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Kinney AR, Brenner LA, Nance M, Mignogna J, Cobb AD, Forster JE, Ulmer CS, Nakase-Richardson R, Bahraini NH. Factors influencing shared decision-making for insomnia and obstructive sleep apnea treatment among Veterans with mild traumatic brain injury. J Clin Sleep Med 2024; 20:801-812. [PMID: 38189353 PMCID: PMC11063707 DOI: 10.5664/jcsm.10994] [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: 06/29/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/09/2024]
Abstract
STUDY OBJECTIVES We elicited perspectives of clinical stakeholders and Veterans regarding barriers and facilitators to implementing shared decision-making (SDM) for comorbid mild traumatic brain injury (mTBI) and sleep disorders in the Veterans Health Administration. We also compared the perspectives of clinical stakeholders and Veterans regarding determinants of SDM. METHODS Semistructured interviews were conducted with 29 clinical stakeholders and 20 Veterans (n = 49). Clinical stakeholders included Veterans Health Administration providers and policymakers involved in the management of mTBI and/or sleep disorders (insomnia disorder, obstructive sleep apnea). Veterans included those with a clinician-confirmed mTBI who received care for insomnia disorder and/or obstructive sleep apnea within the past year. Themes were identified using a descriptive and interpretive approach to qualitative analysis. We compared results across clinical stakeholders and Veterans. RESULTS Barriers to implementing SDM were identified by both groups at the patient (eg, mTBI sequalae), provider (eg, deprioritization of Veteran preferences), encounter (eg, time constraints), and facility levels (eg, reduced care access). Similarly, both groups identified facilitators at the patient (eg, enhanced trust), provider (eg, effective communication), encounter (eg, decision support), and facility levels (eg, mitigating access barriers). Integrated services and provider discontinuity were factors identified by clinical stakeholders and Veterans alone, respectively. CONCLUSIONS Our study revealed factors shaping the implementation of SDM at the levels of the patient, provider, encounter, and facility. Findings can inform the development of strategies aimed at implementing SDM for comorbid mTBI and sleep disorders, promoting patient-centered care and enhancing clinical outcomes. CITATION Kinney AR, Brenner LA, Nance M, et al. Factors influencing shared decision-making for insomnia and obstructive sleep apnea treatment among Veterans with mild traumatic brain injury. J Clin Sleep Med. 2024;20(5):801-812.
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Affiliation(s)
- Adam R. Kinney
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
- University of Colorado, Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Aurora, Colorado
| | - Lisa A. Brenner
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
- University of Colorado, Anschutz Medical Campus, Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, Aurora, Colorado
| | - Morgan Nance
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
- University of Colorado, Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Aurora, Colorado
| | - Joseph Mignogna
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
| | - Audrey D. Cobb
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
| | - Jeri E. Forster
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
- University of Colorado, Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Aurora, Colorado
| | - Christi S. Ulmer
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs, Durham, North Carolina
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Risa Nakase-Richardson
- Research Service, James A. Haley Veterans Hospital, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of South Florida, Tampa, Florida
| | - Nazanin H. Bahraini
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
- University of Colorado, Anschutz Medical Campus, Departments of Physical Medicine and Rehabilitation and Psychiatry, Aurora, Colorado
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Brostow DP, Smith AA, Bahraini NH, Besterman-Dahan K, Forster JE, Brenner LA. Nutrition and Food Security among Veterans: Operationalizing 'Nutritional Functioning'. Arch Phys Med Rehabil 2024:S0003-9993(24)00948-1. [PMID: 38649010 DOI: 10.1016/j.apmr.2024.04.006] [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] [Received: 05/05/2023] [Revised: 04/03/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To assess injured military veterans' experiences, beliefs and daily physical and psychosocial functioning in relation to food and nutrition. DESIGN We used a convergent mixed-methods study design, and the International Classification of Functioning, Disability and Health to operationalize the core constructs and influencing factors related to physical and psychosocial functioning, and food and nutrition. SETTING Three Veterans Affairs Polytrauma Rehabilitation Centers. PARTICIPANTS Veterans who served in the United States military on or after September 11th, 2001, and whose medical diagnoses met the criteria for polytrauma; at least one mild traumatic brain injury, and at least one associated comorbidity (e.g., post-traumatic stress disorder, chronic musculoskeletal pain, vestibular disturbances). INTERVENTION None MAIN OUTCOME MEASURES: Themes from survey responses and semi-structured interview data were pooled into core constructs, and influencing factors. RESULTS 37 veterans completed all surveys and participated in recorded interviews. Based on qualitative and quantitative data, veterans' relation to food and nutrition (i.e., nutritional functioning) was found to be characterized by 5 core constructs, including food background, nutrition knowledge, meal aptitude, resource navigation, and navigation to/of food spaces. Nutritional functioning was found to be shaped by 5 influencing factors, including injuries and health conditions, ideological and cultural exposures, relationships, and current beliefs and behaviors. CONCLUSIONS Nutritional functioning (food background, nutrition knowledge, meal aptitude, resource navigation, and navigation to/of food spaces) among injured veterans is complex, and shaped by multiple physical, psychosocial, economic, and cultural factors.
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Affiliation(s)
- Diana P Brostow
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical, Campus, Aurora, CO, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Alexandra A Smith
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA
| | - Nazanin H Bahraini
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical, Campus, Aurora, CO, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Karen Besterman-Dahan
- VA VISN 5 Mental Illness Research Education and Clinical Center (MIRECC); Department of Nutrition and Dietetics, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Jeri E Forster
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical, Campus, Aurora, CO, USA
| | - Lisa A Brenner
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical, Campus, Aurora, CO, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Sullan MJ, Kinney AR, Stearns-Yoder KA, Reis DJ, Saldyt EG, Forster JE, Cogan CM, Bahraini NH, Brenner LA. A randomized clinical trial for a self-guided sleep intervention following moderate-severe traumatic brain injury: Study protocol. Contemp Clin Trials 2024; 141:107525. [PMID: 38604497 DOI: 10.1016/j.cct.2024.107525] [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] [Received: 05/08/2023] [Revised: 11/10/2023] [Accepted: 04/08/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Individuals with a history of moderate-severe traumatic brain injury (TBI) experience a significantly higher prevalence of insomnia compared to the general population. While individuals living with TBI have been shown to benefit from traditional insomnia interventions (e.g., face-to-face [F2F]), such as Cognitive Behavioral Therapy for Insomnia (CBTI), many barriers exist that limit access to F2F evidence-based treatments. Although computerized CBT-I (CCBT-I) is efficacious in terms of reducing insomnia symptoms, individuals with moderate-severe TBI may require support to engage in such treatment. Here we describe the rationale, design, and methods of a randomized controlled trial (RCT) assessing the efficacy of a guided CCBT-I program for reducing insomnia symptoms for participants with a history of moderate-severe TBI. METHODS This is an RCT of a guided CCBT-I intervention for individuals with a history of moderate-severe TBI and insomnia. The primary outcome is self-reported insomnia severity, pre- to post-intervention. Exploratory outcomes include changes in sleep misperception following CCBT-I and describing the nature of guidance needed by the Study Clinician during the intervention. CONCLUSION This study represents an innovative approach to facilitating broader engagement with an evidence-based online treatment for insomnia among those with a history of moderate-severe TBI. Findings will provide evidence for the level and nature of support needed to implement guided CCBT-I. Should findings be positive, this study would provide support for a strategy by which to deliver guided CCBT-I to individuals with a history of moderate-severe TBI.
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Affiliation(s)
- Molly J Sullan
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Adam R Kinney
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kelly A Stearns-Yoder
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Daniel J Reis
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Emerald G Saldyt
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jeri E Forster
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Chelsea M Cogan
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Nazanin H Bahraini
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lisa A Brenner
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
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Reis DJ, Schneider AL, King SE, Forster JE, Bahraini NH. Delivery of bright light therapy within the Veterans Health Administration. J Affect Disord 2024; 349:1-7. [PMID: 38154586 DOI: 10.1016/j.jad.2023.12.049] [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: 07/13/2023] [Revised: 11/28/2023] [Accepted: 12/23/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Bright light therapy (BLT) is efficacious for seasonal and non-seasonal depression. However, the current state of BLT use in practice is unknown, impeding efforts to identify and address utilization gaps. This study's objective was to investigate BLT delivery in a nationwide U.S. healthcare system. METHODS This was a retrospective observational study of electronic medical records from all veterans who received outpatient mood disorder-related care in the Veterans Health Administration (VHA) from October 2008 through September 2020. BLT delivery was measured through the placement of light box consults. RESULTS Of the 3,442,826 veterans who received outpatient mood disorder care, only 57,908 (1.68 %) received a light box consult. Consults increased by 548.44 % (99.9 % credible interval: 467.36 %, 638.74 %) over the timeframe and displayed a robust yearly cycle that peaked on either December 21st or December 22nd. Past mental health treatment for a mood disorder was associated with a higher probability of a consult (relative risk = 4.79, 99.9 % CI: 4.21, 5.60). There was low representation related to veteran age, gender, race, and ethnicity. LIMITATIONS No information on patients who declined light boxes or actual light box use following consult placement. CONCLUSIONS Outpatient BLT delivery for mood disorders in the VHA remains low, despite significant growth over the past decade. It also displays a strong seasonal rhythm that peaks on the winter solstice, suggesting a limited focus on seasonal depression and a suboptimal reactive approach to changing sunlight. Overall, there exists ample opportunity for novel implementation efforts aimed at increasing utilization of BLT.
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Affiliation(s)
- Daniel J Reis
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Alexandra L Schneider
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA
| | - Samuel E King
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA
| | - Jeri E Forster
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nazanin H Bahraini
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Newell S, Rynerson A, Gade P, Bahraini NH, Denneson LM, Dobscha SK. What Now?: Experiences of VHA patients following disclosure of suicidal ideation in primary care and mental health settings. Gen Hosp Psychiatry 2024; 87:7-12. [PMID: 38266442 PMCID: PMC10939769 DOI: 10.1016/j.genhosppsych.2024.01.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE While screening and treatment options for patients who disclose suicidal ideation in clinical settings have grown in recent decades, little is known about patient experiences following disclosure. We characterize patient perspectives of responses following disclosure of suicidal ideation in Veteran Health Administration (VHA) primary care and mental health settings. METHOD Qualitative thematic analysis using a conventional/directed hybrid approach. RESULTS A national sample comprised of sixty participants who recently screened for suicidal ideation in primary care (n = 28) and mental health (n = 32) settings completed interviews. Many patients described therapeutic experiences following disclosure, including caring staff, timely follow-up care, and offers of multiple treatment options. Other patients, however, reported deficits in staff empathy, long waits for follow-up care, or inadequate treatment options. CONCLUSIONS While many VA clinical settings provided empathic and helpful responses, these experiences were not universal. Our findings reinforce the importance of a patient-centered approach to screening and response to disclosure, including collaboration with patients in treatment planning. Improved follow-up care coordination processes are needed. Following disclosure, contact with the staff who received the disclosure also helps patients feel cared about, and provides opportunity to troubleshoot barriers a patient may experience in accessing care.
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Affiliation(s)
- Summer Newell
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States.
| | - Annabelle Rynerson
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States
| | - Praful Gade
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States
| | - Nazanin H Bahraini
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, Aurora, CO, United States of America; Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz School of Medicine, Aurora, CO, United States of America; Department of Psychiatry University of Colorado, Anschutz School of Medicine, Aurora, CO, United States of America
| | - Lauren M Denneson
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States; Department of Psychiatry, Oregon Health & Sciences University, Portland, OR, United States
| | - Steven K Dobscha
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States; Department of Psychiatry, Oregon Health & Sciences University, Portland, OR, United States
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Kinney AR, Brenner LA, Nance M, Mignogna J, Cobb AD, Forster JE, Ulmer CS, Nakase-Richardson R, Bahraini NH. Factors Influencing Adherence to Insomnia and Obstructive Sleep Apnea Treatments among Veterans with Mild Traumatic Brain Injury. Behav Sleep Med 2024:1-18. [PMID: 38420915 DOI: 10.1080/15402002.2024.2322517] [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] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To understand factors influencing adherence to recommended treatment for insomnia and obstructive sleep apnea (OSA) among Veterans with mild traumatic brain injury (mTBI). METHOD Semi-structured interviews (n = 49) with 29 clinical stakeholders and 20 Veterans were conducted. Clinical stakeholders included Veterans Health Administration providers and policymakers involved in the management of mTBI and/or sleep disorders. Veterans included those with a clinician-confirmed mTBI with a recent history of insomnia disorder and/or OSA treatment. Themes were identified using a Descriptive and Interpretive approach. RESULTS Barriers to sleep disorder treatment adherence included factors associated with the patient (e.g., negative appraisal of treatment benefit), intervention (e.g., side effects), health conditions (e.g., cognitive challenges), health care system (e.g., limited availability of care), and socioeconomic status (e.g., economic instability). Similarly, facilitators of adherence included patient- (e.g., positive appraisal of treatment benefit), intervention- (e.g., flexible delivery format), condition- (e.g., accommodating cognitive impairments), health care system- (e.g., access to adherence support), and socioeconomic-related factors (e.g., social support). CONCLUSIONS Interviews revealed the multi-faceted nature of factors influencing adherence to sleep disorder treatment among Veterans with mTBI. Findings can inform the development of novel interventions and care delivery models that meet the complex needs of this population.
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Affiliation(s)
- Adam R Kinney
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain MIRECC, Aurora, CO
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Lisa A Brenner
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain MIRECC, Aurora, CO
- Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Morgan Nance
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain MIRECC, Aurora, CO
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Joseph Mignogna
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain MIRECC, Aurora, CO
- Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Audrey D Cobb
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain MIRECC, Aurora, CO
| | - Jeri E Forster
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain MIRECC, Aurora, CO
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Christi S Ulmer
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs, Durham, NC
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Risa Nakase-Richardson
- Research Service, James A. Haley Veterans Hospital, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of South Florida, Tampa
| | - Nazanin H Bahraini
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain MIRECC, Aurora, CO
- Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO
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Kinney AR, Schneider AL, King SE, Yan XD, Forster JE, Bahraini NH, Brenner LA. Identifying and Predicting Subgroups of Veterans With Mild Traumatic Brain Injury Based on Distinct Configurations of Postconcussive Symptom Endorsement: A Latent Class Analysis. J Head Trauma Rehabil 2024:00001199-990000000-00103. [PMID: 38259092 DOI: 10.1097/htr.0000000000000890] [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: 01/24/2024]
Abstract
OBJECTIVE To identify distinct subgroups of veterans with mild traumatic brain injury (mTBI) based on configurations of postconcussive symptom (PCS) endorsement, and to examine predictors of subgroup membership. SETTING Outpatient Veterans Health Administration (VHA). PARTICIPANTS Veterans with clinician-confirmed mTBI who completed the Neurobehavioral Symptom Inventory (NSI), determined using the Comprehensive Traumatic Brain Injury Evaluation database. Individuals who tended to overreport symptoms were excluded via an embedded symptom validity scale. DESIGN Retrospective cohort study leveraging national VHA clinical data from 2012 to 2020. Latent class analysis (LCA) with a split-sample cross-validation procedure was used to identify subgroups of veterans. Multinomial logistic regression was used to examine predictors of subgroup membership. MAIN MEASURES Latent classes identified using NSI items. RESULTS The study included 72 252 eligible veterans, who were primarily White (73%) and male (94%). The LCA supported 7 distinct subgroups of veterans with mTBI, characterized by diverging patterns of risk for specific PCS across vestibular (eg, dizziness), somatosensory (eg, headache), cognitive (eg, forgetfulness), and mood domains (eg, anxiety). The most prevalent subgroup was Global (20.7%), followed by Cognitive-Mood (16.3%), Headache-Cognitive-Mood (H-C-M; 16.3%), Headache-Mood (14.2%), Anxiety (13.8%), Headache-Sleep (10.3%), and Minimal (8.5%). The Global class was used as the reference class for multinomial logistic regression because it was distinguished from others based on elevated risk for PCS across all domains. Female (vs male), Black (vs White), and Hispanic veterans (vs non-Hispanic) were less likely to be members of most subgroups characterized by lesser PCS endorsement relative to the Global class (excluding Headache-Mood). CONCLUSION The 7 distinct groups identified in this study distill heterogenous patterns of PCS endorsement into clinically actionable phenotypes that can be used to tailor clinical management of veterans with mTBI. Findings reveal empirical support for potential racial, ethnic, and sex-based disparities in PCS among veterans, informing efforts aimed at promoting equitable recovery from mTBI in this population.
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Affiliation(s)
- Adam R Kinney
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado (Drs Kinney, Forster, Bahraini, and Brenner, Ms Schneider, and Messrs King and Yan); and Departments of Physical Medicine and Rehabilitation (Drs Kinney, Forster, Bahraini, and Brenner), Psychiatry (Drs Bahraini and Brenner), and Neurology (Dr Brenner), Anschutz Medical Campus, University of Colorado, Aurora
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Reis DJ, Yen P, Tizenberg B, Gottipati A, Postolache SY, De Riggs D, Nance M, Dagdag A, Plater L, Federline A, Grassmeyer R, Dagdag A, Akram F, Ozorio Dutra SV, Gragnoli C, RachBeisel JA, Volkov J, Bahraini NH, Stiller JW, Brenner LA, Postolache TT. Longitude-based time zone partitions and rates of suicide. J Affect Disord 2023; 339:933-942. [PMID: 37481129 PMCID: PMC10870927 DOI: 10.1016/j.jad.2023.07.080] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/19/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Increasing evidence suggests that conditions with decreased morning and increased evening light exposure, including shift work, daylight-saving time, and eveningness, are associated with elevated mortality and suicide risk. Given that the alignment between the astronomical, biological, and social time varies across a time zone, with later-shifted daylight exposure in the western partition, we hypothesized that western time zone partitions would have higher suicide rates than eastern partitions. METHODS United States (U.S.) county-level suicide and demographic data, from 2010 to 2018, were obtained from a Centers for Disease Control database. Using longitude and latitude, counties were sorted into the western, middle, or eastern partition of their respective time zones, as well as the northern and southern halves of the U.S. Linear regressions were used to estimate the associations between suicide rates and time zone partitions, adjusting for gender, race, ethnicity, age group, and unemployment rates. RESULTS Data were available for 2872 counties. Across the U.S., western partitions had statistically significantly higher rates of suicide compared to eastern partitions and averaged up to two additional yearly deaths per 100,000 people (p < .001). LIMITATIONS Ecological design and limited adjustment for socioeconomic factors. CONCLUSIONS To our knowledge, this is the first study of the relationship between longitude-based time zone partitions and suicide. The results were consistent with the hypothesized elevated suicide rates in the western partitions, and concordant with previous reports on cancer mortality and transportation fatalities. The next step is to retest the hypothesis with individual-level data, accounting for latitude, photoperiodic changes, daylight-saving time, geoclimatic variables, physical and mental health indicators, as well as socioeconomic adversity and protection.
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Affiliation(s)
- Daniel J Reis
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Poyu Yen
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Boris Tizenberg
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Anurag Gottipati
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sonia Y Postolache
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Demitria De Riggs
- VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center, Baltimore, MD, USA
| | - Morgan Nance
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alexandra Dagdag
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lynn Plater
- VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center, Baltimore, MD, USA
| | - Amanda Federline
- VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center, Baltimore, MD, USA
| | - Riley Grassmeyer
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA
| | - Aline Dagdag
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Faisal Akram
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA; Psychiatry Residency Training, Saint Elizabeth's Hospital, Department of Behavioral Health, Washington, DC, USA
| | | | - Claudia Gragnoli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Division of Endocrinology, Department of Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Jill A RachBeisel
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Janna Volkov
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA; Psychiatry Residency Training, Saint Elizabeth's Hospital, Department of Behavioral Health, Washington, DC, USA
| | - Nazanin H Bahraini
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - John W Stiller
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA; Saint Elizabeth's Hospital, Neurology Consultation Service, Washington, DC, USA; Maryland State Athletic Commission, Baltimore, MD, USA
| | - Lisa A Brenner
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Denver, CO, USA
| | - Teodor T Postolache
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA; Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA; VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center, Baltimore, MD, USA; Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Denver, CO, USA
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9
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Matarazzo BB, Eagan A, Landes SJ, Mina LK, Clark K, Gerard GR, McCarthy JF, Trafton J, Bahraini NH, Brenner LA, Keen A, Gamble SA, Lawson WC, Katz IR, Reger MA. The Veterans Health Administration REACH VET Program: Suicide Predictive Modeling in Practice. Psychiatr Serv 2023; 74:206-209. [PMID: 36039552 DOI: 10.1176/appi.ps.202100629] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Indexed: 02/03/2023]
Abstract
The U.S. Veterans Health Administration developed a suicide prediction statistical model and implemented a novel clinical program, Recovery Engagement and Coordination for Health-Veterans Enhanced Treatment (REACH VET). This high-value suicide prevention program aims to efficiently identify patients at risk and connect them with care. Starting in April 2017, national REACH VET metric data were collected from electronic health records to evaluate required task completion. By October 2020, 98% of veterans identified (N=6,579) were contacted by providers and had their care evaluated. In the nation's largest health care system, it was feasible to implement a clinical program based on a suicide prediction model.
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Affiliation(s)
- Bridget B Matarazzo
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Aaron Eagan
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Sara J Landes
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Liam K Mina
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Kaily Clark
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Georgia R Gerard
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - John F McCarthy
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Jodie Trafton
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Nazanin H Bahraini
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Lisa A Brenner
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Angela Keen
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Stephanie A Gamble
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - W Cole Lawson
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Ira R Katz
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Mark A Reger
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
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10
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Reis DJ, Hoffberg AS, Stearns-Yoder KA, Bahraini NH. Bright light therapy for mental and behavioral illness: A systematic umbrella review. Chronobiol Int 2023; 40:204-214. [PMID: 36369785 DOI: 10.1080/07420528.2022.2140669] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/10/2022] [Accepted: 10/23/2022] [Indexed: 11/13/2022]
Abstract
Bright light therapy (BLT) is a promising non-pharmacological treatment for a range of psychiatric conditions. The goal of this review was to provide a comprehensive overview of the efficacy of BLT across mental and behavioral illnesses. Using systematic umbrella review methodology, we searched Ovid MEDLINE, Embase, PsycInfo, Web of Science, and Google Scholar for systematic reviews of randomized controlled trials (RCTs) evaluating BLT for any mental or behavioral illness from the date of inception until March 2021. Review quality was assessed using the AMSTAR 2 tool and summary efficacy data were extracted from recent reviews. Of 792 unique records, 67 systematic reviews were included which targeted a range of disorders related to mood, neurocognition, sleep, and eating. Recent meta-analyses targeting seasonal or non-seasonal depression found that BLT outperformed light-related control conditions. Reviews of other disorders identified few RCTs and generally did not support the efficacy of BLT for various outcomes. Overall, the extant literature supports the efficacy of BLT for seasonal and non-seasonal depression, although higher quality systematic reviews are needed to increase confidence in these findings. There was no specific funding for this review, and it was preregistered on Prospero (ID: CRD42021240751).
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Affiliation(s)
- Daniel J Reis
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Adam S Hoffberg
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado, USA
| | - Kelly A Stearns-Yoder
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nazanin H Bahraini
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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11
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Reis DJ, Kaizer AM, Kinney AR, Bahraini NH, Forster JE, Brenner LA. The unique association of posttraumatic stress disorder with hypertension among veterans: A replication of Kibler et al. (2009) using Bayesian estimation and data from the United States-Veteran Microbiome Project. Psychol Trauma 2023; 15:131-139. [PMID: 35816586 PMCID: PMC9976482 DOI: 10.1037/tra0001304] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Kibler et al. (2009) reported that hypertension was related to PTSD independent of depression. These two conditions have significant diagnostic overlap. The present study sought to conceptually replicate this work with a veteran sample, using Bayesian estimation to directly update past results, as well as examine symptom severity scores in relation to hypertension. METHOD This was a secondary analysis of data obtained from the United States-Veteran Microbiome Project. Lifetime diagnoses of PTSD and major depressive disorder (MDD) were obtained from a structured clinical interview and hypertension diagnoses were extracted from electronic medical records. PTSD and depressive symptom severity were obtained from self-report measures. Logistic regressions with Bayesian estimation were used to estimate the associations between hypertension and (a) psychiatric diagnostic history and (b) symptom severity scores. RESULTS Compared with veterans without lifetime diagnoses of either disorder, the PTSD-only group was estimated to have a 29% increase in hypertension risk, and the PTSD + MDD group was estimated to have a 66% increase in hypertension risk. Additionally, higher levels of PTSD symptom severity were associated with a higher risk of hypertension. CONCLUSION PTSD diagnosis and symptom severity are uniquely associated with hypertension, independent of MDD or depressive symptom severity. These results support previous findings that PTSD might be a modifiable risk factor for the prevention and treatment of hypertension. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Daniel J. Reis
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado, USA,Department of Psychiatry, University of Colorado Anschutz Medical Campus
| | - Alexander M. Kaizer
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus
| | - Adam R. Kinney
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado, USA,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus
| | - Nazanin H. Bahraini
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado, USA,Department of Psychiatry, University of Colorado Anschutz Medical Campus,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus
| | - Jeri E. Forster
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado, USA,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus
| | - Lisa A. Brenner
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado, USA,Department of Psychiatry, University of Colorado Anschutz Medical Campus,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus,Department of Neurology, University of Colorado Anschutz Medical Campus
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12
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Reis DJ, Kaizer AM, Kinney AR, Bahraini NH, Holliday R, Forster JE, Brenner LA. A practical guide to random-effects Bayesian meta-analyses with application to the psychological trauma and suicide literature. Psychol Trauma 2023; 15:121-130. [PMID: 35862085 PMCID: PMC10021079 DOI: 10.1037/tra0001316] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Bayesian meta-analyses offer several advantages over traditional approaches, including improved accuracy when using a small number of studies and enhanced estimation of heterogeneity. However, psychological trauma research has yet to see widespread adoption of these statistical methods, potentially due to researchers' unfamiliarity with the processes involved. The purpose of this article is to provide a practical tutorial for conducting random-effects Bayesian meta-analyses. METHOD Explanations and recommendations are provided for completing the primary steps of a Bayesian meta-analysis, ranging from model specification to interpretation of results. Furthermore, an illustrative example is used to demonstrate the application of each step. In the example, results are synthesized from six studies included in a previously published systematic review (Holliday et al., 2020), with a combined sample size of 21,244,109, examining the association between posttraumatic stress disorder and risk of suicide in veterans and military personnel. RESULTS The posterior distributions for each model estimate, such as the pooled effect size and the heterogeneity parameter, are discussed and interpreted with regard to the probability of increased suicide risk. CONCLUSIONS Our hope is that this tutorial, along with the provided data and code, facilitate the use of Bayesian meta-analyses in the study of psychological trauma. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Daniel J Reis
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention
| | | | - Adam R Kinney
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention
| | - Nazanin H Bahraini
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention
| | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention
| | - Lisa A Brenner
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention
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13
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Brostow DP, Smith AA, Bahraini NH, Besterman-Dahan K, Forster JE, Brenner LA. Food Insecurity and Food Worries During the COVID-19 Pandemic: A Point-In-Time Study of Injured United States Veterans. Journal of Hunger & Environmental Nutrition 2022; 17. [DOI: 10.1080/19320248.2022.2118564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Diana P. Brostow
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alexandra A. Smith
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA
| | - Nazanin H. Bahraini
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Karen Besterman-Dahan
- Research Service, Department of Veterans Affairs, James A. Haley VA Hospital, Tampa, FL, USA
- Department of Nutrition and Dietetics, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Jeri E. Forster
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lisa A. Brenner
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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14
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Barnes SM, Borges LM, Sorensen D, Smith GP, Bahraini NH, Walser RD. Safety Planning Within Acceptance and Commitment Therapy. Cognitive and Behavioral Practice 2022. [DOI: 10.1016/j.cbpra.2022.01.002] [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: 11/03/2022]
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15
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Monteith LL, Schneider AL, Holliday R, Bahraini NH. Assessing Institutional Betrayal Among Female Veterans Who Experienced Military Sexual Trauma: A Rasch Analysis of the Institutional Betrayal Questionnaire.2. J Interpers Violence 2021; 36:10861-10883. [PMID: 33403916 DOI: 10.1177/0886260520983959] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Military sexual trauma (MST; i.e., sexual harassment and/or sexual assault during one's military service) is highly prevalent among female veterans and is associated with numerous adverse health and psychosocial sequelae. When institutions fail to prevent sexual trauma from happening or respond in an unsupportive manner (i.e., institutional betrayal [IB]), MST survivors typically report more severe health-related outcomes. Although the Institutional Betrayal Questionnaire.2 (IBQ.2) was developed to assess IB, no studies have examined the factor structure or dimensionality of the IBQ.2 among MST survivors. In addition, initial research has reported differing factor structures for this measure. The present study examined the dimensionality and factor structure of the IBQ.2, and tested for differential item functioning (DIF) based on whether military sexual assault was experienced. The sample comprised 235 female veterans who reported a history of MST in an anonymous national survey. Rasch analysis suggested multidimensionality and DIF based on history of military sexual assault. Exploratory factor analysis and parallel analysis suggested the IBQ.2 comprises three factors: (1) Environment Leading to MST, (2) Institutional Response to MST, and (3) Institutional Belongingness following MST. Although these results suggest that the IBQ.2 is multidimensional, the three-factor model had significant issues with respect to dimensionality, item fit, and person separation and reliability. Thus, using the full IBQ.2 may be more advantageous. Further examination of the IBQ.2 is warranted to ensure optimal assessment of IB in relation to MST, irrespective of whether the MST comprised sexual harassment or sexual assault, as well as to ensure that the IBQ.2 is culturally meaningful for MST survivors.
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Affiliation(s)
- Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alexandra L Schneider
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA
| | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nazanin H Bahraini
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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16
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Borges LM, Holliday R, Barnes SM, Bahraini NH, Kinney A, Forster JE, Brenner LA. A longitudinal analysis of the role of potentially morally injurious events on COVID-19-related psychosocial functioning among healthcare providers. PLoS One 2021; 16:e0260033. [PMID: 34767617 PMCID: PMC8589198 DOI: 10.1371/journal.pone.0260033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/29/2021] [Indexed: 11/19/2022] Open
Abstract
Medical leaders have warned of the potential public health burden of a "parallel pandemic" faced by healthcare workers during the COVID-19 pandemic. These individuals may have experienced scenarios in which their moral code was violated resulting in potentially morally injurious events (PMIEs). In the present study, hierarchical linear modeling was utilized to examine the role of PMIEs on COVID-19 pandemic-related difficulties in psychosocial functioning among 211 healthcare providers (83% female, 89% White, and an average of 11.30 years in their healthcare profession [9.31]) over a 10-month span (May 2020 -March 2021). Reported exposure to PMIEs was associated with statistically significant poorer self-reported psychosocial functioning at baseline and over the course of 10-months of data collection. Within exploratory examinations of PMIE type, perceptions of transgressions by self or others (e.g., "I acted in ways that violated my own moral code or values"), but not perceived betrayal (e.g., "I feel betrayed by leaders who I once trusted"), was associated with poorer COVID-19 related psychosocial functioning (e.g., feeling connected to others, relationship with spouse or partner). Findings from this study speak to the importance of investing in intervention and prevention efforts to mitigate the consequences of exposure to PMIEs among healthcare providers. Interventions for healthcare providers targeting psychosocial functioning in the context of moral injury is an important area for future research.
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Affiliation(s)
- Lauren M. Borges
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado, United States of America
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado, United States of America
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Sean M. Barnes
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado, United States of America
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Nazanin H. Bahraini
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado, United States of America
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Adam Kinney
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado, United States of America
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Jeri E. Forster
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado, United States of America
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Lisa A. Brenner
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado, United States of America
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
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17
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McGarity S, Stacy S, Borges LM, Barnes SM, Nazem S, Gerard GR, Clark K, Matarazzo BB, Bahraini NH, Wortzel HS. Therapeutic Risk Management for Violence: Safety Planning for Other-directed Violence. J Psychiatr Pract 2021; 27:296-304. [PMID: 34398580 DOI: 10.1097/pra.0000000000000565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Therapeutic management of risk for other-directed violence (ODV) involves screening, assessment, and clinically appropriate intervention. In this 5-part series, effective screening and assessment for ODV have been described as a combination of clinical interviewing and the use of structured tools to inform clinical impressions of both acute and chronic risk for violence. Once risk of violence is identified, therapeutic management of the risk throughout the course of treatment is best achieved by determining the function of the violent ideation and behavior. This can be achieved through the use of functional chain analysis. Chain analysis not only serves the purpose of providing insight into the contingencies of violent behavior but also helps to identify target areas of intervention where other skills, strategies, and means to access resources for support can be applied. In this fifth and final column of the series, we describe an intervention with all of these outcomes as its goals. A safety plan for ODV assists both clients and mental health professionals in disrupting patterns of violent ideation or behavior that would otherwise continue causing not only harm to others but prolonged negative consequences for those engaging in such behaviors.
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Barnes SM, Borges LM, Smith GP, Walser RD, Forster JE, Bahraini NH. Acceptance and Commitment Therapy to Promote Recovery from suicidal crises: A Randomized Controlled Acceptability and Feasibility Trial of ACT for life. Journal of Contextual Behavioral Science 2021. [DOI: 10.1016/j.jcbs.2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Monteith LL, Holliday R, Schneider AL, Miller CN, Bahraini NH, Forster JE. Institutional betrayal and help-seeking among women survivors of military sexual trauma. Psychol Trauma 2021; 13:814-823. [PMID: 33764096 DOI: 10.1037/tra0001027] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Women veterans experience disproportionately high rates of military sexual trauma (MST). Nonetheless, many MST survivors delay or forgo health care, particularly within Veterans Health Administration (VHA) settings. Institutional betrayal (IB) has been posited as a potential explanation for this. OBJECTIVE The current study examined if IB was associated with women veterans' willingness to seek VHA and non-VHA mental health and medical care, prior use of VHA care, past year use of VHA care, and use of VHA and non-VHA MST-related care. METHOD Participants were 242 women veterans who screened positive for MST and completed self-report measures of IB and willingness to seek VHA and non-VHA mental health and medical care. Use of VHA care was assessed through VA Corporate Data Warehouse data. RESULTS IB was associated with lower willingness to use VHA medical care and higher willingness to use non-VHA mental health care. Although IB was not significantly associated with prior use of VHA care, participants who reported more IB were more likely to have used VHA care in the past year and to have used both VHA and non-VHA MST-related care. CONCLUSION These findings illuminate the relationship between the institutional response to MST with women's help-seeking willingness and use. Addressing IB may be important for increasing women MST survivors' willingness to use VHA medical care. Additionally, as IB was associated with greater willingness to use non-VHA mental health care, non-VHA institutions and providers should be prepared to serve women veterans who have experienced MST-related IB. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention
| | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention
| | - Alexandra L Schneider
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention
| | - Christin N Miller
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention
| | - Nazanin H Bahraini
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention
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20
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Monteith LL, Holliday R, Hoffmire CA, Bahraini NH. Female Veterans' Willingness to Seek Veterans Health Administration and Non-Veterans Health Administration Services for Suicidal Thoughts and Mental Health Concerns. Med Care 2021; 59:S23-S30. [PMID: 33438879 DOI: 10.1097/mlr.0000000000001480] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 01/16/2023]
Abstract
BACKGROUND The extent to which female veterans are willing to seek Veterans Health Administration (VHA) and non-VHA care when they are suicidal or experiencing mental health (MH) concerns is unknown. OBJECTIVES The objectives of this study were to: (1) examine whether current, past, and never VHA using female veterans' willingness to seek VHA care differs from their willingness to seek non-VHA care if suicidal or experiencing MH symptoms; (2) examine if VHA use, military sexual trauma, and suicidal ideation and attempt are associated with female veterans' willingness to use VHA and non-VHA care when experiencing suicidal thoughts or MH symptoms. RESEARCH DESIGN A cross-sectional anonymous survey. SUBJECTS Four hundred thirty nine female veterans, including current, past, and never VHA users were included. MEASURES General Help-Seeking Questionnaire, Self-Injurious Thoughts and Behaviors Interview, and the VA Military Sexual Trauma Screening Questions. RESULTS Current VHA users reported more willingness to use VHA than non-VHA care; conversely, past and never VHA users reported less willingness to use VHA care relative to non-VHA care. Military sexual assault and none or past VHA use were associated with lower willingness to use VHA care if suicidal or experiencing MH symptoms. In contrast, those with none or past VHA use reported greater willingness to use non-VHA care if suicidal or experiencing MH symptoms, while prior suicide attempt was associated with lower willingness. CONCLUSIONS Ensuring that acceptable and effective suicide prevention services are available to female veterans in both VHA and community settings is critical. Increasing help-seeking intentions among female veterans who have attempted suicide or experienced military sexual assault is also essential.
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Affiliation(s)
- Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention
- Departments of Psychiatry
| | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention
- Departments of Psychiatry
| | - Claire A Hoffmire
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention
- Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Nazanin H Bahraini
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention
- Departments of Psychiatry
- Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO
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21
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Matarazzo BB, Brenner LA, Wortzel HS, Bahraini NH. Balancing Scientific Evidence, Clinical Expertise, and Patient Preferences: VHA's Suicide Risk Identification Strategy. Psychiatr Serv 2020; 71:1303-1305. [PMID: 32781925 DOI: 10.1176/appi.ps.202000109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Bridget B Matarazzo
- Rocky Mountain Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, Aurora, Colorado (all authors); Departments of Psychiatry (all authors), Physical Medicine and Rehabilitation (Brenner, Bahraini), and Neurology (Brenner, Wortzel), University of Colorado School of Medicine, Aurora
| | - Lisa A Brenner
- Rocky Mountain Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, Aurora, Colorado (all authors); Departments of Psychiatry (all authors), Physical Medicine and Rehabilitation (Brenner, Bahraini), and Neurology (Brenner, Wortzel), University of Colorado School of Medicine, Aurora
| | - Hal S Wortzel
- Rocky Mountain Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, Aurora, Colorado (all authors); Departments of Psychiatry (all authors), Physical Medicine and Rehabilitation (Brenner, Bahraini), and Neurology (Brenner, Wortzel), University of Colorado School of Medicine, Aurora
| | - Nazanin H Bahraini
- Rocky Mountain Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, Aurora, Colorado (all authors); Departments of Psychiatry (all authors), Physical Medicine and Rehabilitation (Brenner, Bahraini), and Neurology (Brenner, Wortzel), University of Colorado School of Medicine, Aurora
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22
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Monteith LL, Holliday R, Miller C, Schneider AL, Hoffmire CA, Bahraini NH, Forster JE. Suicidal ideation, suicide attempt, and non-suicidal self-injury among female veterans: Prevalence, timing, and onset. J Affect Disord 2020; 273:350-357. [PMID: 32560928 DOI: 10.1016/j.jad.2020.04.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 11/22/2019] [Revised: 02/19/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Suicide rates among female veterans have continued to increase, particularly among those not using Veterans Health Administration (VHA) care. Nonetheless, suicide research has rarely focused on female veterans, particularly non-VHA users. The present study examined the prevalence and onset of suicidal ideation (SI), suicide attempt (SA), and non-suicidal self-injury (NSSI) in relation to military service among female veterans. Additionally, current, past, and never VHA users were compared in regard to SI, SA, and NSSI prevalence. METHODS Female veterans (n = 439) participated in a national, cross-sectional survey. RESULTS Lifetime prevalence of SI (47.9%), SA (17.7%), and NSSI (13.2%) were high. Participants were more likely to report experiencing SI and SA following separation, compared to preceding (SI, SA) or during (SI only) military service, controlling for time at risk. However, onset was more likely to occur prior to military service, compared to after separation, for SI, SA, and NSSI. In age-adjusted analyses, current and past users of VHA care were more likely to report experiencing lifetime SI, compared to those who never used VHA care. However, when adjusting for service era, past and never VHA users did not significantly differ. LIMITATIONS Cross-sectional design, retrospective recall, and convenience sample. CONCLUSIONS For female veterans, onset of SI, SA, and NSSI appears to most commonly occur before military service. However, SI and SA prevalence are highest following separation, suggesting a period warranting additional support and intervention. Results underscore the need for continued suicide surveillance, prevention, and intervention efforts for female veterans, especially current VHA users.
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Affiliation(s)
- Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States.
| | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States
| | - Christin Miller
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, United States
| | - Alexandra L Schneider
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, United States
| | - Claire A Hoffmire
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, United States; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, United States
| | - Nazanin H Bahraini
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, United States
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, United States; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, United States; Department of Biostatistics and Informatics, Colorado School of Public Health, United States
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Bahraini NH, Matarazzo BB, Barry CN, Post EP, Forster JE, Dollar KM, Dobscha SK, Brenner LA. Protocol: examining the effectiveness of an adaptive implementation intervention to improve uptake of the VA suicide risk identification strategy: a sequential multiple assignment randomized trial. Implement Sci 2020; 15:58. [PMID: 32698812 PMCID: PMC7374070 DOI: 10.1186/s13012-020-01019-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/11/2020] [Accepted: 07/08/2020] [Indexed: 12/31/2022] Open
Abstract
Background In 2018, the Veterans Health Administration (VHA) mandated implementation of a national suicide risk identification strategy (Risk ID). The goal of Risk ID is to improve the detection and management of suicide risk by standardizing suicide risk screening and evaluation enterprise-wide. In order to ensure continuous quality improvement (QI), ongoing evaluation and targeted interventions to improve implementation of Risk ID are needed. Moreover, given that facilities will vary with respect to implementation needs and barriers, the dose and type of intervention needed may vary across facilities. Thus, the objective of this study is to examine the effectiveness of an adaptive implementation strategy to improve the uptake of suicide risk screening and evaluation in VHA ambulatory care settings. In addition, this study will examine specific factors that may impact the uptake of suicide risk screening and evaluation and the adoption of different implementation strategies. This protocol describes the stepped implementation approach and proposed evaluation plan. Methods Using a sequential multiple assignment randomized trial (SMART) design, two evidence-based implementation strategies will be evaluated: (1) audit and feedback (A&F); (2) A&F plus external facilitation (A&F + EF). Implementation outcomes of interest include uptake of secondary suicide risk screening and uptake of comprehensive suicide risk evaluation (stages 2 and 3 of Risk ID). Secondary outcomes include rates of other clinical outcomes (i.e., safety planning) and organizational factors that may impact Risk ID implementation (i.e., leadership climate and leadership support). Discussion This national QI study will use a SMART design to evaluate whether an adaptive implementation strategy is effective in improving uptake of a mandated VHA-wide suicide risk screening and evaluation initiative. If this study finds that the proposed stepped implementation strategy is effective at increasing uptake and maintaining performance improvements, this approach may be used as an overarching QI strategy for other national suicide prevention programs. Trial registration ClinicalTrials.gov NCT04243330. Registered 28 January 2020
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Affiliation(s)
- Nazanin H Bahraini
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO, 80045, USA. .,Department of Psychiatry, University of Colorado Anschutz School of Medicine, Aurora, CO, USA. .,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz School of Medicine, Aurora, CO, USA.
| | - Bridget B Matarazzo
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO, 80045, USA.,Department of Psychiatry, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Catherine N Barry
- VA Program Evaluation and Resource Center (PERC), Palo Alto, CA, USA
| | - Edward P Post
- Ann Arbor VA Health Care System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jeri E Forster
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO, 80045, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | | | - Steven K Dobscha
- VA Center to Improve Veteran Involvement in Care, Portland VA Health Care System, Portland, OR, USA.,Department of Psychiatry, Oregon Health & Science University School of Medicine, Portland, OR, USA
| | - Lisa A Brenner
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO, 80045, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz School of Medicine, Aurora, CO, USA.,Department of Neurology, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
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24
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Borges LM, Barnes SM, Farnsworth JK, Bahraini NH, Brenner LA. A commentary on moral injury among health care providers during the COVID-19 pandemic. Psychol Trauma 2020; 12:S138-S140. [PMID: 32496101 DOI: 10.1037/tra0000698] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although little is known about moral injury in nonmilitary populations, the COVID-19 pandemic has made it clear that moral injury's relevance extends beyond the battlefield. Health care providers are experiencing potentially morally injurious events that may violate their moral code or values, yet almost no research has been conducted on moral injury among health care providers to date. The purpose of this commentary is to describe the relevance of moral injury to health care providers and to spark a dialogue that motivates future research, prevention, and intervention. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Lauren M Borges
- Rocky Mountain Mental Illness Research, Education, and Clinical Center
| | - Sean M Barnes
- Rocky Mountain Mental Illness Research, Education, and Clinical Center
| | | | | | - Lisa A Brenner
- Rocky Mountain Mental Illness Research, Education, and Clinical Center
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25
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Monteith LL, Wendleton L, Bahraini NH, Matarazzo BB, Brimner G, Mohatt NV. Together With Veterans: VA National Strategy Alignment and Lessons Learned from Community-Based Suicide Prevention for Rural Veterans. Suicide Life Threat Behav 2020; 50:588-600. [PMID: 31950557 DOI: 10.1111/sltb.12613] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 12/17/2018] [Accepted: 10/28/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rural veterans are at increased risk for dying by suicide compared with urban veterans, yet interventions for preventing suicide among rural veterans have been limited. OBJECTIVES (1) Describe how Together With Veterans (TWV), a community-based intervention to prevent suicide among veterans in rural communities, aligns with the VA National Strategy for Preventing Veteran Suicide; (2) share lessons learned while beginning to implement TWV in rural communities. METHODS Together With Veterans is being implemented in four rural communities and comprises six suicide prevention best practices: (1) reducing stigma and promoting help-seeking; (2) lethal means safety, with an emphasis on firearms; (3) gatekeeper training; (4) training primary care providers; (5) improving access to crisis services; and (6) enhancing support for high-risk veterans. RESULTS Together With Veterans best practices align with most, but not all, of the strategies in the VA National Strategy for Preventing Veteran Suicide. Community veteran partners have shown a willingness to collaborate and provide local leadership, enthusiasm, and a sense of duty. CONCLUSIONS By supporting and facilitating local veteran leaders and their community partners in increasing suicide prevention knowledge, public awareness, and resources, we propose that TWV offers an acceptable and feasible approach that builds on the strengths of rural communities. Systematic evaluation is warranted.
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Affiliation(s)
- Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Aurora, Colorado, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Leah Wendleton
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Aurora, Colorado, USA
| | - Nazanin H Bahraini
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Aurora, Colorado, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Bridget B Matarazzo
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Aurora, Colorado, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Gina Brimner
- Western Interstate Commission for Higher Education Behavioral Health Program, Boulder, Colorado, USA
| | - Nathaniel V Mohatt
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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26
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Monteith LL, Bahraini NH, Gerber HR, Dorsey Holliman B, Schneider AL, Holliday R, Matarazzo BB. Military sexual trauma survivors’ perceptions of Veterans Health Administration care: A qualitative examination. Psychol Serv 2020; 17:178-186. [DOI: 10.1037/ser0000290] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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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Borges LM, Bahraini NH, Holliman BD, Gissen MR, Lawson WC, Barnes SM. Veterans’ perspectives on discussing moral injury in the context of evidence‐based psychotherapies for PTSD and other VA treatment. J Clin Psychol 2019; 76:377-391. [DOI: 10.1002/jclp.22887] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lauren M. Borges
- Rocky Mountain Mental Illness ResearchEducation, and Clinical Center (MIRECC)Aurora Colorado
- Department of PsychiatryUniversity of Colorado School of MedicineAurora Colorado
| | - Nazanin H. Bahraini
- Rocky Mountain Mental Illness ResearchEducation, and Clinical Center (MIRECC)Aurora Colorado
- Department of PsychiatryUniversity of Colorado School of MedicineAurora Colorado
- Department of Physical Medicine and RehabilitationUniversity of Colorado School of MedicineAurora Colorado
| | - Brooke Dorsey Holliman
- Rocky Mountain Mental Illness ResearchEducation, and Clinical Center (MIRECC)Aurora Colorado
- Department of Community and Behavioral HealthColorado School of Public HealthAurora Colorado
| | - Maura R. Gissen
- Rocky Mountain Mental Illness ResearchEducation, and Clinical Center (MIRECC)Aurora Colorado
| | - W. Cole Lawson
- Rocky Mountain Mental Illness ResearchEducation, and Clinical Center (MIRECC)Aurora Colorado
| | - Sean M. Barnes
- Rocky Mountain Mental Illness ResearchEducation, and Clinical Center (MIRECC)Aurora Colorado
- Department of PsychiatryUniversity of Colorado School of MedicineAurora Colorado
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Barnes SM, Monteith LL, Forster JE, Nazem S, Borges LM, Stearns-Yoder KA, Bahraini NH. Developing Predictive Models to Enhance Clinician Prediction of Suicide Attempts Among Veterans With and Without PTSD. Suicide Life Threat Behav 2019; 49:1094-1104. [PMID: 30206955 DOI: 10.1111/sltb.12511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/30/2017] [Accepted: 07/06/2018] [Indexed: 11/29/2022]
Abstract
UNLABELLED The limitations of self-report confine clinicians' ability to accurately predict suicides and suicide attempts (SAs). Behavioral assessments (e.g., Death Implicit Association Test [IAT]) may be a means of supplementing self-report and clinician prediction. OBJECTIVE The authors aimed to build and test a predictive model of SAs that included established risk factors and measures of suicide risk, and Death IAT scores. The authors also sought to test the predictive validity of the SA model among subgroups of Veterans with and without PTSD. METHOD Participants included 166 psychiatrically hospitalized Veterans. RESULTS A model that included patient prediction, age, and Death IAT scores improved upon clinician prediction of SAs during the six-month follow-up (C-statistic for clinician prediction = 73.6, 95% CI [62.9, 84.4] and C-statistic for model = 82.8, 95% CI [74.6, 91.0]). The model was tested in subgroups of Veterans with and without PTSD. Among Veterans without PTSD, the Death IAT and patient prediction predicted SAs above and beyond clinician prediction, while these variables did not significantly improve prediction among Veterans with PTSD (C-statistic for no-PTSD = 91.3, 95% CI [80.6, 1.00]; C-statistic for PTSD = 86.8, 95% CI [76.8, 96.8]). Building a separate model for Veterans with PTSD did not improve upon clinician prediction. CONCLUSIONS Findings indicate that predictive models may bolster clinician prediction of SAs and that predictors may differ for Veterans with PTSD.
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Affiliation(s)
- Sean M Barnes
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Aurora, CO, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Aurora, CO, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Aurora, CO, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Sarra Nazem
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Aurora, CO, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Lauren M Borges
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Aurora, CO, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kelly A Stearns-Yoder
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Aurora, CO, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Nazanin H Bahraini
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Aurora, CO, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
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Monteith LL, Holliday R, Schneider AL, Forster JE, Bahraini NH. Identifying factors associated with suicidal ideation and suicide attempts following military sexual trauma. J Affect Disord 2019; 252:300-309. [PMID: 30991258 DOI: 10.1016/j.jad.2019.04.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 11/08/2018] [Revised: 03/12/2019] [Accepted: 04/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND As increasing research demonstrates that military sexual trauma (MST) is associated with suicidal ideation and attempts, discerning factors that place MST survivors at risk for these outcomes is critical. The present study aimed to: (1) characterize suicidal ideation and attempts among MST survivors; (2) identify factors associated with post-MST suicide attempts, post-MST suicidal ideation, and past-week suicidal ideation. METHODS A convenience sample of 108 veterans (66 women, 42 men) who reported a history of MST participated in this cross-sectional study. Pre-MST suicidal ideation and attempt, childhood physical and sexual abuse, military sexual assault, institutional betrayal, and posttraumatic cognitions about self, world, and self-blame were examined, with age and gender as covariates. RESULTS Seventy-five percent of participants reported experiencing post-MST suicidal ideation, and 40.7% reported attempting suicide following MST. Pre-MST suicide attempt and posttraumatic cognitions about self were associated with post-MST suicide attempt. Pre-MST suicidal ideation, military sexual assault, childhood physical abuse, and posttraumatic cognitions about self were associated with post-MST suicidal ideation. Lastly, pre-MST suicidal ideation and posttraumatic cognitions about self were associated with past-week suicidal ideation; results were unchanged when accounting for recent PTSD or depressive symptoms. LIMITATIONS The cross-sectional design, retrospective self-report, and small sample are limitations. CONCLUSIONS Addressing negative posttraumatic beliefs about self may be important for managing suicide risk among MST survivors. Assessing for pre-MST suicidal ideation and attempt is likely also warranted. Further understanding of the longitudinal impact of posttraumatic beliefs about self on subsequent risk for suicidal ideation and attempt is warranted.
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Affiliation(s)
- Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, 1700 North Wheeling, Aurora, CO 80045, United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States.
| | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, 1700 North Wheeling, Aurora, CO 80045, United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States
| | - Alexandra L Schneider
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, 1700 North Wheeling, Aurora, CO 80045, United States
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, 1700 North Wheeling, Aurora, CO 80045, United States; Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, United States; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, United States
| | - Nazanin H Bahraini
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, 1700 North Wheeling, Aurora, CO 80045, United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, United States
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Affiliation(s)
- Lisa A Brenner
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Center, Aurora, CO, USA.
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Monteith LL, Brownstone LM, Gerber HR, Soberay KA, Bahraini NH. Understanding suicidal self-directed violence among men exposed to military sexual trauma: An ecological framework. Psychology of Men & Masculinities 2019. [DOI: 10.1037/men0000141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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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Mohatt NV, Billera M, Demers N, Monteith LL, Bahraini NH. A menu of options: Resources for preventing veteran suicide in rural communities. Psychol Serv 2018; 15:262-269. [PMID: 30080083 DOI: 10.1037/ser0000203] [Citation(s) in RCA: 7] [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
Suicide rates are higher in rural communities than in their urban counterparts. Of particular concern are veterans residing in rural communities, who have a 20% higher risk of dying by suicide than veterans who live in urban areas. The objective of this manuscript is to assess the availability of evidence-based and promising practices to support a community-based suicide prevention effort for rural veterans. We compiled a compendium of evidence-based and promising practices-the "menu of options"-with resources across 4 levels: increasing access to crisis services, enhancing primary care suicide prevention, training community members, and raising public awareness. We compiled resources from multiple sources, then reviewed and rated each one to arrive at consensus on the final selections. The final menu includes 70 resources. However, only 20 are tailored for veterans, only one for rural communities, and none for rural veterans. More research is needed to identify effective strategies and develop rural-tailored resources for preventing suicide among this unique and often underserved population. The menu of options represents a first step toward developing an approach to rural veteran-suicide prevention that aligns with evidence-based practice, theory, and a public health model for suicide prevention. (PsycINFO Database Record
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Affiliation(s)
- Nathaniel V Mohatt
- United States Department of Veterans Affairs, Veterans Health Administration, Rocky Mountain Mental Illness Research, Education, and Clinical Center
| | - Melodi Billera
- PTSD Residential Rehabilitation Treatment Program, Denver Veterans Affairs Medical Center
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Bahraini NH, Hostetter TA, Forster JE, Schneider AL, Brenner LA. A Rasch analysis of the Neurobehavioral Symptom Inventory in a national cohort of Operation Enduring and Iraqi Freedom veterans with mild traumatic brain injury. Psychol Assess 2018; 30:1013-1027. [PMID: 29878819 DOI: 10.1037/pas0000555] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 11/08/2022]
Abstract
This study investigated the dimensionality and measurement properties of the Neurobehavioral Symptom Inventory (NSI), a 22-item questionnaire of postconcussive symptoms, in a national sample of 9,679 Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) Veterans with mild traumatic brain injury. Dimensionality of the NSI was examined using exploratory factor analysis (EFA) and Rasch analysis. Rasch measurement properties, including overall fit, unidimensionality, item level statistics, and category functioning were examined for individual NSI symptom domains identified through EFA. Differential item functioning (DIF) analyses of subgroups based on gender and Posttraumatic Stress Disorder (PTSD) diagnosis were also conducted. Results showed that the NSI items are multidimensional and responses can be differentiated into 3 unidimensional domains reflecting Cognitive, Mood-Behavioral, and Vestibular-Sensory symptoms. All items in each of the 3 subscales demonstrated adequate fit to the Rasch model. In each domain, the item hierarchy was consistent with expectations regarding the theoretical ordering of symptoms. Some problems were observed regarding test targeting for all 3 subscales, such that items were generally concentrated around the mean ability level of the population. As such there were fewer items that differentiated between those at the upper and lower extremes of the scale. Differential item functioning (DIF) based on gender was noted for hearing difficulty. This item on average reflected a higher degree of severity for women than for men. There was no DIF based on PTSD status. Implications for using the NSI as an outcome measure are discussed. (PsycINFO Database Record
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Affiliation(s)
- Nazanin H Bahraini
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs
| | - Trisha A Hostetter
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs
| | - Alexandra L Schneider
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs
| | - Lisa A Brenner
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs
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Bahraini NH, Monteith LL, Gerber HR, Forster JE, Hostetter TA, Brenner LA. The Association Between Posttraumatic Stress Disorder and Perceptions of Deployment-Related Injury in Veterans With and Without Mild Traumatic Brain Injury. J Head Trauma Rehabil 2018; 33:E7-E15. [DOI: 10.1097/htr.0000000000000307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Monteith LL, Bahraini NH, Menefee DS. Perceived Burdensomeness, Thwarted Belongingness, and Fearlessness about Death: Associations With Suicidal Ideation among Female Veterans Exposed to Military Sexual Trauma. J Clin Psychol 2017; 73:1655-1669. [DOI: 10.1002/jclp.22462] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 11/10/2016] [Accepted: 01/03/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Lindsey L. Monteith
- Rocky Mountain Mental Illness Research; Education and Clinical Center and University of Colorado Anschutz Medical Campus
| | - Nazanin H. Bahraini
- Rocky Mountain Mental Illness Research; Education and Clinical Center and University of Colorado Anschutz Medical Campus
| | - Deleene S. Menefee
- Michael E. DeBakey Veterans Affairs Medical Center; South Central Mental Illness Research; Education and Clinical Center, and Baylor College of Medicine
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Barnes SM, Bahraini NH, Forster JE, Stearns-Yoder KA, Hostetter TA, Smith G, Nagamoto HT, Nock MK. Moving Beyond Self-Report: Implicit Associations about Death/Life Prospectively Predict Suicidal Behavior among Veterans. Suicide Life Threat Behav 2017; 47:67-77. [PMID: 27387836 DOI: 10.1111/sltb.12265] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 08/07/2015] [Accepted: 01/19/2016] [Indexed: 11/30/2022]
Abstract
Reliance on self-report limits clinicians' ability to accurately predict suicidal behavior. In this study the predictive validity of an objective measure, the death/suicide Implicit Association Test (d/sIAT), was tested among psychiatrically hospitalized veterans. Following acute stabilization, 176 participants completed the d/sIAT and traditional suicide risk assessments. Participants had similar d/sIAT scores regardless of whether they had recently attempted suicide. However, d/sIAT scores significantly predicted suicide attempts during the 6-month follow-up above and beyond other known risk factors for suicidal behavior (OR = 1.89; 95% CI: 1.15-3.12; based on 1SD increase). The d/sIAT may augment the accuracy of suicide risk assessment.
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Affiliation(s)
- Sean M Barnes
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Denver, CO, USA.,Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Nazanin H Bahraini
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Denver, CO, USA.,Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Denver, CO, USA.,Departments of Physical Medicine and Rehabilitation and Biostatistics and Informatics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Kelly A Stearns-Yoder
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Denver, CO, USA
| | - Trisha A Hostetter
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Denver, CO, USA
| | - Geoffrey Smith
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Denver, CO, USA
| | - Herbert T Nagamoto
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Denver, CO, USA.,Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
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Monteith LL, Menefee DS, Forster JE, Bahraini NH. A Closer Examination of Sexual Trauma During Deployment: Not all Sexual Traumas are Associated with Suicidal Ideation. Suicide Life Threat Behav 2016; 46:46-54. [PMID: 26096625 DOI: 10.1111/sltb.12171] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
Abstract
Military personnel can be exposed to a wide range of sexual trauma while deployed, including sexual harassment and sexual assault. We examined whether different types of sexual trauma during deployment associated with recent suicidal ideation among previously deployed OEF/OIF/OND veterans admitted to trauma-focused treatment (n = 199). More severe forms of sexual trauma (e.g., sexual assault) were significantly and positively associated with suicidal ideation. In contrast, sexual trauma involving verbal remarks (e.g., sexual harassment) was not associated with suicidal ideation. Our findings suggest that sexual harassment and sexual assault during deployment may be differentially associated with suicidal ideation.
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Affiliation(s)
- Lindsey L Monteith
- Denver Veterans Affairs Medical Center, Veterans Integrated Service Network 19 Mental Illness Research, Education and Clinical Center (VISN 19 MIRECC), Denver, CO, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Deleene S Menefee
- Michael E. DeBakey Veterans Affairs Medical Center, VISN 16 MIRECC, Houston, TX, USA.,The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Jeri E Forster
- Denver Veterans Affairs Medical Center, Veterans Integrated Service Network 19 Mental Illness Research, Education and Clinical Center (VISN 19 MIRECC), Denver, CO, USA.,Colorado School of Public Health, Aurora, CO, USA
| | - Nazanin H Bahraini
- Denver Veterans Affairs Medical Center, Veterans Integrated Service Network 19 Mental Illness Research, Education and Clinical Center (VISN 19 MIRECC), Denver, CO, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Monteith LL, Menefee DS, Forster JE, Wanner JL, Bahraini NH. Sexual Trauma and Combat During Deployment: Associations With Suicidal Ideation Among OEF/OIF/OND Veterans. J Trauma Stress 2015; 28:283-8. [PMID: 26190530 DOI: 10.1002/jts.22018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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] [Indexed: 11/09/2022]
Abstract
Compelling evidence has emerged on the association between military sexual trauma and suicide attempt; however, research investigating how sexual trauma during deployment relates to suicidal ideation has received considerably less attention and has yielded mixed findings. Furthermore, such research has not accounted for other types of trauma that may occur during deployment. Our objectives were to examine whether sexual trauma during deployment was associated with recent suicidal ideation, adjusting for exposure to combat. Our sample included 199 Operation Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) veterans entering inpatient trauma-focused treatment who completed the Beck Scale for Suicide Ideation (Beck & Steer, ) and the Deployment Risk and Resilience Inventory Sexual Harassment and Combat Experiences Scales (King, King, Vogt, Knight, & Samper, ). Deployment-related sexual trauma was significantly associated with recent suicidal ideation, adjusting for age and gender (β = .18, ηp (2) = .03) and additionally for combat (β = .17, ηp (2) = .02). These findings underscore the importance of assessing for deployment-related sexual trauma when assessing suicide risk in OEF/OIF/OND veterans in inpatient settings.
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Affiliation(s)
- Lindsey L Monteith
- Denver Veterans Affairs Medical Center, Veterans Integrated Service Network (VISN) 19 Mental Illness Research, Education and Clinical Center (MIRECC), Denver, Colorado, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Deleene S Menefee
- Michael E. DeBakey Veterans Affairs Medical Center, VISN 16 MIRECC, Houston, Texas, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Jeri E Forster
- Denver Veterans Affairs Medical Center, Veterans Integrated Service Network (VISN) 19 Mental Illness Research, Education and Clinical Center (MIRECC), Denver, Colorado, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Jill L Wanner
- Michael E. DeBakey Veterans Affairs Medical Center, VISN 16 MIRECC, Houston, Texas, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Nazanin H Bahraini
- Denver Veterans Affairs Medical Center, Veterans Integrated Service Network (VISN) 19 Mental Illness Research, Education and Clinical Center (MIRECC), Denver, Colorado, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Pease JL, Monteith LL, Hostetter TA, Forster JE, Bahraini NH. Military Service and Suicidal Thoughts and Behaviors in a National Sample of College Students. Crisis 2015; 36:117-125. [DOI: 10.1027/0227-5910/a000300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: As a result of the post-9/11 GI Bill, increasing numbers of veterans are enrolling in college. However, little is known regarding suicidal outcomes among this group. In prior research, college student veterans reported high rates of suicidal ideation and attempt. Nonetheless, no research has examined whether military service is associated with increased suicide risk among college students. Aims: Our primary aims were to examine whether a history of military service was related to past-year suicidal ideation, plan, and attempt among college students. On the basis of previous research with college students, we hypothesized that students with a history of military service (i.e., current or prior) would report a higher percentage of past-year suicidal ideation, plan, and attempt. Our secondary aims were to examine the associations between military service and major depression and nonsuicidal self-injury. Method: Our sample included 3,290 college students with and without a history of military service who participated in the Healthy Minds Study in 2011 and 2012. Results: Military service was not significantly associated with past-year suicidal ideation, plan, or attempt. Students without a history of military service were more likely to report nonsuicidal self-injury. There was no significant difference in screening positive for major depression. Conclusions: These findings conflict with previous research that identified student veterans as being at elevated risk.
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Affiliation(s)
- James L. Pease
- Veterans Integrated Service Network 19 Mental Illness Research, Education and Clinical Center, Denver, Co, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Co, USA
| | - Lindsey L. Monteith
- Veterans Integrated Service Network 19 Mental Illness Research, Education and Clinical Center, Denver, Co, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Co, USA
| | - Trisha A. Hostetter
- Veterans Integrated Service Network 19 Mental Illness Research, Education and Clinical Center, Denver, Co, USA
| | - Jeri E. Forster
- Veterans Integrated Service Network 19 Mental Illness Research, Education and Clinical Center, Denver, Co, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Co, USA
| | - Nazanin H. Bahraini
- Veterans Integrated Service Network 19 Mental Illness Research, Education and Clinical Center, Denver, Co, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Co, USA
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Monteith LL, Pease JL, Forster JE, Homaifar BY, Bahraini NH. Values as Moderators of the Association between Interpersonal-Psychological Constructs and Suicidal Ideation among Veterans. Arch Suicide Res 2015; 19:422-34. [PMID: 25856250 DOI: 10.1080/13811118.2015.1004486] [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: 10/23/2022]
Abstract
This study examined whether valuing relationships, achievement, and security moderated the association between interpersonal-psychological constructs (Joiner, 2005) and suicidal ideation (SI). A total of 122 veterans completed the Interpersonal Needs Questionnaire, Survey of Life Principles, and Beck Scale for Suicide Ideation. Valuing relationships moderated the association between thwarted belongingness and SI. Specifically, thwarted belongingness predicted SI among veterans who reported moderate and high, but not low, levels of valuing relationships. The estimated impact of perceived burdensomeness on SI was stronger at higher levels of valuing relationships, but only approached statistical significance. Valuing achievement and security did not moderate the association between perceived burdensomeness and SI. Future research should continue to examine specific values as they relate to interpersonal-psychological constructs and suicidal behavior.
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Nazem S, Spitzer EG, Brenner LA, Bahraini NH. Beyond categorical classifications: the importance of identifying posttrauma symptom trajectories and associated negative outcomes. J Clin Psychiatry 2014; 75:e947-9. [PMID: 25295439 DOI: 10.4088/jcp.14com09450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Sarra Nazem
- US Department of Veterans Affairs, Veterans Integrated Service Network 19 Mental Illness Research, Education and Clinical Center
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Signoracci GM, Bahraini NH, Matarazzo BB, Olson-Madden JH, Brenner LA. Delivering Mental Health Services to OEF/OIF Veterans: A VHA Qualitative Study. J Holist Nurs 2014; 32:161-72. [PMID: 24668062 DOI: 10.1177/0898010114524484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 11/15/2022]
Abstract
PURPOSE Veterans Health Administration (VHA) mental health (MH) professionals are providing care to increasing numbers of veterans who served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). This study aimed to describe MH clinicians' views of OEF/OIF veteran needs and how providers meet those needs within a large system of care. DESIGN Qualitative research methodology, specifically qualitative description, was used to explore VHA MH clinicians' experiences providing MH services to OEF/OIF veterans. METHODS Thirteen VA MH providers participated in semistructured interviews, which included questions regarding the following areas: psychiatric needs of OEF/OIF veterans; collaboration and referral; needs and resources; and the personal/professional impact of providing services to this cohort. FINDINGS Themes emerged which highlighted complex challenges faced by OEF/OIF veterans, barriers associated with matching the unique needs of these veterans with existing treatments, and the challenges and rewards associated with providing care to members of this population. CONCLUSIONS Capturing provider perspectives within MH services suggest potential areas for innovation aimed at providing patient-centered care to this cohort of veterans. Results may also inform future work aimed at meeting the needs of both OEF/OIF veterans and MH providers.
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Affiliation(s)
- Gina M Signoracci
- Veterans Integrated Service Network 19 (VISN 19) Mental Illness Research, Education, and Clinical Center (MIRECC)School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Nazanin H Bahraini
- Veterans Integrated Service Network 19 (VISN 19) Mental Illness Research, Education, and Clinical Center (MIRECC)School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Bridget B Matarazzo
- Veterans Integrated Service Network 19 (VISN 19) Mental Illness Research, Education, and Clinical Center (MIRECC)School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jennifer H Olson-Madden
- Veterans Integrated Service Network 19 (VISN 19) Mental Illness Research, Education, and Clinical Center (MIRECC)School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Lisa A Brenner
- Veterans Integrated Service Network 19 (VISN 19) Mental Illness Research, Education, and Clinical Center (MIRECC)School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Abstract
Given the upsurge of research in posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI), much of which has focused on military samples who served in Iraq and Afghanistan, the purpose of this article is to review the literature published after September 11th, 2001 that addresses the epidemiology, pathophysiology, evaluation, and treatment of PTSD in the context of TBI.
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Affiliation(s)
- Nazanin H Bahraini
- Department of Veterans Affairs, Veteran Integrated Service Network (VISN) 19 Mental Illness Research Education and Clinical Center (MIRECC), 1055 Clermont Street, Denver, CO 80220, USA; Department of Psychiatry, School of Medicine, University of Colorado, 13001 East 17th Place, Aurora, CO 80045, USA.
| | - Ryan E Breshears
- Wellstar Health System, Psychological Services, 55 Whitcher Street, Suite 420, Marietta, GA 30060, USA; Department of Counseling and Human Development, University of Georgia, 402 Aderhold Hall, Athens, GA 30602, USA
| | - Theresa D Hernández
- Department of Veterans Affairs, Veteran Integrated Service Network (VISN) 19 Mental Illness Research Education and Clinical Center (MIRECC), 1055 Clermont Street, Denver, CO 80220, USA; Department of Psychology and Neuroscience, University of Colorado, 1905 Colorado Avenue, Boulder, CO 80309, USA
| | - Alexandra L Schneider
- Department of Veterans Affairs, Veteran Integrated Service Network (VISN) 19 Mental Illness Research Education and Clinical Center (MIRECC), 1055 Clermont Street, Denver, CO 80220, USA
| | - Jeri E Forster
- Department of Veterans Affairs, Veteran Integrated Service Network (VISN) 19 Mental Illness Research Education and Clinical Center (MIRECC), 1055 Clermont Street, Denver, CO 80220, USA; Department of Biostatistics & Informatics, Colorado School of Public Health, University of Colorado Denver, 13001 E. 17th Place, Aurora, CO 80045, USA
| | - Lisa A Brenner
- Department of Veterans Affairs, Veteran Integrated Service Network (VISN) 19 Mental Illness Research Education and Clinical Center (MIRECC), 1055 Clermont Street, Denver, CO 80220, USA; Department of Psychiatry, School of Medicine, University of Colorado, 13001 East 17th Place, Aurora, CO 80045, USA; Department of Neurology, School of Medicine, University of Colorado, 13001 E. 17th Place, Aurora, CO 80045, USA; Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado, 13001 E. 17th Place, Aurora, CO 80045, USA
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Bahraini NH, Devore MD, Monteith LL, Forster JE, Bensen S, Brenner LA. The role of value importance and success in understanding suicidal ideation among Veterans. Journal of Contextual Behavioral Science 2013. [DOI: 10.1016/j.jcbs.2013.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bahraini NH, Gutierrez PM, Harwood JEF, Huggins JA, Hedegaard H, Chase M, Brenner LA. The Colorado Violent Death Reporting System (COVDRS): validity and utility of the Veteran status variable. Public Health Rep 2012; 127:304-9. [PMID: 22547861 DOI: 10.1177/003335491212700310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Using the Veterans Affairs Beneficiary Identification Record Locator Subsystem (BIRLS) as the criterion database, we evaluated the sensitivity and specificity of the death certificate information in the Colorado Violent Death Reporting System (COVDRS) to determine Veteran status for those who died by suicide. METHODS The study sample consisted of 3,820 individuals aged 18 years and older who died by suicide in Colorado from January 1, 2004, through December 31, 2008. To determine agreement on Veteran status, COVDRS data were submitted to the Veterans Benefits Administration for linkage to the BIRLS using Social Security numbers. RESULTS Sensitivity and specificity of the Veteran status information on the death certificate were 93.1% (95% confidence interval [CI] 90.7, 95.2) and 91.7% (95% CI 90.5, 92.8), respectively. The overall agreement between the death certificate and the BIRLS on Veteran status was very good (kappa = 0.76; 95% CI 0.74, 0.79). CONCLUSIONS This study of 3,820 suicide deaths in Colorado demonstrated a high level of agreement between the COVDRS Veteran status variable and the BIRLS. Such findings offer support for using the COVDRS in studying factors associated with suicide in the Veteran population.
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Affiliation(s)
- Nazanin H Bahraini
- Veterans Integrated Service Network 19, Mental Illness Research, Education and Clinical Center, Denver, CO 80220, USA.
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Bahraini NH, Brenner LA, Harwood JEF, Homaifar BY, Ladley-O’Brien SE, Filley CM, Kelly JP, Adler LE. Utility of the Trauma Symptom Inventory for the Assessment of Post-Traumatic Stress Symptoms in Veterans With a History of Psychological Trauma and/or Brain Injury. Mil Med 2009; 174:1005-9. [DOI: 10.7205/milmed-d-00-9509] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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