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DuBois D, Richmond R, Stephanie Roberts L, Mahar A, Fear N, Gill K, Samantha Leroux J, Cramm H. A scoping review of military and Veteran families within international suicidality and suicide prevention research. Prev Med Rep 2023; 33:102206. [PMID: 37223562 PMCID: PMC10201831 DOI: 10.1016/j.pmedr.2023.102206] [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: 07/23/2022] [Revised: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 05/25/2023] Open
Abstract
The impacts of suicidality on families are well known, which is particularly relevant in at-risk populations, such as active duty military personnel and Veteran communities. This scoping review describes how military and Veteran families have been conceptualized within suicide prevention research. A systematic, multi-database search was conducted, and 4,835 studies were screened. All included studies underwent quality assessment. Bibliographic, participant, methodological, and family-relevant data was extracted and descriptively analyzed into Factors, Actors, and Impacts. In total, 51 studies (2007 - 2021) were included. Most studies focused on suicidality rather than suicide prevention. Factor studies described family constructs as a suicidality risk or protective factor for military personnel or Veterans. Actor studies described families' roles or responsibilities to act in relation to the suicidality of military personnel or Veterans. Impacts studies described the impacts of suicidality on military and Veteran family members. The search was limited to English language studies. There were few studies on suicide prevention interventions for or including military and Veteran family members. Family was typically considered peripheral to the military personnel or Veteran experiencing suicidality. However, there was also emerging evidence of suicidality and its consequences in military-connected family members.
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Affiliation(s)
- Denise DuBois
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
| | - Rachel Richmond
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
| | - Lauren Stephanie Roberts
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
| | - Alyson Mahar
- Max Rady College of Medicine, Community Health Sciences, University of Manitoba, Winnipeg, Ontario R3E 3P5, Canada
| | - Nicola Fear
- Department of Military Mental Health, Institute of Psychiatry, King’s College London, London WC2R 2LS, England, United Kingdom
| | - Kamaldeep Gill
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
| | - Janette Samantha Leroux
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
| | - Heidi Cramm
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
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Higgins Neyland MK, Shank LM, Lavender JM, Burke NL, Rice A, Gallagher-Teske J, Markos B, Faulkner LM, Djan KG, Kwarteng EA, LeMay-Russell S, Parker MN, Schvey NA, Sbrocco T, Wilfley DE, Ford B, Ford C, Haigney M, Klein DA, Olsen CH, Quinlan J, Jorgensen S, Brady S, Shomaker LB, Yanovski JA, Tanofsky-Kraff M. Examination of the Interaction between Parental Military-Status and Race among Non-Hispanic Black and Non-Hispanic White Adolescents with Overweight/Obesity. J Pediatr Psychol 2022; 47:743-753. [PMID: 35238941 PMCID: PMC9297095 DOI: 10.1093/jpepsy/jsac008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Adolescent military-dependents experience distinct risk and protective factors, which may necessitate additional clinical considerations. In civilian youth, overweight/obesity is associated with eating, internalizing, and externalizing difficulties, with some studies reporting more difficulties among non-Hispanic White (vs. non-Hispanic Black) youth. It is unknown if these disparities exist among adolescent military-dependents, or between civilian and military-dependent youth. METHODS Non-Hispanic Black (187 civilian, 38 military-dependent) and non-Hispanic White (205 civilian, 84 military-dependent) adolescents with overweight/obesity (14.7 ± 1.6 years; 73.9% girls; body mass index adjusted for age and sex 1.9 ± 0.5) completed a disordered-eating interview; parents completed a measure assessing their child's internalizing and externalizing difficulties. Multiple linear regressions examined parental military-status as a moderator of the relationship of participant race with eating, internalizing, and externalizing difficulties. RESULTS White civilian youth with overweight/obesity reported significantly greater disordered-eating than their Black peers (p < .001); there were no other significant racial differences. In all regressions, parental military-status significantly moderated the association between race and each dependent variable (ps < .047). Black military-dependents (vs. civilians) reported more disordered-eating and internalizing difficulties (ps = .01). White military-dependents (vs. civilians) reported fewer externalizing difficulties (p = .01). CONCLUSIONS Black adolescent military-dependents with overweight/obesity may experience more eating and internalizing difficulties (vs. civilians), a pattern not observed among White participants. Future work should examine if being a military-dependent and a historically marginalized racial group member accounts for these findings. Such data may inform providers of youth with intersecting minority identities.
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Affiliation(s)
- M K Higgins Neyland
- Military Cardiovascular Outcomes Research (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences (USU), USA
| | - Lisa M Shank
- Military Cardiovascular Outcomes Research (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences (USU), USA
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), USA
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences (USU), USA
| | | | - Alexander Rice
- Military Cardiovascular Outcomes Research (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences (USU), USA
| | - Julia Gallagher-Teske
- Military Cardiovascular Outcomes Research (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences (USU), USA
| | - Bethelhem Markos
- Military Cardiovascular Outcomes Research (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences (USU), USA
| | - Loie M Faulkner
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), USA
| | - Kweku G Djan
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), USA
| | - Esther A Kwarteng
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), USA
| | - Sarah LeMay-Russell
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), USA
- Department of Medical and Clinical Psychology, USU, USA
| | - Megan N Parker
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), USA
- Department of Medical and Clinical Psychology, USU, USA
| | - Natasha A Schvey
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), USA
- Department of Medical and Clinical Psychology, USU, USA
| | - Tracy Sbrocco
- Department of Medical and Clinical Psychology, USU, USA
| | | | | | - Caitlin Ford
- Department of Family Medicine, Fort Belvoir Community Hospital, USA
| | - Mark Haigney
- Military Cardiovascular Outcomes Research (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences (USU), USA
| | - David A Klein
- Department of Family Medicine, USU, USA
- Department of Pediatrics, USU, USA
| | - Cara H Olsen
- Preventative Medicine and Biometrics Department, USU, USA
| | - Jeffrey Quinlan
- Department of Family Medicine, University of Iowa Hospitals & Clinics, USA
| | - Sarah Jorgensen
- Department of Family Medicine, University of Iowa Hospitals & Clinics, USA
| | - Sheila Brady
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), USA
| | - Lauren B Shomaker
- Department of Human Development and Family Studies, Colorado State University, USA
| | - Jack A Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), USA
| | - Marian Tanofsky-Kraff
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), USA
- Department of Medical and Clinical Psychology, USU, USA
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Stark CM, Susi A, Nierenberg AA, Nylund CM. Association of Early Life Prescriptions for Antibiotics and Acid Suppressants with Childhood Psychotropic Prescriptions. J Pediatr 2022; 246:191-198.e4. [PMID: 35460701 DOI: 10.1016/j.jpeds.2022.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/18/2022] [Accepted: 04/15/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine the association between antibiotic and acid suppressant prescriptions in the first 2 years of life and subsequent treatment for childhood psychiatric disorders. STUDY DESIGN This was a retrospective cohort study of children born between October 2001 and September 2012 in the Military Health System enrolled in TRICARE past age 2 years and within 35 days of birth, with an initial hospital stay <7 days, and without psychotropic agents dispensed during the first 2 years of life. Exposure was defined as a filled prescription for an antibiotic or acid suppressant before age 2 years, and the outcome was defined as a filled prescription for a psychotropic agent after age 2 years. RESULTS For the 804 920 patients (51% males and 49% female) composing the study population, the mean age at first psychotropic prescription was 6.8 years. A total of 24 176 children (3%) were prescribed a proton pump inhibitor (PPI), 79 243 (10%) were prescribed a histamine-2 receptor antagonist (H2RA), and 607 348 (76%) were prescribed an antibiotic during the first 2 years of life. The adjusted hazard ratio (aHR) of a psychotropic prescription was significantly increased in children prescribed any H2RA (1.79; 95% CI, 1.63-1.96), PPI (1.47; 95% CI, 1.26-1.71), or antibiotic (1.71; 95% CI, 1.59-1.84). The aHR of psychotropic prescriptions increased commensurately with each additional antibiotic class added and with each additional class of medication (H2RA, PPI, or antibiotics) prescribed. CONCLUSIONS Children prescribed antibiotic and acid suppressants in the first 2 years of life have a significant increase in future prescriptions for psychotropics, with a dose-related effect observed. This association represents a potential risk of early exposure to antibiotics and acid suppressants.
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Affiliation(s)
- Christopher M Stark
- Department of Pediatrics, William Beaumont Army Medical Center, El Paso, TX; Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.
| | - Apryl Susi
- Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Andrew A Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Cade M Nylund
- Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
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Hisle-Gorman E, Schvey NA, Adirim TA, Rayne AK, Susi A, Roberts TA, Klein DA. Mental Healthcare Utilization of Transgender Youth Before and After Affirming Treatment. J Sex Med 2021; 18:1444-1454. [PMID: 34247956 DOI: 10.1016/j.jsxm.2021.05.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/12/2021] [Accepted: 05/14/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Transgender and gender-diverse (TGD) adolescents experience increased mental health risk compared to cisgender peers. Limited research suggests improved outcomes following gender-affirmation. This study examined mental healthcare and psychotropic medication utilization among TGD youth compared to their siblings without gender-related diagnoses and explored utilization patterns following gender-affirming care. METHOD This retrospective cohort study used military healthcare data from 2010-2018 to identify mental healthcare diagnoses and visits, and psychotropic medication prescriptions among TGD youth who received care for gender dysphoria before age 18, and their siblings. Logistic and Poisson regression analyses compared mental health diagnosis, visits, and psychotropic prescriptions of TGD youth to their siblings, and compared healthcare utilization pre- and post-initiation of gender-affirming pharmaceuticals among TGD adolescents. RESULTS 3,754 TGD adolescents and 6,603 cisgender siblings were included. TGD adolescents were more likely to have a mental health diagnosis (OR 5.45, 95% CI [4.77-6.24]), use more mental healthcare services (IRR 2.22; 95% CI [2.00-2.46]), and be prescribed more psychotropic medications (IRR = 2.57; 95% CI [2.36-2.80]) compared to siblings. The most pronounced increases in mental healthcare were for adjustment, anxiety, mood, personality, psychotic disorders, and suicidal ideation/attempted suicide. The most pronounced increased in psychotropic medication were in SNRIs, sleep medications, anti-psychotics and lithium. Among 963 TGD youth (Mage: 18.2) using gender-affirming pharmaceuticals, mental healthcare did not significantly change (IRR = 1.09, 95% CI [0.95-1.25]) and psychotropic medications increased (IRR = 1.67, 95% CI [1.46-1.91]) following gender-affirming pharmaceutical initiation; older age was associated with decreased care and prescriptions. CONCLUSION Results support clinical mental health screening recommendations for TGD youth. Further research is needed to elucidate the longer-term impact of medical affirmation on mental health, including family and social factors associated with the persistence and discontinuation of mental healthcare needs among TGD youth. Hisle-Gorman E, Schvey NA, Adirim TA, et al. Mental Healthcare Utilization of Transgender Youth Before and After Affirming Treatment. J Sex Med 2021;18:1444-1454.
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Affiliation(s)
- Elizabeth Hisle-Gorman
- Department of Pediatrics, Uniformed Services University, Bethesda, MD; Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, USA.
| | - Natasha A Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD, USA
| | - Terry A Adirim
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD; Department of Defense, Washington, DC, USA
| | - Anna K Rayne
- Department of Family Medicine, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | - Apryl Susi
- Department of Pediatrics, Uniformed Services University, Bethesda, MD; Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, USA
| | - Timothy A Roberts
- Division of Adolescent Medicine, Children's Mercy Kansas City; Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - David A Klein
- Department of Pediatrics, Uniformed Services University, Bethesda, MD; Department of Family Medicine, Uniformed Services University, Bethesda, MD, USA
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Hisle-Gorman E, Susi A. The Impact of Parental Injury on Children's Mental Health Diagnoses and Classes of Psychotropic Medication by Child Age. Mil Med 2021; 186:222-229. [PMID: 33499532 DOI: 10.1093/milmed/usaa466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/21/2020] [Accepted: 10/23/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Civilian and military research has linked parental illness and injury with increased overall mental health care and psychiatric medication use in children. Care for specific mental health conditions and medications by child age have not been reported. OBJECTIVE We sought to quantify the effect of parental illness and injury on child mental health care and psychiatric medication use in children overall and stratified by age. METHODS A self-controlled case series analyzed the impact of parental illness/injury on mental health and psychiatric medication use of military dependent children. Children were aged 2-16 years (51% male) when their parents were injured and received care in the Military Health System for 2 years before and 2 years after their parent's illness/injury. We used International Classification of Diseases 9th edition codes to identify outpatient mental healthcare visits. Outpatient care for 14 specific mental health diagnoses was classified using the Agency for Healthcare Research and Quality clinical classification system. Outpatient pharmacy records identified psychiatric medication prescriptions by therapeutic class. Parental illness/injury was identified by inclusion in the Military Health System Ill, Injured, and Wounded Warrior database. Adjusted negative binomial regression analysis compared rates of outpatient visits and medication days in the 2 years following parental illness/injury to the 2 years before the parent's illness/injury overall. Secondary analyses were stratified by age groups of 2-5 years (n = 158,620), 6-12 years (n = 239,614), and 13-16 years n = 86,768) and adjusted for parental pre-injury/illness deployment and child sex. Additional secondary analysis compared post-parental injury/illness care of children whose parents had post-traumatic stress disorder or traumatic brain injury to children of parents with physical/mental health injury/illness. RESULTS There were 485,002 children of 272,211 parents injured during the study period. After adjustment for child sex, years of pre-injury/illness parental deployment, and child age, parental illness/injury was associated with increased mental visits across all categories of care except developmental diagnoses. Post-parental injury visits for suicidal ideation, alcohol abuse, mood, and anxiety disorders were all doubled. For children aged 2-5 years at parental illness/injury, the largest increases in care were in psychotic, anxiety, attention deficit, and mood disorders. In children aged 6-12 years, the largest increases were in psychotic conditions, suicidal ideation, and personality disorders. In adolescents aged 13-16 years, the largest increases were for alcohol and substance abuse disorders, with visits increasing by 4-5 times. For children of all ages, parental injury was associated with increased use of all therapeutic classes of psychiatric medications; use of stimulant medications was increased in younger children and decreased in older children following parental injury (P < .001). CONCLUSION Parental illness/injury is associated with increased mental health care and days of psychiatric medication use in dependent children. Practitioners who care for families impacted by parental illness/injury should be cognizant of children's mental health risk. Early identification and treatment of child-related mental health issues can improve family functioning and increase military family readiness.
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Affiliation(s)
| | - Apryl Susi
- Department of Pediatrics, Uniformed Services University, Bethesda, MD 20814, USA
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Pearlman AT, Schvey NA, Higgins Neyland MK, Solomon S, Hennigan K, Schindler R, Leu W, Gillmore D, Shank LM, Lavender JM, Burke NL, Wilfley DE, Sbrocco T, Stephens M, Jorgensen S, Klein D, Quinlan J, Tanofsky-Kraff M. Associations between Family Weight-Based Teasing, Eating Pathology, and Psychosocial Functioning among Adolescent Military Dependents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:E24. [PMID: 31861426 PMCID: PMC6982056 DOI: 10.3390/ijerph17010024] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/13/2019] [Accepted: 12/15/2019] [Indexed: 01/25/2023]
Abstract
Weight-based teasing (WBT) by family members is commonly reported among youth and is associated with eating and mood-related psychopathology. Military dependents may be particularly vulnerable to family WBT and its sequelae due to factors associated with their parents' careers, such as weight and fitness standards and an emphasis on maintaining one's military appearance; however, no studies to date have examined family WBT and its associations within this population. Therefore, adolescent military dependents at-risk for adult obesity and binge-eating disorder were studied prior to entry in a weight gain prevention trial. Youth completed items from the Weight-Based Victimization Scale (to assess WBT by parents and/or siblings) and measures of psychosocial functioning, including the Beck Depression Inventory-II, The Rosenberg Self-Esteem Scale, and the Social Adjustment Scale. Eating pathology was assessed via the Eating Disorder Examination interview, and height and fasting weight were measured to calculate BMIz. Analyses of covariance, adjusting for relevant covariates including BMIz, were conducted to assess relationships between family WBT, eating pathology, and psychosocial functioning. Participants were 128 adolescent military dependents (mean age: 14.35 years old, 54% female, 42% non-Hispanic White, mean BMIz: 1.95). Nearly half the sample (47.7%) reported family WBT. Adjusting for covariates, including BMIz, family WBT was associated with greater eating pathology, poorer social functioning and self-esteem, and more depressive symptoms (ps ≤ 0.02). Among military dependents with overweight and obesity, family WBT is prevalent and may be linked with eating pathology and impaired psychosocial functioning; prospective research is needed to elucidate the temporal nature of these associations.
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Affiliation(s)
- Arielle T. Pearlman
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (A.T.P.); (M.K.H.N.); (S.S.); (K.H.); (R.S.); (W.L.); (D.G.); (J.M.L.); (T.S.); (M.T.-K.)
| | - Natasha A. Schvey
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (A.T.P.); (M.K.H.N.); (S.S.); (K.H.); (R.S.); (W.L.); (D.G.); (J.M.L.); (T.S.); (M.T.-K.)
| | - M. K. Higgins Neyland
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (A.T.P.); (M.K.H.N.); (S.S.); (K.H.); (R.S.); (W.L.); (D.G.); (J.M.L.); (T.S.); (M.T.-K.)
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (D.K.); (J.Q.)
- Military Cardiovascular Outcomes Research Program (MiCOR), Bethesda, MD 20814, USA;
- Metis Foundation, 300 Convent St #1330, San Antonio, TX 78205, USA
| | - Senait Solomon
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (A.T.P.); (M.K.H.N.); (S.S.); (K.H.); (R.S.); (W.L.); (D.G.); (J.M.L.); (T.S.); (M.T.-K.)
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (D.K.); (J.Q.)
- Military Cardiovascular Outcomes Research Program (MiCOR), Bethesda, MD 20814, USA;
- Metis Foundation, 300 Convent St #1330, San Antonio, TX 78205, USA
| | - Kathrin Hennigan
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (A.T.P.); (M.K.H.N.); (S.S.); (K.H.); (R.S.); (W.L.); (D.G.); (J.M.L.); (T.S.); (M.T.-K.)
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (D.K.); (J.Q.)
- Military Cardiovascular Outcomes Research Program (MiCOR), Bethesda, MD 20814, USA;
- Metis Foundation, 300 Convent St #1330, San Antonio, TX 78205, USA
| | - Rachel Schindler
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (A.T.P.); (M.K.H.N.); (S.S.); (K.H.); (R.S.); (W.L.); (D.G.); (J.M.L.); (T.S.); (M.T.-K.)
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (D.K.); (J.Q.)
- Military Cardiovascular Outcomes Research Program (MiCOR), Bethesda, MD 20814, USA;
- Metis Foundation, 300 Convent St #1330, San Antonio, TX 78205, USA
| | - William Leu
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (A.T.P.); (M.K.H.N.); (S.S.); (K.H.); (R.S.); (W.L.); (D.G.); (J.M.L.); (T.S.); (M.T.-K.)
| | - Dakota Gillmore
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (A.T.P.); (M.K.H.N.); (S.S.); (K.H.); (R.S.); (W.L.); (D.G.); (J.M.L.); (T.S.); (M.T.-K.)
| | - Lisa M. Shank
- Military Cardiovascular Outcomes Research Program (MiCOR), Bethesda, MD 20814, USA;
- Metis Foundation, 300 Convent St #1330, San Antonio, TX 78205, USA
| | - Jason M. Lavender
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (A.T.P.); (M.K.H.N.); (S.S.); (K.H.); (R.S.); (W.L.); (D.G.); (J.M.L.); (T.S.); (M.T.-K.)
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (D.K.); (J.Q.)
- Military Cardiovascular Outcomes Research Program (MiCOR), Bethesda, MD 20814, USA;
- Metis Foundation, 300 Convent St #1330, San Antonio, TX 78205, USA
| | - Natasha L. Burke
- Department of Psychology, Fordham University, Bronx, NY 10458, USA;
| | - Denise E. Wilfley
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO 63110, USA;
| | - Tracy Sbrocco
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (A.T.P.); (M.K.H.N.); (S.S.); (K.H.); (R.S.); (W.L.); (D.G.); (J.M.L.); (T.S.); (M.T.-K.)
| | - Mark Stephens
- Department of Family and Community Medicine, Pennsylvania State University, Old Main, State College, PA 16801, USA;
| | - Sarah Jorgensen
- Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA;
| | - David Klein
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (D.K.); (J.Q.)
- Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, MD 20762, USA
| | - Jeffrey Quinlan
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (D.K.); (J.Q.)
| | - Marian Tanofsky-Kraff
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (A.T.P.); (M.K.H.N.); (S.S.); (K.H.); (R.S.); (W.L.); (D.G.); (J.M.L.); (T.S.); (M.T.-K.)
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (D.K.); (J.Q.)
- Military Cardiovascular Outcomes Research Program (MiCOR), Bethesda, MD 20814, USA;
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