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Gilmore N, Tseng CEJ, Maffei C, Tromly SL, Deary KB, McKinney IR, Kelemen JN, Healy BC, Hu CG, Ramos-Llordén G, Masood M, Cali RJ, Guo J, Belanger HG, Yao EF, Baxter T, Fischl B, Foulkes AS, Polimeni JR, Rosen BR, Perl DP, Hooker JM, Zürcher NR, Huang SY, Kimberly WT, Greve DN, Mac Donald CL, Dams-O'Connor K, Bodien YG, Edlow BL. Impact of repeated blast exposure on active-duty United States Special Operations Forces. Proc Natl Acad Sci U S A 2024; 121:e2313568121. [PMID: 38648470 DOI: 10.1073/pnas.2313568121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
United States (US) Special Operations Forces (SOF) are frequently exposed to explosive blasts in training and combat, but the effects of repeated blast exposure (RBE) on SOF brain health are incompletely understood. Furthermore, there is no diagnostic test to detect brain injury from RBE. As a result, SOF personnel may experience cognitive, physical, and psychological symptoms for which the cause is never identified, and they may return to training or combat during a period of brain vulnerability. In 30 active-duty US SOF, we assessed the relationship between cumulative blast exposure and cognitive performance, psychological health, physical symptoms, blood proteomics, and neuroimaging measures (Connectome structural and diffusion MRI, 7 Tesla functional MRI, [11C]PBR28 translocator protein [TSPO] positron emission tomography [PET]-MRI, and [18F]MK6240 tau PET-MRI), adjusting for age, combat exposure, and blunt head trauma. Higher blast exposure was associated with increased cortical thickness in the left rostral anterior cingulate cortex (rACC), a finding that remained significant after multiple comparison correction. In uncorrected analyses, higher blast exposure was associated with worse health-related quality of life, decreased functional connectivity in the executive control network, decreased TSPO signal in the right rACC, and increased cortical thickness in the right rACC, right insula, and right medial orbitofrontal cortex-nodes of the executive control, salience, and default mode networks. These observations suggest that the rACC may be susceptible to blast overpressure and that a multimodal, network-based diagnostic approach has the potential to detect brain injury associated with RBE in active-duty SOF.
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Affiliation(s)
- Natalie Gilmore
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA 02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Chieh-En J Tseng
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129
| | - Chiara Maffei
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA 02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129
| | - Samantha L Tromly
- Institute of Applied Engineering, University of South Florida, Tampa, FL 33612
| | | | - Isabella R McKinney
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA 02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Jessica N Kelemen
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA 02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Brian C Healy
- Harvard T.H. Chan School of Public Health, Boston, MA 02115
| | - Collin G Hu
- United States Army Special Operations Aviation Command, Fort Liberty, NC 28307
- Department of Family Medicine, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Gabriel Ramos-Llordén
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129
| | - Maryam Masood
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA 02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Ryan J Cali
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA 02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Jennifer Guo
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Heather G Belanger
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL 33613
| | - Eveline F Yao
- Office of the Air Force Surgeon General, Falls Church, VA 22042
| | - Timothy Baxter
- Institute of Applied Engineering, University of South Florida, Tampa, FL 33612
| | - Bruce Fischl
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129
| | | | - Jonathan R Polimeni
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129
| | - Bruce R Rosen
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129
| | - Daniel P Perl
- Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Jacob M Hooker
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129
| | - Nicole R Zürcher
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129
| | - Susie Y Huang
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129
| | - W Taylor Kimberly
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Douglas N Greve
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129
| | | | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Yelena G Bodien
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA 02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, MA 02129
| | - Brian L Edlow
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA 02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129
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Panaite V, Finch DK, Pfeiffer P, Cohen NJ, Alman A, Haun J, Schultz SK, Miles SR, Belanger HG, Kozel FAF, Rottenberg J, Devendorf AR, Barrett B, Luther SL. Predictive modeling of initiation and delayed mental health contact for depression. BMC Health Serv Res 2024; 24:529. [PMID: 38664738 PMCID: PMC11046938 DOI: 10.1186/s12913-024-10870-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/14/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Depression is prevalent among Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) Veterans, yet rates of Veteran mental health care utilization remain modest. The current study examined: factors in electronic health records (EHR) associated with lack of treatment initiation and treatment delay; the accuracy of regression and machine learning models to predict initiation of treatment. METHODS We obtained data from the VA Corporate Data Warehouse (CDW). EHR data were extracted for 127,423 Veterans who deployed to Iraq/Afghanistan after 9/11 with a positive depression screen and a first depression diagnosis between 2001 and 2021. We also obtained 12-month pre-diagnosis and post-diagnosis patient data. Retrospective cohort analysis was employed to test if predictors can reliably differentiate patients who initiated, delayed, or received no mental health treatment associated with their depression diagnosis. RESULTS 108,457 Veterans with depression, initiated depression-related care (55,492 Veterans delayed treatment beyond one month). Those who were male, without VA disability benefits, with a mild depression diagnosis, and had a history of psychotherapy were less likely to initiate treatment. Among those who initiated care, those with single and mild depression episodes at baseline, with either PTSD or who lacked comorbidities were more likely to delay treatment for depression. A history of mental health treatment, of an anxiety disorder, and a positive depression screen were each related to faster treatment initiation. Classification of patients was modest (ROC AUC = 0.59 95%CI = 0.586-0.602; machine learning F-measure = 0.46). CONCLUSIONS Having VA disability benefits was the strongest predictor of treatment initiation after a depression diagnosis and a history of mental health treatment was the strongest predictor of delayed initiation of treatment. The complexity of the relationship between VA benefits and history of mental health care with treatment initiation after a depression diagnosis is further discussed. Modest classification accuracy with currently known predictors suggests the need to identify additional predictors of successful depression management.
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Affiliation(s)
- Vanessa Panaite
- Research & Development Service, James A. Haley Veterans' Hospital, Tampa, FL, USA.
- Department of Psychology, University of South Florida, Tampa, FL, USA.
| | - Dezon K Finch
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Paul Pfeiffer
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Nathan J Cohen
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amy Alman
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Jolie Haun
- Research & Development Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Susan K Schultz
- Department of Veterans Affairs VISN 23 Clinical Resource Hub, Minneapolis, MN, USA
| | - Shannon R Miles
- Mental Health and Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Heather G Belanger
- Department of Psychology, University of South Florida, Tampa, FL, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
| | - F Andrew F Kozel
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL, USA
| | | | - Andrew R Devendorf
- Department of Psychology, University of South Florida, Tampa, FL, USA
- Mental Health Service, VA Puget Sound Healthcare System at Seattle, Seattle, WA, USA
| | - Blake Barrett
- Research & Development Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Stephen L Luther
- Research & Development Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
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Stone JR, Avants BB, Tustison NJ, Gill J, Wilde EA, Neumann KD, Gladney LA, Kilgore MO, Bowling F, Wilson CM, Detro JF, Belanger HG, Deary K, Linsenbardt H, Ahlers ST. Neurological Effects of Repeated Blast Exposure in Special Operations Personnel. J Neurotrauma 2024; 41:942-956. [PMID: 37950709 PMCID: PMC11001960 DOI: 10.1089/neu.2023.0309] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2023] Open
Abstract
Exposure to blast overpressure has been a pervasive feature of combat-related injuries. Studies exploring the neurological correlates of repeated low-level blast exposure in career "breachers" demonstrated higher levels of tumor necrosis factor alpha (TNFα) and interleukin (IL)-6 and decreases in IL-10 within brain-derived extracellular vesicles (BDEVs). The current pilot study was initiated in partnership with the U.S. Special Operations Command (USSOCOM) to explore whether neuroinflammation is seen within special operators with prior blast exposure. Data were analyzed from 18 service members (SMs), inclusive of 9 blast-exposed special operators with an extensive career history of repeated blast exposures and 9 controls matched by age and duration of service. Neuroinflammation was assessed utilizing positron emission tomography (PET) imaging with [18F]DPA-714. Serum was acquired to assess inflammatory biomarkers within whole serum and BDEVs. The Blast Exposure Threshold Survey (BETS) was acquired to determine blast history. Both self-report and neurocognitive measures were acquired to assess cognition. Similarity-driven Multi-view Linear Reconstruction (SiMLR) was used for joint analysis of acquired data. Analysis of BDEVs indicated significant positive associations with a generalized blast exposure value (GBEV) derived from the BETS. SiMLR-based analyses of neuroimaging demonstrated exposure-related relationships between GBEV, PET-neuroinflammation, cortical thickness, and volume loss within special operators. Affected brain networks included regions associated with memory retrieval and executive functioning, as well as visual and heteromodal processing. Post hoc assessments of cognitive measures failed to demonstrate significant associations with GBEV. This emerging evidence suggests neuroinflammation may be a key feature of the brain response to blast exposure over a career in operational personnel. The common thread of neuroinflammation observed in blast-exposed populations requires further study.
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Affiliation(s)
- James R. Stone
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Brian B. Avants
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Nicholas J. Tustison
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Jessica Gill
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Elisabeth A. Wilde
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
- George E. Wahlen VA, Salt Lake City Health Healthcare System, Salt Lake City, Utah, USA
| | - Kiel D. Neumann
- Molecular Imaging Research Hub, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Leslie A. Gladney
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Madison O. Kilgore
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - F. Bowling
- U.S. Special Operations Command, Tampa, Florida, USA
| | | | - John F. Detro
- U.S. Special Operations Command, Tampa, Florida, USA
| | - Heather G. Belanger
- Departments of Psychiatry and Behavioral Neurosciences, and Psychology, University of South Florida, Tampa, Florida, USA
- Cognitive Research Corporation, St. Petersburg, Florida, USA
| | - Katryna Deary
- U.S. Special Operations Command, Tampa, Florida, USA
| | | | - Stephen T. Ahlers
- Operational and Undersea Medicine Directorate, Naval Medical Research Command, Silver Spring, Maryland, USA
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4
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Belanger HG, Long LJ, Winsberg M, Sullivan S, Farchione TJ, O'Callaghan E. The utility of completing adjuvant video lessons based on the unified protocol during psychotherapy: A retrospective study using a telehealth platform in routine clinical care. Psychother Res 2024; 34:228-240. [PMID: 36878224 DOI: 10.1080/10503307.2023.2174460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 03/08/2023] Open
Abstract
Digital supplements to tele-psychotherapy are increasingly needed. The purpose of this retrospective study was to investigate the association between outcomes and the use of supplemental video lessons based on the Unified Protocol (UP), an empirically supported transdiagnostic treatment. Participants included 7,326 adults in psychotherapy for depression and/or anxiety. Partial correlations were calculated between number of UP video lessons completed and change in outcomes after 10 weeks, controlling for number of therapy sessions and baseline scores. Then, participants were divided into those who did not complete any UP video lessons (n = 2355) and those who completed at least 7/10 video lessons (n = 549), and propensity-matched on 14 covariates. Repeated measures analysis of variance compared these groups (n = 401 in each group) on outcomes. Among the entire sample, symptom severity decreased as the number of UP video lessons completed increased, with the exception of lessons on avoidance and exposure. Those watching at least 7 lessons showed significantly greater reduction in both depression and anxiety symptoms than those who did not watch any. Viewing supplemental UP video lessons in addition to tele-psychotherapy had a positive and significant association with symptom improvement and may provide an additional tool for clinicians to implement UP components virtually.
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Affiliation(s)
- Heather G Belanger
- Brightside Health Inc., Oakland, CA, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
| | - Laura J Long
- Center for Anxiety and Related Disorders, Department of Psychology & Brain Sciences, Boston University, Boston, MA, USA
| | | | | | - Todd J Farchione
- Center for Anxiety and Related Disorders, Department of Psychology & Brain Sciences, Boston University, Boston, MA, USA
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5
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Panaite V, Cohen NJ, Luther SL, Finch DK, Alman A, Schultz SK, Haun J, Miles SR, Belanger HG, Kozel FA, Rottenberg J, Pfeiffer PN. Mental health treatment utilization patterns among 108,457 Afghanistan and Iraq veterans with depression. Psychol Serv 2024:2024-48650-001. [PMID: 38300588 DOI: 10.1037/ser0000819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
People with depression often underutilize mental health care. This study was conceived as a first step toward a clinical decision support tool that helps identify patients who are at higher risk of underutilizing care. The primary goals were to (a) describe treatment utilization patterns, early termination, and return to care; (b) identify factors associated with early termination of treatment; and (c) evaluate the accuracy of regression models to predict early termination. These goals were evaluated in a retrospective cohort analysis of 108,457 U.S. veterans who received care from the Veterans Health Administration between 2001 and 2021. Our final sample was 16.5% female with an average age of 34.5. Veterans were included if they had a depression diagnosis, a positive depression screen, and received general health care services at least a year before and after their depression diagnosis. Using treatment quality guidelines, the threshold for treatment underutilization was defined as receiving fewer than four psychotherapy sessions or less than 84 days of antidepressants. Over one fifth of veterans (21.6%) received less than the minimally recommended care for depression. The odds of underutilizing treatment increased with lack of Veterans Administration benefits, male gender, racial/ethnic minority status, and having received mental health treatment in the past (adjusted OR > 1.1). Posttraumatic stress disorder comorbidity correlated with increased depression treatment utilization (adjusted OR < .9). Models with demographic and clinical information from medical records performed modestly in classifying patients who underutilized depression treatment (area under the curve = 0.595, 95% CI [0.588, 0.603]). Most veterans in this cohort received at least the minimum recommended treatment for depression. To improve the prediction of underutilization, patient factors associated with treatment underutilization likely need to be supplemented by additional clinical information. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Vanessa Panaite
- Research and Development Service, James A. Haley Veterans' Hospital
| | - Nathan J Cohen
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai
| | - Stephen L Luther
- Research and Development Service, James A. Haley Veterans' Hospital
| | - Dezon K Finch
- Research and Development Service, James A. Haley Veterans' Hospital
| | - Amy Alman
- College of Public Health, University of South Florida
| | - Susan K Schultz
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida
| | - Jolie Haun
- Research and Development Service, James A. Haley Veterans' Hospital
| | - Shannon R Miles
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida
| | - Heather G Belanger
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida
| | - F Andrew Kozel
- Department of Behavioral Sciences and Social Medicine, Florida State University
| | | | - Paul N Pfeiffer
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System
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6
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Edlow BL, Gilmore N, Tromly SL, Deary KB, McKinney IR, Hu CG, Kelemen JN, Maffei C, Tseng CEJ, Llorden GR, Healy BC, Masood M, Cali RJ, Baxter T, Yao EF, Belanger HG, Benjamini D, Basser PJ, Priemer DS, Kimberly WT, Polimeni JR, Rosen BR, Fischl B, Zurcher NR, Greve DN, Hooker JM, Huang SY, Caruso A, Smith GA, Szymanski TG, Perl DP, Dams-O'Connor K, Mac Donald CL, Bodien YG. Optimizing Brain Health of United States Special Operations Forces. J Spec Oper Med 2023; 23:47-56. [PMID: 37851859 DOI: 10.55460/99qw-k0hg] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 10/20/2023]
Abstract
United States Special Operations Forces (SOF) personnel are frequently exposed to explosive blasts in training and combat. However, the effects of repeated blast exposure on the human brain are incompletely understood. Moreover, there is currently no diagnostic test to detect repeated blast brain injury (rBBI). In this "Human Performance Optimization" article, we discuss how the development and implementation of a reliable diagnostic test for rBBI has the potential to promote SOF brain health, combat readiness, and quality of life.
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7
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Belanger HG, Lee C, Winsberg M. Symptom clustering of major depression in a national telehealth sample. J Affect Disord 2023; 338:129-134. [PMID: 37245550 DOI: 10.1016/j.jad.2023.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 03/30/2023] [Accepted: 05/11/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) is a heterogeneous disorder whose possible symptom combinations have not been well delineated. The aim of this study was to explore the heterogeneity of symptoms experienced by those with MDD to characterize phenotypic presentations. METHODS Cross-sectional data (N = 10,158) from a large telemental health platform were used to identify subtypes of MDD. Symptom data, gathered from both clinically-validated surveys and intake questions, were analyzed via polychoric correlations, principal component analysis, and cluster analysis. RESULTS Principal components analysis (PCA) of baseline symptom data revealed 5 components, including anxious distress, core emotional, agitation/irritability, insomnia, and anergic/apathy components. PCA-based cluster analysis resulted in four MDD phenotypes, the largest of which was characterized by a prominent elevation on the anergic/apathy component, but also core emotional. The four clusters differed on demographic and clinical characteristics. LIMITATIONS The primary limitation of this study is that the phenotypes uncovered are limited by the questions asked. These phenotypes will need to be cross validated with other samples, potentially expanded to include biological/genetic variables, and followed longitudinally. CONCLUSIONS The heterogeneity in MDD, as illustrated by the phenotypes in this sample, may explain the heterogeneity of treatment response in large-scale treatment trials. These phenotypes can be used to study varying rates of recovery following treatment and to develop clinical decision support tools and artificial intelligence algorithms. Strengths of this study include its size, breadth of included symptoms, and novel use of a telehealth platform.
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Affiliation(s)
- Heather G Belanger
- Brightside Health Inc., 5241F Diamond Heights Blvd #3422, San Francisco CA 94131, United States of America; University of South Florida, Department of Psychiatry and Behavioral Neurosciences, 3515 E Fletcher Ave, Tampa, FL 33613, United States of America.
| | - Christine Lee
- Brightside Health Inc., 5241F Diamond Heights Blvd #3422, San Francisco CA 94131, United States of America
| | - Mirène Winsberg
- Brightside Health Inc., 5241F Diamond Heights Blvd #3422, San Francisco CA 94131, United States of America
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8
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Walker WC, O'Neil ME, Ou Z, Pogoda TK, Belanger HG, Scheibel RS, Presson AP, Miles SR, Wilde EA, Tate DF, Troyanskaya M, Pugh MJ, Jak A, Cifu DX. Can mild traumatic brain injury alter cognition chronically? A LIMBIC-CENC multicenter study. Neuropsychology 2023; 37:1-19. [PMID: 36174184 PMCID: PMC10117581 DOI: 10.1037/neu0000855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE While outcome from mild traumatic brain injury (mTBI) is generally favorable, concern remains over potential negative long-term effects, including impaired cognition. This study examined the link between cognitive performance and remote mTBIs within the Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) multicenter, observational study of Veterans and service members (SMs) with combat exposure. METHOD Baseline data of the participants passing all cognitive performance validity tests (n = 1,310) were used to conduct a cross-sectional analysis. Using multivariable regression models that adjusted for covariates, including age and estimated preexposure intellectual function, positive mTBI history groups, 1-2 lifetime mTBIs (nonrepetitive, n = 614), and 3 + lifetime mTBIs (repetitive; n = 440) were compared to TBI negative controls (n = 256) on each of the seven cognitive domains computed by averaging Z scores of prespecified component tests. Significance levels were adjusted for multiple comparisons. RESULTS Neither of the mTBI positive groups differed from the mTBI negative control group on any of the cognitive domains in multivariable analyses. Findings were also consistently negative across sensitivity analyses (e.g., mTBIs as a continuous variable, number of blast-related mTBIs, or years since the first and last mTBI). CONCLUSIONS Our findings demonstrate that the average veteran or SM who experienced one or more mTBIs does not have postacute objective cognitive deficits due to mTBIs alone. A holistic health care approach including comorbidity assessment is indicated for patients reporting chronic cognitive difficulties after mTBI(s), and strategies for addressing misattribution may be beneficial. Future study is recommended with longitudinal designs to assess within-subjects decline from potential neurodegeneration. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Terri K Pogoda
- Center for Healthcare Organization and Implementation Research
| | | | | | | | | | | | - David F Tate
- Department of Physical Medicine and Rehabilitation
| | | | - Mary Jo Pugh
- George E. Wahlen Veterans Affairs Salt Lake City Healthcare System
| | - Amy Jak
- VA San Diego Healthcare System
| | - David X Cifu
- Department of Physical Medicine and Rehabilitation
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9
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Miles SR, Sayer NA, Belanger HG, Venkatachalam HH, Kozel FA, Toyinbo PA, McCart JA, Luther SL. Comparing Outcomes of the Veterans Health Administration's Traumatic Brain Injury and Mental Health Screening Programs: Types and Frequency of Specialty Services Used. J Neurotrauma 2023; 40:102-111. [PMID: 35898115 DOI: 10.1089/neu.2022.0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The Veterans Health Administration (VHA) screens veterans who deployed in support of the wars in Afghanistan and Iraq for traumatic brain injury (TBI) and mental health (MH) disorders. Chronic symptoms after mild TBI overlap with MH symptoms, for which there are already established screens within the VHA. It is unclear whether the TBI screen facilitates treatment for appropriate specialty care over and beyond the MH screens. Our primary objective was to determine whether TBI screening is associated with different types (MH, Physical Medicine & Rehabilitation [PM&R], and Neurology) and frequency of specialty services compared with the MH screens. A retrospective cohort design examined veterans receiving VHA care who were screened for both TBI and MH disorders between Fiscal Year (FY) 2007 and FY 2018 (N = 241,136). We calculated service utilization counts in MH, PM&R, and Neurology in the six months after the screens. Zero-inflated negative binomial regression models of encounters (counts) were fit separately by specialty care type and for a total count of specialty services. We found that screening positive for TBI resulted in 2.38 times more specialty service encounters than screening negative for TBI. Compared with screening positive for MH only, screening positive for both MH and TBI resulted in 1.78 times more specialty service encounters and 1.33 times more MH encounters. The TBI screen appears to increase use of MH, PM&R, and Neurology services for veterans with post-deployment health concerns, even in those also identified as having a possible MH disorder.
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Affiliation(s)
- Shannon R Miles
- Mental Health and Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, Florida, USA.,Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Nina A Sayer
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Departments of Medicine and Psychiatry, University of Minnesota, Minneapolis, USA
| | - Heather G Belanger
- Department of Psychology, University of South Florida, Tampa, Florida, USA.,United States Special Operations Command, St. Michael's Inc.,Research and Development Service, James A. Haley Veterans' Hospital, Tampa, Florida, USA
| | - Hari H Venkatachalam
- Research and Development Service, James A. Haley Veterans' Hospital, Tampa, Florida, USA
| | - Frank Andrew Kozel
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Peter A Toyinbo
- Research and Development Service, James A. Haley Veterans' Hospital, Tampa, Florida, USA.,College of Public Health, University of South Florida, Tampa, Florida, USA
| | - James A McCart
- Research and Development Service, James A. Haley Veterans' Hospital, Tampa, Florida, USA.,College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Stephen L Luther
- Research and Development Service, James A. Haley Veterans' Hospital, Tampa, Florida, USA.,College of Public Health, University of South Florida, Tampa, Florida, USA
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10
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Belanger HG, Toyinbo P, Barrett B, King E, Sayer NA. Concussion coach for postconcussive symptoms: A randomized, controlled trial of a smartphone application with Afghanistan and Iraq war Veterans. Clin Neuropsychol 2022; 36:2093-2119. [PMID: 34184976 DOI: 10.1080/13854046.2021.1936188] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: Investigate the effectiveness of Concussion Coach, an interactive smartphone application, as a treatment for residual neurobehavioral symptoms and distress in Veterans with a history of mild traumatic brain injury (mild TBI). Methods: Veterans with mild TBI were randomized to Concussion Coach (n = 238) or Treatment-as-Usual (TAU) (n = 241) in a 3-month randomized controlled trial. Primary outcome measures included postconcussive symptom (PCS) severity as measured by the Neurobehavioral Symptom Inventory (NSI), and psychological distress as measured by the Brief Symptom Inventory-18 (BSI-18). Measures of self-efficacy, social support, and comfort with technology were administered as potential moderators and mediators. An intention-to-treat (ITT) analysis was performed (N = 461: Concussion Coach = 231 and TAU = 230) using Bayesian Network (BN)modeling. Results: The probability of decreased PCS severity was significantly greater for those assigned to Concussion Coach, .35 [.32,.37], than for TAU, .29 (.27, .32), with an odds ratio (OR) of 1.29. Also, Concussion Coach showed a significantly greater probability of increased self-efficacy (.36 [.32, .39]) than did TAU (.28 [.25, .30], OR = 1.42). In turn, self-efficacy (increased vs. decreased) showed a significantly greater probability of decreased PCS severity (.51 [.47, .54] vs. .27 [.24, .30], OR = 2.71) and decreased psychological distress (.53 [.49, .56] vs. .32 [.29, .35], OR = 2.35), suggesting that self-efficacy may have mediated Concussion Coach effects. Conclusions: Concussion Coach is effective at reducing PCS severity and psychological distress. Increased self-efficacy/perception of self-management of symptoms may be key to successful treatment of residual symptoms in those with history of concussion.
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Affiliation(s)
- Heather G Belanger
- Research and Development Service, James A. Haley Veterans' Hospital, Tampa, FL, USA.,United States Special Operations Command (USSOCOM), Tampa, FL, USA.,Department of Psychology and Psychiatry & Behavioral Neurosciences, University of South Florida, Tampa, FL, USA.,St Michael's Inc, Tampa, FL, USA
| | - Peter Toyinbo
- Research and Development Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Blake Barrett
- Research and Development Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | | | - Nina A Sayer
- Minneapolis VA Health Care System, Minneapolis, MN, USA.,Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System and Departments of Medicine and Psychiatry, University of Minnesota, Minneapolis, MN, USA
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11
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Belanger HG, Vincent AS, Caserta RJ, Biggs AT, Yao EF. Automated neuropsychological assessment metrics (v4) military expanded battery: Normative data for special operations forces. Clin Neuropsychol 2022; 36:2300-2312. [PMID: 34157935 DOI: 10.1080/13854046.2021.1933191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: The Automated Neuropsychological Assessment Metrics (ANAM) has long been used to assess cognition in military samples before deployment and following injury. The purpose of this study was to explore the effects of various demographic factors on the ANAM4 Military Expanded (ANAM4 ME) performance of Special Operations Forces (SOF) and to provide regression-based normative data for clinicians working with SOF personnel. Method: The sample was a large active duty military sample of SOF and support personnel (n = 24,072) who were tested under a new baseline policy. Results: Performance differences based on demographic variables were generally small. In general, increasing age was associated with significantly worse performance, except on mathematical processing. Higher education level was associated with better performance on most subtests, as expected, but was associated with worse performance on spatial processing. Conclusion: This paper provides regression formulas for calculating adjusted scores based on the most relevant demographic variables, as well as base rates of obtaining one or more clearly above or below average scores across the entire ANAM4 ME battery.
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Affiliation(s)
- Heather G Belanger
- Special Operations Command (SOCOM), Surgeon General's Office, Tampa, FL, USA.,St Michael's Inc, Tampa, FL, USA.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Andrea S Vincent
- Cognitive Science Research Center, University of Oklahoma, Norman, OK, USA.,Vista LifeSciences, Inc, Denver, CO, USA
| | - Ryan J Caserta
- Special Operations Command (SOCOM), Preservation of the Force and Family (POTFF), Tampa, FL, USA.,KBR, Houston, TX, USA
| | - Adam T Biggs
- Naval Special Warfare Command, Coronado, CA, USA
| | - Eveline F Yao
- Special Operations Command (SOCOM), Surgeon General's Office, Tampa, FL, USA
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12
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O'Callaghan E, Mahrer N, Belanger HG, Sullivan S, Lee C, Gupta CT, Winsberg M. Telehealth-Supported Decision-making Psychiatric Care for Suicidal Ideation: Longitudinal Observational Study. JMIR Form Res 2022; 6:e37746. [PMID: 36178727 PMCID: PMC9568811 DOI: 10.2196/37746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/16/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background Suicide is a leading cause of death in the United States, and suicidal ideation (SI) is a significant precursor and risk factor for suicide. Objective This study aimed to examine the impact of a telepsychiatric care platform on changes in SI over time and remission, as well as to investigate the relationship between various demographic and medical factors on SI and SI remission. Methods Participants included 8581 US-based adults (8366 in the treatment group and 215 in the control group) seeking treatment for depression, anxiety, or both. The treatment group included patients who had completed at least 12 weeks of treatment and had received a prescription for at least one psychiatric medication during the study period. Providers prescribed psychiatric medications for each patient during their first session and received regular data on participants. They also received decision support at treatment onset via the digital platform, which leveraged an empirically derived proprietary precision-prescribing algorithm to give providers real-time care guidelines. Participants in the control group consisted of individuals who completed the initial enrollment data and completed surveys at baseline and 12 weeks but did not receive care. Results Greater feelings of hopelessness, anhedonia, and feeling bad about oneself were most significantly correlated (r=0.24-0.37) with SI at baseline. Sleep issues and feeling tired or having low energy, although significant, had lower correlations with SI (r=0.13-0.14). In terms of demographic variables, advancing age and education were associated with less SI at baseline (r=−0.16) and 12 weeks (r=−0.10) but less improvement over time (r=−0.12 and −0.11, respectively). Although not different at baseline, the SI expression was evident in 34.4% (74/215) of the participants in the control group and 12.32% (1031/8366) of the participants in the treatment group at 12 weeks. Although the participants in the treatment group improved over time regardless of various demographic variables, participants in the control group with less education worsened over time, after controlling for age and depression severity. A model incorporating the treatment group, age, sex, and 8-item Patient Health Questionnaire scores was 77% accurate in its classification of complete remission. Those in the treatment group were 4.3 times more likely (odds ratio 4.31, 95% CI 2.88-6.44) to have complete SI remission than those in the control group. Female participants and those with advanced education beyond high school were approximately 1.4 times more likely (odds ratio 1.38, 95% CI 1.18-1.62) to remit than their counterparts. Conclusions The results highlight the efficacy of an antidepressant intervention in reducing SI, in this case administered via a telehealth platform and with decision support, as well as the importance of considering covariates, or subpopulations, when considering SI. Further research and refinement, ideally via randomized controlled trials, are needed.
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Affiliation(s)
| | - Nicole Mahrer
- Psychology Department, University of La Verne, La Verne, CA, United States
| | - Heather G Belanger
- Brightside Health Inc, Oakland, CA, United States
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States
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13
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O’Callaghan E, Sullivan S, Gupta C, Belanger HG, Winsberg M. Feasibility and acceptability of a novel telepsychiatry-delivered precision prescribing intervention for anxiety and depression. BMC Psychiatry 2022; 22:483. [PMID: 35854281 PMCID: PMC9297585 DOI: 10.1186/s12888-022-04113-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/05/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Major Depressive Disorder and Generalized Anxiety Disorder are pervasive and debilitating conditions, though treatment is often inaccessible and based on trial-and-error prescribing methods. The present observational study seeks to describe the use of a proprietary precision prescribing algorithm piloted during routine clinical practice as part of Brightside's telepsychiatry services. The primary aim is to determine the feasibility and acceptability of implementing this intervention. Secondary aims include exploring remission and symptom improvement rates. METHODS Participants were adult patients enrolled in Brightside who completed at least 12 weeks of treatment for depression and/or anxiety and received a prescription for at least one psychiatric medication. A prescription recommendation was made by Brightside's algorithm at treatment onset and was utilized for clinical decision support. Participants received baseline screening surveys of the PHQ-9 and GAD-7, and at weeks 2,4,6,8,10 and 12. Intent-to-treat (ITT) sensitivity analyses were conducted. Feasibility of the implementation was measured by the platform's ability to enroll and engage participants in timely psychiatric care, as well as offer high touch-point treatment options. Acceptability was measured by patient responses to a 5-star satisfaction rating. RESULTS Brightside accessed and treated 6248 patients from October 2018 to April 2021, treating a majority of patients within 4-days of enrollment. The average plan cost was $115/month. 89% of participants utilized Brightside's core medication plan at a cost of $95/month. 13.4% of patients in the study rated Brightside's services as highly satisfactory, averaging a 4.6-star rating. Furthermore, 90% of 6248 patients experienced a MCID in PHQ-9 or GAD-7 score. Remission rates were 75% (final PHQ-9 or GAD-7 score < 10) for the study sample and 59% for the ITT sample. 69.3% of Brightside patients were treated with the medication initially prescribed at intake. CONCLUSIONS Results suggest that the present intervention may be feasible and acceptable within the assessed population. Exploratory analyses suggest that Brightside's course of treatment, guided by precision recommendations, improved patients' symptoms of anxiety and depression.
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Affiliation(s)
- Erin O’Callaghan
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA 94607-1703 USA
| | - Scott Sullivan
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA 94607-1703 USA
| | - Carina Gupta
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA, 94607-1703, USA.
| | - Heather G. Belanger
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA 94607-1703 USA ,grid.170693.a0000 0001 2353 285XDepartments of Psychology and Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL USA
| | - Mirène Winsberg
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA 94607-1703 USA
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14
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Garcia A, Kretzmer TS, Dams-O'Connor K, Miles SR, Bajor L, Tang X, Belanger HG, Merritt BP, Eapen B, McKenzie-Hartman T, Silva MA. Health Conditions Among Special Operations Forces Versus Conventional Military Service Members: A VA TBI Model Systems Study. J Head Trauma Rehabil 2022; 37:E292-E298. [PMID: 34698680 DOI: 10.1097/htr.0000000000000737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine traumatic brain injury (TBI) characteristics and comorbid medical profiles of Special Operations Forces (SOF) Active Duty Service Member/Veterans (ADSM/Vs) and contrast them with conventional military personnel. SETTING The 5 Veterans Affairs (VA) Polytrauma Rehabilitation Centers. PARTICIPANTS A subset of participants in the VA TBI Model Systems multicenter longitudinal study with known SOF status. These included 157 participants who identified as SOF personnel (average age = 41.8 years; 96% male, 81% active duty), and 365 who identified as Conventional Forces personnel (average age = 37.4 years; 92% male, 30% active duty). DESIGN Retrospective analysis of prospective cohort, cross-sectional. MAIN MEASURES The Health Comorbidities Interview. RESULTS SOF personnel were more likely to have deployed to a combat zone, had more years of active duty service, and were more likely active duty at time of TBI. SOF personnel were more likely to have had mild TBI (vs moderate/severe) and their TBI caused by violent mechanism. SOF personnel had a higher number of comorbidities, with more diagnoses of chronic pain, osteoarthritis, hyperlipidemia, hip fractures, and obstructive sleep apnea. CONCLUSION SOF personnel are at a higher risk for multimorbidity after TBI. Current rehabilitation practices should incorporate early screening and treatment of common conditions in this population, while future practices may benefit from a focus on prevention.
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Affiliation(s)
- Amanda Garcia
- Mental Health and Behavioral Sciences Section (MHBSS) (Drs Garcia, Kretzmer, Miles, Bajor, and Silva) and Physical Medicine & Rehabilitation Service (Dr Merritt), James A. Haley Veterans' Hospital, Tampa, Florida; Traumatic Brain Injury Center of Excellence (TBI CoE), Tampa, Florida (Dr Garcia); Departments of Neurology (Dr Dams-O'Connor) and Rehabilitation and Human Performance (Dr Dams-O'Connor), Icahn School of Medicine at Mount Sinai, New York City, New York; Departments of Psychiatry and Behavioral Neurosciences (Drs Miles, Bajor, Belanger, and Silva), Internal Medicine (Dr Silva), and Psychology (Dr Silva), University of South Florida, Tampa, Florida; Harvard Medical School, Boston, Massachusetts (Dr Bajor); Tampa VA Research and Education Foundation, Inc, Temple Terrace, Florida (Dr Tang); United States Special Operations Command (USSOCOM), Tampa, Florida (Dr Belanger); St Michael's Inc, Woodbridge, Virginia (Dr Belanger); VA Greater Los Angeles Healthcare System, Los Angeles, California (Dr Eapen); National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center (WRNMMC), Bethesda, Maryland (Dr McKenzie-Hartman); and F. Edward Hébert School of Medicine (SOM), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland (Dr McKenzie-Hartman)
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15
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Belanger HG, Winsberg M. Do older adults benefit from telepsychiatric care: Comparison to younger adults. Front Psychiatry 2022; 13:998401. [PMID: 36072453 PMCID: PMC9441623 DOI: 10.3389/fpsyt.2022.998401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Telemental health platforms may increase access to care for older adults. Historically, older adults have tended to adopt new technologies at a slower rate which creates a perception that they may not be able to benefit from them. The purpose of this study was to determine whether or not older adult patients receiving psychiatric care for depression via a telemental health platform achieve the same outcomes as younger adults. METHOD Participant data utilized in the current investigation were obtained from a national mental health telehealth company (i.e., Brightside) and consisted of 12,908 U.S.-based adult patients receiving psychiatric care for depression between October, 2018 and January, 2022. Propensity matching was used to create an older and younger sample (n = 141 in each) using 23 covariates. These samples were then compared using repeated measures ANOVA on Patient Health Questionnaire-9 (PHQ-9) scores at start of treatment, 6 weeks, 8 weeks, 10 weeks, 12 weeks, 14 weeks, and 16 weeks. RESULTS Despite matching, the groups still significantly differed on prior mental health treatment, such that more older adults reported having had prior mental health treatment. There were no other differences between the groups on assessed variables. Both younger and older adults had decreasing scores over time with no significant differences between them. CONCLUSION Older adults have similar improvement in depression symptom severity over time following initiation of psychiatric treatment via a telehealth platform. These findings suggest that age is not a barrier to benefitting from telepsychiatric care.
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Affiliation(s)
- Heather G Belanger
- Brightside Health Inc., Oakland, CA, United States.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States
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16
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Belanger HG, Winsberg M. Exploring social determinants of health: Comparing lower and higher income individuals participating in telepsychiatric care for depression. Front Psychiatry 2022; 13:1026361. [PMID: 36683980 PMCID: PMC9849930 DOI: 10.3389/fpsyt.2022.1026361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Telemental health may increase access to care; there has been little research on efficacy with those at the lower end of the income distribution. The purpose of this study was to determine whether lower vs. higher income patients receiving telepsychiatric care for depression achieve: (1) effective symptom reduction and (2) similar outcomes. METHODS Data utilized were obtained from a national mental health telehealth company and consisted of 5,426 U.S.-based patients receiving psychiatric care for moderate to severe depression between October, 2018 and January, 2022. Propensity matching was used to create lower and higher income samples (n = 379 in each) using 22 covariates. These samples were then compared using repeated measures ANOVA on Patient Health Questionnaire-9 (PHQ-9) scores at start of treatment, 6, 8, 10, 12, 14, and 16 weeks. RESULTS Both lower and higher income groups made significant improvement over time, with groups averaging mild symptom severity by week 16. There was a significant group x time interaction, such that the lower income group had significantly greater depression severity at the last two timepoints. CONCLUSION Lower and higher income groups both made significant improvement in depression symptom severity over time following initiation of psychiatric treatment via a telehealth platform, though higher income individuals, all else being equal besides employment, tend to do better. These findings suggest that when lower income individuals do participate in care, good outcomes can be achieved. Further research is needed to better understand the role social determinants of health (SDOH) play in outcome disparities.
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Affiliation(s)
- Heather G Belanger
- Brightside Health Inc., Oakland, CA, United States.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States
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17
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Garcia A, Miles SR, Reljic T, Silva MA, Dams-O'Connor K, Belanger HG, Bajor L, Richardson R. Neurobehavioral Symptoms in U.S. Special Operations Forces in Rehabilitation After Traumatic Brain Injury: A TBI Model Systems Study. Mil Med 2021; 187:1412-1421. [PMID: 34591087 DOI: 10.1093/milmed/usab347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/26/2021] [Accepted: 08/10/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Special Operations Forces (SOF) personnel are at increased risk for traumatic brain injury (TBI), when compared with conventional forces (CF). Prior studies of TBI in military samples have not typically investigated SOF vs. CF as specific subgroups, despite documented differences in premorbid resilience and post-injury comorbidity burden. The aim of the current study was to compare SOF vs. CF on the presence of neurobehavioral symptoms after TBI, as well as factors influencing perception of symptom intensity. MATERIALS AND METHODS This study conducted an analysis of the prospective veterans affairs (VA) TBI Model Systems Cohort, which includes service members and veterans (SM/V) who received inpatient rehabilitation for TBI at one of the five VA Polytrauma Rehabilitation Centers. Of those with known SOF status (N = 342), 129 participants identified as SOF (average age = 43 years, 98% male) and 213 identified as CF (average age = 38.7 years, 91% male). SOF vs. CF were compared on demographics, injury characteristics, and psychological and behavioral health symptoms. These variables were then used to predict neurobehavioral symptom severity in univariable and multivariable analyses. RESULTS SOF personnel reported significantly greater posttraumatic stress disorder (PTSD) symptoms but less alcohol and drug use than the CF. SOF also reported greater neurobehavioral symptoms. When examining those with TBIs of all severities, SOF status was not associated with neurobehavioral symptom severity, while race, mechanism of TBI, and PTSD symptoms were. When examining only those with mTBI, SOF status was associated with lower neurobehavioral symptoms, while PTSD severity, white race, and certain mechanisms of injury were associated with greater neurobehavioral symptoms. CONCLUSIONS Among those receiving inpatient treatment for TBI, SOF SM/V reported higher neurobehavioral and symptom severity. PTSD was the strongest predictor of neurobehavioral symptoms and should be considered an important treatment target in both SOF and CF with co-morbid PTSD/TBI. A proactive human performance approach towards identification and treatment of psychological and neurobehavioral symptoms is recommended for SOF.
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Affiliation(s)
- Amanda Garcia
- Traumatic Brain Injury Center of Excellence, James A. Haley Veterans' Hospital, Tampa, FL 33612, USA.,Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL 33612, USA
| | - Shannon R Miles
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL 33612, USA.,Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL 33613, USA
| | - Tea Reljic
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - Marc A Silva
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL 33612, USA.,Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL 33613, USA.,Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA.,Department of Psychology, University of South Florida, Tampa, FL 33620, USA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine, New York, NY 10029, USA.,Department of Neurology, Icahn School of Medicine, New York, NY 10029, USA
| | - Heather G Belanger
- Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL 33613, USA.,United States Special Operations Command (USSOCOM), MacDill AFB, FL 33621, USA.,St Michael's Inc., Woodbridge, VA 22192, USA
| | - Laura Bajor
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL 33612, USA.,Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL 33613, USA.,Harvard South Shore Psychiatry Residency Program, Brockton, MA 02301, USA
| | - Risa Richardson
- Traumatic Brain Injury Center of Excellence, James A. Haley Veterans' Hospital, Tampa, FL 33612, USA.,Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL 33612, USA.,Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
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18
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Kim SK, Roche MD, Fredericson M, Dragoo JL, Horton BH, Avins AL, Belanger HG, Ioannidis JPA, Abrams GD. A Genome-wide Association Study for Concussion Risk. Med Sci Sports Exerc 2021; 53:704-711. [PMID: 33017352 DOI: 10.1249/mss.0000000000002529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to screen the entire genome for genetic markers associated with risk for concussion. METHODS A genome-wide association analyses was performed using data from the Kaiser Permanente Research Bank and the UK Biobank. Concussion cases were identified based on electronic health records from the Kaiser Permanente Research Bank and the UK Biobank from individuals of European ancestry. Genome-wide association analyses from both cohorts were tested for concussion using a logistic regression model adjusting for sex, height, weight, and race/ethnicity using allele counts for single nucleotide polymorphisms. Previously identified genes within the literature were also tested for association with concussion. RESULTS There were a total of 4064 cases of concussion and 291,472 controls within the databases, with two single nucleotide polymorphisms demonstrating a genome-wide significant association with concussion. The first polymorphism, rs144663795 (P = 9.7 × 10-11; OR = 2.91 per allele copy), is located within the intron of SPATA5. Strong, deleterious mutations in SPATA5 cause intellectual disability, hearing loss, and vision loss. The second polymorphism, rs117985931 (P = 3.97 × 10-9; OR = 3.59 per allele copy), is located within PLXNA4. PLXNA4 plays a key role is axon outgrowth during neural development, and DNA variants in PLXNA4 are associated with risk for Alzheimer's disease. Previous investigations have identified five candidate genes that may be associated with concussion, but none showed a significant association in the current model (P < 0.05). CONCLUSION Two genetic markers were identified as potential risk factors for concussion and deserve further validation and investigation of molecular mechanisms.
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Affiliation(s)
- Stuart K Kim
- Department of Developmental Biology, Stanford University Medical School, Stanford, CA
| | - Megan D Roche
- Department Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA
| | - Michael Fredericson
- Department Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA
| | - Jason L Dragoo
- UCHealth Steadman Hawkins Clinic Denver-Surgery Center, Englewood, CO
| | - Brandon H Horton
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Andy L Avins
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | | | - Geoffrey D Abrams
- Department Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA
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19
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Tate DF, Dennis EL, Adams JT, Adamson MM, Belanger HG, Bigler ED, Bouchard HC, Clark AL, Delano-Wood LM, Disner SG, Eapen BC, Franz CE, Geuze E, Goodrich-Hunsaker NJ, Han K, Hayes JP, Hinds SR, Hodges CB, Hovenden ES, Irimia A, Kenney K, Koerte IK, Kremen WS, Levin HS, Lindsey HM, Morey RA, Newsome MR, Ollinger J, Pugh MJ, Scheibel RS, Shenton ME, Sullivan DR, Taylor BA, Troyanskaya M, Velez C, Wade BS, Wang X, Ware AL, Zafonte R, Thompson PM, Wilde EA. Coordinating Global Multi-Site Studies of Military-Relevant Traumatic Brain Injury: Opportunities, Challenges, and Harmonization Guidelines. Brain Imaging Behav 2021; 15:585-613. [PMID: 33409819 PMCID: PMC8035292 DOI: 10.1007/s11682-020-00423-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 12/19/2022]
Abstract
Traumatic brain injury (TBI) is common among military personnel and the civilian population and is often followed by a heterogeneous array of clinical, cognitive, behavioral, mood, and neuroimaging changes. Unlike many neurological disorders that have a characteristic abnormal central neurologic area(s) of abnormality pathognomonic to the disorder, a sufficient head impact may cause focal, multifocal, diffuse or combination of injury to the brain. This inconsistent presentation makes it difficult to establish or validate biological and imaging markers that could help improve diagnostic and prognostic accuracy in this patient population. The purpose of this manuscript is to describe both the challenges and opportunities when conducting military-relevant TBI research and introduce the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Military Brain Injury working group. ENIGMA is a worldwide consortium focused on improving replicability and analytical power through data sharing and collaboration. In this paper, we discuss challenges affecting efforts to aggregate data in this patient group. In addition, we highlight how "big data" approaches might be used to understand better the role that each of these variables might play in the imaging and functional phenotypes of TBI in Service member and Veteran populations, and how data may be used to examine important military specific issues such as return to duty, the late effects of combat-related injury, and alteration of the natural aging processes.
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Affiliation(s)
- David F Tate
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA.
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA.
| | - Emily L Dennis
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, Los Angeles, CA, USA
| | - John T Adams
- Western University of Health Sciences, Pomona, CA, USA
| | - Maheen M Adamson
- Defense and Veterans Brain Injury Center, VA Palo Alto, Palo Alto, CA, USA
- Neurosurgery, Stanford School of Medicine, Stanford, CA, USA
| | - Heather G Belanger
- United States Special Operations Command (USSOCOM), Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- St Michaels Inc, Tampa, FL, USA
| | - Erin D Bigler
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Heather C Bouchard
- Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA
| | - Alexandra L Clark
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Lisa M Delano-Wood
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, USA
| | - Seth G Disner
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
- Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Blessen C Eapen
- Department of Physical Medicine and Rehabilitation, VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Carol E Franz
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, USA
| | - Elbert Geuze
- University Medical Center Utrecht, Utrecht, Netherlands
- Brain Research and Innovation Centre, Ministry of Defence, Utrecht, The Netherlands
| | - Naomi J Goodrich-Hunsaker
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Kihwan Han
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Jasmeet P Hayes
- Psychology Department, The Ohio State University, Columbus, OH, USA
- Chronic Brain Injury Program, The Ohio State University, Columbus, OH, USA
| | - Sidney R Hinds
- Department of Defense/United States Army Medical Research and Materiel Command, Fort Detrick, Frederick, MD, USA
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Cooper B Hodges
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Elizabeth S Hovenden
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Andrei Irimia
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Kimbra Kenney
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - William S Kremen
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, USA
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, USA
| | - Harvey S Levin
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Hannah M Lindsey
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Rajendra A Morey
- Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Mary R Newsome
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - John Ollinger
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Mary Jo Pugh
- Information Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City, Salt Lake City, UT, USA
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Randall S Scheibel
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
- Brockton Division, VA Boston Healthcare System, Brockton, MA, USA
| | - Danielle R Sullivan
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Brian A Taylor
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
- C. Kenneth and Dianne Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Maya Troyanskaya
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Carmen Velez
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Benjamin Sc Wade
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Xin Wang
- Department of Psychiatry, University of Toledo, Toledo, OH, USA
| | - Ashley L Ware
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital/Brigham & Women's Hospital, Boston, MA, USA
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, Los Angeles, CA, USA
- Department of Neurology, USC, Los Angeles, CA, USA
- Department of Pediatrics, USC, Los Angeles, CA, USA
- Department of Psychiatry, USC, Los Angeles, CA, USA
- Department of Radiology, USC, Los Angeles, CA, USA
- Department of Engineering, USC, Los Angeles, CA, USA
- Department of Ophthalmology, USC, Los Angeles, CA, USA
| | - Elisabeth A Wilde
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
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Garcia A, Reljic T, Pogoda TK, Kenney K, Agyemang A, Troyanskaya M, Belanger HG, Wilde EA, Walker WC, Nakase-Richardson R. Obstructive Sleep Apnea Risk Is Associated with Cognitive Impairment after Controlling for Mild Traumatic Brain Injury History: A Chronic Effects of Neurotrauma Consortium Study. J Neurotrauma 2020; 37:2517-2527. [PMID: 32709212 PMCID: PMC7698980 DOI: 10.1089/neu.2019.6916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The contribution of sleep disturbance to persistent cognitive symptoms following a mild traumatic brain injury (mTBI) remains unclear. Obstructive sleep apnea (OSA) is very common, yet its relationship between risk factors for developing OSA and cognitive performance in those with history of mTBI has not been investigated. The current study examined OSA risk levels and its association with cognitive performance in 391 combat-exposed, post-911 veterans and service members (median age = 37 years) enrolled in the Chronic Effects of Neurotrauma Consortium (CENC) prospective multi-center study. Participants included those with and without mTBI (n = 326 and 65, respectively). When using clinical cut-offs, those with history of mTBI were more likely to be categorized as high risk for OSA (mTBI positive = 65% vs. mTBI negative = 51%). After adjustment for TBI status and demographic variables, increased OSA risk was significantly associated with worse performance on measures of complex processing speed and executive functioning (Wechsler Adult Intelligence Scale Fourth Edition Coding, Trail Making Test, part B) and greater symptom burden (Neurobehavioral Symptom Inventory). Thus, OSA, a modifiable behavioral health factor, likely contributes to cognitive performance following mTBI. Accordingly, OSA serves as a potential point of intervention to improve clinical and cognitive outcomes after injury.
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Affiliation(s)
- Amanda Garcia
- Defense and Veterans Brain Injury Center, James A. Haley VA Hospital, Tampa, Florida, USA
- Mental Health and Behavioral Sciences and Defense and Veterans Brain Injury Center, James A. Haley VA Hospital, Tampa, Florida, USA
| | - Tea Reljic
- Morsani College of Medicine, Sleep and Pulmonary Division, University of South Florida, Tampa, Florida, USA
| | - Terri K. Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kimbra Kenney
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Neurology, Uniformed Services University, Bethesda, Maryland, USA
| | - Amma Agyemang
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Maya Troyanskaya
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Heather G. Belanger
- United States Special Operations Command, Tampa, Florida, USA
- Department of Psychology and Psychiatry and Behavioral Neurosciences, Sleep and Pulmonary Division, University of South Florida, Tampa, Florida, USA
| | - Elisabeth A. Wilde
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
- George E. Wahlen VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
- Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City, Utah, USA
| | - William C. Walker
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Risa Nakase-Richardson
- Defense and Veterans Brain Injury Center, James A. Haley VA Hospital, Tampa, Florida, USA
- Mental Health and Behavioral Sciences and Defense and Veterans Brain Injury Center, James A. Haley VA Hospital, Tampa, Florida, USA
- Department of Internal Medicine, Sleep and Pulmonary Division, University of South Florida, Tampa, Florida, USA
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Belanger HG. Introduction to a special issue on military neuropsychology: Serving those who serve. Clin Neuropsychol 2020; 34:1065-1069. [PMID: 32619383 DOI: 10.1080/13854046.2020.1786605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The military has a long history with neuropsychology and its precursors. From developing intelligence tests during World War I, to developing early capacity and personality assessments during World War II, to forward deploying for the evaluation and treatment of frequent concussive brain injuries during more recent conflicts, clinical neuropsychology has been at the forefront of military selection, healthcare and research. The objective of this special issue is to provide an overview of the latest clinical research relevant to military neuropsychology-some contributors address assessment and treatment issues that are relevant to current practice and others foretell the future of our field. METHOD We solicited papers from established researchers and issued a general call for papers for the special issue on military neuropsychology. Results: We received submissions from several authors, eleven of which are included in this issue. These submissions cover assessment and treatment issues, as well as healthcare utilization and return to duty issues. Two apparent themes are the importance of assessing, treating, and attending to comorbidities following traumatic brain injury (TBI) and future assessment techniques moving beyond traditional cognitive performance assessment. CONCLUSIONS The issue highlights the importance of research in clinical neuropsychology to the practice and advancement of military neuropsychology.
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Affiliation(s)
- Heather G Belanger
- United States Special Operations Command (USSOCOM), Departments of Psychology and Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA.,St Michael's Inc, Tampa, FL, USA
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Bradley SE, Haun J, Powell-Cope G, Haire S, Belanger HG. Qualitative assessment of the use of a smart phone application to manage post-concussion symptoms in Veterans with traumatic brain injury. Brain Inj 2020; 34:1031-1038. [DOI: 10.1080/02699052.2020.1771770] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Sarah E. Bradley
- Research Service, James A. Haley Veterans’ Hospital, Tampa, Florida, USA
| | - Jolie Haun
- Research Service, James A. Haley Veterans’ Hospital, Tampa, Florida, USA
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Gail Powell-Cope
- Research Service, James A. Haley Veterans’ Hospital, Tampa, Florida, USA
| | - Sharon Haire
- Research Service, James A. Haley Veterans’ Hospital, Tampa, Florida, USA
| | - Heather G. Belanger
- Defense and Veterans Brain Injury Center (DVBIC), United States Special Operations Command, Tampa, Florida, USA
- Departments of Psychology, and Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida, USA
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Belanger HG, Bowling F, Yao EF. Low-Level Blast Exposure in Humans A Systematic Review of Acute and Chronic Effects. J Spec Oper Med 2020; 20:87-93. [PMID: 32203612 DOI: 10.55460/3ac6-ax9i] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/01/2020] [Indexed: 06/10/2023]
Abstract
There is growing concern that military breaching and training and firing artillery and mortars, grenades, and shoulder-fired weapons may have some type of cumulative deleterious effects. There are anecdotal reports of those with repetitive exposure to low-level blast complaining of various symptoms, as well as increasing empirical evidence. The purpose of this report is to provide a systematic review of the literature on repetitive lowlevel blast as it pertains to military and police training protocols. An extensive literature search was conducted, resulting in detailed review of 18 studies. Results suggest few consistent findings, likely due to the heterogeneity of methods, high risk of bias, and lack of reliance on objective blast-exposure data. Adverse effects, when present, dissipated over time. All studies that used blast gauges found significant associations, though only a subset actually reported using the blast-gauge data (to correlate objective exposure with outcomes). When comparing studies within an outcome domain (e.g., cognitive), findings were largely inconsistent. Research with larger sample sizes, followed longitudinally, is needed.
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Belanger HG, Wortzel HS, Vanderploeg RD, Cooper DB. A model for intervening with veterans and service members who are concerned about developing Chronic Traumatic Encephalopathy (CTE). Clin Neuropsychol 2019; 34:1105-1123. [DOI: 10.1080/13854046.2019.1699166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Heather G. Belanger
- Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
- James A, Haley Veterans Hospital, United States Special Operations Command, 9Line LLC, Tampa, FL, USA
| | - Hal S. Wortzel
- Rocky Mountain MIRECC, Rocky Mountain Regional Medical Center, Aurora, CO, USA
- Departments of Psychiatry, Neurology, and PM&R, University of Colorado, Aurora, CO, USA
| | - Rodney D. Vanderploeg
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Douglas B. Cooper
- Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
- Polytrauma Rehabilitation Center, Audie Murphy Memorial VA Hospital, San Antonio, TX, USA
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Melillo C, Downs K, Dillahunt-Aspillaga C, Lind J, Besterman-Dahan K, Hahm B, Antinori N, Elnitsky C, Sander AM, Belanger HG, Toyinbo P, Powell-Cope G. Action Ethnography of Community Reintegration for Veterans and Military Service Members With Traumatic Brain Injury: Protocol for a Mixed Methods Study. JMIR Res Protoc 2019; 8:e14170. [PMID: 31755868 PMCID: PMC6898887 DOI: 10.2196/14170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/10/2019] [Accepted: 08/31/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Numerous studies of community reintegration (CR) in traumatic brain injury (TBI) have been conducted in civilian populations, but research is limited in veteran and military service member populations. Little is known about how knowledge from civilian studies translates into veterans' experiences and needs. The US Department of Veterans Health Administration (VHA) recognizes the distinctive health care needs of post-9/11 veteran and military service members, particularly with TBI, including the need to bridge health and rehabilitation-related services from acute care and inpatient settings to veteran and military service members' homes and communities to facilitate CR. OBJECTIVE The goal of this study is to better understand the experiences of veterans with complicated mild, moderate, or severe TBI; their families; and CR workers as veterans and servicemembers transition to and sustain living in communities. This paper describes the rationale, design, and methods used to reach this goal. METHODS This five-year longitudinal mixed methods study uses both a community-engaged research (CEnR) approach and an ethnographic approach. The sample includes 30 veterans and service members with TBI, 13 family caregivers, 11 CR specialists, 16 key stakeholders, and 82 community events. Interviews and observations are coded and analyzed using hierarchical coding schemes and thematic analysis. Analyses include data from surveys, interviews, and participant observations. Content analysis is used to highlight the complex social context of reintegration and to triangulate quantitative data. Egocentric (personal) social network analysis is used to examine the support system a veteran or service member has in place to facilitate reintegration. RESULTS Study enrollment and data collection are completed. Data analyses are underway. CONCLUSIONS The results of this study may provide a heightened understanding of environmental factors affecting CR in complicated mild, moderate, or severe TBI. Veteran, servicemember and family voices and insights provide VHA clinicians and policy makers with an ecological view of CR that is grounded in the life experiences of veterans, military service members, and families. The results of this study provide a roadmap for designing and testing interventions to maximize CR in a variety of domains. The longitudinal ethnographic approach allows for capturing detailed experiences within the naturalistic context. CEnR allows collaborative assessment of the social context of reintegration with community members. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/14170.
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Affiliation(s)
- Christine Melillo
- Research and Development Service, James A Haley Veterans' Hospital, Veterans Health Administration, Tampa, FL, United States
| | - Kiersten Downs
- Research and Development Service, James A Haley Veterans' Hospital, Veterans Health Administration, Tampa, FL, United States
| | - Christina Dillahunt-Aspillaga
- Research and Development Service, James A Haley Veterans' Hospital, Veterans Health Administration, Tampa, FL, United States.,Rehabilitation and Mental Health Counseling Program, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States
| | - Jason Lind
- Research and Development Service, James A Haley Veterans' Hospital, Veterans Health Administration, Tampa, FL, United States
| | - Karen Besterman-Dahan
- Research and Development Service, James A Haley Veterans' Hospital, Veterans Health Administration, Tampa, FL, United States
| | - Bridget Hahm
- Research and Development Service, James A Haley Veterans' Hospital, Veterans Health Administration, Tampa, FL, United States
| | - Nicole Antinori
- Research and Development Service, James A Haley Veterans' Hospital, Veterans Health Administration, Tampa, FL, United States
| | - Christine Elnitsky
- School of Nursing, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Angelle M Sander
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, United States.,H Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States
| | - Heather G Belanger
- Defense and Veterans Brain Injury Center, US Special Operations Command, Tampa, FL, United States
| | - Peter Toyinbo
- Research and Development Service, James A Haley Veterans' Hospital, Veterans Health Administration, Tampa, FL, United States
| | - Gail Powell-Cope
- Research and Development Service, James A Haley Veterans' Hospital, Veterans Health Administration, Tampa, FL, United States
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Abstract
Objective: Stroke is commonly seen in neuropsychological practice. Individual differences, diffuse damage, and the difficulty inherent in researching stroke create challenges for the clinician trying to synthesize the latest information to educate patients and families on prognosis. The objective of this special issue is to provide an overview of the latest clinical research in stroke - the contributors address assessment and treatment issues that are relevant to practice. Method: We solicited papers from established researchers and issued a general call for papers for the special issue on stroke. Results: We received submissions from several authors, eight of which are included in this issue. These submissions cover both assessment and treatment issues and include two review articles, one on language and one on spatial neglect. Two apparent themes are the utility of early assessment/treatment and the importance of executive functioning in predicting later functioning. Conclusions: The issue highlights the need for clinical neuropsychologists to be aware of the latest research on recovery from stroke and the importance of both assessment and management strategies to reduce impact on daily life.
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Affiliation(s)
- Heather G Belanger
- a Defense and Veterans Brain Injury Center (DVBIC) , Tampa , FL , USA.,b Department of Psychology , University of South Florida , Tampa , FL , USA.,c Department of Psychiatry and Behavioral Neurosciences , University of South Florida , Tampa , FL , USA.,d 9Line LLC , Tampa , FL , USA
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Belanger HG, Vanderploeg RD, Curtiss G, Armistead-Jehle P, Kennedy JE, Tate DF, Eapen BC, Bowles AO, Cooper DB. Self-efficacy predicts response to cognitive rehabilitation in military service members with post-concussive symptoms. Neuropsychol Rehabil 2019; 30:1190-1203. [DOI: 10.1080/09602011.2019.1575245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Heather G. Belanger
- Defense and Veterans Brain Injury Center (DVBIC), Special Operations Command (SOCOM), Tampa, FL, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Rodney D. Vanderploeg
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Glenn Curtiss
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | | | - Jan E. Kennedy
- Department of Rehabilitation Medicine, Brooke Army Medical Center (BAMC)
| | - David F. Tate
- Missouri Institute of Mental Health and University of Missouri, St Louis, MO, USA
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Blessen C. Eapen
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, TX, USA
- Department of Rehabilitation Medicine, University of Texas Health, San Antonio, TX, USA
| | - Amy O. Bowles
- Department of Rehabilitation Medicine, Brooke Army Medical Center (BAMC)
- Department of Physical Medicine & Rehabilitation, Uniformed Services University of Health Sciences (USUHS), Bethesda, MD, USA
| | - Douglas B. Cooper
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, TX, USA
- Defense and Veteran’s Brain Injury Center (DVBIC), South Texas Veterans Health Care System, San Antonio, TX, USA
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Vanderploeg RD, Belanger HG, Curtiss G, Bowles AO, Cooper DB. Reconceptualizing rehabilitation of individuals with chronic symptoms following mild traumatic brain injury. Rehabil Psychol 2019; 64:1-12. [DOI: 10.1037/rep0000255] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hirsch S, Belanger HG, Levin H, S Eggleston B, Wilde EA, McDonald SD, Brearly TW, Tate DF. Exploring the factor structure of a battery of neuropsychological assessments among the CENC cohort. Brain Inj 2018; 32:1226-1235. [PMID: 29985676 DOI: 10.1080/02699052.2018.1492738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The goal of the Chronic Effects of Neurotrauma Consortium (CENC) study is to explore the effects of concussions among Service Members and Veterans. A factor model was fit to selected neuropsychological measures to identify potentially useful relationships between assessments collected on CENC-enrolled participants. METHOD 492 post-9/11 participants with combat exposure were enrolled across four VA study sites. Participants completed assessments including concussion history, neurocognitive functioning, and self-report questionnaires. Exploratory factor analyses (EFA) using four different methods with varimax and promax rotations were used to analyse the cognitive variables. Final model selection was based on factor loadings towards simple structure. RESULTS The scree plot suggested the number of factors to be extracted was between 4 and 5. EFA produced a 5-factor MINRES model with promax rotation that resulted in a factor loading with variables loading on only one factor with a predefined threshold (0.40). Variables loaded on five cognition domains: list learning, working memory/executive skills, cognitive control, fluency, and memory. CONCLUSION These results provide reasonable evidence that data collected from the CENC neuropsychological battery can be reduced to five clinically useful factors. This will enable us to use the factors for further study of the impact of concussion on neurodegeneration.
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Affiliation(s)
| | - Heather G Belanger
- b James A. Haley VA Medical Center; University of South Florida , Tampa , FL, USA
| | - Harvey Levin
- c Michael E. DeBakey VA Medical Center and Baylor College of Medicine , Houston , TX, USA
| | | | - Elisabeth A Wilde
- c Michael E. DeBakey VA Medical Center and Baylor College of Medicine , Houston , TX, USA.,d University of Utah , Salt Lake City , UT, USA
| | | | - Timothy W Brearly
- f Walter Reed National Military Medical Center, Bethesda, MD, USA; W. G. "Bill" Hefner VA Medical Center , Salisbury , NC, USA
| | - David F Tate
- g Missouri Institute of Mental Health, University of Missouri-St Louis, MO, USA
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Dismuke-Greer CE, Nolen TL, Nowak K, Hirsch S, Pogoda TK, Agyemang AA, Carlson KF, Belanger HG, Kenney K, Troyanskaya M, Walker WC. Understanding the impact of mild traumatic brain injury on veteran service-connected disability: results from Chronic Effects of Neurotrauma Consortium. Brain Inj 2018; 32:1178-1187. [PMID: 29889561 DOI: 10.1080/02699052.2018.1482428] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Disability evaluation is complex. The association between mild traumatic brain injury (mTBI) history and VA service-connected disability (SCD) ratings can have implications for disability processes in the civilian population. We examined the association of VA SCD ratings with lifetime mTBI exposure in three models: any mTBI, total mTBI number, and blast-related mTBI. METHODS Participants were 492 Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans from four US VA Medical Centers enrolled in the Chronic Effects of Neurotrauma Consortium study between January 2015 and August 2016. Analyses entailed standard covariate-adjusted linear regression models, accounting for demographic, military, and health-related confounders and covariates. RESULTS Unadjusted and adjusted results indicated lifetime mTBI was significantly associated with increased SCD, with the largest effect observed for blast-related mTBI. Every unit increase in mTBI was associated with an increase in 3.6 points of percent SCD. However, hazardous alcohol use was associated with lower SCD. CONCLUSIONS mTBI, especially blast related, is associated with higher VA SCD ratings, with each additional mTBI increasing percent SCD. The association of hazardous alcohol use with SCD should be investigated as it may impact veteran health services access and health outcomes. These findings have implications for civilian disability processes.
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Affiliation(s)
- Clara Elizabeth Dismuke-Greer
- a Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VA Medical Center, and Department of Medicine , Medical University of South Carolina , Charleston , SC , USA.,b Research Service , Ralph H. Johnson VAMC , Charleston , SC, USA
| | | | | | | | - Terri K Pogoda
- d Center for Healthcare Organization and Implementation Research , VA Boston Healthcare System, and Boston University School of Public Health , Boston , MA , USA
| | - Amma A Agyemang
- e Department of Physical Medicine and Rehabilitation , Virginia Commonwealth University , Richmond , VA, USA
| | - Kathleen F Carlson
- f HSR&D Center of Innovation, VA Portland Health Care System, and OHSU-PSU School of Public Health , Oregon Health and Science University , Portland , OR, USA
| | - Heather G Belanger
- g HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital (VH), and Department of Psychiatry and Behavioral Neurosciences , University of South Florida , Tampa , FL, USA
| | - Kimbra Kenney
- h Uniformed Services University of the Health Sciences , Bethesda , MD, USA
| | - Maya Troyanskaya
- i Michael E. DeBakey VA Medical Center and Department of Physical Medicine and Rehabilitation , Baylor College of Medicine , Houston , TX, USA
| | - William C Walker
- e Department of Physical Medicine and Rehabilitation , Virginia Commonwealth University , Richmond , VA, USA.,j Hunter Holmes McGuire VA Medical Center
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Armistead-Jehle P, Soble JR, Cooper DB, Belanger HG. Unique Aspects of Traumatic Brain Injury in Military and Veteran Populations. Phys Med Rehabil Clin N Am 2018; 28:323-337. [PMID: 28390516 DOI: 10.1016/j.pmr.2016.12.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Traumatic brain injury (TBI), in particular mild TBI (mTBI), is a relatively common injury experienced by service members across both deployed and nondeployed environments. Although many of the principles and practices used by civilian health care providers for identifying and treating this injury apply to military settings, there are unique factors that impact mTBI-related care in service members and Veterans. This article reviews several of these factors, including the epidemiology of TBI in the military/Veteran population, the influence of military culture on this condition, and identification and treatment of mTBI in the war zone.
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Affiliation(s)
- Patrick Armistead-Jehle
- Concussion Clinic, Munson Army Health Center, 550 Pope Avenue, Fort Leavenworth, KS 66027, USA.
| | - Jason R Soble
- Psychology Service, South Texas Veterans Healthcare System, 7400 Merton Minter, San Antonio, TX 78229, USA
| | - Douglas B Cooper
- Defense and Veterans Brain Injury Center, Department of Neurology, San Antonio Military Medical Center, Joint Base San Antonio, MCHE-ZDM-N, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234-4504, USA; Department of Psychiatry, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
| | - Heather G Belanger
- HSR&D, Tampa VA TBI/Polytrauma Rehabilitation Center, Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, 13000 Bruce B. Downs Boulevard - 116A, Tampa, FL 33612, USA; Department of Mental Health and Behavioral Sciences, James A. Haley Veterans' Hospital, 13000 Bruce B Downs Boulevard (116B), Tampa, FL 33612, USA; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, 4202 E Fowler Avenue, Tampa, FL 33612, USA; Defense and Veterans Brain Injury Center, 13000 Bruce B Downs Boulevard (116B), Tampa, FL 33612, USA
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McQuaid EL, Aosved AC, Belanger HG. Integrating research into postdoctoral training in health service psychology: Challenges and opportunities. Training and Education in Professional Psychology 2018. [DOI: 10.1037/tep0000173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Silva MA, Belanger HG, Dams-O’Connor K, Tang X, McKenzie-Hartman T, Nakase-Richardson R. Prevalence and predictors of tobacco smoking in veterans and service members following traumatic brain injury rehabilitation: a VA TBIMS study. Brain Inj 2018; 32:994-999. [DOI: 10.1080/02699052.2018.1468576] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Marc A. Silva
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans’ Hospital, Tampa, FL, USA
- Dept. of Psychology, University of South Florida, Tampa, FL, USA
- Defense and Veterans Brain Injury Center (DVBIC) Tampa, FL, USA
- Center of Innovation on Disability and Rehabilitation Research (CINDRR), Health Services Research and Development Service (HSR&D), Tampa, FL, USA
| | - Heather G. Belanger
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans’ Hospital, Tampa, FL, USA
- Defense and Veterans Brain Injury Center (DVBIC) Tampa, FL, USA
- Center of Innovation on Disability and Rehabilitation Research (CINDRR), Health Services Research and Development Service (HSR&D), Tampa, FL, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
| | | | - Xinyu Tang
- Biostatistics Program, Dept. of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Risa Nakase-Richardson
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans’ Hospital, Tampa, FL, USA
- Defense and Veterans Brain Injury Center (DVBIC) Tampa, FL, USA
- Center of Innovation on Disability and Rehabilitation Research (CINDRR), Health Services Research and Development Service (HSR&D), Tampa, FL, USA
- Department of Internal Medicine, University of South Florida, Tampa, FL, USA
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Moore DH, Powell-Cope G, Belanger HG. The Veterans Health Administration’s Traumatic Brain Injury Screen and Evaluation: Service Delivery Insights. Mil Med 2018; 183:e494-e501. [DOI: 10.1093/milmed/usy036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/18/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- D Helen Moore
- Center of Innovation on Disability and Rehabilitation Research (CINDRR), Health Services Research and Development Service (HSR&D), Veterans Health Administration, James A. Haley Veterans’ Hospital, 8900 Grand Oak Circle, Tampa, FL
| | - Gail Powell-Cope
- Center of Innovation on Disability and Rehabilitation Research (CINDRR), Health Services Research and Development Service (HSR&D), Veterans Health Administration, James A. Haley Veterans’ Hospital, 8900 Grand Oak Circle, Tampa, FL
- College of Nursing, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL
- College of Public Health, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL
| | - Heather G Belanger
- Center of Innovation on Disability and Rehabilitation Research (CINDRR), Health Services Research and Development Service (HSR&D), Veterans Health Administration, James A. Haley Veterans’ Hospital, 8900 Grand Oak Circle, Tampa, FL
- Department of Psychiatry and Behavioral Neurosciences, College of Medicine, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL
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Panaite V, Brown R, Henry M, Garcia A, Powell-Cope G, Vanderploeg RD, Belanger HG. Post-deployment Mental Health Screening: A Systematic Review of Current Evidence and Future Directions. Adm Policy Ment Health 2018; 45:850-875. [PMID: 29603055 DOI: 10.1007/s10488-018-0869-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Population-based post-deployment screening programs within the Departments of Defense and Veterans Affairs have been implemented to assess for mental health conditions and traumatic brain injury. The purpose of this paper is to systematically review the literature on post-deployment screening within this context and evaluate evidence compared to commonly accepted screening implementation criteria. Findings reflected highly variable psychometric properties of the various screens, variable treatment referral rates following screening, low to moderate treatment initiation rates following screening, and no information on treatment completion or long-term outcomes following screening. In sum, the evidence supporting population based post-deployment screening is inconclusive. Implications are discussed.
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Affiliation(s)
- Vanessa Panaite
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, 8900 Grand Oak Circle, 104B, Tampa, FL, 33637, USA.
- Departments of Psychology, University of South Florida, Tampa, FL, USA.
| | - Racine Brown
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, 8900 Grand Oak Circle, 104B, Tampa, FL, 33637, USA
| | | | - Amanda Garcia
- Department of Mental Health and Behavioral Sciences, James A. Haley VA, Tampa, FL, USA
| | - Gail Powell-Cope
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, 8900 Grand Oak Circle, 104B, Tampa, FL, 33637, USA
| | - Rodney D Vanderploeg
- Department of Mental Health and Behavioral Sciences, James A. Haley VA, Tampa, FL, USA
- Departments of Psychology, University of South Florida, Tampa, FL, USA
- Psychiatry & Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- Defense and Veterans Brain Injury Center, Tampa, FL, USA
| | - Heather G Belanger
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, 8900 Grand Oak Circle, 104B, Tampa, FL, 33637, USA
- Department of Mental Health and Behavioral Sciences, James A. Haley VA, Tampa, FL, USA
- Psychiatry & Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- Defense and Veterans Brain Injury Center, Tampa, FL, USA
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Belanger HG, Vanderploeg RD, Sayer N. Screening for Remote History of Mild Traumatic Brain Injury in VHA: A Critical Literature Review. J Head Trauma Rehabil 2018; 31:204-14. [PMID: 26394295 DOI: 10.1097/htr.0000000000000168] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The authors reviewed the existing literature on the Veterans Health Administration's (VHA's) traumatic brain injury (TBI) screening and evaluation program to provide a qualitative synthesis and critical review of results focusing on the psychometric properties of the screen. METHODS All studies of the VHA's screening and evaluation process were reviewed, both those involving primary data collection and those relying upon VHA data. Diagnostic statistics were summarized and also recalculated on the basis of a positive screening rate of 20%, the observed rate within the VHA, and an estimated population prevalence of TBI of 15% within the Department of Veterans Affairs (VHA). RESULTS The TBI screen within the VHA is administered to nearly every eligible patient. The majority of clinical presentations are deemed to be due to mental health and/or a combination of mental health and TBI factors. The screen has good internal consistency, variable test-retest reliability, and questionable validity, with poor agreement between the TBI screen and criterion standards overall. Studies based on nonrepresentative samples reported high sensitivity. Assuming the VHA's TBI screening rate of 20% in a hypothetical sample, sensitivity is poor (the screen misses 30%-60% of TBI cases). However, specificity remains adequate. Studies based on samples with high rates of TBI reported much higher positive predictive values (and slightly lower negative predictive values) than those observed when a hypothetical TBI prevalence of 15% was used. CONCLUSION Questions remain about the validity of the TBI screen. Future research should address the utility of screening for TBI.
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Affiliation(s)
- Heather G Belanger
- Department of Mental Health and Behavioral Sciences, James A. Haley VA, Tampa, Florida (Drs Belanger and Vanderploeg); Departments of Psychology and Psychiatry, University of South Florida, Tampa (Drs Belanger and Vanderploeg); Defense and Veterans Brain Injury Center, Tampa, Florida (Drs Belanger and Vanderploeg); Tampa HSR&D/RR&D Center of Innovation on Disability and Rehabilitation Research (CIDRR8), Tampa, Florida (Drs Belanger and Vanderploeg); Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota (Dr Sayer); and Departments of Medicine and Psychiatry, University of Minnesota, Minneapolis (Dr Sayer)
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Toyinbo PA, Vanderploeg RD, Belanger HG, Spehar AM, Lapcevic WA, Scott SG. A Systems Science Approach to Understanding Polytrauma and Blast-Related Injury: Bayesian Network Model of Data From a Survey of the Florida National Guard. Am J Epidemiol 2017; 185:135-146. [PMID: 27986702 DOI: 10.1093/aje/kww074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 04/28/2016] [Accepted: 05/25/2016] [Indexed: 01/08/2023] Open
Abstract
We sought to further define the epidemiology of the complex, multiple injuries collectively known as polytrauma/blast-related injury (PT/BRI). Using a systems science approach, we performed Bayesian network modeling to find the most accurate representation of the complex system of PT/BRI and identify key variables for understanding the subsequent effects of blast exposure in a sample of Florida National Guard members (1,443 deployed to Operation Enduring Freedom/Operation Iraqi Freedom and 1,655 not deployed) who completed an online survey during the period from 2009 to 2010. We found that postdeployment symptoms reported as present at the time of the survey were largely independent of deployment per se. Blast exposure, not mild traumatic brain injury (TBI), acted as the primary military deployment-related driver of PT/BRI symptoms. Blast exposure was indirectly linked to mild TBI via other deployment-related traumas and was a significant risk for a high level of posttraumatic stress disorder (PTSD) arousal symptoms. PTSD arousal symptoms and tinnitus were directly dependent upon blast exposure, with both acting as bridge symptoms to other postdeployment mental health and physical symptoms, respectively. Neurobehavioral or postconcussion-like symptoms had no significant dependence relationship with mild TBI, but they were synergistic with blast exposure in influencing PTSD arousal symptoms. A replication of this analysis using a larger PT/BRI database is warranted.
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Belanger HG, Barwick F, Silva MA, Kretzmer T, Kip KE, Vanderploeg RD. Web-based psychoeducational intervention for postconcussion symptoms: a randomized trial. Mil Med 2016; 180:192-200. [PMID: 25643387 DOI: 10.7205/milmed-d-14-00388] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The objective of this study was to investigate the effectiveness of a web-based educational intervention for reducing postconcussion symptoms. 158 participants with self-reported symptomatic mild traumatic brain injury were randomized to intervention versus control. There was no effect of intervention on symptom severity or attributions. Subgroup analyses suggested benefit of the web-based intervention in those receiving concurrent mental health treatment and in those participants with the greatest time since injury (>1 year after mild traumatic brain injury). Web-based educational intervention was not effective overall in this sample. However, there is some suggestion of promise in those receiving concurrent mental health treatment and with more chronic symptoms. Findings also suggest potential benefit of interventions targeting self-efficacy.
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Affiliation(s)
- Heather G Belanger
- Department of Mental Health and Behavioral Sciences, James A. Haley VA, 13000 Bruce B. Downs Boulevard, Tampa, FL 33612
| | - Fiona Barwick
- Department of Mental/Behavioral Health, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073
| | - Marc A Silva
- Department of Mental Health and Behavioral Sciences, James A. Haley VA, 13000 Bruce B. Downs Boulevard, Tampa, FL 33612
| | - Tracy Kretzmer
- Department of Mental Health and Behavioral Sciences, James A. Haley VA, 13000 Bruce B. Downs Boulevard, Tampa, FL 33612
| | - Kevin E Kip
- College of Nursing, University of South Florida, 12901 Bruce B. Downs Boulevard, Tampa, FL
| | - Rodney D Vanderploeg
- Department of Mental Health and Behavioral Sciences, James A. Haley VA, 13000 Bruce B. Downs Boulevard, Tampa, FL 33612
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Silva M, McKenzie-Hartman T, Belanger HG, Dams-O'Connor K, Tang X, Nakase-Richardson R. Prevalence and Predictors of Tobacco Smoking 1-year After Traumatic Brain Injury: A VA TBI Model Systems Study. Arch Phys Med Rehabil 2016. [DOI: 10.1016/j.apmr.2016.08.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Belanger HG, Lange RT, Bailie J, Iverson GL, Arrieux JP, Ivins BJ, Cole WR. [Formula: see text]Interpreting change on the neurobehavioral symptom inventory and the PTSD checklist in military personnel. Clin Neuropsychol 2016; 30:1063-73. [PMID: 27266484 DOI: 10.1080/13854046.2016.1193632] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the prevalence and stability of symptom reporting in a healthy military sample and to develop reliable change indices for two commonly used self-report measures in the military health care system. PARTICIPANTS AND METHOD Participants were 215 U.S. active duty service members recruited from Fort Bragg, NC as normal controls as part of a larger study. Participants completed the Neurobehavioral Symptom Inventory (NSI) and Posttraumatic Checklist (PCL) twice, separated by approximately 30 days. RESULTS Depending on the endorsement level used (i.e. ratings of 'mild' or greater vs. ratings of 'moderate' or greater), approximately 2-15% of this sample met DSM-IV symptom criteria for Postconcussional Disorder across time points, while 1-6% met DSM-IV symptom criteria for Posttraumatic Stress Disorder. Effect sizes for change from Time 1 to Time 2 on individual symptoms were small (Cohen's d = .01 to .13). The test-retest reliability for the NSI total score was r = .78 and the PCL score was r = .70. An eight-point change in symptom reporting represented reliable change on the NSI total score, with a seven-point change needed on the PCL. CONCLUSIONS Postconcussion-like symptoms are not unique to mild TBI and are commonly reported in a healthy soldier sample. It is important for clinicians to use normative data when evaluating a service member or veteran and when evaluating the likelihood that a change in symptom reporting is reliable and clinically meaningful.
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Affiliation(s)
- Heather G Belanger
- a Department of Mental Health and Behavioral Sciences , James A. Haley VAMC , Tampa , FL , USA.,b Department of Psychiatry & Behavioral Neurosciences , University of South Florida , Tampa , FL , USA.,c Defense and Veterans Brain Injury Center , Silver Spring , MD , USA
| | - Rael T Lange
- c Defense and Veterans Brain Injury Center , Silver Spring , MD , USA.,d National Intrepid Center of Excellence , Bethesda , MD , USA.,e Walter Reed National Military Medical Center , Bethesda , MD , USA.,f University of British Columbia , Vancouver , Canada
| | - Jason Bailie
- c Defense and Veterans Brain Injury Center , Silver Spring , MD , USA.,g Naval Hospital , Camp Pendleton , CA , USA
| | - Grant L Iverson
- c Defense and Veterans Brain Injury Center , Silver Spring , MD , USA.,h Harvard Medical School , Boston , MA , USA.,i Spaulding Rehabilitation Hospital , Charlestown , MA , USA.,j Red Sox Foundation and Massachusetts General Hospital Home Base Program , Boston , MA , USA
| | - Jacques P Arrieux
- c Defense and Veterans Brain Injury Center , Silver Spring , MD , USA.,k Womack Army Medical Center , Fort Bragg , NC , USA
| | - Brian J Ivins
- c Defense and Veterans Brain Injury Center , Silver Spring , MD , USA
| | - Wesley R Cole
- c Defense and Veterans Brain Injury Center , Silver Spring , MD , USA.,k Womack Army Medical Center , Fort Bragg , NC , USA
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Belanger HG, Powell-Cope G, Spehar AM, McCranie M, Klanchar SA, Yoash-Gantz R, Kosasih JB, Scholten J. The Veterans Health Administration’s traumatic brain injury clinical reminder screen and evaluation: Practice patterns. ACTA ACUST UNITED AC 2016; 53:767-780. [DOI: 10.1682/jrrd.2015.09.0187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 04/13/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Heather G. Belanger
- Center of Innovation on Disability and Rehabilitation Research, Health Services Research & Development, James A. Haley Veterans’ Hospital, Tampa, FL
- Department of Mental Health and Behavioral Sciences, James A. Haley Veterans’ Hospital, Tampa, FL; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL; and Defense and Veterans Brain Injury Center, Silver Spring, MD
| | - Gail Powell-Cope
- Center of Innovation on Disability and Rehabilitation Research, Health Services Research & Development, James A. Haley Veterans’ Hospital, Tampa, FL
| | | | - Mark McCranie
- Center of Innovation on Disability and Rehabilitation Research, Health Services Research & Development, James A. Haley Veterans’ Hospital, Tampa, FL
| | - S. Angelina Klanchar
- Center of Innovation on Disability and Rehabilitation Research, Health Services Research & Development, James A. Haley Veterans’ Hospital, Tampa, FL
| | - Ruth Yoash-Gantz
- Department of Mental Health and Behavioral Sciences, W. G. (Bill) Hefner Department of Veterans Affairs Medical Center (VAMC), Salisbury, NC; and Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Judith B. Kosasih
- Department of Physical Medicine and Rehabilitation, Clement J. Zablocki VAMC, Milwaukee, WI; and Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI
| | - Joel Scholten
- Department of Physical Medicine and Rehabilitation, Washington DC VAMC, Washington, DC
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Vanderploeg RD, Nazem S, Brenner LA, Belanger HG, Donnell AJ, Scott SG. Suicidal Ideation among Florida National Guard Members: Combat Deployment and Non-Deployment Risk and Protective Factors. Arch Suicide Res 2015; 19:453-71. [PMID: 25517207 DOI: 10.1080/13811118.2014.957454] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study examined relationships among risk/protective factors and suicidal ideation (SI) in deployed and non-deployed National Guard members, particularly examining for possible differential effects of deployment on SI. A total of 3,098 Florida National Guard members completed an anonymous online survey that assessed variables associated with SI including demographics, current psychiatric diagnoses, and pre-, during, and post-deployment experiences. Those deployed had significantly higher rates of SI (5.5%) than those not deployed (3.0%; p < .001). In multivariate analyses, among those not deployed, SI was significantly associated with major depressive disorder (p < .001), posttraumatic stress disorder (PTSD) (p < .001), prior psychological trauma (p < .01), and heavy/hazardous alcohol consumption (p < .05). In contrast, in the deployed, only PTSD (p < .001) and deployment-related mild traumatic brain injury (p < .05) were independently associated with SI. Risk and protective factors differed by deployment status in National Guard members suggesting the possible need for cohort-specific treatment targets to minimize SI.
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Vanderploeg RD, Belanger HG, Kaufmann PM. Erratum to: Nocebo Effects and Mild Traumatic Brain Injury: Legal Implications. Psychol Inj and Law 2014. [DOI: 10.1007/s12207-014-9205-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Soble JR, Silva MA, Vanderploeg RD, Curtiss G, Belanger HG, Donnell AJ, Scott SG. Normative Data for the Neurobehavioral Symptom Inventory (NSI) and Post-Concussion Symptom Profiles Among TBI, PTSD, and Nonclinical Samples. Clin Neuropsychol 2014; 28:614-32. [DOI: 10.1080/13854046.2014.894576] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Vanderploeg RD, Donnell AJ, Belanger HG, Curtiss G. Consolidation deficits in traumatic brain injury: The core and residual verbal memory defect. J Clin Exp Neuropsychol 2013; 36:58-73. [DOI: 10.1080/13803395.2013.864600] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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King EG, Kretzmer TS, Vanderploeg RD, Asmussen SB, Clement VL, Belanger HG. Pilot of a novel intervention for postconcussive symptoms in active duty, veterans, and civilians. Rehabil Psychol 2013; 58:272-9. [DOI: 10.1037/a0033116] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Soble JR, Donnell AJ, Belanger HG. TBI and Nonverbal Executive Functioning: Examination of a Modified Design Fluency Test's Psychometric Properties and Sensitivity to Focal Frontal Injury. Applied Neuropsychology: Adult 2013; 20:257-262. [DOI: 10.1080/09084282.2012.713056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jason R. Soble
- a Department of Mental Health and Behavioral Sciences , James A. Haley Veterans Affairs Medical Center , Tampa , Florida
| | - Alison J. Donnell
- a Department of Mental Health and Behavioral Sciences , James A. Haley Veterans Affairs Medical Center , Tampa , Florida
- b Defense and Veterans Brain Injury Center
| | - Heather G. Belanger
- a Department of Mental Health and Behavioral Sciences , James A. Haley Veterans Affairs Medical Center , Tampa , Florida
- c Department of Psychology , University of South Florida , Tampa , Florida
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Belanger HG, Barwick FH, Kip KE, Kretzmer T, Vanderploeg RD. Postconcussive Symptom Complaints and Potentially Malleable Positive Predictors. Clin Neuropsychol 2013; 27:343-55. [DOI: 10.1080/13854046.2013.774438] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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