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Cloitre M, Morabito D, Macia K, Speicher S, Froelich J, Webster K, Prins A, Villasenor D, Bauer A, Jackson C, Fabricant L, Wiltsey-Stirman S, Morland L. A home-based telehealth randomized controlled trial of skills training in affective and interpersonal regulation versus present-centered therapy for women veterans who have experienced military sexual trauma. J Consult Clin Psychol 2024:2024-43678-001. [PMID: 38227462 DOI: 10.1037/ccp0000872] [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: 01/17/2024]
Abstract
OBJECTIVE This randomized trial tested the effectiveness of Skills Training in Affective and Interpersonal Regulation (STAIR) compared to present-centered therapy (PCT) delivered virtually to women veterans who had experienced military sexual trauma (MST) and screened positive for posttraumatic stress disorder (PTSD). METHOD One hundred sixty-one eligible women veterans were randomized into the study. The primary outcome was clinician-assessed PTSD severity (Clinician-Administered PTSD Scale-5), while secondary outcomes included social support and several other symptom measures at posttreatment through 2- and 4-month follow-up. RESULTS PTSD severity decreased in both conditions by posttreatment but significantly more (p = .028, d = 0.39) in STAIR (d = 1.12 [0.87, 1.37]) than PCT (d = .78 [0.54, 1.02]). STAIR was also superior in improving social support and emotion regulation and reducing depression and negative cognitions. Improvement in psychosocial functioning was moderate and did not differ between conditions. All changes were maintained through 2- and 4-month follow-ups. Dropout rates were low and did not differ (19.0% and 12.2%, respectively). CONCLUSION STAIR provided superior outcomes compared to PCT regarding PTSD, social support, and multiple types of mental health problems among women veterans with MST. The application of STAIR to other populations with social support and related concerns warrants investigation. The substantial effect sizes for PTSD symptoms in both treatments suggest that they are practical alternatives for individuals who do not wish to participate in trauma-focused therapy and may increase engagement in mental health services. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Marylene Cloitre
- National Center for PTSD, Division of Dissemination and Training, Veterans Affairs Palo Alto Health Care System
| | - Danielle Morabito
- National Center for PTSD, Division of Dissemination and Training, Veterans Affairs Palo Alto Health Care System
| | - Kathryn Macia
- National Center for PTSD, Division of Dissemination and Training, Veterans Affairs Palo Alto Health Care System
| | - Sarah Speicher
- National Center for PTSD, Division of Dissemination and Training, Veterans Affairs Palo Alto Health Care System
| | - Jessilyn Froelich
- National Center for PTSD, Division of Dissemination and Training, Veterans Affairs Palo Alto Health Care System
| | | | - Annabel Prins
- National Center for PTSD, Division of Dissemination and Training, Veterans Affairs Palo Alto Health Care System
| | - Diana Villasenor
- National Center for PTSD, Division of Dissemination and Training, Veterans Affairs Palo Alto Health Care System
| | - Asha Bauer
- National Center for PTSD, Division of Dissemination and Training, Veterans Affairs Palo Alto Health Care System
| | - Christie Jackson
- National Center for PTSD, Division of Dissemination and Training, Veterans Affairs Palo Alto Health Care System
| | - Laura Fabricant
- Department of Psychiatry and Human Behavior, Brown University
| | - Shannon Wiltsey-Stirman
- National Center for PTSD, Division of Dissemination and Training, Veterans Affairs Palo Alto Health Care System
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Khalifian CE, Titone M, Wooldridge JS, Knopp K, Seibert G, Monson C, Morland L. The role of veterans' PTSD symptoms in veteran couples' insomnia. Fam Process 2023; 62:1725-1739. [PMID: 36347178 DOI: 10.1111/famp.12835] [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] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/14/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
Insomnia contributes to individual mental and physical health and relationship well-being. Veterans' PTSD symptoms are associated with their own insomnia. However, research has not explored whether and how veterans' PTSD symptoms are associated with their partners' insomnia. The present study examined the association between veterans' PTSD symptom severity and veterans' and partners' insomnia. Veterans (n = 192) and their partners (n = 192; total N = 384) completed baseline assessments in a PTSD treatment study for veterans with PTSD and their partners. Path analysis was used to examine the relation between veterans' PTSD symptom severity, as measured by the PTSD symptom checklist-5 (PCL-5) and veterans' and partners' insomnia, as measured by the Insomnia Severity Index (ISI). Veterans' full-scale PCL-5 was positively related to veterans' and partners' insomnia. For veterans, intrusion and arousal symptoms were positively related to their own insomnia severity, while veterans' negative alterations in cognition and mood were associated with partners' insomnia severity. In exploratory analyses, partners' depressive symptoms fully mediated the relation between veterans' negative cognitions and mood and partners' insomnia. PTSD symptoms impact both veterans' and partners' insomnia. However, different PTSD symptom clusters were related to insomnia for each partner, and the link for partners was explained by their own depression symptoms. PTSD, insomnia, and integrated treatments should consider strategies for including partners in treatment to address these interconnected problems.
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Affiliation(s)
- Chandra E Khalifian
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Madison Titone
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Jennalee S Wooldridge
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Kayla Knopp
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Gregory Seibert
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | | | - Leslie Morland
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
- National Center for PTSD -Pacific Islands division, Honolulu, Hawaii, USA
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Crenshaw AO, Whitfield KM, Collins A, Valela R, Varma S, Landy MSH, Ip J, Donkin V, Earle E, Siegel A, Samonas C, Bushe J, Mensah DH, Xiang A, Doss BD, Morland L, Wagner AC, Fitzpatrick S, Monson CM. Partner outcomes from an uncontrolled trial of Couple HOPES: A guided online couple intervention for posttraumatic stress disorder and relationship enhancement. J Trauma Stress 2023; 36:230-238. [PMID: 36116104 DOI: 10.1002/jts.22878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 11/11/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with significant individual and relationship impairment for people with PTSD and their romantic partners. Conjoint treatments, such as cognitive behavioral conjoint therapy for PTSD (CBCT), are designed to address individual and relationship factors, yet significant barriers impede accessing in-person therapy. Couple HOPES (i.e., Helping Overcome PTSD and Enhance Satisfaction) is a coach-guided, online couple intervention for PTSD based on CBCT that was designed to address these barriers. Previous investigations have found preliminary efficacy of Couple HOPES for improving PTSD symptoms, relationship functioning, and some individual functioning domains for the partner with probable PTSD. However, no study to date has tested individual outcomes for romantic partners, which is needed to fully evaluate the intervention's promise. The current study tested these partner outcomes in a combined, uncontrolled sample of 27 couples. Intent-to-intervene analyses found significant improvements at postintervention in four of eight tested outcomes, including ineffective arguing, g = 0.74; anger, g = 0.32; perceived health, g = 0.67; and quality of life, g = 0.56. Depressive symptoms, generalized anxiety, alcohol misuse, and work functioning did not significantly change, gs = 0.17-0.42. Among participants who completed a 1-month follow-up assessment, generalized anxiety, g = 0.43, and perceived health, g = 0.73, significantly improved over follow-up, whereas anger, g = -0.48, lost gains previously made. Results were largely consistent in the completer sample. These findings show the potential of Couple HOPES to have broad benefits not only for individuals with probable PTSD but also for their romantic partners.
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Affiliation(s)
| | | | - Alexis Collins
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | - Robert Valela
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | - Sonya Varma
- Department of Psychology, York University, Toronto, Canada
| | - Meredith S H Landy
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada.,MindBeacon, Toronto, Canada
| | - Jennifer Ip
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | - Victoria Donkin
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada.,Department of Psychology, York University, Toronto, Canada.,MindBeacon, Toronto, Canada
| | | | - Ashley Siegel
- Department of Psychology, York University, Toronto, Canada
| | - Christina Samonas
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | - Julianne Bushe
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | | | - Angela Xiang
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | - Brian D Doss
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Leslie Morland
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Anne C Wagner
- Remedy, 703 Bloor St. W, #201, Toronto, ON, M6G 1L5, Canada
| | | | - Candice M Monson
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
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McLean CP, Wachsman T, Morland L, Norman SB, Hooper V, Cloitre M. The mental health impact of COVID-19-related stressors among treatment-seeking trauma-exposed veterans. J Trauma Stress 2022; 35:1792-1800. [PMID: 36065487 PMCID: PMC9538243 DOI: 10.1002/jts.22874] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 12/24/2022]
Abstract
Trauma-exposed veterans receiving mental health care may have an elevated risk of experiencing COVID-19-related difficulties. Using data from several ongoing clinical trials (N = 458), this study examined exposure to COVID-19-related stressors and their associations with key sociodemographic factors and mental health outcomes. The results showed that exposure to COVID-19-related stressors was common, higher among veterans who were racial/ethnic minorities d = 0.32, and associated with elevated posttraumatic stress disorder (PTSD), r = .288, and depressive symptom severity, r = .246. Women veterans experienced more difficulty accessing social support, d = 0.31, and higher levels of COVID-19-related distress, d = 0.31, than men. Qualitative data were consistent with survey findings and highlighted the broader societal context in veterans' experience of COVID-19-related distress. These findings may inform future research on the impact of the pandemic on veterans, particularly those who are women and members of minoritized racial/ethnic groups, as well as mental health treatment planning for this population.
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Affiliation(s)
- Carmen P. McLean
- Dissemination and Training Division, National Center for PTSDVA Palo Alto Health Care SystemMenlo ParkCalifornia
- Department of Psychiatry and Behavioral Sciences, School of MedicineStanford UniversityStanfordCalifornia
| | | | - Leslie Morland
- VA San Diego Healthcare SystemSan DiegoCalifornia
- National Center for PTSDPacific Islands DivisionHonoluluHawaii
- Department of PsychiatryUniversity of California San Diego School of MedicineSan DiegoCalifornia
| | - Sonya B. Norman
- VA San Diego Healthcare SystemSan DiegoCalifornia
- Department of PsychiatryUniversity of California San Diego School of MedicineSan DiegoCalifornia
- Executive DivisionNational Center for PTSDWhite River JunctionVermont
| | - Vaughan Hooper
- Dissemination and Training Division, National Center for PTSDVA Palo Alto Health Care SystemMenlo ParkCalifornia
| | - Marylene Cloitre
- Dissemination and Training Division, National Center for PTSDVA Palo Alto Health Care SystemMenlo ParkCalifornia
- Department of Psychiatry and Behavioral Sciences, School of MedicineStanford UniversityStanfordCalifornia
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5
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Monson CM, Wagner AC, Crenshaw AO, Whitfield KM, Newnham CM, Valela R, Varma S, Di Bartolomeo AA, Fulham L, Collins A, Donkin V, Mensah DH, Landy MSH, Samonas C, Morland L, Doss BD, Fitzpatrick S. An uncontrolled trial of couple HOPES: A guided online couple intervention for PTSD and relationship enhancement. J Fam Psychol 2022; 36:1036-1042. [PMID: 35266773 DOI: 10.1037/fam0000976] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Novel interventions that overcome limited access to empirically supported psychotherapies for posttraumatic stress disorder (PTSD) are sorely needed. Couple helping overcome PTSD and enhance relationships (HOPES), a guided, online couple intervention drawing from cognitive-behavioral conjoint therapy (CBCT) for PTSD (Monson, 2012), was designed to decrease PTSD symptoms and improve relationship satisfaction. The present study is the first uncontrolled trial of 17 couples in which one partner was a military member, veteran, or first responder and had probable PTSD (PTSD + partner) based on self-report assessment. Intent-to-intervene analyses revealed significant improvements from pre- to postintervention in PTSD + partners' self-reported PTSD symptoms (g = .72), as well as their intimate partner's relationship satisfaction (g = .34) and behavioral accommodation of PTSD symptoms (g = .84). There were also significant improvements in PTSD + partners' depression (g = .43) and perceived relationship arguments (g = .62). There were similar results found in the completer sample. There were no adverse events and high satisfaction with the intervention in those who completed the evaluation. These findings provide additional initial data on the safety, feasibility, and efficacy of Couple HOPES. The similarities of intent-to-intervene and completer results, as well as the need for randomized controlled trial designs to test Couple HOPES, are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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6
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Bredemeier K, Larsen S, Shivakumar G, Grubbs K, McLean C, Tress C, Rosenfield D, DeRubeis R, Xu C, Foa E, Morland L, Pai A, Tsao C, Crawford J, Weitz E, Mayinja L, Feler B, Wachsman T, Lupo M, Hooper V, Cook R, Thase M. A comparison of prolonged exposure therapy, pharmacotherapy, and their combination for PTSD: What works best and for whom; study protocol for a randomized trial. Contemp Clin Trials 2022; 119:106850. [PMID: 35842108 DOI: 10.1016/j.cct.2022.106850] [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] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/22/2022] [Accepted: 07/10/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Several efficacious psychological and pharmacological treatments for posttraumatic stress disorder (PTSD) are available; however, the comparative effectiveness of these treatments represents a major gap in the literature. The proposed study will compare the effectiveness of two leading PTSD treatments - Prolonged Exposure (PE) therapy and pharmacotherapy with paroxetine or venlafaxine extended release - as well as the combination of PE and medication. METHODS In a randomized clinical trial, veterans with PTSD (N = 450) recruited across six Veterans Affairs Medical Centers will complete assessments at baseline, mid-treatment (Week 7), post-treatment (Week 14), and follow-up (Weeks 27 and 40). The primary outcome will be change in (both clinician-rated and self-reported) PTSD severity. Depression symptoms, quality of life, and functioning will also be measured and examined as secondary outcomes. Baseline demographic and clinical data will be used to develop "personalized advantage indices" (PAIs), with the goal of identifying who is most likely to benefit from which treatment. CONCLUSIONS This planned trial will yield findings to directly inform clinical practice guidelines for PTSD, by providing comparative effectiveness data to support recommendations about what can be considered the "first-line" treatment option(s) for PTSD. Further, findings from this trial have the potential to guide treatment planning for individual patients, through implementation of PAIs developed from study data, in service of "personalized medicine." TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04961190.
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Affiliation(s)
- Keith Bredemeier
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Sadie Larsen
- Milwaukee VA Medical Center, 5000 West National Avenue, Milwaukee, WI 53295-1000, USA; Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Geetha Shivakumar
- Dallas VA Medical Center, 4500 South Lancaster Road, Dallas, TX 75216-7167, USA; University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| | - Kathleen Grubbs
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161-0002, USA; University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA.
| | - Carmen McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA; Stanford University, 450 Serra Mall, Stanford, CA 94305, USA.
| | - Carmella Tress
- Coatesville VA Medical Center, 1400 Black Horse Hill Road, Coatesville, PA 19320-2096, USA.
| | - David Rosenfield
- Southern Methodist University, 6425 Boaz Lane, Dallas, TX 75205, USA.
| | - Rob DeRubeis
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Colin Xu
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Edna Foa
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Leslie Morland
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161-0002, USA; University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA.
| | - Anushka Pai
- Dallas VA Medical Center, 4500 South Lancaster Road, Dallas, TX 75216-7167, USA; University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| | - Carol Tsao
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Jaclyn Crawford
- Coatesville VA Medical Center, 1400 Black Horse Hill Road, Coatesville, PA 19320-2096, USA.
| | - Erica Weitz
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Lindiwe Mayinja
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA; Coatesville VA Medical Center, 1400 Black Horse Hill Road, Coatesville, PA 19320-2096, USA.
| | - Bridget Feler
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
| | - Tamara Wachsman
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161-0002, USA.
| | - Margaret Lupo
- Dallas VA Medical Center, 4500 South Lancaster Road, Dallas, TX 75216-7167, USA.
| | - Vaughan Hooper
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA.
| | - Riley Cook
- Dallas VA Medical Center, 4500 South Lancaster Road, Dallas, TX 75216-7167, USA.
| | - Michael Thase
- University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA; Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA.
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7
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McLean CP, Back SE, Capone C, Morland L, Norman SB, Rauch SAM, Schnurr PP, Teng E, Acierno R. The Impact of COVID-19 on Psychotherapy Participation Among Individuals With Posttraumatic Stress Disorder Enrolled in Treatment Research. J Trauma Stress 2022; 35:308-313. [PMID: 34291832 PMCID: PMC8426668 DOI: 10.1002/jts.22718] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/25/2022]
Abstract
The onset of the COVID-19 pandemic disrupted many aspects of daily life and required a rapid and unprecedented shift in psychotherapy delivery from in-person to telemental health. In the present study, we explored the impact of the pandemic on individuals' ability to participate in posttraumatic stress disorder (PTSD) psychotherapy and the association between the impact of COVID-19 impact on health and financial well-being and psychotherapy participation. Participants (N = 161, 63.2% male, Mage = 42.7 years) were United States military veterans (n = 108), active duty military personnel (n = 12), and civilians (n = 6), who were participating in one of nine PTSD treatment trials. The results indicate a predominately negative COVID-19 impact on therapy participation, although some participants (26.1%) found attending therapy sessions through telehealth to be easier than in-person therapy. Most participants (66.7%) reported that completing in vivo exposure homework became harder during the pandemic. Moreover, the impact of the pandemic on PTSD symptom severity and daily stress were each associated with increased difficulty with aspects of therapy participation. The findings highlight the unique challenges to engaging in PTSD treatment during the pandemic as well as a negative impact on daily stress and PTSD severity, both of which were related to treatment engagement difficulties.
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Affiliation(s)
- Carmen P. McLean
- Dissemination and Training Division, National Center for PTSDVA Palo Alto Health Care SystemMenlo ParkCaliforniaUSA,Department of Psychiatry and Behavioral Sciences, School of MedicineStanford UniversityStanfordCaliforniaUSA
| | - Sudie E. Back
- Department of Psychiatry and Behavioral SciencesMedical University of South CarolinaCharlestonSouth CarolinaUSA,Ralph H. Johnson Veterans Affairs Medical CenterCharlestonSouth Carolina
| | - Christy Capone
- Providence VA Medical CenterProvidenceRhode IslandUSA,Department of Psychiatry and Human BehaviorCenter for Alcohol and Addiction StudiesBrown UniversityProvidenceRhode IslandUSA
| | - Leslie Morland
- VA San Diego Healthcare SystemSan DiegoCaliforniaUSA,National Center for PTSD Pacific Islands DivisionHonoluluHawaiiUSA,Department of PsychiatryUniversity of California San Diego School of MedicineSan DiegoCaliforniaUSA
| | - Sonya B. Norman
- VA San Diego Healthcare SystemSan DiegoCaliforniaUSA,Department of PsychiatryUniversity of California San Diego School of MedicineSan DiegoCaliforniaUSA,Executive DivisionNational Center for PTSDWhite River JunctionVermontUSA
| | - Sheila A. M. Rauch
- Health Service LineAtlanta VA Medical CenterAtlantaGeorgiaUSA,Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaGeorgiaUSA
| | - Paula P. Schnurr
- Executive DivisionNational Center for PTSDWhite River JunctionVermontUSA,Geisel School of Medicine at DartmouthHanoverNew HampshireUSA
| | - Ellen Teng
- Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTexasUSA,Michael E. DeBakey VA Medical CenterHoustonTexasUSA
| | - Ron Acierno
- Louis Faillace Department of PsychiatryMcGovern Medical School at UTHealth HoustonHoustonTexas
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8
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Siddiqui Z, Morland L, Speakman S, Birley R, Hughes K. 742 Transurethral LASER Ablation (TULA): A Safe and Well Tolerated Procedure for The Treatment of Bladder Tumours Up To 4cm In Diameter in An Outpatient Setting. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
Traditionally the management of recurrent non-muscle invasive bladder cancer (NMIBC) involves rigid cystoscopy and bladder biopsies/tumour resection under general/regional anaesthesia. As a result, many frail patients endure frequent anaesthetics and therefore are at increased risk of adverse outcomes including cognitive decline. Discontinuation of anti-platelet/anti-coagulation is not required for TULA. An outpatient TULA service was recently started at our trust. We present a case series of our first 4 months data.
Method
All TULA cases (n = 39) performed between Aug-Dec 2020 were included. Data was gathered prospectively including patient demographics, co-morbidities, initial cancer diagnosis and number of subsequent recurrences, post-procedural complications, and patient procedural satisfaction.
Results
Median age was 82 years (range 34-96) and median number of co-morbidities were 4 (range 0-10). Previous bladder cancer diagnosis was present for 85% with the most common initial stage G2pTa (n = 11). Median number of recurrences was 1 (range 1-5). Median patient perceived pain score was 3 (range 1-7) with 100% of patients preferring TULA over TURBT. Reasons included reduced procedural time (n = 18) and enhanced recovery (n = 15). Only 1 patient was readmitted post-procedure due to haematuria, however urine was clear after catheterisation and the patient was discharged.
Conclusions
TULA is safe for all low risk NMIBC, particularly for frail patients. It is well tolerated and facilitates improved patient experience. It also alleviates demand on theatre capacity and inpatient beds which has a positive effect on surgical waiting lists. Further audit of clinical outcomes should continue as recommended by NICE.
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Affiliation(s)
- Z Siddiqui
- St Helens & Knowsley NHS Trust, St Helens, United Kingdom
| | - L Morland
- St Helens & Knowsley NHS Trust, St Helens, United Kingdom
| | - S Speakman
- St Helens & Knowsley NHS Trust, St Helens, United Kingdom
| | - R Birley
- St Helens & Knowsley NHS Trust, St Helens, United Kingdom
| | - K Hughes
- St Helens & Knowsley NHS Trust, St Helens, United Kingdom
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9
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Fitzpatrick S, Wagner AC, Crenshaw AO, Varma S, Whitfield KM, Valela R, Di Bartolomeo AA, Fulham L, Martin-Newnham C, Mensah DH, Collins A, Landy MS, Morland L, Doss BD, Monson CM. Initial outcomes of couple HOPES: A guided online couple intervention for PTSD and relationship enhancement. Internet Interv 2021; 25:100423. [PMID: 34401382 PMCID: PMC8350611 DOI: 10.1016/j.invent.2021.100423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 12/30/2022] Open
Abstract
Couple HOPES (Helping Overcome PTSD and Enhance Satisfaction) is a guided, online couple intervention adapted from Cognitive-Behavioral Conjoint Therapy for posttraumatic stress disorder (PTSD). It was created to overcome a range of barriers to accessing evidence-based treatments for PTSD and the intimate relationship problems associated with it. This manuscript describes initial outcomes of the intervention in a series of 10 couples. Participants were military, veteran and first responders with probable PTSD and their intimate partners. Couples completed the program and measurements of PTSD, relationship satisfaction, and secondary outcomes at pre-, mid-, and post-intervention. Mean satisfaction for the program was high and it was completed by seven of ten couples. Participants with PTSD evidenced significant and large pre- to post-intervention effect size improvements in PTSD symptoms (g = 0.80) and perceived health (g = 1.13). They also exhibited non-significant but medium effect size pre- to post-intervention improvements in quality of life (g = 0.62), and depression (g = 0.53), and small effect size pre- to post-intervention improvements in argumentativeness (g = 0.43), anger (g = 0.31), and anxiety (g = 0.31). Partners reported significant and moderate pre- to post-intervention effect size improvements in relationship satisfaction (g = 0.68), and medium but not significant effect size improvements in accommodation of PTSD (g = 0.56). Results provide initial support for the feasibility, acceptability, and efficacy of Couple HOPES for improving PTSD and relationship satisfaction. However, more testing in larger samples, including with randomized controlled designs, is needed.
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Affiliation(s)
- Skye Fitzpatrick
- Department of Psychology, York University, 4700 Keele St., Toronto, ON M3J 1P3, Canada,Corresponding author at: Department of Psychology, York University, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada.
| | - Anne C. Wagner
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada,Remedy, 703 Bloor St. W, #201, Toronto, ON M6G 1L5, Canada
| | - Alexander O. Crenshaw
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
| | - Sonya Varma
- Department of Psychology, York University, 4700 Keele St., Toronto, ON M3J 1P3, Canada
| | - Kristen M. Whitfield
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
| | - Robert Valela
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
| | | | - Lindsay Fulham
- Department of Psychology, York University, 4700 Keele St., Toronto, ON M3J 1P3, Canada
| | - Cait Martin-Newnham
- Department of Psychology, York University, 4700 Keele St., Toronto, ON M3J 1P3, Canada
| | - Desiree H. Mensah
- Department of Psychology, York University, 4700 Keele St., Toronto, ON M3J 1P3, Canada
| | - Alexis Collins
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
| | - Meredith S.H. Landy
- Remedy, 703 Bloor St. W, #201, Toronto, ON M6G 1L5, Canada,MindBeacon, 175 Bloor St. E., Toronto, ON M4W 358, Canada
| | - Leslie Morland
- VA San Diego Healthcare System, San Diego, CA, USA and University of California San Diego, La Jolla, 3350 La Jolla Village Dr., San Diego, CA 92161, United States of America
| | - Brian D. Doss
- University of Miami, 1320 S Dixie Hwy, Coral Gables, FL, 33146, United States of America
| | - Candice M. Monson
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
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10
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Monson CM, Fitzpatrick S, Wagner AC, Valela R, Whitfield KM, Varma S, Landy MSH, Di Bartolomeo A, Crenshaw AO, Fulham L, Morland L, Knopp K, Proctor DW, Toller A, Webster K, Doss BD. The development of Couple HOPES: a guided online intervention for PTSD and relationship satisfaction enhancement. Eur J Psychotraumatol 2021; 12:1917879. [PMID: 34104350 PMCID: PMC8158260 DOI: 10.1080/20008198.2021.1917879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: Couple HOPES (Helping Overcome PTSD and Enhance Satisfaction) was created to help overcome a range of barriers to accessing psychotherapy for posttraumatic stress disorder (PTSD) and commonly associated intimate relationship problems. Objective: Couple HOPES is a guided, online self-help intervention adapted from Cognitive-Behavioural Conjoint Therapy for PTSD that aims to improve PTSD and enhance relationship satisfaction. Method/Results: This paper describes the processes and principles used to develop the Couple HOPES intervention platform as well as the coaching model and manual used to promote engagement and adherence to the intervention. Conclusions: Current research and future directions in testing Couple HOPES are outlined.
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Affiliation(s)
- Candice M Monson
- Psychology Department, Ryerson University, Toronto, Ontario, Canada
| | - Skye Fitzpatrick
- Psychology Department, York University, Toronto, Ontario, Canada
| | - Anne C Wagner
- Psychology Department, Ryerson University, Toronto, Ontario, Canada.,Psychology Department, Remedy, Toronto, Ontario, Canada
| | - Robert Valela
- Psychology Department, Ryerson University, Toronto, Ontario, Canada
| | | | - Sonya Varma
- Psychology Department, York University, Toronto, Ontario, Canada
| | | | | | | | - Lindsay Fulham
- Psychology Department, York University, Toronto, Ontario, Canada
| | - Leslie Morland
- Psychology Department, VA San Diego Healthcare System, San Diego, CA, USA.,Psychology Department, University of California San Diego, La Jolla, CA, USA
| | - Kayla Knopp
- Psychology Department, VA San Diego Healthcare System, San Diego, CA, USA.,Psychology Department, University of California San Diego, La Jolla, CA, USA
| | | | - Alec Toller
- Circlesnake Productions, Toronto, Ontario, Canada
| | - Katelyn Webster
- Psychology Department, VA San Diego Healthcare System, San Diego, CA, USA.,Psychology Department, University of California San Diego, La Jolla, CA, USA
| | - Brian D Doss
- Psychology Department, University of Miami, Miami, FL, USA
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11
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Wooldridge JS, Bosch J, Crawford JN, Morland L, Afari N. Relationships among adverse childhood experiences, posttraumatic stress disorder symptom clusters, and health in women veterans. Stress Health 2020; 36:596-605. [PMID: 32369234 DOI: 10.1002/smi.2953] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 04/17/2020] [Accepted: 04/24/2020] [Indexed: 11/08/2022]
Abstract
Adverse childhood experiences (ACEs) increase risk for negative health outcomes. The goal of this study was to examine the relationships among cumulative ACEs, ACEs type, posttraumatic stress disorder (PTSD) symptoms, PTSD symptom clusters, and physical health symptoms in a sample of women veterans (N = 76). Bivariate correlations were used to determine which ACE domains were associated with PTSD and physical health symptoms. Follow-up linear regressions indicated cumulative ACEs were significantly associated with total PTSD symptoms. Cumulative ACEs were also significantly associated with the avoidance and hyperarousal symptom clusters, but not the re-experiencing symptom cluster. Total PTSD symptoms were significantly related to physical health symptoms. Of the three symptom clusters, only hyperarousal was significantly associated with physical health symptoms. Cross-sectional mediation analyses indicated the total and direct effects of ACEs on physical health were not significant. However, the indirect effect through PTSD was significant (b = 0.46, [95% CI: 0.02, 0.91]), as well as through the avoidance (b = 0.47, [95% CI: 0.06, 0.90]), and hyperarousal symptom clusters (b = 0.56, [95% CI: 0.11, 1.04]). This study highlights the potential impact of ACEs on PTSD symptoms and physical health and suggests that hyperarousal symptoms of PTSD, may play a potential role in the development of physical health problems.
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Affiliation(s)
- Jennalee S Wooldridge
- VA San Diego Healthcare System, San Diego, California, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Jeane Bosch
- VA San Diego Healthcare System, San Diego, California, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Jennifer N Crawford
- VA San Diego Healthcare System, San Diego, California, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Leslie Morland
- VA San Diego Healthcare System, San Diego, California, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, California, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, San Diego, California, USA
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12
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Skumlien S, Haave E, Morland L, Bjørtuft O, Ryg MS. Gender differences in the performance of activities of daily living among patients with chronic obstructive pulmonary disease. Chron Respir Dis 2016; 3:141-8. [PMID: 16916008 DOI: 10.1191/1479972306cd114oa] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 11/05/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) limits the ability to perform activities of daily living (ADL). The Pulmonary Functional Status and Dyspnoea Questionnaire (PFSDQ) measures general dyspnoea, dyspnoea during ADL (dyspnoea score) and loss of functional performance (activity score) for a large number of activities commonly performed by adults. The questionnaire is only validated for male patients. The aim of our study was therefore to validate the PFSDQ for women with COPD. We then wanted to investigate possible gender differences in responses to the PFSDQ and whether associations between the PFSDQ and pulmonary function, exercise capacity, health related quality of life (HRQoL) and general quality of life (QoL) were influenced by gender. This cross-sectional, observational study included 110 COPD patients. Sixty-five men and 45 women, referred to pulmonary rehabilitation participated. Pulmonary function and six-minute walking distance (6MWD) were measured. Patients completed PFSDQ, St George’s Respiratory Questionnaire (SGRQ, HRQoL) and Perceived Quality of Life Scale (PQoL, QoL). No gender differences were found in pulmonary function (% of predicted), 6MWD, SGRQ or PQoL. Most items in the PFSDQ were found relevant by both women and men. Activity Scores were only different for men and women for items concerning home management; women had changed their functional performance the most, particularly for the heaviest chores. No gender differences were found in dyspnoea scores. Moderate correlations were found between PFSDQ and 6MWD, SGRQ and PQoL. Multiple linear regression analyses showed that these relations were not influenced by gender. We consider PFSDQ as applicable to women as to men as a comprehensive measure of functional performance and dyspnoea. The questionnaire gives information complementary to measures of exercise capacity, HRQOL and QOL. The larger loss of functional performance in home management among women should be taken into account in the treatment of COPD patients.
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13
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Williams K, Kern S, Thorp SR, Paulus M, Shah N, Morland L, Hauser P. VISN 22 Evidenced-Based Psychotherapy Telemental Health Center and Regional Pilot. Fed Pract 2015; 32:32-39. [PMID: 30766076 PMCID: PMC6363295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A pilot program that delivers telemental health care for posttraumatic stress disorder provides best practices for facilities looking to expand in-home and remote care to veterans.
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Affiliation(s)
- Kathryn Williams
- is the associate director of VISN 22 Evidenced-Based Telemental Health Center; is a research psychologist; was the past director of VISN 22 Evidence-Based Telemental Health Center; is the director of Telehealth; and is the current director of VISN 22 Evidence-Based Telemental Health Center, all at the VA San Diego Healthcare System in California. is a research assistant and is a research psychiatrist, both at the Long Beach VA Healthcare System in California. Dr. Hauser is a clinical professor at the University of California's San Diego and Irvine campuses and mental health care services lead at the VISN 22 office in Long Beach. Dr. Thorp is an associate professor; Dr. Paulus is a professor; and Dr. Shah is an assistant professor, all also at the University of California, San Diego. Dr. Thorp is a research psychologist at the Center of Excellence for Stress and Mental Health in San Diego
| | - Shira Kern
- is the associate director of VISN 22 Evidenced-Based Telemental Health Center; is a research psychologist; was the past director of VISN 22 Evidence-Based Telemental Health Center; is the director of Telehealth; and is the current director of VISN 22 Evidence-Based Telemental Health Center, all at the VA San Diego Healthcare System in California. is a research assistant and is a research psychiatrist, both at the Long Beach VA Healthcare System in California. Dr. Hauser is a clinical professor at the University of California's San Diego and Irvine campuses and mental health care services lead at the VISN 22 office in Long Beach. Dr. Thorp is an associate professor; Dr. Paulus is a professor; and Dr. Shah is an assistant professor, all also at the University of California, San Diego. Dr. Thorp is a research psychologist at the Center of Excellence for Stress and Mental Health in San Diego
| | - Steven R Thorp
- is the associate director of VISN 22 Evidenced-Based Telemental Health Center; is a research psychologist; was the past director of VISN 22 Evidence-Based Telemental Health Center; is the director of Telehealth; and is the current director of VISN 22 Evidence-Based Telemental Health Center, all at the VA San Diego Healthcare System in California. is a research assistant and is a research psychiatrist, both at the Long Beach VA Healthcare System in California. Dr. Hauser is a clinical professor at the University of California's San Diego and Irvine campuses and mental health care services lead at the VISN 22 office in Long Beach. Dr. Thorp is an associate professor; Dr. Paulus is a professor; and Dr. Shah is an assistant professor, all also at the University of California, San Diego. Dr. Thorp is a research psychologist at the Center of Excellence for Stress and Mental Health in San Diego
| | - Martin Paulus
- is the associate director of VISN 22 Evidenced-Based Telemental Health Center; is a research psychologist; was the past director of VISN 22 Evidence-Based Telemental Health Center; is the director of Telehealth; and is the current director of VISN 22 Evidence-Based Telemental Health Center, all at the VA San Diego Healthcare System in California. is a research assistant and is a research psychiatrist, both at the Long Beach VA Healthcare System in California. Dr. Hauser is a clinical professor at the University of California's San Diego and Irvine campuses and mental health care services lead at the VISN 22 office in Long Beach. Dr. Thorp is an associate professor; Dr. Paulus is a professor; and Dr. Shah is an assistant professor, all also at the University of California, San Diego. Dr. Thorp is a research psychologist at the Center of Excellence for Stress and Mental Health in San Diego
| | - Nilesh Shah
- is the associate director of VISN 22 Evidenced-Based Telemental Health Center; is a research psychologist; was the past director of VISN 22 Evidence-Based Telemental Health Center; is the director of Telehealth; and is the current director of VISN 22 Evidence-Based Telemental Health Center, all at the VA San Diego Healthcare System in California. is a research assistant and is a research psychiatrist, both at the Long Beach VA Healthcare System in California. Dr. Hauser is a clinical professor at the University of California's San Diego and Irvine campuses and mental health care services lead at the VISN 22 office in Long Beach. Dr. Thorp is an associate professor; Dr. Paulus is a professor; and Dr. Shah is an assistant professor, all also at the University of California, San Diego. Dr. Thorp is a research psychologist at the Center of Excellence for Stress and Mental Health in San Diego
| | - Leslie Morland
- is the associate director of VISN 22 Evidenced-Based Telemental Health Center; is a research psychologist; was the past director of VISN 22 Evidence-Based Telemental Health Center; is the director of Telehealth; and is the current director of VISN 22 Evidence-Based Telemental Health Center, all at the VA San Diego Healthcare System in California. is a research assistant and is a research psychiatrist, both at the Long Beach VA Healthcare System in California. Dr. Hauser is a clinical professor at the University of California's San Diego and Irvine campuses and mental health care services lead at the VISN 22 office in Long Beach. Dr. Thorp is an associate professor; Dr. Paulus is a professor; and Dr. Shah is an assistant professor, all also at the University of California, San Diego. Dr. Thorp is a research psychologist at the Center of Excellence for Stress and Mental Health in San Diego
| | - Peter Hauser
- is the associate director of VISN 22 Evidenced-Based Telemental Health Center; is a research psychologist; was the past director of VISN 22 Evidence-Based Telemental Health Center; is the director of Telehealth; and is the current director of VISN 22 Evidence-Based Telemental Health Center, all at the VA San Diego Healthcare System in California. is a research assistant and is a research psychiatrist, both at the Long Beach VA Healthcare System in California. Dr. Hauser is a clinical professor at the University of California's San Diego and Irvine campuses and mental health care services lead at the VISN 22 office in Long Beach. Dr. Thorp is an associate professor; Dr. Paulus is a professor; and Dr. Shah is an assistant professor, all also at the University of California, San Diego. Dr. Thorp is a research psychologist at the Center of Excellence for Stress and Mental Health in San Diego
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14
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Whealin JM, Stotzer RL, Pietrzak RH, Vogt D, Shore J, Morland L, Southwick SM. Deployment-related sequelae and treatment utilization in rural and urban war veterans in Hawaii. Psychol Serv 2013; 11:114-123. [PMID: 24099457 DOI: 10.1037/a0032782] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study compared common deployment-related health issues and correlates of mental health service utilization among rural and urban veterans of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) living in Hawaii. Frequency of utilization of a broad range of mental health resources, including clergy/spiritual leaders, videoconference/online programs, and traditional/alternative healers, was also characterized. A random sample of 116 rural and 117 urban ethnoracially diverse veterans completed a mail survey. Rural veterans were more likely than urban veterans to meet screening criteria for posttraumatic stress disorder (PTSD), deployment-related concussion with persistent postconcussive symptoms, and alcohol use problems. Over one third of veterans who desired help for a mental health problem reported no current use of any services. Rural veterans were more likely than urban veterans to have accessed Veteran Readjustment Centers, but they did not differ with respect to utilization of other services. Correlates of mental health service utilization included higher education, PTSD, and lower mental-health-related quality of life. Results of this study underscore the need for dissemination efforts to enable OEF/OIF/OND veterans to access mental health resources.
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Affiliation(s)
- Julia M Whealin
- National Center for Posttraumatic Stress Disorder, Pacific Islands Division, VA Pacific Island Health Care System
| | | | - Robert H Pietrzak
- National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Pacific Island Health Care System
| | - Dawne Vogt
- Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System
| | - Jay Shore
- Native Domain, Department of Veterans Affairs Office of Rural Veterans Rural Health Resource Center-Western Region
| | - Leslie Morland
- National Center for Posttraumatic Stress Disorder, Pacific Islands Division, VA Pacific Island Health Care System
| | - Steven M Southwick
- National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System
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15
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Abstract
Few studies have investigated the impact of deployment stressors on the mental health outcomes of women deployed to Iraq in support of Operation Iraqi Freedom. This pilot study examined exposure to combat experiences and military sexual harassment in a sample of 54 active duty women and assessed the impact of these stressors on post-deployment posttraumatic stress disorder (PTSD) symptoms and depressive symptoms. Within 3 months of returning from deployment to Iraq, participants completed (a) the Combat Experiences Scale and the Sexual Harassment Scale of the Deployment Risk and Resilience Inventory, (b) the Primary Care PTSD Screen, and (c) an abbreviated version of the Center for Epidemiological Studies-Depression scale. Approximately three quarters of the sample endorsed exposure to combat experiences, and more than half of the sample reported experiencing deployment-related sexual harassment, with nearly half of the sample endorsing both stressors. Approximately one third of the sample endorsed clinical or subclinical levels of PTSD symptoms, with 11% screening positive for PTSD and 9% to 14% of the sample endorsing depressive symptoms. Regression analyses revealed that combat experiences and sexual harassment jointly accounted for significant variance in post-deployment PTSD symptoms, whereas military sexual harassment was identified as the only unique significant predictor of these symptoms. Findings from the present study lend support to research demonstrating that military sexual trauma may be more highly associated with post-deployment PTSD symptoms than combat exposure among female service members and veterans.
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Affiliation(s)
- Lissa Dutra
- Tripler Army Medical Center and the National Center forPosttraumatic Stress Disorder, Pacific Islands Division, Pacific Islands VA Health Care System, Honolulu, Hawaii, USA.
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16
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Morland L, Goebert D, Onoye J, Frattarelli L, Derauf C, Herbst M, Matsu C, Friedman M. Posttraumatic Stress Disorder and Pregnancy Health: Preliminary Update and Implications. Psychosomatics 2007; 48:304-8. [PMID: 17600166 DOI: 10.1176/appi.psy.48.4.304] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Posttraumatic stress disorder (PTSD) is pervasive among women of childbearing age. The cascade of behavioral health and neuroendocrine changes commonly associated with PTSD may adversely affect perinatal health. The authors examined the relationship between PTSD and perinatal health in a sample of 101 women seeking prenatal care on the island of Oahu, Hawaii. Trauma, PTSD, and psychological and behavioral health were assessed during prenatal care. Pregnancy health, labor and delivery information, and birth outcomes were abstracted from medical records post-partum. Findings suggest that women with PTSD entering pregnancy are at increased risk for engaging in high-risk health behaviors, such as smoking, alcohol consumption, substance use, poor prenatal care, and excessive weight gain. Authors discuss clinical and research implications.
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Affiliation(s)
- Leslie Morland
- Department of Psychiatry, John A. Burns School of Medicine, University of Hawai'i at Manoa. leslie.morland@va
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17
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Goebert D, Morland L, Frattarelli L, Onoye J, Matsu C. Mental health during pregnancy: a study comparing Asian, Caucasian and Native Hawaiian women. Matern Child Health J 2006; 11:249-55. [PMID: 17111218 DOI: 10.1007/s10995-006-0165-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [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] [Received: 12/30/2005] [Accepted: 10/23/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study examines perinatal mental health issues, ethnic differences, and comorbidity among pregnant women in Hawaii. METHODS Eighty-four participants were recruited from women, ages 18-35, seeking prenatal care on Oahu. They were interviewed at their initial prenatal visit about substance use, depression, and anxiety. RESULTS Sixty-one percent of women screened positive for at least one mental health issue. Thirteen percent of all pregnant women reported drinking during pregnancy with 5% reporting problem drinking, 15% reported smoking cigarettes on a regular basis, 5% of pregnant women had probable depression, and 13% of pregnant women had probable anxiety. Significant ethnic differences were found in cigarette smoking, with the highest rate among Native Hawaiian women (35%). Native Hawaiian women were also more likely to binge drink. CONCLUSION Given the high rates of potential mental health issues in our sample, our findings highlight the importance of screening and treatment for mental health issues early in pregnancy in Hawaii.
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Affiliation(s)
- Deborah Goebert
- Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii, 1356 Lusitana Street, 4th Floor, Honolulu, Hawaii 96813, USA.
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18
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Margolin G, Oliver PH, Gordis EB, O'Hearn HG, Medina AM, Ghosh CM, Morland L. The nuts and bolts of behavioral observation of marital and family interaction. Clin Child Fam Psychol Rev 1998; 1:195-213. [PMID: 11324091 DOI: 10.1023/a:1022608117322] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.0] [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: 11/12/2022]
Abstract
Despite considerable discussion in the literature about the advantages of observational research and the relative benefits of different coding systems and strategies, little is written about the actual implementation of this assessment strategy. This paper presents an overall framework as well as the essential components involved in collecting (selection of task, setting, unit of analysis, and coding system) and coding (transcribing, selecting and training coders, transforming data, and analyzing reliability) of observational data. To achieve success with observational methods, we emphasize several issues, including (a) the research question as the motivator for all decisions, (b) the interrelatedness of tasks, and (c) the implications of decisions early in the process for later stages of analysis and interpretation. Investigators are encouraged to communicate the details of their observational and coding procedures so that these methods are readily accessible for purposes of replication and comparison.
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Affiliation(s)
- G Margolin
- Department of Psychology, University of Southern California, Los Angeles, California 90089, USA.
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19
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Morland L. [A 10-year tuberculosis case load. Symptoms, clinical findings and laboratory data of patients in Glittre Sanatorium]. Tidsskr Nor Laegeforen 1990; 110:3605-8. [PMID: 2260056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
This article presents retrospective data from a ten-year material consisting of 426 patients with tuberculosis. There was a large difference in age between Norwegian and foreign patients. Median duration of symptoms before treatment was 15 weeks. The most common extrapulmonary form was lymph node tuberculosis, with a striking overpercentage of females. General symptoms were more common among patients with pulmonary tuberculosis than among patients with extrapulmonary forms. In 43% of the patients with pulmonary tuberculosis no abnormal signs were registered by auscultation. Febrile patients became quickly afebrile after start of treatment. 83% of the patients were tb culture-positive. 9.5% of the isolates tested for resistance showed reduced sensitivity to one or more antituberculous drugs. Chest x-ray manifestations were more common in the right than in the left lung. Older people are the main source of tuberculosis in Norway. One should be particularly aware of this diagnosis in immigrants from the Third World.
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20
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Morland L. [Treatment of tuberculosis. Drug combinations, therapeutic problems and results in a 10-year case load]. Tidsskr Nor Laegeforen 1990; 110:3608-11. [PMID: 2260057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The article describes the treatment of tuberculosis in 426 patients over a period of ten years. The length of treatment decreased during the period. The standard treatment was isoniazide and rifampicin, usually with initial administration of pyrazinamide. In pulmonary tuberculosis (n = 334) the median bacteriologic conversion time was five weeks. In 69 patients the medical regimen had to be changed because of side effects. Of the primary antituberculous drugs, isoniazide was the one producing the highest frequency of side effects. 31 patients showed lowered sensitivity to the usual antituberculous drugs and were treated with varying combinations of second line drugs. In two cases surgery was necessary in order to achieve bacteriologic conversion. Ten patients died of tuberculosis in spite of treatment. Five patients with pulmonary tuberculosis suffered a relapse after treatment. No relapse was noted among patients with extrapulmonary tuberculosis. There were large differences between the different pulmonary treatment centres in Eastern Norway as regards how they practised the Norwegian control routines.
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