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Cooper DC, Campbell MS, Case SR, Fraine MC, Jones RA, Klein IF, Hoyt T. Outcome metrics utilized in evaluations of programs and interventions for combat and operational stress: A review of psychometric properties. MILITARY PSYCHOLOGY 2024; 36:227-237. [PMID: 38377250 PMCID: PMC10880499 DOI: 10.1080/08995605.2022.2117537] [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: 01/13/2021] [Accepted: 08/23/2022] [Indexed: 10/15/2022]
Abstract
The Department of Defense has mandated combat and operational stress control (COSC) efforts for the Services since 1999. Although several COSC-related programs have been implemented, few have undergone evaluation, and no standardized metrics have been established to assess their effectiveness and utility. The purpose of this review was to characterize the content and psychometrics of measures that have been utilized as outcome metrics in evaluations of COSC-related programs and interventions. Systematic literature searches were conducted for publications that: a) evaluated at least one measure from U.S. service members who participated in a program or intervention to prevent or reduce the adverse effects of combat and operational stress; and b) reported U.S. data on the internal consistency, test-retest reliability, convergent validity, and sensitivity/specificity of the identified measures. This process identified 15 measures for which psychometric properties were reviewed for acceptability based on recommended criteria. Identified measures varied from well-validated measures to newer instruments for which more data is needed on one or more of the target psychometric properties. Aside from internal consistency, psychometric data from U.S. military samples were sparse. Results further suggested that some measures might have reduced sensitivity in service members under certain conditions, such as large-scale screening. Additional studies are needed to validate COSC-relevant measures in service members. Future evaluations of programs and interventions for combat and operational stress should select measures that will increase the consistency of the literature, allow comparisons across studies, and ensure alignment with the objectives of identified programs.
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Affiliation(s)
- Denise C. Cooper
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia
| | - Marjorie S. Campbell
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia
| | - Spencer R. Case
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia
| | - Melissa C. Fraine
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia
| | - Rebecca A. Jones
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia
| | - Ilene F. Klein
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia
| | - Tim Hoyt
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia
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Romaniuk M, Fisher G, Sunderland M, Batterham PJ. Development and psychometric evaluation of the mental readiness for military transition scale (MT-Ready). BMC Psychiatry 2023; 23:575. [PMID: 37553664 PMCID: PMC10410831 DOI: 10.1186/s12888-023-05032-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND The transition to civilian life following separation from military service is associated with increased risk of mental health disorders, suicide, and poor adjustment. No measure currently enables pre-separation screening to assess mental readiness for transition and identify personnel most at risk of poor outcomes. The Mental Readiness for Military Transition Scale (MT-Ready) was developed to identify psychosocial factors predictive of post-separation psychological adjustment and mental health. METHODS Phase I was a qualitative study including transitioned veterans (n = 60), partners of transitioned veterans (n = 20) and mental health clinicians (n = 20) which enabled development of candidate items that were subsequently piloted with a current serving Australian Defence Force (ADF) sample (n = 19). Phase II included evaluation of the factor structure, psychometric properties, and scale refinement of the initial pool of 50 items with a convenience sample of transitioning ADF personnel (n = 345). Analyses included exploratory factor analysis, evaluation of test-retest reliability, internal consistency, convergent, divergent, discriminant and predictive validity. Receiver Operating Characteristic Curve Analysis was also conducted to determine an optimal cut-off score. RESULTS Exploratory factor analysis resulted in a 15-item, three-factor solution that explained 62.2% of the variance: Future focus and optimism; Anger and perceived failure; Civilian connections and social support. Reliability and convergent, divergent, and discriminant validity was established. Receiver Operating Characteristic Curve Analysis determined a cut-off score of 55. MT-Ready scores significantly differentiated those reporting adjusting versus not adjusting to civilian life 3.7 months post-separation, and predicted post-separation outcomes including symptoms of Posttraumatic Stress Disorder, depression, anxiety, psychological adjustment and quality of life. CONCLUSIONS This evaluation provides promising evidence the MT-Ready is a valid, reliable measure of mental readiness for transition, with predictive capability and considerable potential to assist prevention of poor post-separation outcomes among military personnel.
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Affiliation(s)
- Madeline Romaniuk
- Greenslopes Private Hospital, Gallipoli Medical Research Foundation, 121 Newdegate Street, 4120, Greenslopes, QLD, Australia.
- Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Australia.
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.
| | - Gina Fisher
- Greenslopes Private Hospital, Gallipoli Medical Research Foundation, 121 Newdegate Street, 4120, Greenslopes, QLD, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Australia
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental health and Substance use, The University of Sydney, Camperdown, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
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Krauss SW, Trachik BJ, Elliman TD, Toner KA, Zust J, Riviere LA, Hoge CW. The Impact of Just and Unjust War Events on Mental Health Need and Utilization within U.S. Service Members. Psychiatry 2023; 86:29-41. [PMID: 36265001 DOI: 10.1080/00332747.2022.2120310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Soldiers are resilient to just war events, such as killing enemy combatants and life-threatening experiences, but these same soldiers appear to struggle with unjust war events, such as killing a noncombatant or being unable to help civilian women and children in need. This study is the first to examine how just and unjust war experiences are associated with clinical health service outcomes. Methods: Two samples of soldiers in different stages of readjustment from deployment were drawn from a longitudinal, survey-based study of a US Army brigade. Measures included items related to combat events, mental health utilization, perceived mental health need, PTSD, depression, and functional impairment. Results: After controlling for other kinds of combat events, just war events (i.e., life-threatening events and killing enemy combatants) predicted outcomes in soldiers who are less than three months post-deployment, but only predicted 2 of 26 outcomes in soldiers one year post deployment. In contrast, unjust war events were found to be robust predictors of short-term and long-term outcomes related to mental health need and utilization, even after controlling for exposure to other combat events. Conclusions: The results extend previous longitudinal research that suggests that exposure to unjust war events carry a heavier long-term mental health burden than other types of events. Additionally, Soldiers exposed to unjust war events had an unmet need for care one year post deployment that was not directly tied to PTSD or depression. The results question the emphasis on life-threat within mental health pathogenesis models.
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Kaysen D, Walton TO, Rhew IC, Jaffe AE, Pierce AR, Walker DD. Development of StressCheck: A telehealth motivational enhancement therapy to improve voluntary engagement for PTSD treatment among active-duty service members. Contemp Clin Trials 2022; 119:106841. [PMID: 35777697 PMCID: PMC10030051 DOI: 10.1016/j.cct.2022.106841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/09/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Rates of PTSD in active-duty military are high relative to the general population. Although efficacious treatments exist, they are underutilized. Many service members with PTSD do not present for treatment and, of those who do, many do not receive sufficient doses of the interventions to receive full benefits. Motivational Enhancement Therapy (MET) "check-ups", are brief interventions designed to elicit treatment engagement for those who are not treatment-seeking. METHODS StressCheck is an MET for nontreatment seeking Army and Air Force personnel. StressCheck aims to improve PTSD and increase treatment engagement, especially around evidence-based interventions, as well as to decrease stigma about seeking mental health services and improve knowledge about treatment options. This paper describes the intervention components and process of treatment development. The paper also describes next steps in testing the effectiveness of the intervention. CONCLUSION PTSD is associated with deleterious health, occupational, and psychological effects. If effective, this innovative intervention will bridge the gap between those who are not treatment seeking and existing services, thereby enhancing reach and impact of existing services. CLINICALTRIALS GOV IDENTIFIER NCT03423394.
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Affiliation(s)
- Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, 401 Quarry Road, Palo Alto, CA 94305, USA; National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, NCPTSD - 334 795 Willow Rd, Menlo Park, CA 94025, USA.
| | - Thomas O Walton
- School of Social Work, University of Washington, 909 NE 43rd St. #304, Seattle, WA 98105, USA.
| | - Isaac C Rhew
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 1959 NE Pacific St., Box 357238, Seattle, WA 98195, USA.
| | - Anna E Jaffe
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588, USA.
| | - Adam R Pierce
- School of Social Work, University of Washington, 909 NE 43rd St. #304, Seattle, WA 98105, USA.
| | - Denise D Walker
- School of Social Work, University of Washington, 909 NE 43rd St. #304, Seattle, WA 98105, USA.
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Elliman TD, Schwalb ME, Krauss S, Mikoski P, Adler AB. US Army Drill Sergeants: Stressors, Behavioral Health, and Mitigating Factors. Mil Med 2021; 186:767-776. [PMID: 33491063 DOI: 10.1093/milmed/usab002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The role of the drill sergeant is one of the most challenging within the US Army, involving unusually long hours and little time off, for a minimum of 2 years. The current study sought to examine the behavioral health of this population and identify risk factors that might be addressed by policy changes. MATERIALS AND METHODS In total, 856 drill sergeants across all Army basic training sites completed surveys from September to November of 2018. Drill sergeants identified factors that had caused stress or worry during their assignment. Rates were measured for behavioral health outcomes including depression, insomnia, anxiety, burnout, functional impairment, alcohol misuse, aggression, and low morale. Potential risk and resilience factors included time as a drill sergeant, sleep, route of assignment, general leadership, health-promoting leadership, and drill sergeant camaraderie. The study was approved by the Walter Reed Army Institute of Research Institutional Review Board. RESULTS The most commonly experienced stressors were finding time to exercise, lack of sleep, and long work hours. Percentages of drill sergeants meeting behavioral health screening criteria were 19% for depression, 27% for moderate-to-severe insomnia, 14% for generalized anxiety disorder, 48% for high burnout, 32% for functional impairment, 35% for moderate alcohol misuse, 32% for off-duty aggression, and 25% for low morale. Rates for most outcomes were associated with time spent as a drill sergeant, with behavioral health issues peaking during 13-18 months. Poorer outcomes were also associated with fewer hours of sleep and initial unhappiness regarding involuntary assignment to the role of drill sergeant, while better outcomes were associated with higher ratings of general leadership, health-promoting leadership, and drill sergeant camaraderie. CONCLUSIONS This study is the first to examine behavioral health and morale of drill sergeants and to identify risk and resilience factors. Suggestions for policy changes include increasing the number of drill sergeants to decrease workload and allow sufficient time for recovery and sleep.
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Affiliation(s)
- Toby D Elliman
- Research Transition Office, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Molly E Schwalb
- Research Transition Office, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Stephen Krauss
- Research Transition Office, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Peter Mikoski
- Research Transition Office, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Amy B Adler
- Research Transition Office, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
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Curley JM, Duffy FF, Kim PY, Clarke-Walper KM, Nugent KL, Penix EA, Elliman TD, Wilk JE, Riviere LA. Methodology of the U.S. Army's Suicide Prevention Leadership Tool Study: The Behavioral Health Readiness and Suicide Risk Reduction Review (R4). Mil Med 2021; 186:336-343. [PMID: 33219666 DOI: 10.1093/milmed/usaa503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/04/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The Secretary of the U.S. Army issued two directives in late 2017 to directly combat the problem of suicide in the U.S. Army. The first was to develop an Army tool to assist commanders and first-line leaders in preventing suicide and improving behavioral health (BH) outcomes, which has been previously published as the BH Readiness and Risk Reduction Review (R4). The second was to conduct an evaluation study of the tool with Army units in the field. This study is the first to empirically examine the Army's tool-based methods for identifying and caring for the health and welfare of soldiers at risk for suicide, and this article outlines the methodology employed to study the effectiveness of the R4 tools and accomplish the Secretary's second directive. METHODS The Walter Reed Army Institute of Research Institutional Review Board approved the R4 study. The study employed a repeated measurements in pre/post quasi-experimental design, including a nonequivalent but comparable business-as-usual control group. The R4 intervention consisted of the R4 tools, accompanying instructions, and an orientation. Samples were drawn from two geographically separated U.S. Army divisions in the continental United States, each composed of four comparable brigades. Study implementation consisted of three phases and three data collections over the course of 12 months. Soldiers completed anonymous survey instruments to assess a range of health factors, behaviors, characteristics, tool-related decision-making processes, and the frequency, type, and quality of interactions between soldiers and leaders. RESULTS The R4 study commenced on May 6, 2019, and concluded on June 4, 2020. Sample size goals were achieved for both the divisions at all three data collection time points. CONCLUSIONS The methodology of the R4 study is critical for the U.S. Army from both a precedential and an outcome-based standpoint. Despite the use of many previous tools and programs for suicide prevention, this is the first time the Army has been able to empirically test the effectiveness of tool-supported decision-making among Army units in a rigorous fashion. The methodology of such a test is a critical marker for future interventional inquiries on the subject of suicide in the Army, and the results will allow for more informed decision-making by leaders when approaching these ongoing challenges.
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Affiliation(s)
- Justin M Curley
- Department of the Army, Office of the Deputy Under Secretary of the Army, Arlington, VA 22202, USA.,Department of Military Psychiatry, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Farifteh F Duffy
- Department of Military Psychiatry, TechWerks, Arlington, VA 22201, USA
| | - Paul Y Kim
- Department of Military Psychiatry, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Kristina M Clarke-Walper
- Department of Military Psychiatry, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Katie L Nugent
- Department of Military Psychiatry, TechWerks, Arlington, VA 22201, USA
| | - Elizabeth A Penix
- Department of Military Psychiatry, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Toby D Elliman
- Department of Military Psychiatry, TechWerks, Arlington, VA 22201, USA
| | - Joshua E Wilk
- Department of Military Psychiatry, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Lyndon A Riviere
- Department of Military Psychiatry, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
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Krauss SW, Zust J, Frankfurt S, Kumparatana P, Riviere LA, Hocut J, Sowden WJ, Adler AB. Distinguishing the Effects of Life Threat, Killing Enemy Combatants, and Unjust War Events in U.S. Service Members. J Trauma Stress 2021; 34:357-366. [PMID: 33301629 DOI: 10.1002/jts.22635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 11/08/2022]
Abstract
Although previous studies have identified behavioral health risks associated with combat exposure, it is unclear which types of combat events are associated with these risks, particularly regarding contrasts among the risks associated with life-threatening experiences, killing combatants, and exposure to unjust war events, such as killing a noncombatant or being unable to help civilian women and children. In the present study, we examined surveys from 402 soldiers following deployment (i.e., baseline) and again 13 months later (i.e., Year 1). Regression analyses were conducted across a range of behavioral health (e.g., posttraumatic stress disorder, depression, suicide ideation, anxiety, somatic, insomnia, aggression) and benefit-finding measures, each controlling for two combat event categories while assessing the predictive utility of a third. The results suggested that life-threatening events were associated with poor behavioral health at baseline, relative risk (RR) = 10.00, but not at Year 1, RR = 2.67. At both baseline and Year 1, killing enemy combatants was not associated with behavioral health, RRs = 1.67-3.33, but was positively associated with benefit-finding, RRs = 26.67-40.00. Exposure to unjust war events was associated with a transdiagnostic pattern of behavioral health symptoms at baseline, RR = 40.00, and Year 1, RR = 23.33. Overall, the results suggest unjust war event exposure is particularly injurious, above and beyond exposure to other combat-related events. Future research can build on these findings to develop clearer descriptions of the combat events that might place service members at risk for moral injury and inform the development of assessment and treatment options.
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Affiliation(s)
- Stephen W Krauss
- Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA
| | - Jeffrey Zust
- Evangelical Lutheran Church in America, Chicago, Illinois, USA
| | - Sheila Frankfurt
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA
- Central Texas VA Healthcare System, Temple, Texas, USA
- College of Medicine, Texas A&M University, College Station, Texas, USA
| | - Pam Kumparatana
- Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA
| | - Lyndon A Riviere
- Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA
| | - Joy Hocut
- Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA
| | - Walter J Sowden
- Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA
- Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Amy B Adler
- Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA
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Mantua J, Pirner MC, Doyle ST, Bessey AF, Naylor JA, Ritland BM, Sowden WJ, Burke TM, McKeon AB. Sleep and occupational well-being in active duty special operations soldiers: A replication and expansion. Sleep Health 2021; 7:500-503. [PMID: 33685830 DOI: 10.1016/j.sleh.2021.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the relationship between sleep quality and occupational well-being in active duty military Service Members. DESIGN Longitudinal prospective analysis. SETTING An annual military training event. PARTICIPANTS US Army special operations Soldiers (n = 60; 100% male; age 25.41 ± 3.74). INTERVENTION None. MEASUREMENTS The Pittsburgh Sleep Quality Index (PSQI) was administered prior to the training event, and the Emotional Exhaustion Scale, the Role Overload Scale, the Walter Reed Army Institute of Research Soldier-Specific Functional Impairment Scale, and the Perceived Stress Scale were administered after the event. Linear regression models were used to assess the relationship between sleep and occupational wellness measures, and the outcome measures of "good" and "poor" sleepers (per the PSQI scoring criteria) were compared with Student's t tests. RESULTS Higher (poorer) PSQI Global Scores predicted poorer occupational wellness of all measures (emotional exhaustion: B = 1.60, P < .001, R2 = 0.25; functional impairment: B = 0.29, P = .03, R2 = 0.14; role overload: B = 0.28, P = .008, R2 = 0.12; and perceived stress: B = 0.34, P = .004, R2 = 0.20). There were additional relationships between specific PSQI component scores and occupational wellness measures, which is a replication of This team's previous work. Furthermore, emotional exhaustion (t(58) = -4.18, P < .001), functional impairment (t(59)= -3.68, P = .001), role overload (t(58) = -3.20, P = .002), and perceived stress (t(58) = -2.43, P = .02) were all higher in poor sleepers. CONCLUSIONS The findings of this study suggest that US Army special operations Soldiers who have poorer sleep quality may be at increased risk for having poorer occupational well-being.
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Affiliation(s)
- Janna Mantua
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.
| | - Maddison C Pirner
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Scott T Doyle
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Alexxa F Bessey
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA; Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Jacob A Naylor
- 75th Ranger Regiment Headquarters, Ft. Benning, Georgia, USA
| | - Bradley M Ritland
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Walter J Sowden
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA; Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Tina M Burke
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Ashlee B McKeon
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
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Smith NA, Brady JM, Hammer LB, Carlson KF, Mohr CD. Military sexual trauma among women Veterans: The buffering effect of coworker support. MILITARY PSYCHOLOGY 2020; 32:441-449. [PMID: 38536334 PMCID: PMC10013453 DOI: 10.1080/08995605.2020.1806635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/24/2020] [Indexed: 10/22/2022]
Abstract
Prior research has demonstrated the impact of military sexual trauma (MST) on health and well-being. However, little empirical work has been published identifying protective factors for women who have experienced MST. We examined the impact of two different forms of MST, harassment-only and assault MST, on PTSD symptoms and social functional impairment in a sample of women Veterans employed in the civilian workforce. The effects of MST were examined at three different times over a period of 9 months. We found that MST that included both harassment and assault was associated with significantly higher levels of PTSD symptoms and social functional impairment across three different time points among women Veterans employed in civilian jobs. Further, the pattern of results suggested that coworker support can buffer against these negative outcomes experienced by women who reported assault MST. Overall, findings suggest that coworker support is one critical resource for women Veterans who experienced assault MST.
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Affiliation(s)
- Nicholas A. Smith
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University & Department of Psychology, Portland State University, Portland, Oregon
| | - Jacquelyn M. Brady
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, Oregon
| | - Leslie B. Hammer
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University & Department of Psychology, Portland State University, Portland, Oregon
| | - Kathleen F. Carlson
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System & Epidemiology & Environmental Systems and Human Health, OHSU-PSU School of Public Health, Portland, Oregon
| | - Cynthia D. Mohr
- Department of Psychology, Portland State University, Portland, Oregon
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Romaniuk M, Fisher G, Kidd C, Batterham PJ. Assessing psychological adjustment and cultural reintegration after military service: development and psychometric evaluation of the post-separation Military-Civilian Adjustment and Reintegration Measure (M-CARM). BMC Psychiatry 2020; 20:531. [PMID: 33167907 PMCID: PMC7654614 DOI: 10.1186/s12888-020-02936-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The transition out of military service and subsequent reintegration to civilian life has been established as a period associated with an increased risk of psychological adjustment difficulties, psychiatric disorders and suicide risk, yet no tool exists to measure cultural and psychological adjustment following permanent separation from the military. This study describes the two-phase mixed-methods development and validation of the self-report Military-Civilian Adjustment and Reintegration Measure (M-CARM). METHODS In Phase I, four focus groups (n = 20) and semi-structured one-on-one interviews (n = 80) enabled thematic analysis and generation of 53 initial items that were reviewed by an expert multidisciplinary panel (n = 12) and piloted for clarity and relevance in an Australian service-veteran sample (n = 11). In Phase II, psychometric properties of the 47 items resulting from Phase I were evaluated with online assessment of a convenience sample of transitioned Australian Defence Force veterans (n = 725). Analyses included exploratory and confirmatory factor analyses, as well as evaluation of test-retest reliability, internal consistency, and convergent, divergent and discriminant validity. RESULTS Exploratory factor analysis on a randomized split-half sample (n = 357), resulted in a 21-item, five-factor solution of Purpose and Connection, Help seeking, Beliefs about civilians, Resentment and regret, and Regimentation, explaining 53.22% of the variance. Confirmatory factor analysis (n = 368) verified this factor structure without modification (χ2 = 304.96, df = 160; CFI = .96, TLI = .94, NFI = .91, RMSEA = .05). Strong convergent, divergent and discriminant validity was demonstrated as M-CARM scores significantly correlated with related constructs assessed by standardised clinical measures as well as differentiated groups based on three binary reintegration items, with large effect sizes (d = > 1). Strong test-retest reliability for the total score (n = 186, r = .93) and excellent internal consistency (n = 725, a = .90) were also found. CONCLUSIONS Results provide promising evidence the M-CARM is a valid, reliable measure of psychological and cultural reintegration to civilian life, with potential for considerable clinical and research application.
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Affiliation(s)
- Madeline Romaniuk
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Australia. .,Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia. .,Institute of Resilient Regions, University of Southern Queensland, Toowoomba, Australia. .,Centre for Mental Health Research, Research School of Population Health, Australian National University, Canberra, Australia.
| | - Gina Fisher
- grid.413313.70000 0004 0406 7034Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Australia
| | - Chloe Kidd
- grid.413313.70000 0004 0406 7034Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Australia
| | - Philip J. Batterham
- grid.1001.00000 0001 2180 7477Centre for Mental Health Research, Research School of Population Health, Australian National University, Canberra, Australia
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Wyman PA, Pisani AR, Brown CH, Yates B, Morgan-DeVelder L, Schmeelk-Cone K, Gibbons RD, Caine ED, Petrova M, Neal-Walden T, Linkh DJ, Matteson A, Simonson J, Pflanz SE. Effect of the Wingman-Connect Upstream Suicide Prevention Program for Air Force Personnel in Training: A Cluster Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2022532. [PMID: 33084901 PMCID: PMC7578767 DOI: 10.1001/jamanetworkopen.2020.22532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Suicide has been a leading manner of death for US Air Force personnel in recent years. Universal prevention programs that reduce suicidal thoughts and behaviors in military populations have not been identified. OBJECTIVES To determine whether the Wingman-Connect program for Airmen-in-training reduces suicidal ideation, depression, and occupational problems compared with a stress management program and to test the underlying network health model positing that cohesive, healthy units are protective against suicidal ideation. DESIGN, SETTING, AND PARTICIPANTS This cluster randomized clinical trial was conducted from October 2017 to October 2019 and compared classes of personnel followed up for 6 months. The setting was a US Air Force technical training school, with participants studied to their first base assignment, whether US or international. Participants in 216 classes were randomized, with an 84% retention rate. Data analysis was performed from November 2019 to May 2020. INTERVENTIONS The Wingman-Connect program used group skill building for cohesion, shared purpose, and managing career and personal stressors (3 blocks of 2 hours each). Stress management training covered cognitive and behavioral strategies (2 hours). Both conditions had a 1-hour booster session, plus text messages. MAIN OUTCOMES AND MEASURES The primary outcomes were scores on the suicidal ideation and depression scales of the Computerized Adaptive Test for Mental Health and self-reports of military occupational impairment. Class network protective factors hypothesized to mediate the effect of Wingman-Connect were assessed with 4 measures: cohesion assessed perceptions that classmates cooperate, work well together, and support each other; morale was measured with a single item used in other studies with military samples; healthy class norms assessed perceptions of behaviors supported by classmates; and bonds to classmates were assessed by asking each participant to name classmates whom they respect and would choose to spend time with. RESULTS A total of 215 classes including 1485 individuals (1222 men [82.3%]; mean [SD] age, 20.9 [3.1] years) participated; 748 individuals were enrolled in the Wingman-Connect program and 737 individuals were enrolled in the stress management program. At 1 month, the Wingman-Connect group reported lower suicidal ideation severity (effect size [ES], -0.23; 95% CI, -0.39 to -0.09; P = .001) and depression symptoms (ES, -0.24; 95% CI, -0.41 to -0.08; P = .002) and fewer occupational problems (ES, -0.14; 95% CI, -0.31 to -0.02; P = .02). At 6 months, the Wingman-Connect group reported lower depression symptoms (ES, -0.16; 95% CI, -0.34 to -0.02; P = .03), whereas the difference in suicidal ideation severity was not significant (ES, -0.13; 95% CI, -0.29 to 0.01; P = .06). The number needed to treat to produce 1 fewer participant with elevated depression at either follow-up point was 21. The benefits of the training on occupational problems did not extend past 1 month. The Wingman-Connect program strengthened cohesive, healthy class units, which helped reduce suicidal ideation severity (estimate, -0.035; 95% CI, -0.07 to -0.01; P = .02) and depression symptom scores (estimate, -0.039; 95% CI, -0.07 to -0.01; P = .02) at 1 month. CONCLUSIONS AND RELEVANCE Wingman-Connect is the first universal prevention program to reduce suicidal ideation and depression symptoms in a general Air Force population. Group training that builds cohesive, healthy military units is promising for upstream suicide prevention and may be essential for ecological validity. Extension of the program to the operational Air Force is recommended for maintaining continuity and testing the prevention impact on suicidal behavior. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04067401.
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Affiliation(s)
- Peter A Wyman
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Anthony R Pisani
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bryan Yates
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Lacy Morgan-DeVelder
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Karen Schmeelk-Cone
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Robert D Gibbons
- Department of Medicine, Biological Sciences, The University of Chicago, Chicago, Illinois
- Department of Public Health Sciences, Biological Sciences, The University of Chicago, Chicago, Illinois
| | - Eric D Caine
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Mariya Petrova
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
- Now with Miller School of Medicine, University of Miami, Miami, Florida
| | - Tracy Neal-Walden
- US Air Force Surgeon General's Office, Falls Church, Virginia
- Now with Cohen Veterans Network, Silver Spring, Maryland
| | - David J Linkh
- US Air Force Surgeon General's Office, Falls Church, Virginia
| | | | | | - Steven E Pflanz
- US Air Force Surgeon General's Office, Falls Church, Virginia
- Now with Syracuse Veterans Affairs Medical Center, Syracuse, New York
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Ramanathan-Elion DM, Baydoun HA, Johnstone B. Psychological predictors of functional outcomes in service members with traumatic brain injury. Brain Inj 2020; 34:1183-1192. [PMID: 32683899 DOI: 10.1080/02699052.2020.1793387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PRIMARY OBJECTIVE Research is increasingly demonstrating the significant impact that non-medical factors can have on outcomes of service members (SMs) with mild traumatic brain injury (mTBI). Thus, the current study examined which demographic, TBI-related factors, and psychological variables are most predictive of functional outcomes. RESEARCH DESIGN Retrospective database analysis from medical chart review. METHODS AND PROCEDURES One hundred forty-one patients who received rehabilitation services at an outpatient TBI military treatment facility between 2013 and 2018. Data collected included demographic variables, time since injury, neuropsychological measures, psychological diagnoses, Personality Assessment Inventory (PAI) scores, and Walter Reed Functional Impairment Scale (FIS). Hierarchical linear regression models were used to predict functional outcomes (measured by FIS total, work, social functioning scales). MAIN OUTCOMES AND RESULTS Results indicated that comorbid PTSD diagnosis and PAI Negative Impression Management (NIM) score were predictive of total functional, work, and social outcomes, over and above demographic and TBI-related factors. CONCLUSIONS Current findings confirmed the importance of evaluating and treating psychological factors, as well as exploring one's responding style (NIM), when managing chronic mTBI in SMs. Given ongoing findings of psychological underpinnings to mTBI outcome, there is further need to focus on early interventions to optimize psychological and functional outcomes for SMs.
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Affiliation(s)
- Deepa M Ramanathan-Elion
- Department of Behavioral Health, Fort Belvoir Intrepid Spirit Center , Fort Belvoir, Virginia, USA
| | - Hind A Baydoun
- Department of Research Programs, Fort Belvoir Community Hospital , Fort Belvoir, Virginia, USA
| | - Brick Johnstone
- Defense and Veterans Brain Injury Center, Fort Belvoir Intrepid Spirit Center , Fort Belvoir, Virginia, USA.,Virginia Crawford Research Institute, Shepherd Center , Atlanta, Georgia, USA
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Mantua J, Bessey AF, Sowden WJ. Poor Subjective Sleep Quality Is Associated with Poor Occupational Outcomes in Elite Soldiers. Clocks Sleep 2020; 2:182-193. [PMID: 33089199 PMCID: PMC7445833 DOI: 10.3390/clockssleep2020015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/09/2020] [Indexed: 11/16/2022] Open
Abstract
We aimed to assess the relationship between subjective sleep quality and occupationally-relevant outcomes in military personnel. Participants were from an elite unit of US Army soldiers who worked extended (~30 h) shifts (with minimal recovery time between shifts) during 3-week work sessions. Questionnaires assessing subjective sleep quality during the month prior (Pittsburgh Sleep Quality Index [PSQI]) were administered at the beginning of the session. Occupational outcomes (emotional exhaustion, functional impairment, role overload, daytime sleepiness) were assessed on the final day of the session. Regression analyses were conducted to link sleep quality and occupational outcomes. The study sample participants had relatively poor sleep prior to the exercise (PSQI Global score average = 6.3 ± 3.1). Higher PSQI Global Scores prior to the work session longitudinally predicted daytime sleepiness (f2: 0.56) after the work session. PSQI component 7, which queries daytime dysfunction attributed to poor sleep quality, longitudinally predicted emotional exhaustion, functional impairment, and role overload (f2 range: 0.19-0.70). In conclusion, poor sleep quality-in aggregation with occupationally-mandated sleep loss-is predictive of poorer subsequent occupational outcomes. Future work should aim to increase sleep opportunities prior to occupationally-mandated sleep loss in order to build resilience when sleep loss is unavoidable.
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Affiliation(s)
- Janna Mantua
- Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA; (A.F.B.); (W.J.S.)
| | - Alexxa F Bessey
- Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA; (A.F.B.); (W.J.S.)
| | - Walter J Sowden
- Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA; (A.F.B.); (W.J.S.)
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14
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Conway MA, Cabrera OA, Clarke-Walper K, Dretsch MN, Holzinger JB, Riviere LA, Quartana PJ. Sleep disturbance mediates the association of adverse childhood experiences with mental health symptoms and functional impairment in US soldiers. J Sleep Res 2020; 29:e13026. [PMID: 32166811 DOI: 10.1111/jsr.13026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/10/2020] [Accepted: 02/12/2020] [Indexed: 01/20/2023]
Abstract
Adverse childhood experiences (ACEs) can have long-term impacts on a person's mental health, which extend into adulthood. There is a high prevalence of ACEs among service members. Further, service members also report frequently experiencing disrupted sleep. We hypothesized that disrupted sleep may serve a mechanistic function connecting ACEs to functional impairment and poorer mental health. In a cross-sectional sample (n = 759), we found evidence for an indirect effect of ACEs on mental health outcomes through disrupted sleep. In a different sample using two time-points (n = 410), we found evidence for an indirect effect of ACEs on changes in mental health outcomes and functional impairment during a reset period, through changes in disrupted sleep during the same period. Implications, limitations and future research directions are discussed.
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Affiliation(s)
- Morgan A Conway
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Oscar A Cabrera
- U.S. Army Medical Research Directorate-West, Walter Reed Army Institute for Research, Tacoma, WA, USA
| | | | - Michael N Dretsch
- U.S. Army Medical Research Directorate-West, Walter Reed Army Institute for Research, Tacoma, WA, USA
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15
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Adrian AL, Adler AB, Thomas JL, Britt TW. Integrating new soldiers: The role of leaders and unit members. MILITARY PSYCHOLOGY 2018. [DOI: 10.1080/08995605.2018.1425064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Amanda L. Adrian
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Amy B. Adler
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jeffrey L. Thomas
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Thomas W. Britt
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Department of Psychology, Clemson University, Clemson, South Carolina
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16
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Hammer LB, Wan WH, Brockwood KJ, Mohr CD, Carlson KF. Military, Work, and Health Characteristics of Separated and Active Service Members From the Study for Employment Retention of Veterans (SERVe). MILITARY PSYCHOLOGY 2018. [DOI: 10.1037/mil0000196] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Leslie B. Hammer
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University
| | - Wylie H. Wan
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University
| | - Krista J. Brockwood
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University
| | | | - Kathleen F. Carlson
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System (R&D 66), Portland, Oregon, and School of Public Health, Oregon Health & Science University
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17
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Adrian AL, Adler AB, Metzler JN. Vigor predicting health outcomes in a high risk occupational context. MILITARY PSYCHOLOGY 2018. [DOI: 10.1080/08995605.2017.1420975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Amanda L. Adrian
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Amy B. Adler
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jonathan N. Metzler
- Primary Curriculum Developer, Armed Forces Services Corporation, Fort Hood, Texas
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18
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Abstract
Studies have found that soldiers returning from combat deployment report elevated levels of anger and aggression. The present study examined the perception that anger was helpful in performing occupationally related duties and whether this perception was associated with mental health problems, somatic symptoms, and functioning. Soldiers (N = 627) completed a survey 4 months after their deployment to Afghanistan and again 3 months later. When examining anger over time, findings revealed four groups of different latent classes: low stable (resilient), high stable (chronic), decreasing over time (improved), and increasing over time (delayed problems). For two of the groups (chronic and delayed problems), perceiving anger as helpful was closely related to anger reactions. Perceiving anger as helpful was also associated with worse mental health symptoms. Further work in understanding how to mitigate this positive perception of anger in prevention initiatives may be useful in addressing anger reactions.
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19
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Adler AB, Gunia BC, Bliese PD, Kim PY, LoPresti ML. Using actigraphy feedback to improve sleep in soldiers: an exploratory trial. Sleep Health 2017; 3:126-131. [DOI: 10.1016/j.sleh.2017.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 12/24/2016] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
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Federici S, Bracalenti M, Meloni F, Luciano JV. World Health Organization disability assessment schedule 2.0: An international systematic review. Disabil Rehabil 2016; 39:2347-2380. [PMID: 27820966 DOI: 10.1080/09638288.2016.1223177] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument. METHOD Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases. RESULTS We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry). CONCLUSIONS The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.
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Affiliation(s)
- Stefano Federici
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Marco Bracalenti
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Fabio Meloni
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Juan V Luciano
- b Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu , St. Boi De Llobregat , Spain.,c Primary Care Prevention and Health Promotion Research Network (RedIAPP) , Madrid , Spain
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21
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Weeks M, Garber BG, Zamorski MA. Disability and Mental Disorders in the Canadian Armed Forces. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:56S-63S. [PMID: 27270743 PMCID: PMC4800473 DOI: 10.1177/0706743716628853] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The initial goal was to validate the use of a self-report measure of disability in the Canadian Armed Forces (CAF). The main goal was to document the extent of disability in personnel with and without mental disorders. METHODS Data were obtained from the 2013 Canadian Forces Mental Health Survey; the sample included 6700 Regular Forces personnel. Disability was measured with the 12-item version of the World Health Organization Disability Assessment Schedule (WHODAS-2); established cut points were used to demarcate severe, moderate, minimal, and no disability. The following recent (past-year) and remote (lifetime but not past-year) disorders were assessed with diagnostic interviews: posttraumatic stress disorder, major depressive episode, generalized anxiety disorder, panic disorder, and alcohol use disorder. RESULTS The WHODAS-2 showed good internal consistency (α = 0.89) and a 1-factor structure. Most personnel had no disability (59.2%) or minimal disability (30.8%). However, an important minority had moderate or severe disability (8.4% and 1.6%, respectively). Individuals with recent disorders reported greater disability than those without lifetime disorders, although many had minimal or no disability (41.2% and 24.7%, respectively). Disability increased with the number of recent disorders. Relative to those without lifetime disorders, individuals with remote disorders showed slightly greater disability, but most had no disabilty (57.1%) or minimal disability (35.0%). CONCLUSIONS The 12-item WHODAS-2 is a valid measure of disability in the CAF. Mental disorders may be important drivers of disability in this population, although limited residual disability is seen in individuals with remote disorders.
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Affiliation(s)
- Murray Weeks
- Research and Analysis Section, Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, ON
| | - Bryan G Garber
- Research and Analysis Section, Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, ON
| | - Mark A Zamorski
- Research and Analysis Section, Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, ON Department of Family Medicine, University of Ottawa, Ottawa, ON
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Hoge CW, Riviere LA, Wilk JE, Herrell RK, Weathers FW. The prevalence of post-traumatic stress disorder (PTSD) in US combat soldiers: a head-to-head comparison of DSM-5 versus DSM-IV-TR symptom criteria with the PTSD checklist. Lancet Psychiatry 2014; 1:269-77. [PMID: 26360860 DOI: 10.1016/s2215-0366(14)70235-4] [Citation(s) in RCA: 239] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The definition of post-traumatic stress disorder (PTSD) underwent substantial changes in the 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). How this will affect estimates of prevalence, whether clinical utility has been improved, and how many individuals who meet symptom criteria according to the previous definition will not meet new criteria is unknown. Updated screening instruments, including the PTSD checklist (PCL), have not been compared with previously validated methods through head-to-head comparisons. METHODS We compared the new 20-item PCL, mapped to DSM-5 (PCL-5), with the original validated 17-item specific stressor version (PCL-S) in 1822 US infantry soldiers, including 946 soldiers who had been deployed to Iraq or Afghanistan. Surveys were administered in November, 2013. Soldiers alternately received either of two surveys that were identical except for the order of the two PCL versions (911 per group). Standardised scales measured major depression, generalised anxiety, alcohol misuse, and functional impairment. RESULTS In analysis of all soldiers, 224 (13%) screened positive for PTSD by DSM-IV-TR criteria and 216 (12%) screened positive by DSM-5 criteria (κ 0·67). In soldiers exposed to combat, 177 (19%) screened positive by DSM-IV-TR and 165 (18%) screened positive by DSM-5 criteria (0·66). However, of 221 soldiers with complete data who met DSM-IV-TR criteria, 67 (30%) did not meet DSM-5 criteria, and 59 additional soldiers met only DSM-5 criteria. PCL-5 scores from 15-38 performed similarly to PCL-S scores of 30-50; a PCL-5 score of 38 gave optimum agreement with a PCL-S of 50. The two definitions showed nearly identical association with other psychiatric disorders and functional impairment. CONCLUSIONS Our findings showed the PCL-5 to be equivalent to the validated PCL-S. However, the new PTSD symptom criteria do not seem to have greater clinical utility, and a high percentage of soldiers who met criteria by one definition did not meet the other criteria. Clinicians need to consider how to manage discordant outcomes, particularly for service members and veterans with PTSD who no longer meet criteria under DSM-5. FUNDING US Army Military Operational Medicine Research Program (MOMRP), Fort Detrick, MD.
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Affiliation(s)
- Charles W Hoge
- Center for Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
| | - Lyndon A Riviere
- Center for Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Joshua E Wilk
- Center for Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Richard K Herrell
- Center for Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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