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Sullivan-Baca E, Tantillo G, Zhou R, Rehman R, Raquel Lopez M, Haneef Z. Comorbidities in Hispanic/Latino Veterans with epilepsy. Epilepsy Behav 2024; 157:109871. [PMID: 38833739 DOI: 10.1016/j.yebeh.2024.109871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/13/2024] [Accepted: 05/29/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Hispanic/Latino people with epilepsy may be at a differential risk of medical and psychiatric comorbidities given genetic, environmental, sociocultural, and quality of care factors. In people with epilepsy, comorbidities are especially crucial to investigate given the well-known impact on quality of life and risk of adverse outcomes. Yet, Hispanic/Latino Veterans with Epilepsy (HL-VWE) remain an understudied population. The present nationwide population study sought to investigate medical and psychiatric comorbidities in this group. METHODS Data from the Veterans Health Administration (VHA) Corporate Data Warehouse administrative data were used to identify 56,556 VWE (5.7 % HL-VWE) using a one-year cross-sectional analysis of ICD codes. Elixhauser Comorbidity Index scores and psychiatric diagnoses were calculated based on ICD-9/ICD-10-CM diagnoses using a lookback period. Comparisons were made between HL-VWE and non-HL-VWE using chi-squared and student t-tests. Regression analyses were then performed to examine group differences while accounting for age. RESULTS HL-VWE had higher probability of being diagnosed with several psychiatric conditions when accounting for age, including depression (OR 1.21, 95 % CI 1.13-1.31) and schizophrenia (OR 1.56, 95 % CI 1.31-1.84). There were no significant differences in medical comorbidities between the HL-VWE and non-HL-VWE groups. CONCLUSIONS We present results from the largest known study of HL people with epilepsy examining their psychiatric and medical comorbidities and one of the first to specifically study HL-VWE. Compared to non-HL-VWE, the Hispanic/Latino group had comparable medical comorbidity, but higher rates of multiple psychiatric conditions. Results indicate a need for increased screening and interventions in this population to reduce psychiatric disease burden.
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Affiliation(s)
- Erin Sullivan-Baca
- Department of Neurology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States; Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, United States.
| | - Gabriela Tantillo
- Department of Neurology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States.
| | - Richard Zhou
- Department of Neurology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States.
| | - Rizwana Rehman
- Durham VA Medical Center, 508 Fulton St., Durham, NC 27705, United States.
| | - María Raquel Lopez
- Miami VA Medical Center, 1201 NW 16th Street, Miami, FL 33125, United States; Miller School of Medicine, University of Miami, 1600 NW 10th Ave, Miami, FL 33136, United States.
| | - Zulfi Haneef
- Department of Neurology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States; Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, United States.
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2
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C. Coleman B, Finch D, Wang R, L. Luther S, Heapy A, Brandt C, J. Lisi A. Extracting Pain Care Quality Indicators from U.S. Veterans Health Administration Chiropractic Care Using Natural Language Processing. Appl Clin Inform 2023; 14:600-608. [PMID: 37164327 PMCID: PMC10411229 DOI: 10.1055/a-2091-1162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/27/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Musculoskeletal pain is common in the Veterans Health Administration (VHA), and there is growing national use of chiropractic services within the VHA. Rapid expansion requires scalable and autonomous solutions, such as natural language processing (NLP), to monitor care quality. Previous work has defined indicators of pain care quality that represent essential elements of guideline-concordant, comprehensive pain assessment, treatment planning, and reassessment. OBJECTIVE Our purpose was to identify pain care quality indicators and assess patterns across different clinic visit types using NLP on VHA chiropractic clinic documentation. METHODS Notes from ambulatory or in-hospital chiropractic care visits from October 1, 2018 to September 30, 2019 for patients in the Women Veterans Cohort Study were included in the corpus, with visits identified as consultation visits and/or evaluation and management (E&M) visits. Descriptive statistics of pain care quality indicator classes were calculated and compared across visit types. RESULTS There were 11,752 patients who received any chiropractic care during FY2019, with 63,812 notes included in the corpus. Consultation notes had more than twice the total number of annotations per note (87.9) as follow-up visit notes (34.7). The mean number of total classes documented per note across the entire corpus was 9.4 (standard deviation [SD] = 1.5). More total indicator classes were documented during consultation visits with (mean = 14.8, SD = 0.9) or without E&M (mean = 13.9, SD = 1.2) compared to follow-up visits with (mean = 9.1, SD = 1.4) or without E&M (mean = 8.6, SD = 1.5). Co-occurrence of pain care quality indicators describing pain assessment was high. CONCLUSION VHA chiropractors frequently document pain care quality indicators, identifiable using NLP, with variability across different visit types.
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Affiliation(s)
- Brian C. Coleman
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States
- Yale Center for Medical Informatics, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - Dezon Finch
- Research Service, James A. Haley Veterans Hospital, Tampa, Florida, United States
| | - Rixin Wang
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States
- Yale Center for Medical Informatics, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - Stephen L. Luther
- Research Service, James A. Haley Veterans Hospital, Tampa, Florida, United States
- College of Public Health, University of South Florida, Tampa, Florida, United States
| | - Alicia Heapy
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - Cynthia Brandt
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States
- Yale Center for Medical Informatics, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - Anthony J. Lisi
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States
- Yale Center for Medical Informatics, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
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3
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Ward MJ, Hwang U, Hastings SN, Timko C, Chen JI, Vashi AA, Mattocks K, Abel EA, Bravata DM. Research and policy recommendations from the SOTA XVI: State of the Art Conference on VA Emergency Medicine. Acad Emerg Med 2023; 30:240-251. [PMID: 36775279 DOI: 10.1111/acem.14679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 02/14/2023]
Abstract
To better understand and prioritize research on emergency care for Veterans, the Department of Veteran Affairs (VA) Health Services Research and Development convened the 16th State of the Art Conference on VA Emergency Medicine (SAVE) in Winter 2022 with emergency clinicians, researchers, operational leaders, and additional stakeholders in attendance. Three specific areas of focus were identified including older Veterans, Veterans with mental health needs, and emergency care in the community (non-VA) settings. Among older Veterans, identified priorities included examination of variation in care and its impact on patient outcomes, utilization, and costs; quality of emergency department (ED) care transitions and strategies to improve them; impact of geriatric ED care improvement initiatives; and use of geriatric assessment tools in the ED. For Veterans with mental health needs, priorities included enhancing the reach of effective, multicomponent suicide prevention interventions; development and evaluation of interventions to manage substance use disorders; and identifying and examining safety and effective acute psychosis practices. Community (non-VA) emergency care priorities included examining changes in patterns of use and costs in VA and the community care settings as a result of recent policy and coverage changes (with an emphasis on modifiable factors); understanding quality, safety, and Veteran experience differences between VA and community settings; and better understanding follow-up needs among Veterans who received emergency care (or urgent care) and how well those needs are being coordinated, communicated, and met. Beyond these three groups, cross-cutting themes included the use of telehealth and implementation science to refine multicomponent interventions, care coordination, and data needs from both VA and non-VA sources. Findings from this conference will be disseminated through multiple mechanisms and contribute to future funding applications focused on improving Veteran health.
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Affiliation(s)
- Michael J Ward
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Geriatric Research Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Ula Hwang
- Geriatric Research Education and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, New York, USA.,Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - S Nicole Hastings
- HSR&D Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA.,Department of Medicine, Division of Geriatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christine Timko
- HSR&D Center for Innovation to Implementation, Center for Innovation to Implementation, VHA Palo Alto Health Care System, Menlo Park, California, USA.,Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, California, USA
| | - Jason I Chen
- HSR&D Center to Improve Veteran Involvement in Care, Portland VA Medical Center, Portland, Oregon, USA.,Department of Psychiatry, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Anita A Vashi
- HSR&D Center for Innovation to Implementation, Center for Innovation to Implementation, VHA Palo Alto Health Care System, Menlo Park, California, USA.,Department of Emergency Medicine, University of California, San Francisco, California, USA.,Department of Emergency Medicine (Affiliated), Stanford University, Stanford, California, USA
| | - Kristin Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Erica A Abel
- HSR&D Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale Center for Medical Informatics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Dawn M Bravata
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.,Departments of Medicine and Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Regenstrief Institute, Indianapolis, Indiana, USA
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Improvement in Veterans' Openness to Seeking Professional Psychological Help After Participating in Therapeutic Adventure Trips. ECOPSYCHOLOGY 2022. [DOI: 10.1089/eco.2022.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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5
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McGuire AP, Fagan J, Tsai J, Merians AN, Nichter B, Norman S, Southwick SM, Pietrzak RH. Dispositional gratitude predicts the development of psychopathology and suicidal behaviors: Results from a 7-year population-based study of U.S. military veterans. J Psychiatr Res 2022; 149:168-176. [PMID: 35278781 PMCID: PMC9017955 DOI: 10.1016/j.jpsychires.2022.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/15/2022] [Accepted: 02/28/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Dispositional gratitude has been implicated as a psychological characteristic that may modulate risk for mental health outcomes. Using a population-based sample of U.S. military veterans, this study evaluated the association between dispositional gratitude and the development of psychopathology and suicidal behaviors over a 7-year period. METHODS A nationally representative sample of U.S. veterans was surveyed at four timepoints across seven years. Analyses were restricted to veterans without incident outcomes at baseline. Multivariable analyses were conducted to examine the relation between baseline levels of dispositional gratitude and risk of developing (a) major depressive disorder (MDD), generalized anxiety disorder (GAD), or posttraumatic stress disorder (PTSD); (b) suicidal ideation; and (c) suicide attempts. RESULTS A total 9.6% of veterans developed MDD, GAD, and/or PTSD, 9.5% developed suicidal ideation, and 2.8% reported having attempted suicide over the 7-year follow-up period. Among veterans with high levels of dispositional gratitude, incidence was lower for MDD/GAD/PTSD (8.0%), suicidal ideation (6.8%), and suicide attempts (1.5%). Conversely, veterans with low dispositional gratitude were at substantially higher risk of developing MDD/GAD/PTSD (27.7%), suicidal ideation (33.6%), and suicide attempts (20.3%). CONCLUSIONS High dispositional gratitude may help protect against the development of psychopathology and suicidal behaviors in U.S. military veterans, whereas low gratitude may increase risk of developing these outcomes. Collectively, these results support the potential utility of enhancing gratitude as part of primary prevention efforts for veterans, service members, and other populations at heightened risk for adverse mental health outcomes.
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Affiliation(s)
- Adam P. McGuire
- Department of Psychology and Counseling, The University of Texas at Tyler, 3900 University Blvd, Tyler, TX 75799, USA,VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Dr (151C), Waco, TX 76711, USA,Central Texas Veterans Health Care System, 1901 Veterans Memorial Dr, Temple, TX 76504, USA
| | - Joanna Fagan
- Department of Psychology and Counseling, The University of Texas at Tyler, 3900 University Blvd, Tyler, TX 75799, USA
| | - Jack Tsai
- U.S. Department of Veterans Affairs National Center on Homelessness Among Veterans, Tampa, FL, USA,School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX 77030, USA,Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT 06511, USA
| | - Addie N. Merians
- Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT 06511, USA,U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA
| | - Brandon Nichter
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
| | - Sonya Norman
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA,National Center for PTSD, VA Medical Center, 215 N Main St, White River Junction, VT 05005, USA,VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA 92161, USA
| | - Steven M. Southwick
- Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT 06511, USA
| | - Robert H. Pietrzak
- Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT 06511, USA,U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA,Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, New Haven, CT 06510, USA
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6
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Rahnejat AM, Ebrahimi M, Khoshdel A, Noorbala AA, Shahmiri Barzoki H, Avarzamani L, Avakh F, Taghva A. The prevalence of depression among iran-iraq war veterans, combatants and former prisoners of war: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2022; 57:295-305. [PMID: 34608645 DOI: 10.1002/ijop.12813] [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: 02/03/2021] [Accepted: 09/10/2021] [Indexed: 02/05/2023]
Abstract
By exposing individuals to trauma, wars can cause a host of psychiatric disorders. This study aimed to collect and compare the studies conducted to estimate the prevalence of depression among veterans, former prisoners of war (POWs) and military personnel in the Iran-Iraq war (1980-1988). In this systematic review, a search was conducted using relevant keywords in major national and international databases, personal archives and national academic libraries. We screened 135 records using their abstracts and selected a total of 56 studies for full-text review. Eventually, 19 studies were included in our systematic review and meta-analysis. The estimated pooled prevalence of depression among Iranian veterans and POWs was 22.4% (95% confidence interval = 15.0-32.0). Although the results indicated disparities in the prevalence of depression among veterans and POWs, the aggregate estimated prevalence was much higher than what has been reported for military personnel. Effective policies and strategies are required for prevention and treatment of depression and related psychiatric complications among veterans and former POWs.
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Affiliation(s)
- Amir Mohsen Rahnejat
- Department of Clinical Psychology, Aja University of Medical Sciences, Tehran, Iran
| | | | - Alireza Khoshdel
- Department of Epidemiology, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Ahmad Ali Noorbala
- Psychosomatic Medicine Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Farhad Avakh
- School of Aerospace and Subaquatic Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Arsia Taghva
- Department of Clinical Psychology, Aja University of Medical Sciences, Tehran, Iran
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7
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Long CR, Salsbury SA, Vining RD, Lisi AJ, Corber L, Twist E, Abrams T, Wallace RB, Goertz CM. Care Outcomes for Chiropractic Outpatient Veterans (COCOV): a single-arm, pragmatic, pilot trial of multimodal chiropractic care for U.S. veterans with chronic low back pain. Pilot Feasibility Stud 2022; 8:54. [PMID: 35256010 PMCID: PMC8900358 DOI: 10.1186/s40814-022-01008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/18/2022] [Indexed: 08/30/2023] Open
Abstract
Background Over 25% of veterans seeking care at U.S. Veterans Health Administration facilities have chronic low back pain (LBP), with high rates of mental health comorbidities. The primary objective of this study was to assess the feasibility of participant recruitment, retention, and electronic data collection to prepare for the subsequent randomized trial of multimodal chiropractic care for pain management of veterans with chronic low back pain. The secondary objectives were to estimate effect sizes and variability of the primary outcome and choose secondary outcomes for the full-scale trial. Methods This single-arm pilot trial enrolled 40 veterans with chronic LBP at one Veterans Health Administration facility for a 10-week course of pragmatic multimodal chiropractic care. Recruitment was by (1) provider referral, (2) invitational letter from the electronic health record pre-screening, and (3) standard direct recruitment. We administered patient-reported outcome assessments through an email link to REDCap, an electronic data capture platform, at baseline and 5 additional timepoints. Retention was tracked through adherence to the treatment plan and completion rates of outcome assessments. Descriptive statistics were calculated for baseline characteristics and outcome variables. Results We screened 91 veterans over 6 months to enroll our goal of 40 participants. Seventy percent were recruited through provider referrals. Mean age (range) was 53 (22–79) years and 23% were female; 95% had mental health comorbidities. The mean number of chiropractic visits was 4.5 (1–7). Participants adhered to their treatment plan, with exception of 3 who attended only their first visit. All participants completed assessments at the in-person baseline visit and 80% at the week 10 final endpoint. We had no issues administering assessments via REDCap. We observed clinically important improvements on the Roland-Morris Disability Questionnaire [mean change (SD): 3.6 (6.1)] and on PROMIS® pain interference [mean change (SD): 3.6 (5.6)], which will be our primary and key secondary outcome, respectively, for the full-scale trial. Conclusions We demonstrated the feasibility of participant recruitment, retention, and electronic data collection for conducting a pragmatic clinical trial of chiropractic care in a Veterans Health Administration facility. Using the pilot data and lessons learned, we modified and refined a protocol for a full-scale, multisite, pragmatic, National Institutes of Health-funded randomized trial of multimodal chiropractic care for veterans with chronic LBP that began recruitment in February 2021. Trial registration ClinicalTrials.gov NCT03254719 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01008-0.
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8
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Gupta S, Guleria RS, Szabo YZ. MicroRNAs as biomarker and novel therapeutic target for posttraumatic stress disorder in Veterans. Psychiatry Res 2021; 305:114252. [PMID: 34739954 PMCID: PMC8857765 DOI: 10.1016/j.psychres.2021.114252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/04/2021] [Accepted: 10/23/2021] [Indexed: 12/16/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a common psychiatric disorder for military Veterans, characterized by hyperarousal, intrusive thoughts, flashbacks, hypervigilance, and distress after experiencing traumatic events. Some of the known physiological effects of PTSD include hypothalamic-pituitary-adrenal (HPA)-axis imbalance, a cortical function resulting in neuronal deficit and changes in behavior. Moreover, excessive discharge of inflammatory molecules and a dysregulated immune system are implicated in the pathophysiology of PTSD. Due to complex nature of this disorder, the biological underpinnings of PTSD remain inexplicable. Investigating novel biomarkers to understanding the pathogenesis of PTSD may reflect the underlying molecular network for therapeutic use and treatment. Circulatory microRNAs (miRNAs) and exosomes are evolving biomarkers that have shown a key role in psychiatric and neurological disorders including PTSD. Given the unique nature of combat trauma, as well as evidence that a large portion of Veterans do not benefit from frontline treatments, focus on veterans specifically is warranted. In the present review, we delineate the identification and role of several miRNAs in PTSD among veterans. An association of miRNA with HPA-axis regulation through FKBP5, a key modulator in PTSD is discussed as an emerging molecule in psychiatric diseases. We conclude that miRNAs may be used as circulatory biomarker detection in Veterans with PTSD.
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Affiliation(s)
- Sudhiranjan Gupta
- VISN 17 Center of Excellence for Research on Returning War Veterans, Biomarkers & Genetics Core, Central Texas Veterans Health Care System, 4800 Memorial Drive (151C), Waco, TX, 76711, USA.
| | - Rakeshwar S. Guleria
- VISN 17 Center of Excellence for Research on Returning War Veterans, Biomarkers & Genetics Core, Central Texas Veterans Health Care System, 4800 Memorial Drive (151C), Waco, Texas, 76711
| | - Yvette Z. Szabo
- VISN 17 Center of Excellence for Research on Returning War Veterans, Biomarkers & Genetics Core, Central Texas Veterans Health Care System, 4800 Memorial Drive (151C), Waco, Texas, 76711
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9
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Pickover A, Lowell A, Lazarov A, Lopez-Yianilos A, Sanchez-Lacay A, Ryba M, Such S, Arnon S, Amsalem D, Neria Y, Markowitz JC. Interpersonal Psychotherapy of Posttraumatic Stress Disorder for Veterans and Family Members: An Open Trial. Psychiatr Serv 2021; 72:866-873. [PMID: 33557597 PMCID: PMC8328866 DOI: 10.1176/appi.ps.202000355] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Military service members and veterans have high rates of posttraumatic stress disorder (PTSD), as do military family members. Exposure-based, cognitive-behavioral approaches have received ample research, but other PTSD therapies require further empirical attention. Interpersonal psychotherapy (IPT) targets affective awareness, life circumstances, and social support. IPT has shown efficacy for civilians with PTSD but awaits rigorous testing among military personnel; only two small military pilot studies and two case reports have been published. Military family members have received minimal attention from clinical outcomes research. Addressing these gaps, this open trial examined IPT for PTSD among veterans, service members, and family members, including a patient subset with comorbid PTSD and depression. METHODS Fifty U.S. military service members, veterans, and family members (age ≥18 years) were offered 14 sessions of IPT for PTSD. Individuals with psychosis, bipolar disorder, moderate or severe substance use disorders, or high suicide risk were excluded. PTSD and depressive symptoms were assessed at baseline, midtreatment, posttreatment, and 3-month follow-up. RESULTS Clinician-assessed PTSD (Clinician-Administered PTSD Scale) and depression (Hamilton Depression Rating Scale) symptoms decreased over time in the full sample and the comorbid PTSD/depression subset (p<0.05). Service members, veterans, and family members had similar treatment responses. CONCLUSIONS Patients receiving IPT showed reductions in PTSD and depressive symptoms. These open trial findings provide preliminary support for the utility of IPT in reducing PTSD symptoms among veterans and family members. This largest IPT trial to date for PTSD in military patients also bolsters the literature on treating military family members.
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Affiliation(s)
- Alison Pickover
- New York State Psychiatric Institute, NY
- Department of Psychiatry, Columbia University Irving Medical Center, NY
| | - Ari Lowell
- New York State Psychiatric Institute, NY
- Department of Psychiatry, Columbia University Irving Medical Center, NY
| | - Amit Lazarov
- Department of Psychiatry, Columbia University Irving Medical Center, NY
- School of Psychological Sciences, Tel Aviv University, Israel
| | | | - Arturo Sanchez-Lacay
- New York State Psychiatric Institute, NY
- Department of Psychiatry, Columbia University Irving Medical Center, NY
| | - Matthew Ryba
- New York State Psychiatric Institute, NY
- Department of Psychiatry, Weill-Cornell Medical Center, NY
| | - Sara Such
- New York State Psychiatric Institute, NY
| | - Shay Arnon
- New York State Psychiatric Institute, NY
| | - Doron Amsalem
- New York State Psychiatric Institute, NY
- Department of Psychiatry, Columbia University Irving Medical Center, NY
| | - Yuval Neria
- New York State Psychiatric Institute, NY
- Department of Psychiatry, Columbia University Irving Medical Center, NY
| | - John C. Markowitz
- New York State Psychiatric Institute, NY
- Department of Psychiatry, Columbia University Irving Medical Center, NY
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10
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Gaffey AE, Burg MM, Rosman L, Portnoy GA, Brandt CA, Cavanagh CE, Skanderson M, Dziura J, Mattocks KM, Bastian LA, Haskell SG. Baseline Characteristics from the Women Veterans Cohort Study: Gender Differences and Similarities in Health and Healthcare Utilization. J Womens Health (Larchmt) 2021; 30:944-955. [PMID: 33439756 PMCID: PMC8290312 DOI: 10.1089/jwh.2020.8732] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction: With the unprecedented expansion of women's roles in the U.S. military during recent (post-9/11) conflicts in Iraq and Afghanistan, the number of women seeking healthcare through the Veterans Health Administration (VHA) has increased substantially. Women Veterans often present as medically complex due to multiple medical, mental health, and psychosocial comorbidities, and consequently may be underserved. Thus, we conducted the nationwide Women Veterans Cohort Study (WVCS) to examine post-9/11 Veterans' unique healthcare needs and to identify potential disparities in health outcomes and care. Methods: We present baseline data from a comprehensive questionnaire battery that was administered from 2016 to 2019 to a national sample of post-9/11 men and women Veterans who enrolled in Veterans Affairs care (WVCS2). Data were analyzed for descriptives and to compare characteristics by gender, including demographics; health risk factors and symptoms of cardiovascular disease, chronic pain, and mental health; healthcare utilization, access, and insurance. Results: WVCS2 included 1,141 Veterans (51% women). Women were younger, more diverse, and with higher educational attainment than men. Women also endorsed lower traditional cardiovascular risk factors and comorbidities (e.g., weight, hypertension) and greater nontraditional cardiovascular risk factors (e.g., trauma, psychological symptoms). More women reported single-site pain (e.g., neck, stomach, pelvic) and multisite pain, but did not differ from men in posttraumatic stress disorder (PTSD) symptoms or treatment for PTSD. Women seek care at VHA medical centers more frequently, often combined with outside health services, but do not significantly differ from men in their insurance coverage. Conclusion: Overall, this investigation indicates substantial variation in risk factors, health outcomes, and healthcare utilization among post-9/11 men and women Veterans. Further research is needed to determine best practices for managing women Veterans in the VHA healthcare system.
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Affiliation(s)
- Allison E. Gaffey
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Internal Medicine (Cardiovascular Medicine), Yale School of Medicine, New Haven, Connecticut, USA
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Matthew M. Burg
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Internal Medicine (Cardiovascular Medicine), Yale School of Medicine, New Haven, Connecticut, USA
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lindsey Rosman
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Galina A. Portnoy
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Cynthia A. Brandt
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Casey E. Cavanagh
- Department of Psychiatry and Neurobehavioral Sciences, Charlottesville, Virginia, USA
| | | | - James Dziura
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kristin M. Mattocks
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Research and Development, VA Central Western Massachusetts and Department of Quantitative Health Science, University of Massachusetts Medical School, Leeds, Massachusetts, USA
| | - Lori A. Bastian
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Internal Medicine (General), Yale School of Medicine, New Haven, Connecticut, USA
| | - Sally G. Haskell
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Internal Medicine (General), Yale School of Medicine, New Haven, Connecticut, USA
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11
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Walker LE, Watrous J, Poltavskiy E, Howard JT, Janak JC, Pettey WBP, Zarzabal LA, Sim A, Gundlapalli A, Stewart IJ. Longitudinal mental health outcomes of combat-injured service members. Brain Behav 2021; 11:e02088. [PMID: 33662185 PMCID: PMC8119815 DOI: 10.1002/brb3.2088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/13/2021] [Accepted: 02/15/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The relationship between traumatic injury and subsequent mental health diagnoses is not well understood and may have significant implications for patient screening and clinical intervention. We sought to determine the adjusted association between traumatic injury and the subsequent development of post-traumatic stress disorder (PTSD), depression, and anxiety. METHODS Using Department of Defense and Veterans Affairs datasets between February 2002 and June 2016, we conducted a retrospective cohort study of 7,787 combat-injured United States service members matched 1:1 to combat-deployed, uninjured service members. The primary exposure was combat injury versus no combat injury. Outcomes were diagnoses of PTSD, depression, and anxiety, defined by International Classification of Diseases 9th and 10th Revision Clinical Modification codes. RESULTS Compared to noninjured service members, injured service members had higher observed incidence rates per 100 person-years for PTSD (17.1 vs. 5.8), depression (10.4 vs. 5.7), and anxiety (9.1 vs. 4.9). After adjustment, combat-injured patients were at increased risk of development of PTSD (HR 2.92, 95%CI 2.68-3.17), depression (HR 1.47, 95%CI 1.36-1.58), and anxiety (HR 1.34, 95%CI 1.24-1.45). CONCLUSIONS Traumatic injury is associated with subsequent development of PTSD, depression, and anxiety. These findings highlight the importance of increased screening, prevention, and intervention in patients with exposure to physical trauma.
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Affiliation(s)
| | | | | | | | | | - Warren B P Pettey
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lee Ann Zarzabal
- PEO Defense Healthcare Management Systems (DHMS), San Antonio, TX, USA
| | - Alan Sim
- PEO Defense Healthcare Management Systems (DHMS), San Antonio, TX, USA
| | - Adi Gundlapalli
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ian J Stewart
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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12
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Brown T, Berman S, McDaniel K, Radford C, Mehta P, Potter J, Hirsh DA. Trauma-Informed Medical Education (TIME): Advancing Curricular Content and Educational Context. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:661-667. [PMID: 32675789 DOI: 10.1097/acm.0000000000003587] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The majority of patients and medical students experience some form of psychological trauma or adversity across their life course. All forms of trauma can be associated with adverse health consequences and can negatively affect learning and professional development. Trauma-informed care (TIC) offers a framework to address and mitigate these consequences and promote safety and health. The Substance Abuse and Mental Health Services Administration describes 6 domains of TIC: safety; trust and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and cultural, historic, and gender issues. At present, TIC is not taught routinely in undergraduate medical education (UME)-a crucial educational gap given that UME grounds the development of key perspectives and practices that students use throughout their careers. Further, given the prevalence of preexisting trauma among learners and the likelihood of new traumatic exposures during training, medical schools' processes, practices, and learning environments may risk exacerbating or even causing trauma. To address this educational need and support students and their future patients, the authors propose a trauma-informed medical education (TIME) framework. TIME informs medical schools' curricular content and educational context. In UME, curricular content should address trauma epidemiology, physiology, and effects; trauma-informed clinical skills including sensitive communication and physical exam techniques; and trauma-informed self-care techniques including education on organizational resources, how to elicit supports, and personal self-care practices. A trauma-informed educational context encompasses curricular development, including student-faculty coproduction of educational content; curricular delivery, including faculty development on TIC principles; and learning environment, including trauma-informed educational practices, medical student advising, institutional policies, and recruitment. TIME offers practical strategies to support teaching, learning, educational administration, and professional development and aims to inspire new strategies for effective learner and faculty engagement. TIME aims to foster students' development of competency in TIC and promote student engagement, learning, health, and well-being.
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Affiliation(s)
- Taylor Brown
- T. Brown is a third-year medical student, Harvard Medical School, Boston, Massachusetts
| | - Sarah Berman
- S. Berman is a fourth-year medical student, Harvard Medical School, Boston, Massachusetts
| | - Katherine McDaniel
- K. McDaniel is a third-year medical student, Harvard Medical School, Boston, Massachusetts
| | - Caitlin Radford
- C. Radford is a third-year medical student, Harvard Medical School, Boston, Massachusetts
| | - Pooja Mehta
- P. Mehta is a first-year resident, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer Potter
- J. Potter is professor of medicine, Harvard Medical School, Boston, Massachusetts
| | - David A Hirsh
- D.A. Hirsh is the George E. Thibault Academy Associate Professor and director, HMS Academy, Harvard Medical School, Boston, Massachusetts
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13
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Mahoney CT, Moshier SJ, Keane TM, Marx BP. Heightened healthcare utilization & risk of mental disorders among Veterans with comorbid opioid use disorder & posttraumatic stress disorder. Addict Behav 2021; 112:106572. [PMID: 32861102 DOI: 10.1016/j.addbeh.2020.106572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/24/2020] [Accepted: 07/21/2020] [Indexed: 12/01/2022]
Abstract
Although Veterans with posttraumatic stress disorder (PTSD) are vulnerable to opioid misuse, there is limited research evaluating the psychosocial and medical sequalae experienced by Veterans with comorbid PTSD and opioid use disorder (OUD). Using data from a nationwide, longitudinal registry of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Veterans oversampled for PTSD with a 1:1 ratio of men to women, we identified Veterans with lifetime diagnoses of comorbid PTSD and OUD (n = 40), PTSD and non-opioid substance use disorder (SUD; n = 386), PTSD only (n = 901), and non-opioid SUD only (n = 52) using medical record data. We then compared these groups on Veterans Affairs emergency, urgent care, and inpatient healthcare utilization, suicide risk, functional impairment, and the presence of comorbid mental conditions in the following 1-2 years. Relative to all other groups, Veterans with comorbid OUD and PTSD had increased likelihood of emergency room and inpatient care, probable somatoform and major depressive disorders, and greater functional impairment. Both the PTSD/OUD group and PTSD/non-opioid SUD group demonstrated increased suicidality, urgent care utilization, and probable generalized anxiety disorder relative to Veterans with PTSD only or non-opioid SUD only. Results suggest that comorbid OUD and PTSD are associated with greater likelihood of negative psychiatric and healthcare related outcomes, even relative to PTSD comorbid with other types of SUDs. Findings support the importance of concentrated and sustained efforts to improve prevention and intervention strategies for Veterans struggling with PTSD symptoms and opioid misuse.
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Affiliation(s)
- Colin T Mahoney
- VA Boston Healthcare System, Boston, MA, United States; National Center for PTSD, Behavioral Science Division, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | | | - Terence M Keane
- VA Boston Healthcare System, Boston, MA, United States; National Center for PTSD, Behavioral Science Division, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Brian P Marx
- VA Boston Healthcare System, Boston, MA, United States; National Center for PTSD, Behavioral Science Division, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States.
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14
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Lawrence KA, Vogt D, Nigam S, Dugan AJ, Slade E, Smith BN. Temporal Sequencing of Mental Health Symptom Severity and Suicidal Ideation in Post-9/11 Men and Women Veterans Who Recently Separated from the Military. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2021; 5:24705470211061347. [PMID: 34870056 PMCID: PMC8637689 DOI: 10.1177/24705470211061347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/03/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite some evidence for gender differences in associations between military veterans' mental health and suicidal ideation (SI), gender-specific prospective studies are lacking. The aims of this prospective study were to: (1) examine gender differences in veterans' initial status and trajectories of mental health severity and SI status and (2) identify temporal sequencing of mental health predictors of SI. METHODS Surveys of 1035 US veterans were administered at 3 time-points (T1, T2, T3) over a 7-year period following military separation, with an initial assessment within 2 years of military separation. RESULTS Men reported higher baseline PTSD and alcohol misuse severity than women. No baseline gender difference in SI prevalence was detected. Baseline gender differences in mental health severity were maintained over time. For both men and women, remittance of SI was more likely from T1 to T2 than from T2 to T3 while chronic SI was more likely from T2 to T3. The strongest predictors of T3 SI were prior SI followed by alcohol misuse, depression, and PTSD severity with stronger effects for T2 predictors than T1. CONCLUSION The maintenance of baseline gender differences throughout trajectories of mental health predictors of SI supports the need for ongoing gender-specific mental health services. Current governmental interorganizational efforts are focused on suicide prevention during the first year after military service completion. Our findings indicate a need to extend mental health screening and treatment beyond the early post-military period to reduce risk and recurrence of SI for both men and women.
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Affiliation(s)
| | - Dawne Vogt
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Boston University School of
Medicine, Boston, MA, USA
| | | | | | | | - Brian N. Smith
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Boston University School of
Medicine, Boston, MA, USA
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15
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Franz MR, Kaiser AP, Phillips RJ, Lee LO, Lawrence AE, Taft CT, Vasterling JJ. Associations of warzone veteran mental health with partner mental health and family functioning: Family Foundations Study. Depress Anxiety 2020; 37:1068-1078. [PMID: 32805764 PMCID: PMC8252135 DOI: 10.1002/da.23083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Warzone participation is associated with increased risk of stress-related psychopathology, including posttraumatic stress disorder (PTSD) and depression. Prior research suggests that the mental health of spouses of warzone veterans (WZVs) is linked to that of their partners. Additionally, PTSD among WZVs has been associated with marital dysfunction. Less is known about the effects of depression among WZVs on partner mental health and family relationships. We sought in this study to examine associations between WZV PTSD and depression and partner mental health and relationship outcomes. METHODS Using a nationally dispersed sample of Iraq and Afghanistan veterans and their married and unmarried intimate partners, 245 dyads completed structured psychiatric interviews and psychometric surveys assessing family functioning and relationship aggression. RESULTS Adjusted regression analyses indicated that depression among WZVs was associated with partner depression and anxiety disorders. WZV PTSD and depression were also associated with partner-reported relationship dysfunction, dissatisfaction, and communication issues, and higher rates of intimate partner aggression victimization and perpetration. CONCLUSIONS Mental health consequences of war extend beyond WZVs to the mental health of their intimate partners and their relationships with intimate partners.
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Affiliation(s)
- Molly R. Franz
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Anica Pless Kaiser
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts,Psychology Service, VA Boston Healthcare System, Boston, Massachusetts
| | | | - Lewina O. Lee
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts,Psychology Service, VA Boston Healthcare System, Boston, Massachusetts
| | - Amy E. Lawrence
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts,Psychology Service, VA Boston Healthcare System, Boston, Massachusetts
| | - Casey T. Taft
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts,Psychology Service, VA Boston Healthcare System, Boston, Massachusetts
| | - Jennifer J. Vasterling
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts,Psychology Service, VA Boston Healthcare System, Boston, Massachusetts
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16
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Zamora KA, Abraham TH, Koenig CJ, Hill CC, Pyne JM, Seal KH. Using an Adapted Case Study Approach to Understand Rural Veteran Experiences in Patient Engagement and Patient-Centered Care Research. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2020. [DOI: 10.4081/qrmh.2020.8977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to best engage rural veterans in mental health care is challenging and a topic of public health concern. Rural-dwelling veterans experience greater mental health burden and poorer outcomes than their urban counterparts, making rural veteran engagement in mental health care a public health concern. In this article, we describe how institutional notions of “patient engagement” align with or diverge from rural veteran patient experiences of engagement in mental health care. Using an adapted case study approach developed for our study, we detail the mental health care experiences of three rural-dwelling veteran participants. These case studies illustrate varied forms of mental health care engagement, including use of community resources and self-management activities, that might not be recognized by clinicians as contributing to mental health treatment. Our findings highlight how critical gaps in institutional definitions of care engagement fail to acknowledge veterans’ experiences.
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17
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Polak K, Meyer BL, Neale ZE, Reisweber J. Program Evaluation of Group Transcending Self Therapy: An Integrative Modular Cognitive-Behavioral Therapy for Substance Use Disorders. Subst Abuse 2020; 14:1178221820947653. [PMID: 32874092 PMCID: PMC7436794 DOI: 10.1177/1178221820947653] [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: 03/03/2020] [Accepted: 07/03/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Substance Use Disorders (SUDs) are increasingly prevalent among Veterans. Effective interventions for SUDs that also meet the clinical reality of open treatment groups are needed. Transcending Self Therapy: Group Integrative Cognitive Behavioral Treatment (Group TST-I-CBT) was developed to address this need. Group TST-I-CBT is a four-module, 20-session treatment designed so that a person can enter at any point in the treatment. We conducted a program evaluation of Group TST-I-CBT for veterans with SUDs. METHODS Participants were N = 68 veterans enrolled in the 28-day Substance Abuse Residential Rehabilitation Treatment Program at an urban Veterans Administration Medical Center who received either Group TST-I-CBT (N = 34) or treatment-as-usual (TAU; N = 34). Medical records were reviewed and participant treatment outcome data was retrieved. Group TST-I-CBT clients completed a knowledge and feedback form at treatment completion. RESULTS Compared to TAU participants, Group TST-I-CBT participants were significantly less likely to have a positive urine drug screen (UDS) during treatment (17.6% versus 0%; P = .01) and within one month post-discharge (50% versus 17.6%; P = .04). Among Group TST-I-CBT clients, Quality of Life Inventory scores significantly increased by an average of 14 points from pre- to post-treatment, t(15) = -3.31, P = .005, d = 0.83. Group TST-I-CBT clients displayed cognitive-behavioral therapy knowledge (mean correct answers ranged from 92%-100%) and rated Group TST-I-CBT as helpful, understandable, and useful (mean scores ranged from 9.3-9.6 out of 10). CONCLUSIONS These preliminary data indicate that Group TST-I-CBT may be an effective group therapy as part of SUD treatment. A formal randomized controlled trial of Group TST-I-CBT may be warranted.
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Affiliation(s)
- Kathryn Polak
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Brian L Meyer
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Hunter Holmes McGuire Veterans Administration Medical Center, Richmond, VA, USA
- Department of Psychiatry, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Zoe E Neale
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Jarrod Reisweber
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Hunter Holmes McGuire Veterans Administration Medical Center, Richmond, VA, USA
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18
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Wilks CR, Khalifian CE, Glynn SM, Morland LA. The association between anger experiences and expression and veteran suicidal thoughts in intimate couple relationships. J Clin Psychol 2020; 76:1869-1881. [DOI: 10.1002/jclp.22960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Chelsey R. Wilks
- Department of Psychology Harvard University Cambridge Massachusetts
- Semel Institute of Neuroscience and Human Behavior University of California, Los Angeles Los Angeles CA
| | - Chandra E. Khalifian
- Regional TeleMental Health Program Veterans Affairs Healthcare System San Diego California
- Department of Psychiatry University of California La Jolla California
| | - Shirley M. Glynn
- Research Service Veterans Affairs Greater Los Angeles Healthcare System Los Angeles California
| | - Leslie A. Morland
- Regional TeleMental Health Program Veterans Affairs Healthcare System San Diego California
- Department of Psychiatry University of California La Jolla California
- Pacific Islands Division National Center for PTSD Honolulu Hawaii
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19
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Hallgren KA, Witwer E, West I, Baldwin LM, Donovan D, Stuvek B, Keppel GA, Mollis B, Stephens KA. Prevalence of documented alcohol and opioid use disorder diagnoses and treatments in a regional primary care practice-based research network. J Subst Abuse Treat 2020; 110:18-27. [PMID: 31952624 PMCID: PMC7255441 DOI: 10.1016/j.jsat.2019.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 11/09/2019] [Accepted: 11/14/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Most people with alcohol or opioid use disorders (AUD or OUD) are not diagnosed or treated for these conditions in primary care. This study takes a critical step toward quantifying service gaps and directing improvement efforts for AUD and OUD by using electronic health record (EHR) data from diverse primary care organizations to quantify the extent to which AUD and OUD are underdiagnosed and undertreated in primary care practices. METHODS We extracted and integrated diagnosis, medication, and behavioral health visit data from the EHRs of 21 primary care clinics within four independent healthcare organizations representing community health centers and rural hospital-associated clinics in the Pacific Northwest United States. Rates of documented AUD and OUD diagnoses, pharmacological treatments, and behavioral health visits were evaluated over a two-year period (2015-2016). RESULTS Out of 47,502 adult primary care patients, 1476 (3.1%) had documented AUD; of these, 115 (7.8%) had orders for AUD medications and 271 (18.4%) had at least one documented visit with a non-physician behavioral health specialist. Only 402 (0.8%) patients had documented OUD, and of these, 107 (26.6%) received OUD medications and 119 (29.6%) had at least one documented visit with a non-physician behavioral health specialist. Rates of AUD diagnosis and AUD and OUD medications were higher in clinics that had co-located non-physician behavioral health specialists. CONCLUSIONS AUD and OUD are underdiagnosed and undertreated within a sample of independent primary care organizations serving mostly rural patients. Primary care organizations likely need service models, technologies, and workforces, including non-physician behavioral health specialists, to improve capacities to diagnose and treat AUD and OUD.
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Affiliation(s)
- Kevin A Hallgren
- University of Washington, Department of Psychiatry and Behavioral Sciences, United States.
| | - Elizabeth Witwer
- University of Washington, Department of Family Medicine, United States
| | - Imara West
- University of Washington, Department of Psychiatry and Behavioral Sciences, United States
| | - Laura-Mae Baldwin
- University of Washington, Department of Family Medicine, United States
| | - Dennis Donovan
- University of Washington, Department of Psychiatry and Behavioral Sciences, United States; University of Washington, Alcohol and Drug Abuse Institute, United States
| | - Brenda Stuvek
- University of Washington, Alcohol and Drug Abuse Institute, United States
| | - Gina A Keppel
- University of Washington, Department of Family Medicine, United States
| | - Brenda Mollis
- University of Washington, Department of Family Medicine, United States
| | - Kari A Stephens
- University of Washington, Department of Psychiatry and Behavioral Sciences, United States; University of Washington, Department of Biomedical Informatics and Medical Education, United States
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20
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Galea S, Vaughan R. A Public Health of Consequence: Review of the February 2017 Issue of AJPH. Am J Public Health 2019; 107:203-204. [PMID: 28075630 DOI: 10.2105/ajph.2016.303592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Sandro Galea
- Sandro Galea is Dean and Professor, School of Public Health, Boston University, Boston, MA. Roger Vaughan is an AJPH editor, and is also the Vice Dean and Professor of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Roger Vaughan
- Sandro Galea is Dean and Professor, School of Public Health, Boston University, Boston, MA. Roger Vaughan is an AJPH editor, and is also the Vice Dean and Professor of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
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21
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Bravo AJ, Kelley ML, Mason R, Ehlke S, Vinci C, Redman Ret LJC. Rumination as a Mediator of the Associations Between Moral Injury and Mental Health Problems in Combat-Wounded Veterans. ACTA ACUST UNITED AC 2019; 26:52-60. [PMID: 32863781 DOI: 10.1037/trm0000198] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Moral injury is hypothesized to develop from witnessing or engaging in events that violate one's beliefs about themselves and has been shown to be associated with negative mental health symptoms. Although there has been an increase in research examining moral injury among military veterans, mechanisms that link moral injury to mental health outcomes are not well understood. The present study examined rumination subcomponents (problem-focused thoughts, counterfactual thinking, repetitive thoughts, and anticipatory thoughts) as possible mediators of the associations between moral injury (both self-directed and other-directed symptoms) and negative mental health symptoms (i.e., depression, anxiety, suicidality, sleep disturbance, memory problems, and posttraumatic stress disorder symptoms). Participants were 189 combat wounded veterans (180 men; Mean age = 43.14 years) who had experienced one or more deployments (defined as 90 days or more). Nearly all participants reported a service-connected disability (n = 176, 93.1%), with the average participant reporting a 90% total VA disability ranking, and most participants had received a purple heart (n = 163, 86.2%). Within our comprehensive mediation model, we found eight significant mediation effects with the most consistent mediator being problem-focused thoughts. Specifically, both self-directed and other- directed moral injury were associated with increased problem-focused thoughts, which in turn was associated with higher reported symptoms of depression, anxiety, and posttraumatic stress disorder. Taken together, rumination, and in particular, problem-focused thoughts, is relevant to understand the increased vulnerability of military veterans to exhibit poor mental health outcomes when experiencing moral injury.
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Affiliation(s)
- Adrian J Bravo
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
| | - Michelle L Kelley
- Old Dominion University, Virginia Consortium Program in Clinical Psychology
| | | | - Sarah Ehlke
- Department of Psychology, Old Dominion University
| | - Christine Vinci
- Department of Health Outcomes and Behavior, Moffitt Cancer Center
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22
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Jongsma HE, Turner C, Kirkbride JB, Jones PB. International incidence of psychotic disorders, 2002-17: a systematic review and meta-analysis. Lancet Public Health 2019; 4:e229-e244. [PMID: 31054641 PMCID: PMC6693560 DOI: 10.1016/s2468-2667(19)30056-8] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/18/2019] [Accepted: 03/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The last comprehensive systematic review of the incidence of psychotic disorders was published in 2004. New epidemiological data from different settings now permit a broader understanding of global variation. We examined the variation in psychosis by demographic characteristics and study method. METHODS For this systematic review and meta-analysis, we searched PubMed, Embase, Web of Science, PsycINFO, and bibliographies, and directly contacted first authors. We sought to obtain citations of original research published between Jan 1, 2002, and Dec 31, 2017, on incidence of non-organic adult-onset psychotic disorder. We included papers that were published or in grey literature and had no language restrictions. Data were extracted from published reports, where possible, by sex, age, and ethnic group. Quality of yield was assessed. Data were assessed using univariable random-effects meta-analysis and meta-regression. We registered our systematic review on PROSPERO, number CRD42018086800. FINDINGS From 56 721 records identified, 177 met inclusion criteria. The pooled incidence of all psychotic disorders was 26·6 per 100 000 person-years (95% CI 22·0-31·7). Heterogeneity was high (I2≥98·5%). Men were at higher risk of all psychotic disorders (incidence rate ratio 1·44 [1·27-1·62]) and non-affective disorders (1·60 [1·44-1·77]) than women, but not affective psychotic disorders (0·87 [0·75-1·00]). Ethnic minorities were also at excess risk of all psychotic disorders (1·75 [1·53-2·00]), including non-affective disorders (1·71 [1·40-2·09]). Meta-regression revealed that population registers reported higher rates of non-affective disorders (9·64 [2·72-31·82]), schizophrenia (2·51 [1·24-5·21]), and bipolar disorder (4·53 [2·41-8·51]) than first contact study designs. INTERPRETATION We found marked variation in incidence of psychotic disorders by personal characteristics and place. Some geographical variation could be partially explained by differences in case ascertainment methods. FUNDING None.
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Affiliation(s)
- Hannah E Jongsma
- Department of Psychiatry, University of Cambridge, Cambridge, UK; PsyLife Group, Division of Psychiatry, University College London, London, UK.
| | - Caitlin Turner
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - James B Kirkbride
- PsyLife Group, Division of Psychiatry, University College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK; CAMEO, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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23
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Epstein EL, Martindale SL, Va Mid-Atlantic Mirecc Workgroup, Miskey HM. Posttraumatic stress disorder and traumatic brain Injury: Sex differences in veterans. Psychiatry Res 2019; 274:105-111. [PMID: 30784779 DOI: 10.1016/j.psychres.2019.01.097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 12/13/2022]
Abstract
Around half of Iraq and Afghanistan war veterans with traumatic brain injury (TBI) have co-occurring posttraumatic stress disorder (PTSD). Research on the differences between male and female veterans with co-occurring PTSD/TBI is sparse. This study evaluated behavioral health differences between sexes with these conditions. Veterans (N = 1577) completed a structured psychiatric interview, TBI interview, and self-report interviews assessing sleep quality, alcohol use, substance use, pain, depression symptoms, PTSD symptoms, and combat exposure. Groups depended on the presence/absence of a lifetime PTSD diagnosis and history of TBI. Among veterans with PTSD and TBI, males and females were equally likely to meet criteria for current PTSD, and in the PTSD only group, male veterans were more likely to have current PTSD. Male veterans with PTSD were also more likely to meet criteria for lifetime alcohol and substance use disorders (AUD and SUD), and mild TBI. Although TBI severity did not differ between sexes in the TBI only group, female veterans were more likely to have a moderate/severe TBI among veterans with co-occurring PTSD. Female veterans without PTSD and TBI were more likely to have major depressive disorder (MDD). Significant sex differences were found for AUD, MDD, current PTSD, and TBI severity.
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Affiliation(s)
- Erica L Epstein
- Salisbury VA Health Care System, 1601 Brenner Ave, Salisbury, NC 28144, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), 508 Fulton St, Durham, NC 27705, USA; Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Sarah L Martindale
- Salisbury VA Health Care System, 1601 Brenner Ave, Salisbury, NC 28144, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), 508 Fulton St, Durham, NC 27705, USA; Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | | | - Holly M Miskey
- Salisbury VA Health Care System, 1601 Brenner Ave, Salisbury, NC 28144, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), 508 Fulton St, Durham, NC 27705, USA; Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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24
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Gonzalez OI, Naifeh JA, Biggs QM, Ng THH, Fullerton CS, Ursano RJ. Internal consistency and factor structure of a brief scale assessing sensitivity to blood, injury, and mutilation. BMC Res Notes 2019; 12:167. [PMID: 30909956 PMCID: PMC6434799 DOI: 10.1186/s13104-019-4200-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 03/16/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE US Army soldiers and military veterans experience high rates of post-traumatic stress disorder (PTSD). However, PTSD risk factors are not fully understood. Sensitivity to blood, injury, and mutilation (SBIM), which includes fear of being injured, seeing another person injured, and exposure to mutilation-relevant stimuli (e.g., blood, wounds) may be a PTSD risk factor that is identifiable prior to trauma exposure. Building on previous research that used a subset of items from the Mutilation Questionnaire (MQ), the aim of this study was to examine the reliability and validity of two brief scales assessing SBIM. RESULTS Data from two independent samples of male, US Army soldiers, was utilized to examine a brief 10-item SBIM measure (MQ-SBIM-10) and a shorter version 5-item SBIM measure (MQ-SBIM-5). Internal consistency was indexed by the Kuder-Richardson 20 formula. Construct validity was assessed using confirmatory factor analysis and results obtained from each sample, and from a combined sample. The MQ-SBIM-10 demonstrated acceptable internal consistency and the hypothesized one-factor structure. Although the MQ-SBIM-5 explained a substantial amount of the variance in the 10-item measure and had a one-factor structure, internal consistency of the 5-item measure was poor. Analyses supported the MQ-SBIM-10 as a reliable and cohesive measure of sensitivity to blood, injury, and mutilation.
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Affiliation(s)
- Oscar I Gonzalez
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - James A Naifeh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Quinn M Biggs
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Tsz Hin Hinz Ng
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Carol S Fullerton
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
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25
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Yaffe K, Lwi SJ, Hoang TD, Xia F, Barnes DE, Maguen S, Peltz CB. Military-related risk factors in female veterans and risk of dementia. Neurology 2019; 92:e205-e211. [PMID: 30541865 PMCID: PMC6340384 DOI: 10.1212/wnl.0000000000006778] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/31/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To determine whether diagnoses of traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and depression, alone or in combination, increase dementia risk among older female veterans. METHODS This cohort study included data from 109,140 female veterans ≥55 years of age receiving care from Veterans Health Administration medical centers in the United States between October 2004 and September 2015 with at least 1 follow-up visit. TBI, PTSD, depression, and medical conditions at study baseline and incident dementia were determined according to ICD-9-CM codes. Fine-Gray proportional hazards models were used to determine the association between military-related risk factors and dementia diagnosis, accounting for the competing risk of death. RESULTS During follow-up (mean 4.0 years, SD 2.3), 4% of female veterans (n = 4,125) developed dementia. After adjustment for demographics and medical conditions, women with TBI, PTSD, and depression had a significant increase in risk of developing dementia compared to women without these diagnoses (TBI-adjusted subdistribution hazard ratio [adjusted sHR] 1.49, 95% confidence interval [CI] 1.01-2.20; PTSD adjusted sHR 1.78, 95% CI 1.34-2.36; and depression-adjusted sHR 1.67, 95% CI 1.55-1.80), while women with >1 diagnosis had the highest risk for dementia (adjusted sHR 2.15, 95% CI 1.84-2.51). CONCLUSIONS We found that women with military-related risk factors had an ≈50% to 80% increase in developing dementia relative to women without these diagnoses, while female veterans with multiple risk factors had a >2-fold risk of developing dementia. These findings highlight the need for increased screening of TBI, PTSD, and depression in older women, especially female veterans.
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Affiliation(s)
- Kristine Yaffe
- From the San Francisco Veterans Affairs Health Care System (K.Y., S.J.L., T.D.H., F.X., D.E.B., S.M., C.B.P.); and Departments of Psychiatry (K.Y., D.E.B., S.M.), Neurology (K.Y.), and Epidemiology & Biostatistics (K.Y.), University of California, San Francisco.
| | - Sandy J Lwi
- From the San Francisco Veterans Affairs Health Care System (K.Y., S.J.L., T.D.H., F.X., D.E.B., S.M., C.B.P.); and Departments of Psychiatry (K.Y., D.E.B., S.M.), Neurology (K.Y.), and Epidemiology & Biostatistics (K.Y.), University of California, San Francisco
| | - Tina D Hoang
- From the San Francisco Veterans Affairs Health Care System (K.Y., S.J.L., T.D.H., F.X., D.E.B., S.M., C.B.P.); and Departments of Psychiatry (K.Y., D.E.B., S.M.), Neurology (K.Y.), and Epidemiology & Biostatistics (K.Y.), University of California, San Francisco
| | - Feng Xia
- From the San Francisco Veterans Affairs Health Care System (K.Y., S.J.L., T.D.H., F.X., D.E.B., S.M., C.B.P.); and Departments of Psychiatry (K.Y., D.E.B., S.M.), Neurology (K.Y.), and Epidemiology & Biostatistics (K.Y.), University of California, San Francisco
| | - Deborah E Barnes
- From the San Francisco Veterans Affairs Health Care System (K.Y., S.J.L., T.D.H., F.X., D.E.B., S.M., C.B.P.); and Departments of Psychiatry (K.Y., D.E.B., S.M.), Neurology (K.Y.), and Epidemiology & Biostatistics (K.Y.), University of California, San Francisco
| | - Shira Maguen
- From the San Francisco Veterans Affairs Health Care System (K.Y., S.J.L., T.D.H., F.X., D.E.B., S.M., C.B.P.); and Departments of Psychiatry (K.Y., D.E.B., S.M.), Neurology (K.Y.), and Epidemiology & Biostatistics (K.Y.), University of California, San Francisco
| | - Carrie B Peltz
- From the San Francisco Veterans Affairs Health Care System (K.Y., S.J.L., T.D.H., F.X., D.E.B., S.M., C.B.P.); and Departments of Psychiatry (K.Y., D.E.B., S.M.), Neurology (K.Y.), and Epidemiology & Biostatistics (K.Y.), University of California, San Francisco
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26
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DeBeer BB, Meyer EC, Kimbrel NA, Kittel JA, Gulliver SB, Morissette SB. Psychological Inflexibility Predicts of Suicidal Ideation Over Time in Veterans of the Conflicts in Iraq and Afghanistan. Suicide Life Threat Behav 2018; 48:627-641. [PMID: 28891193 PMCID: PMC8491575 DOI: 10.1111/sltb.12388] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 05/19/2017] [Indexed: 11/28/2022]
Abstract
Psychological inflexibility, or how individuals respond to distressing internal experiences, may be a modifiable risk factor for suicide in veterans. It was hypothesized that psychological inflexibility would predict suicidal ideation after accounting for established risk factors at baseline and 1 year later. Post-9/11 veterans (N = 309) completed clinical interview and self-report measures at baseline and 1-year follow-up. Results indicated that psychological inflexibility predicted severity of suicidal ideation at both baseline and 1 year later, after accounting for established risk factors. Psychological inflexibility is an important marker of risk for suicidal ideation, and could be a target for interventions aimed at reducing suicide.
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Affiliation(s)
- Bryann B DeBeer
- Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA
- Texas A&M University, College Station, TX, USA
- Central Texas VA Health Care System, Temple, TX, USA
| | - Eric C Meyer
- Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA
- Texas A&M University, College Station, TX, USA
- Central Texas VA Health Care System, Temple, TX, USA
- Warriors Research Institute, Baylor Scott & White Health, Waco, TX, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs Medical Center, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
| | - Julie A Kittel
- Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA
| | - Suzy B Gulliver
- Texas A&M University, College Station, TX, USA
- Warriors Research Institute, Baylor Scott & White Health, Waco, TX, USA
| | - Sandra B Morissette
- Department of Psychology, The University of Texas at San Antonio, San Antonio, TX, USA
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27
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Horyniak D, Bojorquez I, Armenta RF, Davidson PJ. Deportation of non-citizen military veterans: A critical analysis of implications for the right to health. Glob Public Health 2018; 13:1369-1381. [PMID: 29243564 PMCID: PMC6561474 DOI: 10.1080/17441692.2017.1413123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Military personnel are commonly exposed to health-harming conditions during their service, resulting in higher rates of physical and mental health conditions compared with the general population. In an era of mass deportations, it is notable that non-citizen military veterans are not exempt from deportation. We utilised a human rights framework to conduct a critical analysis of potential health consequences of deportation for U.S. military veterans, identifying three ways in which veterans' rights to health may be constrained through deportation. First, honourably discharged deported veterans may be denied access to free or subsidised Veterans Affairs health services to which they would likely otherwise be entitled. Second, availability of and access to healthcare may be limited for reasons including barriers to enrolling in public insurance schemes, challenges navigating unfamiliar health systems and stigma and discrimination towards deported migrants. Finally, quality of available care may be sub-optimal due to limited expertise in service-related health issues and lack of evidence-based treatment for some health conditions (e.g. substance abuse/dependence). Binational multi-sectoral efforts are necessary to ensure that the rights to health of deported military veterans are adequately protected.
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Affiliation(s)
- Danielle Horyniak
- Division of Global Public Health, University of California San Diego, La Jolla, USA
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ietza Bojorquez
- Department of Population Studies, El Colegio de la Frontera Norte, Tijuana, Mexico
| | - Richard F. Armenta
- Division of Epidemiology, University of California San Diego, La Jolla, USA
- Department of Kinesiology, College of Education, Health and Human Services, California State University San Marcos, San Marcos, USA
| | - Peter J. Davidson
- Division of Global Public Health, University of California San Diego, La Jolla, USA
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28
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Angel CM, Smith BP, Pinter JM, Young BB, Armstrong NJ, Quinn JP, Brostek DF, Goodrich DE, Hoerster KD, Erwin MS. Team Red, White & Blue: a community-based model for harnessing positive social networks to enhance enrichment outcomes in military veterans reintegrating to civilian life. Transl Behav Med 2018; 8:554-564. [PMID: 30016524 PMCID: PMC6065538 DOI: 10.1093/tbm/iby050] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Military service assimilates individuals into a socially cohesive force to address dangerous and traumatic situations that have no counterpart in civilian life. Upon leaving active duty, many veterans experience a “reverse culture shock” when trying to reintegrate into civilian institutions and cultivate supportive social networks. Poor social reintegration is associated with greater morbidity and premature mortality in part due to adoption of risky health behaviors, social isolation, and inadequate engagement in health care services. Although institutions like the Veterans Health Administration (VA) do much to address the complex psychosocial and health care needs of veterans and their families with evidence-based care, only 61% of Operations Enduring and Iraqi Freedom (OEF/OIF) Veterans are enrolled in VA care and there are numerous perceived barriers to care for enrollees. To address this gap, a community-based nonprofit organization, Team Red, White & Blue (RWB), was created to help veterans establish health-enriching social connections with communities through the consistent provision of inclusive and locally tailored physical, social, and service activities. This article provides an overview of the development and refinement of a theory-based framework for veteran health called the Enrichment Equation, comprised of three core constructs: health, people, and purpose. By operationalizing programming activities and roles, we describe how theoretical components were translated into a social networking implementation package that enabled rapid national spread of Team RWB. We conclude with future opportunities to partner with researchers and other organizations to understand program impact, and to identify effective intervention components that could be adapted for similar vulnerable groups.
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Affiliation(s)
- Caroline M Angel
- Team Red, White & Blue, Tampa, FL, USA.,Eagle Research and Innovation Center, Team Red, White & Blue, Tampa, FL, USA.,The Institute for Veterans and Military Families, Syracuse University, Syracuse, NY, USA
| | - Blayne P Smith
- Team Red, White & Blue, Tampa, FL, USA.,Go Ruck, Jacksonville, FL, USA
| | | | - Brandon B Young
- Team Red, White & Blue, Tampa, FL, USA.,Tennyson Center for Children, Denver, CO, USA
| | - Nicholas J Armstrong
- The Institute for Veterans and Military Families, Syracuse University, Syracuse, NY, USA
| | - Joseph P Quinn
- Team Red, White & Blue, Tampa, FL, USA.,Headstrong Project, New York, NY, USA
| | | | - David E Goodrich
- Center for Evaluation and Implementation Resources and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Katherine D Hoerster
- Seattle Division Mental Health Service, VA Puget Sound Healthcare System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Michael S Erwin
- Team Red, White & Blue, Tampa, FL, USA.,The Positivity Project, Pinehurst, NC, USA
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29
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Young CM, Pedersen ER, Pearson AD, Neighbors C. Drinking to cope moderates the efficacy of changing veteran drinking norms as a strategy for reducing drinking and alcohol-related problems among U.S. veterans. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2018; 32:213-223. [PMID: 29369674 DOI: 10.1037/adb0000347] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Heavy and problematic drinking is a concern among young adult military veterans. Personalized normative feedback (PNF) interventions that target normative misperceptions regarding drinking have been efficacious among young adults and have recently begun to be implemented among veteran populations in an effort to reduce heavy drinking. However, moderators of PNF intervention efficacy among veterans are largely unexplored. This study is a secondary data analysis that evaluated whether a PNF intervention would work better at reducing perceived norms, drinking, and alcohol-related problems specifically for young adult veterans who drink to cope with negative affect. Veterans of the United States (U.S.) military (86% male; Mean age = 28.9 years, SD = 3.4) were randomly assigned to receive either: 1) PNF comparing their drinking and perceived norms to actual drinking rates for same sex veterans; or 2) feedback about same sex veteran video game play (control condition). Seven hundred eighty-four individuals completed baseline and 622 completed 1-month follow-up assessments (79% follow-up), including measures of alcohol use, alcohol-related problems, and drinking motives. Moderated mediation analyses indicated that changes in normative misperceptions as a result of the intervention were more strongly associated with reductions in drinking and problems among veterans scoring higher on drinking to cope. These findings suggest that PNF may be an especially efficacious brief intervention for veterans who drink for coping reasons. (PsycINFO Database Record
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30
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Sippel LM, Watkins LE, Pietrzak RH, Hoff R, Harpaz-Rotem I. The Unique Roles of Emotional Numbing and Arousal Symptoms in Relation to Social Connectedness Among Military Veterans in Residential Treatment for PTSD. Psychiatry 2018; 81:271-282. [PMID: 30015602 DOI: 10.1080/00332747.2017.1395313] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE While poor social connectedness is often a consequence of living with posttraumatic stress disorder (PTSD) symptoms, little is known about whether PTSD symptom clusters may be uniquely related to different aspects of social connectedness. This information can inform case conceptualization and treatment planning to potentially facilitate sustained recovery for individuals with PTSD. METHOD We examined associations among a five-factor model of PTSD and two aspects of social connectedness-distress related to problems getting along with others and days of contact with supportive loved ones in the past 30 days-in a sample of 2,600 U.S. military veterans seeking residential treatment for PTSD. RESULTS A large proportion of veterans reported experiencing distress related to problems getting along with others (66.2%) and few days of contact with supportive people (43.5%). Ordinal regression models controlling for intercorrelations among PTSD symptom clusters revealed that emotional numbing symptoms were independently associated with greater distress (β = 0.130, p < 0.001) and fewer days of contact (β = -0.159, p < 0.001); dysphoric arousal symptoms were associated with more distress (β = 0.236, p < 0.001), while anxious arousal was associated with more days of contact (β = 0.058, p < 0.05). CONCLUSIONS Findings reveal high rates of difficulties in social connectedness and distinct associations among these difficulties with emotional numbing, dysphoric arousal, and anxious arousal symptoms in veterans receiving residential treatment for PTSD. Future studies should examine whether targeting poor social connectedness during treatment improves interpersonal functioning and supports sustained trauma recovery, which may be particularly beneficial to veterans with more severe emotional numbing and dysphoric arousal symptoms.
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31
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Situating mental health work in place: Qualitative findings from interviews with Veterans in Southeastern Louisiana and Northern California. Health Place 2017; 47:63-70. [DOI: 10.1016/j.healthplace.2017.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 06/29/2017] [Accepted: 07/06/2017] [Indexed: 11/18/2022]
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