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Resnik J, Miller CJ, Roth CE, Burns K, Bovin MJ. A Systematic Review of the Department of Veterans Affairs Mental Health-Care Access Interventions for Veterans With PTSD. Mil Med 2024; 189:1303-1311. [PMID: 37837200 DOI: 10.1093/milmed/usad376] [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: 02/02/2023] [Revised: 08/23/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Access to mental health care has been a priority area for the U.S. Department of Veterans Affairs (DVA) for decades. Access for veterans with PTSD is essential because untreated PTSD is associated with numerous adverse outcomes. Although interventions have been developed to improve access to DVA mental health care, the impact of these interventions on access for veterans with untreated PTSD has not been examined comprehensively, limiting guidance on appropriate implementation. MATERIALS AND METHODS We conducted a systematic review of PubMed and PTSDpubs between May 2019 and January 2022 to identify DVA access interventions for veterans with PTSD not engaged in DVA mental health care. We identified 17 interventions and 29 manuscripts reporting quantitative access outcomes. We categorized interventions into four major categories: Primary care mental health integration, other national initiatives, telemental health, and direct outreach. We evaluated five outcome domains: Binary attendance, number of sessions attended, wait time, number of patients seen, and care initiation. We assessed the risk of bias using the Cochrane Collaboration criteria. RESULTS Across articles, binary attendance generally improved, whereas the impact on the number of sessions attended was equivocal. Overall, the number of patients seen increased compared to control participants and retrospective data. The few articles that examined care initiation had mixed results. Only one article examined the impact on wait time. CONCLUSIONS Access interventions for veterans with PTSD demonstrated varied success across interventions and outcomes. The national initiatives-particularly primary care mental health integration -were successful across several outcomes; telemental health demonstrated promise in improving access; and the success of direct outreach varied across interventions. Confidence in these findings is tempered by potential bias among studies. Limited literature on how these interventions impact relevant preattendance barriers, along with incomplete data on how many perform nationally, suggests that additional work is needed to ensure that these interventions increase access for veterans with PTSD nationwide.
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Affiliation(s)
- Jack Resnik
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA 02130, USA
| | - Christopher J Miller
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Clara E Roth
- VA Boston Healthcare System, National Center for PTSD (116B-2), Boston, MA 02130, USA
- Boston VA Research Institute (BVARI), Boston, MA 02130, USA
| | - Katharine Burns
- VA Boston Healthcare System, National Center for PTSD (116B-2), Boston, MA 02130, USA
- Emmanuel College, Boston, MA 02115, USA
| | - Michelle J Bovin
- VA Boston Healthcare System, National Center for PTSD (116B-2), Boston, MA 02130, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
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2
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Teo AR, Niederhausen M, Handley R, Metcalf EE, Call AA, Jacob RL, Zikmund-Fisher BJ, Dobscha SK, Kaboli PJ. Using Nudges to Reduce Missed Appointments in Primary Care and Mental Health: a Pragmatic Trial. J Gen Intern Med 2023:10.1007/s11606-023-08131-5. [PMID: 37340264 DOI: 10.1007/s11606-023-08131-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 03/01/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Missed appointments ("no-shows") are a persistent and costly problem in healthcare. Appointment reminders are widely used but usually do not include messages specifically designed to nudge patients to attend appointments. OBJECTIVE To determine the effect of incorporating nudges into appointment reminder letters on measures of appointment attendance. DESIGN Cluster randomized controlled pragmatic trial. PATIENTS There were 27,540 patients with 49,598 primary care appointments, and 9420 patients with 38,945 mental health appointments, between October 15, 2020, and October 14, 2021, at one VA medical center and its satellite clinics that were eligible for analysis. INTERVENTIONS Primary care (n = 231) and mental health (n = 215) providers were randomized to one of five study arms (four nudge arms and usual care as a control) using equal allocation. The nudge arms included varying combinations of brief messages developed with veteran input and based on concepts in behavioral science, including social norms, specific behavioral instructions, and consequences of missing appointments. MAIN MEASURES Primary and secondary outcomes were missed appointments and canceled appointments, respectively. STATISTICAL ANALYSIS Results are based on logistic regression models adjusting for demographic and clinical characteristics, and clustering for clinics and patients. KEY RESULTS Missed appointment rates in study arms ranged from 10.5 to 12.1% in primary care clinics and 18.0 to 21.9% in mental health clinics. There was no effect of nudges on missed appointment rate in primary care (OR = 1.14, 95%CI = 0.96-1.36, p = 0.15) or mental health (OR = 1.20, 95%CI = 0.90-1.60, p = 0.21) clinics, when comparing the nudge arms to the control arm. When comparing individual nudge arms, no differences in missed appointment rates nor cancellation rates were observed. CONCLUSIONS Appointment reminder letters incorporating brief behavioral nudges were ineffective in improving appointment attendance in VA primary care or mental health clinics. More complex or intensive interventions may be necessary to significantly reduce missed appointments below their current rates. TRIAL NUMBER ClinicalTrials.gov, Trial number NCT03850431.
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Affiliation(s)
- Alan R Teo
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care, 3710 SW US Veterans Hospital Road (R&D 66), Portland, OR, USA.
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
| | - Meike Niederhausen
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care, 3710 SW US Veterans Hospital Road (R&D 66), Portland, OR, USA
- Oregon Health & Science University - Portland State University (OHSU-PSU) School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Robert Handley
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care, 3710 SW US Veterans Hospital Road (R&D 66), Portland, OR, USA
| | - Emily E Metcalf
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care, 3710 SW US Veterans Hospital Road (R&D 66), Portland, OR, USA
| | - Aaron A Call
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care, 3710 SW US Veterans Hospital Road (R&D 66), Portland, OR, USA
| | - R Lorie Jacob
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care, 3710 SW US Veterans Hospital Road (R&D 66), Portland, OR, USA
| | - Brian J Zikmund-Fisher
- Department of Health Behavior of Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Steven K Dobscha
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care, 3710 SW US Veterans Hospital Road (R&D 66), Portland, OR, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Peter J Kaboli
- Comprehensive Access and Delivery Research and Evaluation Center, Iowa City Veterans Affairs Healthcare System, Iowa City, IA, USA
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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3
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Stryczek KC, Honsberger M, Ball SL, Barnard JG, Young JP, Felker B, Au DH, Ho PM, Kirsh SR, Sayre GG. VA Outreach Is an Essential Area for Improving Veterans' Health Care Accessibility. Mil Med 2023; 188:usad019. [PMID: 36790439 DOI: 10.1093/milmed/usad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/05/2022] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION The Veterans Health Administration (VHA) is tasked with providing access to health care to veterans of military service. However, many eligible veterans have either not yet enrolled or underutilized VHA services. Further study of barriers to access before veterans enroll in VHA care is necessary to understand how to address this issue. The ChooseVA (née MyVA Access) initiative aims to achieve this mission to improve veterans' health care access. Although veteran outreach was not specifically addressed by the initiative, it is a critical component of improving veterans' access to health care. Findings from this multisite evaluation of ChooseVA implementation describe sites' efforts to improve VHA outreach and veterans' experiences with access. MATERIALS AND METHODS This quality improvement evaluation employed a multi-method qualitative methodology, including 127 semi-structured interviews and 81 focus groups with VHA providers and staff ("VHA staff") completed during 21 VHA medical center facility site visits between July and November 2017 and 48 telephone interviews with veterans completed between May and October 2018. Interviews and focus groups were transcribed and analyzed using deductive and inductive analysis to capture challenges and strategies to improve VHA health care access (VHA staff data), experiences with access to care (veteran data), barriers and facilitators to care (staff and veteran data), contextual factors, and emerging categories and themes. We developed focused themes describing perceived challenges, descriptions of VHA staff efforts to improve veteran outreach, and veterans' experiences with accessing VHA health care. RESULTS VHA staff and veteran respondents reported a lack of veteran awareness of eligibility for VHA services. Veterans reported limited understanding of the range of services offered. This awareness gap served as a barrier to veterans' ability to successfully access VHA health care services. Veterans described this awareness gap as contributing to delayed VHA enrollment and delayed or underutilized health care benefits and services. Staff focused on community outreach and engaging veterans for VHA enrollment as part of their efforts to implement the ChooseVA access initiative. Staff and veteran respondents agreed that outreach efforts were helpful for engaging veterans and facilitating access. CONCLUSIONS Although efforts across VHA programs informed veterans about VHA services, our results suggest that both VHA staff and veterans agreed that missed opportunities exist. Gaps include veterans' lack of awareness or understanding of VHA benefits for which they qualify for. This can result in delayed access to care which may negatively impact veterans, including those separating from the military and vulnerable populations such as veterans who experience pregnancy or homelessness.
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Affiliation(s)
- Krysttel C Stryczek
- VA Northeast Ohio Healthcare System, Research & Development, Cleveland, OH 44106, USA
| | - Mark Honsberger
- VA Northeast Ohio Healthcare System, Research & Development, Cleveland, OH 44106, USA
| | - Sherry L Ball
- VA Northeast Ohio Healthcare System, Research & Development, Cleveland, OH 44106, USA
| | - Juliana G Barnard
- VA Eastern Colorado Health Care System, Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO 80045, USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Jessica P Young
- VA Puget Sound Health Care System, Health Services Research & Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA 98108, USA
| | - Bradford Felker
- VA Puget Sound Health Care System, Health Services Research & Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA 98108, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA
| | - David H Au
- VA Puget Sound Health Care System, Health Services Research & Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA 98108, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195-6522, USA
| | - P Michael Ho
- VA Eastern Colorado Health Care System, Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO 80045, USA
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Susan R Kirsh
- The U.S. Department of Veterans Affairs Central Office, Washington, DC 20420, USA
| | - George G Sayre
- VA Puget Sound Health Care System, Health Services Research & Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA 98108, USA
- Department of Health Services, University of Washington School of Public Health, Seattle, WA 98195, USA
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4
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Trivedi NU, Gargano LM, Brackbill RM, Jacobson MH. Posttraumatic stress disorder and functional impairment among World Trade Center Health Registry enrollees 14-15 years after the September 11, 2001, terrorist attacks. J Trauma Stress 2023; 36:44-58. [PMID: 36239980 DOI: 10.1002/jts.22887] [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] [Received: 02/16/2021] [Revised: 07/27/2022] [Accepted: 08/03/2022] [Indexed: 11/10/2022]
Abstract
The September 11, 2001, terrorist attacks on the World Trade Center (WTC) in New York City (9/11) had health-related consequences, including posttraumatic stress disorder (PTSD). PTSD is associated with functional impairment, which varies by symptom severity and other factors. This study aimed to identify predictors of functional impairment in individuals with low versus high PTSD symptom severity levels. WTC Health Registry enrollees exposed to 9/11 were surveyed four times between 2003 and 2015; cumulated data for individuals who endorsed at least one symptom on the PTSD Checklist-Civilian Version (PCL-C) at Wave 4 (2015-2016) were included (N = 30,287) and examined cross-sectionally. Individuals were classified based on PCL-C scores as having low/no (2-29) or high levels of PTSD symptom severity (≥ 44). Functional impairment was defined as subsequent difficulties in daily living. Among low/no PTSD severity participants, adjusted odds ratios (aORs) for the associations between functional impairment and poor self-rated health (vs. good), low social support (vs. high), and no physical activity (vs. active) were 1.23-1.92. In the same group, low versus high household income was associated with more functional impairment, aOR = 1.34, 95% CI [1.13, 1.59]. Among participants with high-level PTSD symptoms, women, aOR = 1.70, 95% CI [1.31, 2.20], and Hispanic enrollees, aOR = 1.76, 95% CI [1.31, 2.36], were more likely to report an absence of impairment. Self-rated health, social support, and physical activity emerged as important predictors of PTSD-related functional impairment across PTSD symptom severity levels, supporting clinical interventions targeting these factors.
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Affiliation(s)
- Niti U Trivedi
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, New York, USA.,Delfi Diagnostics, Inc., Baltimore, Maryland, USA
| | - Lisa M Gargano
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, New York, USA
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, New York, USA
| | - Melanie H Jacobson
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, New York, USA.,Division of Environmental Pediatrics, Department of Pediatrics, New York University School of Medicine, New York, New York, USA
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5
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Qin Y, Sneddon DA, MacDermid Wadsworth S, Topp D, Sterrett RA, Newton JR, Eicher-Miller HA. Grit but Not Help-Seeking Was Associated with Food Insecurity among Low Income, At-Risk Rural Veterans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2500. [PMID: 36767870 PMCID: PMC9916015 DOI: 10.3390/ijerph20032500] [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: 11/23/2022] [Revised: 01/14/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
Rural veterans have poorer health, use healthcare services less often than their urban counterparts, and have more prevalent food insecurity than average U.S. households. Food insecurity and resource use may be influenced by modifiable psychological attributes such as grit and help-seeking behaviors, which may be improved through interventions. Grit and help-seeking have not been previously evaluated among rural veterans. Thus, this cross-sectional study evaluated the hypothesis that grit and help-seeking were associated with food insecurity and the use of resources. Food security, resource use, grit, and help-seeking behavior were assessed among rural veterans (≥18 years) from five food pantries in southern Illinois counties (n = 177) from March 2021 to November 2021. Adjusted multiple regression was used to estimate the relationship between the odds of food insecurity and the use of resources with grit and help-seeking scores. Higher grit scores were significantly associated with lower odds of food insecurity (OR = 0.5, p = 0.009). No other associations were detected. The results provided evidence to inform the content of future educational interventions to improve food insecurity and address health disparities among rural veterans by addressing grit. The enhancement of psychological traits such as grit is related to food security and has the potential to benefit other aspects of well-being.
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Affiliation(s)
- Yue Qin
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA
| | - Douglas A. Sneddon
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN 47907, USA
| | | | - Dave Topp
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN 47907, USA
| | - Rena A. Sterrett
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN 47907, USA
| | - Jake R. Newton
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN 47907, USA
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Zikmund-Fisher BJ, Tuepker A, Metcalf EE, Strange W, Teo AR. Applying user-centered design in the development of nudges for a pragmatic trial to reduce no-shows among veterans. PATIENT EDUCATION AND COUNSELING 2022; 105:1620-1627. [PMID: 34756639 PMCID: PMC9033881 DOI: 10.1016/j.pec.2021.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/12/2021] [Accepted: 10/20/2021] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To incorporate user-centered design processes into the refinement of nudges designed to reduce no-shows among healthcare appointments for military veterans in the Veterans Health Administration (VA). METHODS We developed candidate nudges as brief messages based on four broad concepts in behavioral science. We then conducted iterative waves of multi-stage interviews (N = 27) that included a pile sorting task, a "think-aloud" review of each message, and prototype letter reviews. Rapid consensus analysis of each wave's feedback iteratively refined message language. RESULTS Veterans rejected several theoretically plausible messages focusing on avoiding the burden of rescheduling missed appointments or the monetary cost of no-shows. Participants suggested framing calling to cancel an appointment as helping other veterans and emphasized a new motivational theme: expressing personal concern for the veteran. CONCLUSION Use of iterative UCD methods allowed for early identification of both messages inappropriate for veterans and new veteran-generated nudges around non-judgmental validation that could be incorporated in the design of our pragmatic trial. PRACTICE IMPLICATIONS Rapid team-based qualitative analysis, iterative material design, and space in the study design to incorporate entirely new insights from participants into study materials are all approaches that can improve communications of what matters most to a specific population.
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Affiliation(s)
- Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Anaïs Tuepker
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, USA; Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA
| | - Emily E Metcalf
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, USA
| | - Wynn Strange
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, USA
| | - Alan R Teo
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA; School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR, USA
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7
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Johnson EM, Possemato K. Problem recognition and treatment beliefs relate to mental health utilization among veteran primary care patients. Psychol Serv 2021; 18:11-22. [PMID: 30869974 PMCID: PMC6745017 DOI: 10.1037/ser0000341] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mental health concerns are prevalent among primary care patients, but many do not utilize services for these conditions. This study aims to conduct a comprehensive assessment of barriers and facilitators to mental health care utilization among veteran primary care patients with common mental health concerns. We hypothesized that beliefs and knowledge about mental illness and mental health care would be more strongly associated with recent mental health care utilization than stigma, help-seeking behaviors, or logistical barriers. Veterans (n = 116) enrolled in primary care with current symptoms of depression (58%), posttraumatic stress disorder (37%), and/or hazardous alcohol use (50%) who either recently used mental health services (47%) or had no recent mental health treatment utilization (53%) completed a telephone-based screening, medical records review, and mail survey of 10 measures of barriers and facilitators to mental health treatment utilization. Recognition of problems as a cause for concern, odds ratio = 5.95, 95% confidence interval [2.36, 15.01], and beliefs about psychotherapy, odds ratio = 2.53, 95% confidence interval [1.39, 4.60], emerged as stronger correlates of recent mental health care utilization than stigma, self-efficacy, and external barriers to treatment. Results suggest the use of specific theories, measures, and interventions that focus on patient recognition of problems and beliefs about treatment over those that focus on other treatment barriers and facilitators. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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8
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Sagar-Ouriaghli I, Godfrey E, Bridge L, Meade L, Brown JSL. Improving Mental Health Service Utilization Among Men: A Systematic Review and Synthesis of Behavior Change Techniques Within Interventions Targeting Help-Seeking. Am J Mens Health 2020; 13:1557988319857009. [PMID: 31184251 PMCID: PMC6560805 DOI: 10.1177/1557988319857009] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Compared to women, men are less likely to seek help for mental health
difficulties. Despite considerable interest, a paucity in evidence-based
solutions remains to solve this problem. The current review sought to synthesize the specific techniques within
male-specific interventions that may contribute to an improvement in
psychological help-seeking (attitudes, intentions, or behaviors). A systematic
review identified 6,598 potential articles from three databases (MEDLINE,
EMBASE, and PsycINFO). Nine studies were eligible. A meta-analysis was
problematic due to disparate interventions, outcomes, and populations. The
decision to use an innovative approach that adopted the Behavior Change
Technique (BCT) taxonomy to synthesize each intervention’s key features likely
to be responsible for improving help-seeking was made. Of the nine studies, four
were engagement strategies (i.e., brochures/documentaries), two randomized
controlled trials (RCTs), two pilot RCTs, and one retrospective review.
Regarding quality assessment, three were scored as “strong,” five as “moderate,”
and one as “weak.” Key processes that improved help-seeking attitudes,
intentions, or behaviors for men included using role models to convey
information, psychoeducational material to improve mental health knowledge,
assistance with recognizing and managing symptoms, active problem-solving tasks,
motivating behavior change, signposting services, and, finally, content that
built on positive male traits (e.g., responsibility and strength). This is the
first review to use this novel approach of using BCTs to summarize and identify
specific techniques that may contribute to an improvement in male help-seeking
interventions, whether engagement with treatment or the intervention itself.
Overall, this review summarizes previous male help-seeking interventions,
informing future research/clinical developments.
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Affiliation(s)
- Ilyas Sagar-Ouriaghli
- 1 Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Emma Godfrey
- 1 Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,2 School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, UK
| | - Livia Bridge
- 1 Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Laura Meade
- 2 School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, UK
| | - June S L Brown
- 1 Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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9
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Teo AR, Marsh HE, Liebow SBL, Chen JI, Forsberg CW, Nicolaidis C, Saha S, Dobscha SK. Help-Seeking on Facebook Versus More Traditional Sources of Help: Cross-Sectional Survey of Military Veterans. J Med Internet Res 2018; 20:e62. [PMID: 29483064 PMCID: PMC5847817 DOI: 10.2196/jmir.9007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/02/2017] [Accepted: 11/19/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The media has devoted significant attention to anecdotes of individuals who post messages on Facebook prior to suicide. However, it is unclear to what extent social media is perceived as a source of help or how it compares to other sources of potential support for mental health problems. OBJECTIVE This study aimed to evaluate the degree to which military veterans with depression use social media for help-seeking in comparison to other more traditional sources of help. METHODS Cross-sectional self-report survey of 270 adult military veterans with probable major depression. Help-seeking intentions were measured with a modified General Help-Seeking Questionnaire. Facebook users and nonusers were compared via t tests, Chi-square, and mixed effects regression models. Associations between types of help-seeking were examined using mixed effects models. RESULTS The majority of participants were users of social media, primarily Facebook (n=162). Mean overall help-seeking intentions were similar between Facebook users and nonusers, even after adjustment for potential confounders. Facebook users were very unlikely to turn to Facebook as a venue for support when experiencing either emotional problems or suicidal thoughts. Compared to help-seeking intentions for Facebook, help-seeking intentions for formal (eg, psychologists), informal (eg, friends), or phone helpline sources of support were significantly higher. Results did not substantially change when examining users of other social media, women, or younger adults. CONCLUSIONS In its current form, the social media platform Facebook is not seen as a venue to seek help for emotional problems or suicidality among veterans with major depression in the United States.
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Affiliation(s)
- Alan R Teo
- Health Services Research and Development Center to Improve Veteran Involvement in Care, Department of Veterans Affairs Portland Health Care System, Portland, OR, United States.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States.,School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR, United States
| | - Heather E Marsh
- Health Services Research and Development Center to Improve Veteran Involvement in Care, Department of Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - Samuel B L Liebow
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States
| | - Jason I Chen
- Health Services Research and Development Center to Improve Veteran Involvement in Care, Department of Veterans Affairs Portland Health Care System, Portland, OR, United States.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States
| | - Christopher W Forsberg
- Health Services Research and Development Center to Improve Veteran Involvement in Care, Department of Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - Christina Nicolaidis
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR, United States.,Department of Medicine, Oregon Health & Science University, Portland, OR, United States.,Regional Research Institute, School of Social Work, Portland State University, Portland, OR, United States
| | - Somnath Saha
- Health Services Research and Development Center to Improve Veteran Involvement in Care, Department of Veterans Affairs Portland Health Care System, Portland, OR, United States.,School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR, United States.,Department of Medicine, Oregon Health & Science University, Portland, OR, United States.,Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States
| | - Steven K Dobscha
- Health Services Research and Development Center to Improve Veteran Involvement in Care, Department of Veterans Affairs Portland Health Care System, Portland, OR, United States.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States
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10
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Dalton J, Thomas S, Melton H, Harden M, Eastwood A. The provision of services in the UK for UK armed forces veterans with PTSD: a rapid evidence synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Our research arises from anticipated increases in demand for psychological trauma services in the UK, with particular reference to armed forces veterans with post-traumatic stress disorder (PTSD). Commissioning and service provider activity to improve veterans’ health is evolving.
Objectives
To explore what UK services exist and establish potentially effective models of care and effective treatments for armed forces veterans with PTSD.
Design
A four-stage rapid evidence synthesis comprising information gathering on UK service provision; an evidence review on models of care; a metareview on treatment effectiveness; and a synthesis highlighting research priorities.
Setting
For the evidence reviews, any setting that was relevant to the UK health and social care system.
Participants
UK armed forces veterans with PTSD following repeated exposure to traumatic events.
Interventions
Any model of care or treatment.
Main outcome measures
Any relevant outcome.
Data sources
Information about current UK practice. Searches of databases [including MEDLINE, PsycINFO and PILOTS (Published International Literature on Traumatic Stress)], guidelines and relevant websites, up to November 2016.
Review methods
We screened titles and abstracts using EPPI-Reviewer 4 (EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, UK) and EndNote X7 [Clarivate Analytics (formerly Thomson Reuters), Philadelphia, PA, USA]. Decisions to include papers were made by two reviewers independently. We conducted a narrative synthesis of research literature on models of care and on treatments, guided by information from UK practice. In our evidence reviews, we assessed (when appropriate) the quality of included studies using established criteria. To help interpret our findings, we consulted recently published public and patient involvement data, a veteran service user and experts with academic, military and commissioning backgrounds.
Results
We gathered information about current UK practice. Sixty-one studies were included in the rapid evidence review on models of care and seven systematic reviews in the rapid metareview of treatments. The quality of evidence in both evidence reviews was limited. Promising models of care from more robust studies (three randomised controlled trials and one qualitative study) were collaborative arrangements and community outreach for improving intervention access and uptake; integrated mental health services and behavioural intervention on increased smoking abstinence; and peer support as an acceptable complement to PTSD treatment. A poor fit was noted between the research literature and UK service provision. Promising treatments were psychosocial interventions (eye movement desensitisation and reprocessing, cognitive processing therapy, trauma-focused and exposure-based intervention) and pharmacotherapy (selective serotonin reuptake inhibitors, antidepressants, anticonvulsants, antipsychotics) for improving PTSD and mental health symptoms.
Limitations
The literature pool was larger than anticipated. Evidence for potentially effective models of care and potentially effective treatments is limited in quality and quantity. Although we aimed for a comprehensive evidence synthesis, pragmatic decisions in searching, screening and inclusion of studies may mean that relevant studies were overlooked.
Conclusions
There is tentative support for the effectiveness of some models of care and certain treatments currently delivered in UK practice. Our findings are timely for commissioners and service providers when developing present activity in veterans’ health care.
Future work
We report potential implications for future health-care practice, including early intervention for veterans transitioning from military life, improving general practitioners’ knowledge about services, implementing needs-based service design and tackling wider-system challenges. Regarding potential areas of future research, we have identified the need for more-robust (and longer) evaluative studies in the UK setting.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Jane Dalton
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Sian Thomas
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Hollie Melton
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Alison Eastwood
- Centre for Reviews and Dissemination, University of York, York, UK
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Mitchell AJ, Selmes T. Why don't patients attend their appointments? Maintaining engagement with psychiatric services. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.106.003202] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Patients miss about 20% of scheduled appointments for mental health treatment, almost twice the rate in other medical specialties. Up to 50% of patients who miss appointments drop out of scheduled care. Many who miss appointments because of slips and lapses later rearrange their appointments without adverse consequences. Those that do not are at risk of further deterioration, relapse and hospital readmission. Predictors of non-attendance are complex and linked with the predictors of missed medication. Service barriers and administrative errors are common but are often overlooked in the absence of feedback from patients. Of prime importance are the therapeutic alliance and degree of ‘helpfulness’ of the clinician but again these are rarely measured routinely. Useful markers of engagement include patient-rated trust, satisfaction and degree of perceived participation in treatment decisions. Much can be done to improve attendance in most services. Simple measures such as offering prompt, convenient appointments, offering reminders and augmenting with telephone contact have a reasonable evidence base. Scales to assess therapeutic alliance are now available. Complex interventions need to be evaluated carefully in order that the overall benefits outweigh costs. We suggest that clinicians consider accessibility, discharge policies and patient feedback when examining local rates of non-attendance.
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Turchik JA, Rafie S, Rosen CS, Kimerling R. Preferences for Gender-Targeted Health Information. Am J Mens Health 2013; 8:240-8. [DOI: 10.1177/1557988313508304] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
No prior research has examined men’s opinions or preferences regarding receiving health education materials related to sexual violence. The objective of the current study was to investigate whether male veteran patients who have experienced military sexual trauma (MST) prefer gender-targeted versus gender-neutral printed health information and whether receipt of this information increased utilization of outpatient mental health services in the following 6-month period. In-person 45-minute interviews were conducted with 20 male veterans receiving health care services at a large Veterans Health Administration facility to evaluate opinions on a gender-targeted and a gender-neutral brochure about MST. An additional 153 veterans received psychoeducational materials through the mail and participated in the completion of a survey as part of a psychoeducational intervention. Our results demonstrate that male veterans prefer gender-targeted information about sexual trauma compared to gender-neutral information. Whereas veterans in the study had clear preferences for gender-targeted materials, receipt of information about MST (whether gender-targeted or gender-neutral) did not increase utilization of mental health care in the 6 months following receipt of these materials. These results demonstrated that materials about sexual trauma are acceptable to men and should be gender-targeted. Further research is needed to examine strategies to increase access to mental health care among male Veterans who have experienced MST.
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Affiliation(s)
- Jessica A. Turchik
- National Center for PTSD, VA Palo Health Care System, Palo Alto, CA, USA
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Samantha Rafie
- National Center for PTSD, VA Palo Health Care System, Palo Alto, CA, USA
- Palo Alto University, Palo Alto, CA, USA
| | - Craig S. Rosen
- National Center for PTSD, VA Palo Health Care System, Palo Alto, CA, USA
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Rachel Kimerling
- National Center for PTSD, VA Palo Health Care System, Palo Alto, CA, USA
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Jeong Y, Kim D, Oh HY, Park YC. Print media coverage of post-traumatic stress disorder: content analysis of three major Korean newspapers. J Korean Med Sci 2013; 28:1077-82. [PMID: 23853493 PMCID: PMC3708081 DOI: 10.3346/jkms.2013.28.7.1077] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 04/16/2013] [Indexed: 11/21/2022] Open
Abstract
The print media is still one of major sources for health-related information. To shed light on how the media accurately delivers information for post-traumatic stress disorder (PTSD), we searched the newspaper articles and analyzed their contents for accuracy in the description of symptoms, causes, and treatment of PTSD. The articles featuring PSTD were searched from the very first available to 2010 at on-line search systems of three major Korean newspapers. A total of 123 articles appeared and the first article appeared in 1984. The number of articles steadily increased till the early 2000s but we found the robust increase in the late 2000s. Among the mentioned symptoms of PTSD: re-experience (39%) was most common, followed by avoidance or numbing (28%) and hyperarousal (22%). Of the 29 articles mentioning treatment of PTSD, 13 mentioned psychotherapy only and 11 mentioned both psychotherapy and medication equally. However, the psychotherapies mentioned were non-specific and only five articles mentioned any empirically supported therapies. The number of articles on PTSD in Korean newspapers has continually increased during the last three decades. However, the quality of information on the treatment of PTSD was questionable.
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Affiliation(s)
- Yourhee Jeong
- Department of Psychiatry, School of Medicine, Hanyang University, Seoul, Korea
| | - Daeho Kim
- Department of Psychiatry, School of Medicine, Hanyang University, Seoul, Korea
- Traumatic Stress Clinic, Hanyang University Guri Hospital, Guri, Korea
| | - Hyun Young Oh
- Department of Psychiatry, School of Medicine, Hanyang University, Seoul, Korea
- Traumatic Stress Clinic, Hanyang University Guri Hospital, Guri, Korea
| | - Yong Chon Park
- Department of Psychiatry, School of Medicine, Hanyang University, Seoul, Korea
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Morina N, Emmelkamp PMG. Health care utilization, somatic and mental health distress, and well-being among widowed and non-widowed female survivors of war. BMC Psychiatry 2012; 12:39. [PMID: 22578096 PMCID: PMC3418153 DOI: 10.1186/1471-244x-12-39] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 05/11/2012] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND The aim of the study was to assess levels of somatic and mental health distress, well-being, AS WELL AS utilization of primary and specialist health care services among war-related widowed and non-widowed female civilian survivors of war. METHODS 100 war-related widowed lone mothers and 106 non-widowed mothers who had experienced the Kosovo war ten years previously participated in the study. Measures of somatic, depressive, post-traumatic stress, anxiety, and grief complaints, subjective well-being, and utilization of health care services during the previous three months were used. RESULTS Compared to non-widowed mothers, widowed lone mothers reported significantly higher levels of somatic, depressive, post-traumatic stress, and anxiety complaints. Further, they reported significantly lower levels of subjective well-being as composed of positive and negative affect and satisfaction with life. More than half of both widowed and non-widowed mothers reported utilization of health care services during the last three months, without significant differences between the groups. However, only three percent of widowed lone mothers and four percent of non-bereaved mothers reported utilization of mental health services during the last three months, despite high levels of mental health distress especially among widowed lone mothers. Among widowed lone mothers, severity of prolonged grief symptoms significantly predicted number of contacts of specialist health care use over and above sociodemographic variables, number of war-related events, and other psychopathology. CONCLUSION War-related widowed lone mothers suffer from elevated somatic and mental distress even a decade after the war. The tiny proportion of widowed lone mothers in use of mental health services can be seen as a reflection of lack of previous and current mental health services to meet mental health needs of this population.
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Affiliation(s)
- Nexhmedin Morina
- Department of Clinical Psychology, University of Amsterdam, Weesperplein 4, 1018, XA, Amsterdam, The Netherlands.
| | - Paul M G Emmelkamp
- Department of Clinical Psychology, University of Amsterdam, Weesperplein 4, 1018, XA, Amsterdam, The Netherlands
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Abstract
The aim of the study was to explore why people suffering from posttraumatic stress disorder (PTSD) following war do not receive treatment. A total of 212 participants who have PTSD following war in the Balkans and have never received psychiatric treatment were interviewed (86 in Western Europe and 126 in Balkan countries). Answers were subjected to thematic content analysis. Five major and not mutually exclusive themes were identified: "need no help" (57 participants), "personal ways of coping" (72 participants), "negative attitude towards psychiatric treatment" (91 participants), "comparative insignificance" (24 participants), and "external barriers" (65 participants). While most participants, for different reasons, did not want to seek psychiatric treatment, a significant number, particularly in Western European countries, felt prevented from receiving treatment.
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Lefforge NL, Donohue B, Strada MJ. Improving session attendance in mental health and substance abuse settings: a review of controlled studies. Behav Ther 2007; 38:1-22. [PMID: 17292691 DOI: 10.1016/j.beth.2006.02.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Accepted: 02/12/2006] [Indexed: 11/21/2022]
Abstract
Patient nonattendance to scheduled sessions results in excessive costs to mental health and substance abuse providers and compromises the care of clients. This paper presents a comprehensive review of interventions that have been shown to increase session attendance rates in these settings. Unique to other review papers, reliability estimates were performed in the selection and evaluation of obtained studies. Reliability of article selection and evaluation strategies was excellent (.80 to .88). Study results indicate several attendance improvement methods appear to be particularly promising, such as scheduling appointments promptly, reminder letters and telephone calls, soliciting patient commitment, and helping to resolve obstacles to attending the session. The specific manner in which these interventions are implemented appears to influence session attendance rates. Moreover, some attendance improvement interventions are clearly effective in some settings, but not others. Specific recommendations are provided in light of the study findings.
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Affiliation(s)
- Noelle L Lefforge
- Department of Psychology, University of Nevada, Las Vegas 89154, USA.
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Abstract
The Yom Kippur War came as a major shock to the confidence and stability of the national psyche in Israel, and it may be suggested that the incidence of associated psychological trauma at least in war veterans may be more profound and long-standing. Therefore, the aim of this study was to investigate the presence of PTSD in a naturalistic cohort of Yom Kippur veterans 32 years after the war managed for PTSD in a specialized unit during the war. Results indicated that of the 277 (20.9%) initial battle front-injured referred for evaluation who were diagnosed with PTSD, 32 years later only 19 war veterans were still suffering with PTSD (6.85% of the PTSD subpopulation or 1.43% of the original injured combat veteran cohort). Results from this long-term follow-up study indicate a low incidence of chronic symptomatology that may be accounted for by the nature of the initial care, follow-up, and subpopulation investigated.
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Affiliation(s)
- Arie Shlosberg
- Beer Yaakov Mental Health Center, Sackler School of Medicine, Tel Aviv University, Beer Yaakov, Israel
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Abstract
One of the basic rights of crime victims granted under victim-orientated legislation introduced during the last 20 years in more than 100 countries worldwide is the right to be referred to victim support by the police. The under-utilization of psychological services by crime victims who are objectively in need of external support is substantial. Current legal procedures tend to perpetuate this unwanted condition. Programs aimed at the early detection and prevention of persistent postvictimization distress are more in line with the ideals of therapeutic jurisprudence. The RISK (10) screening instrument, which was specifically developed to be administered by police officers, may provide a basis for early detection. RISK (10) consists of a selection of 10 Risk factors with prior empirical evidence and theoretical significance. The focus of the present study was to examine the predictive and diagnostic power of RISK (10) components to detect persistent future psychological distress, among other things, in terms of Adjustment Disorder. Analyses were based on a sample of 93 crime victims who participated in the police and (3 months) follow-up parts of the study. Findings provided initial validation for the predictive accuracy of most RISK (10) components, and confirm the diagnostic value (in terms of specificity, sensitivity, positive and negative predictive power) of risk factors, such as engaging in character attributions, upward comparison processes, fatalistic appraisals of the episode, and the initial reporting of expected deficiencies in social support. The clinical utility of RISK (10) for early detection in police stations is confirmed.
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Benda BB. Discriminators of suicide thoughts and attempts among homeless veterans who abuse substances. Suicide Life Threat Behav 2004; 33:430-42. [PMID: 14695057 DOI: 10.1521/suli.33.4.430.25233] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Six hundred homeless military veterans who abused substances were examined to determine what factors discriminate between nonsuicidal veterans, those who had suicidal thoughts, and persons who had attempted suicide. Several factors were considered based on attachment theory, including caregiver attachment, sexual abuse, physical abuse, resilience, self-efficacy, and self-esteem. Suicide attempters were discriminated from others by psychiatric comorbidity, early abuse, severity of substance abuse, and longevity of drug use. In contrast, the discriminators between nonsuicidal homeless substance abusers and others were elements of attachment and commitments such as marriage, employment, and religiosity. Some implications of the findings for intervention are discussed.
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Affiliation(s)
- Brent B Benda
- School of Social Work, University of Arkansas at Little Rock, 72204, USA.
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Abstract
This was a study of crime among 188 homeless persons who were in a Veterans' Affairs Medical Center program for substance abusers. The purpose of the study was to find out: (a) what proportion committed crimes, and (b) what other problems, relational factors, and personal attributes predict crime. Data indicate 27% of these homeless veterans committed nuisance offenses, and 41% have committed crimes in the past year. Logistic regression procedures indicated that alcohol and other drug abuse, less education, lack of employment, psychiatric problems, and living with a substance abuser increased the odds of committing crimes. This study also finds that physical and sexual abuse before 18 years of age increases the odds of committing crimes, whereas self-efficacy, ego integrity, and resilience decrease these odds. These latter factors have received scant attention in the literature on homeless substance abusers, and yet they are among the strongest predictors of crime. Implications for psychiatric rehabilitation are discussed.
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Affiliation(s)
- Brent B Benda
- University of Arkansas at Little Rock, Little Rock, Arkansas 72204, USA.
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