychiatry, 3811 O'Hara St, Pittsburgh, PA 15213, USA.
| | - Valerie Hruschak
- University of Pittsburgh, School of Social Work, 4200 Forbes Ave. #2006, Pittsburgh, PA 15260, USA
| | - Jennifer L Bacci
- University of Washington, School of Pharmacy, Box 357631, H364 Health Sciences Building, Seattle, WA 98195-7631, USA
| | - Kenneth C Hohmeier
- University of Tennessee, College of Pharmacy, Department of Clinical Pharmacy, 193 Polk Ave. Suite 2D, Nashville, TN 37210, USA
| | - Ralph Tarter
- University of Pittsburgh, School of Pharmacy, 3501 Terrace St, Pittsburgh, PA 15261, USA
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Dodgson JE, Oneha MF, Choi M. A Socioecological Predication Model of Posttraumatic Stress Disorder in Low-Income, High-Risk Prenatal Native Hawaiian/Pacific Islander Women. J Midwifery Womens Health 2016; 59:494-502. [PMID: 26227791 DOI: 10.1111/jmwh.12211] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Only recently has perinatal posttraumatic stress disorder (PTSD) been researched in any depth; however, the causes and consequences of this serious illness remain unclear. Most commonly, childbirth trauma and interpersonal violence have been reported as contributing factors. However, not all Native Hawaiian/Pacific Islander (NHPI) women who experience these events experience PTSD. The factors affecting PTSD are many and complex, intertwining individual, family, and community contexts. Using a socioecological framework, 3 levels of contextual variables were incorporated in this study (individual, family, and social/community). The purpose of this study was to determine the socioecological predictors associated with prenatal PTSD among NHPI. METHODS A case-control design was used to collect retrospective data about socioecological variables from medical record data. The sample was low-income, high-risk NHPI women receiving perinatal health care at a rural community health center in Hawaii who screened positive (n = 55) or negative (n = 91) for PTSD. RESULTS Hierarchical logistic regression was conducted to determine socioecological predictors of positive PTSD screening. Although the majority of women (66.4%) experienced some form of interpersonal violence, a constellation of significant predictor variables from all 3 levels of the model were identified: depression (individual level), lack of family support and family stress (family level), and violence (social/community level). DISCUSSION Each of the predictor variables has been identified by other researchers as significantly affecting perinatal PTSD. However, it is because these variables occur together that a more complex picture emerges, suggesting the importance of considering multiple variables in context when identifying and caring for these women. Although additional research is needed, it is possible that the significant predictor variables could be useful in identifying women who are at higher risk for PTSD in other similar populations.
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Cochran G, Bacci JL, Ylioja T, Hruschak V, Miller S, Seybert AL, Tarter R. Prescription opioid use: Patient characteristics and misuse in community pharmacy. J Am Pharm Assoc (2003) 2016; 56:248-256.e6. [PMID: 27053277 PMCID: PMC4886233 DOI: 10.1016/j.japh.2016.02.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 02/11/2016] [Accepted: 02/12/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Opioid pain medication misuse is a major concern for US public health. The purpose of this article is to: 1) describe the demographic and physical, behavioral, and mental health characteristics of patients who fill opioid medications in community pharmacy settings; and 2) describe the extent of opioid medication misuse behaviors among these patients. DESIGN We recruited and screened a convenience sample of patients with the use of a tablet computer-based assessment protocol that examined behavioral, mental, and physical health. Descriptive and inferential statistics were calculated to describe respondents and their opioid medication misuse and health characteristics. SETTING Patients were screened in 2 urban and 2 rural community pharmacies in southwestern Pennsylvania. PARTICIPANTS Survey participants were adult patients filling opioid pain medications who were not currently receiving treatment for a cancer diagnosis. INTERVENTION None. MAIN OUTCOME MEASURES Validated screening measures included the Prescription Opioid Misuse Index, Alcohol Use Disorders Identification Test C, Short Form 12, Drug Abuse Screening Test 10, Primary Care Post-traumatic Stress Disorder (PTSD) screen, and the Patient Health Questionnaire 2. RESULTS A total of 333 patients were screened (71.2% response rate). Nearly the entire population reported pain above and general health below national norms. Hydrocodone (19.2%) and morphine (20.8%) were found to be the medications with the highest rates of misuse-with hydrocodone having more than 4 times higher odds of misuse compared with other medications (adjusted odds ratio [AOR] 4.48, 95% confidence interval [CI] 1.1-17.4). Patients with positive screens for illicit drug use (AOR 8.07, 95% CI 2.7-24.0), PTSD (AOR 5.88, 95% CI 2.3-14.7), and depression (AOR 2.44, 95% CI 1.0-5.9) also had significantly higher odds for misuse compared with those with negative screening results. CONCLUSION These findings provide important foundational data that suggest implementation of regular opioid misuse screening protocols within community pharmacies. Such screening activities could foster a culture of prevention and overall reduction for misuse among patients filling opioid medications in community pharmacies.
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Kullack C, Laugharne J. Standard EMDR Protocol for Alcohol and Substance Dependence Comorbid With Posttraumatic Stress Disorder: Four Cases With 12-Month Follow-Up. JOURNAL OF EMDR PRACTICE AND RESEARCH 2016. [DOI: 10.1891/1933-3196.10.1.33] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This report begins with a summary of the literature regarding the theoretical models behind the comorbid relationship between posttraumatic stress disorder and substance use disorders and the various modified addiction protocols formulated to assist in treating these disorders. This case series outlines the effect that the standard eye movement desensitization and reprocessing (EMDR) protocol had on alcohol and substance dependence for 4 patients who attended our Post Traumatic Stress Clinic in Fremantle, Western Australia, primarily for treatment for posttraumatic stress disorder. Patients were assessed for substance use disorders using the Mini International Neuropsychiatric Interview Plus prior to, immediately after, and 12 months after completing EMDR therapy. Results indicate that the standard EMDR protocol was successful in reducing alcohol and substance use. Prior to treatment, 3 patients met criteria for alcohol dependence and 1 met criteria for substance dependence. At 12-month follow-up, 3 out of 4 clients did not meet the diagnostic criteria for current alcohol dependence or current substance dependence. The implications of these findings are discussed with reference to theories of comorbid posttraumatic stress disorder and substance use disorder and the modified EMDR protocols developed for patients with substance dependence.
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Tripp JC, Meshesha LZ, Teeters JB, Pickover AM, McDevitt-Murphy ME, Murphy JG. Alcohol craving and demand mediate the relation between posttraumatic stress symptoms and alcohol-related consequences. Exp Clin Psychopharmacol 2015; 23:324-31. [PMID: 26375513 PMCID: PMC4573546 DOI: 10.1037/pha0000040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Posttraumatic stress (PTS) symptoms are associated with alcohol-related consequences, but there is a need to understand mediators that may help explain the reasons for this relationship. Individuals with PTS may experience elevated craving and alcohol reward value (demand), which may contribute to risk for alcohol-related consequences. We examined relationships between PTS status, craving, alcohol demand, and alcohol-related consequences in PTS-positive (n = 64) and PTS-negative (n = 200) college students (M age = 21.7; 77% women; 54% Caucasian; 34% African American) who endorsed past-month alcohol use. We tested craving and alcohol demand as mediators of the relation between PTS status and alcohol-related consequences. Craving (B = .04, SE = .02, 95% CI [.01, .10]), demand intensity (B = .02, SE = .02, 95% CI [.001, .07]), and demand elasticity (B = .05, SE = .03, 95% CI [.006, .12]) significantly mediated the association between PTS symptoms and alcohol-related consequences. Craving remained a significant mediator in a multiple mediators model (B = .08, SE = .04, 95% CI [.03, .19]). Craving and alcohol demand may partially explain the relation between PTS status and alcohol-related consequences. Craving may be especially salient for individuals with PTS symptoms, as it may lead to more severe alcohol-related consequences even in the absence of elevated alcohol consumption.
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Dibbets P, Arntz A. Imagery rescripting: Is incorporation of the most aversive scenes necessary? Memory 2015; 24:683-95. [DOI: 10.1080/09658211.2015.1043307] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Kok T, de Haan HA, van der Meer M, Najavits LM, De Jong CAJ. Screening of current post-traumatic stress disorder in patients with substance use disorder using the Depression, Anxiety and Stress Scale (DASS-21): a reliable and convenient measure. Eur Addict Res 2015; 21:71-7. [PMID: 25413311 DOI: 10.1159/000365283] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 06/17/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Several instruments have been developed and validated as screens for post-traumatic stress disorder (PTSD) in substance use disorder (SUD) patients. Unfortunately, many of these instruments have one or several disadvantages (e.g. low specificity, low sensitivity or high costs). No research has been conducted on instruments that screen simultaneously for other psychiatric disorders, which would be a potentially time-saving and cost-effective approach. In the current study we tested the psychometric properties of the Depression, Anxiety and Stress Scale (DASS) as a screen for PTSD. METHODS The DASS was assessed in an inpatient facility during intake with 58 patients and again 4 weeks after admission. Another 138 patients were assessed 4 weeks after admission only. The results were compared to the Clinician-Administered PTSD Scale (CAPS) that was also administered after 4 weeks of abstinence. RESULTS ROC curve analyses showed an area under the curve of 0.84 for the DASS at intake and 0.78 for the DASS after 4 weeks' abstinence. CONCLUSION The DASS is therefore a reliable and convenient measure to use as a screen for PTSD in SUD patients.
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Affiliation(s)
- Tim Kok
- Tactus Addiction Treatment, Deventer, The Netherlands
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Shell WE, Charuvastra M, Breitstein M, Pavlik SL, Charuvastra A, May L, Silver DS. Administration of an amino Acid-based regimen for the management of autonomic nervous system dysfunction related to combat-induced illness. J Cent Nerv Syst Dis 2014; 6:93-8. [PMID: 25336998 PMCID: PMC4197905 DOI: 10.4137/jcnsd.s13793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/25/2014] [Accepted: 02/27/2014] [Indexed: 11/15/2022] Open
Abstract
The etiology and pathophysiology of posttraumatic stress disorder (PTSD) remains poorly understood. The nutritional deficiencies associated with the altered metabolic processes of PTSD have not previously been studied in detail. This pilot study measured the reduction in symptoms in 21 military veterans reporting moderate to severe symptoms associated with PTSD. Two amino acid–based medical foods specifically formulated with biogenic amines and other nutrients were administered to study subjects targeting specific neurotransmitter deficiencies resulting from altered metabolic activity associated with PTSD. This study included the Physician Checklist – Military (PCL-M), Short Form General Health Survey (SF-36), and Epworth Sleepiness Scale to measure the change in each subject’s score after 30 days of administration. An average decrease of 17 points was seen in the PCL-M, indicating a reduction in PTSD symptoms (P < 0.001). The mental health component of the SF-36 showed an average 57% increase in the subjects’ mental health rating (P < 0.001). The results of this initial study demonstrate that addressing the increased dietary requirements of PTSD can improve symptoms of the disease while eliminating significant side effects. A larger, double-blind, randomized, placebo-controlled trial is warranted.
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Affiliation(s)
| | | | | | | | - Anthony Charuvastra
- New York University Medical Center, Department of Child and Adolescent Psychiatry, New York, NY, USA
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Perez-Dandieu B, Tapia G. Treating Trauma in Addiction with EMDR: A Pilot Study. J Psychoactive Drugs 2014; 46:303-9. [DOI: 10.1080/02791072.2014.921744] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kraanen FL, Vedel E, Scholing A, Emmelkamp PM. Prediction of intimate partner violence by type of substance use disorder. J Subst Abuse Treat 2014; 46:532-9. [DOI: 10.1016/j.jsat.2013.10.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 10/05/2013] [Accepted: 10/08/2013] [Indexed: 11/16/2022]
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Lockwood E, Forbes D. Posttraumatic Stress Disorder and Comorbidity: Untangling the Gordian Knot. PSYCHOLOGICAL INJURY & LAW 2014. [DOI: 10.1007/s12207-014-9189-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Peltzer K, Naidoo P, Matseke G, Louw J, Mchunu G, Tutshana B. Prevalence of post-traumatic stress symptoms and associated factors in tuberculosis (TB), TB retreatment and/or TB–HIV co-infected primary public health-care patients in three districts in South Africa. PSYCHOL HEALTH MED 2013; 18:387-97. [DOI: 10.1080/13548506.2012.726364] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Tiet QQ, Schutte KK, Leyva YE. Diagnostic accuracy of brief PTSD screening instruments in military veterans. J Subst Abuse Treat 2013; 45:134-42. [DOI: 10.1016/j.jsat.2013.01.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 12/20/2012] [Accepted: 01/28/2013] [Indexed: 11/30/2022]
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van Dam D, Ehring T, Vedel E, Emmelkamp PMG. Trauma-focused treatment for posttraumatic stress disorder combined with CBT for severe substance use disorder: a randomized controlled trial. BMC Psychiatry 2013; 13:172. [PMID: 23782590 PMCID: PMC3698199 DOI: 10.1186/1471-244x-13-172] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 06/12/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This randomized controlled trial (RCT) investigated the effectiveness of a combined treatment for co-morbid Posttraumatic Stress Disorder (PTSD) and severe Substance Use Disorder (SUD). METHODS Structured Writing Therapy for PTSD (SWT), an evidence-based traumafocused intervention, was added on to Treatment As Usual (TAU), consisting of an intensive cognitive behavioral inpatient or day group treatment for SUD. The outcomes of the combined treatment (TAU + SWT) were compared to TAU alone in a sample of 34 patients. RESULTS Results showed a general reduction of SUD symptoms for both TAU + SWT and TAU. Treatment superiority of TAU + SWT was neither confirmed by interaction effects (time x condition) for SUD or PTSD symptoms, nor by a group difference for SUD diagnostic status at post-treatment. However, planned contrasts revealed that improvements for PTSD severity over time were only significant within the TAU + SWT group. In addition, within the TAU + SWT group the remission of PTSD diagnoses after treatment was significant, which was not the case for TAU. Finally, at post-treatment a trend was noticed for between group differences for the number of PTSD diagnoses favoring TAU + SWT above TAU. CONCLUSIONS In sum, the current study provides preliminary evidence that adding a trauma-focused treatment on to standard SUD treatment may be beneficial.
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Affiliation(s)
- Debora van Dam
- Department of Clinical Psychology, University of Amsterdam, Weesperplein 4, 1018 XA, Amsterdam, The Netherlands.
| | - Thomas Ehring
- Department of Clinical Psychology, University of Amsterdam, Weesperplein 4, 1018 XA, Amsterdam, The Netherlands,Institute of Psychology, University of Münster, Fliednerstr. 21, 48149, Münster, Germany
| | - Ellen Vedel
- Jellinek Substance Abuse Treatment Center, Arkin, Postbus 3907, 1001 AS Amsterdam, The Netherlands
| | - Paul MG Emmelkamp
- Department of Clinical Psychology, University of Amsterdam, Weesperplein 4, 1018 XA, Amsterdam, The Netherlands,King Abdulaziz University, P.O Box 80203, Jeddah, Saudi Arabia
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Screening for posttraumatic stress disorder in civilian substance use disorder patients: Cross-validation of the Jellinek-PTSD screening questionnaire. J Subst Abuse Treat 2013; 44:126-31. [DOI: 10.1016/j.jsat.2012.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 02/06/2012] [Accepted: 03/19/2012] [Indexed: 11/19/2022]
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