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Britton PC, Karras E, Stecker T, Klein J, Crasta D, Brenner LA, Pigeon WR. The Veterans Crisis Line: Relations among immediate call outcomes and treatment contact and utilization following the call. Suicide Life Threat Behav 2024. [PMID: 38687175 DOI: 10.1111/sltb.13086] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Crisis line callers experience reductions in distress and suicidal ideation and utilize more health care following calls. The purpose of this study was to determine whether changes in distress and suicidal ideation during a call are associated with later healthcare contact and utilization. METHOD Veterans Crisis Line calls from 599 veterans were extracted with call dates between 12/1/2018 and 11/30/2019. Calls were coded for changes in distress and suicidal ideation and linked with VA medical records to obtain healthcare data. Generalized Linear Mixed Modeling was used to examine the associations of changes in distress and suicidal ideation with healthcare contact (yes/no) and utilization (days of treatment) in the month (30 days) following the call. RESULTS Reductions in distress were associated with behavioral (i.e., mental and substance use) healthcare utilization, F(1, 596) = 4.52, p = 0.03, and reductions in suicidal ideation were associated with any healthcare utilization, F(1, 596) = 6.45, p = 0.01. Changes in distress and suicidal ideation were not associated with healthcare contact. CONCLUSION Responders need to help resolve distress and suicidal ideation and link callers with treatment. Unresolved distress and suicidal thoughts may signify later problems with treatment utilization. Research is needed to determine causality.
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Affiliation(s)
- Peter C Britton
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Elizabeth Karras
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Tracy Stecker
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - John Klein
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
| | - Dev Crasta
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Lisa A Brenner
- Rocky Mountain MIRECC for Suicide Prevention, VA Eastern Colorado Health Care System, Denver, Colorado, USA
- Department of Psychiatry, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
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Aldalur A, Dillon KM, Rotoli JM, Stecker T, Conner KR. Deaf perceptions about treatment for alcohol use and mental health. J Subst Use Addict Treat 2024; 158:209233. [PMID: 38061637 PMCID: PMC10947863 DOI: 10.1016/j.josat.2023.209233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 10/26/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Recent research suggests that alcohol use disorder may be more prevalent in the Deaf community, a diverse sociolinguistic minority group. However, rates of treatment-seeking among Deaf individuals are even lower than in the general society. This study used the Theory of Planned Behavior to identify Deaf adults' beliefs about treatment that may prevent their treatment-seeking behaviors. METHODS This study conducted elicitation interviews with 16 Deaf adults. The study team recruited participants from across the U.S. and conducted interviews on Zoom. Participant ages ranged from 27 to 67 years (M = 40, SD =10.8). Seventy-five percent of the sample was male, 75 % were White, and 12.5 % were Hispanic/Latine. The study conducted interviews in American Sign Language, subsequently interpreted into English by a nationally certified interpreter, and transcribed for data analyses. The study analyzed transcripts using the Framework Method. The study team coded the interviews in groups and assessed for saturation (≤ 5 % new themes) of themes throughout the analysis. This study reached saturation in the third group (six total groups). RESULTS Identified themes followed the Theory of Planned Behavior constructs. The study identified nine Behavioral Beliefs with four advantages and five disadvantages of seeking treatment, four Normative Beliefs with one support and three oppositions to seeking treatment, and thirteen Control Beliefs with five facilitators and eight barriers to seeking treatment. Overall, the Deaf participants reported several unique beliefs based on their cultural and linguistic perspectives, including a concern about unqualified providers, experiencing stress in treatment with hearing providers, stigma within the Deaf community, less access to cultural information about alcohol and mental health, less encouragement of traditional treatment in marginalized communities, and additional barriers (e.g., communication, limited Deaf treatment options, discrimination, etc.). CONCLUSIONS A thorough understanding of individual beliefs about treatment is necessary to develop interventions that may increase treatment-seeking behaviors. Previous research has demonstrated that individual beliefs may be modified using Cognitive Behavioral Therapy techniques to increase treatment-seeking behaviors among hearing individuals. Similar interventions may be useful with Deaf individuals; however, they must consider the unique cultural and linguistic perspectives of the community.
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Affiliation(s)
- Aileen Aldalur
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY 14642, United States of America.
| | - Kevin M Dillon
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave., Rochester, NY 14642, United States of America
| | - Jason M Rotoli
- Department of Emergency Medicine, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY 14642, United States of America
| | - Tracy Stecker
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St., MSC 160, Charleston, SC 29425, United States of America
| | - Kenneth R Conner
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY 14642, United States of America; Department of Emergency Medicine, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY 14642, United States of America
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Conner KR, Maisto SA, Abar B, Szafranski S, Chiang A, Hutchison M, Aldalur A, Stecker T. Brief, cognitive-behavioral intervention to promote treatment seeking in adults with severe alcohol use disorder: A randomized controlled trial. Addiction 2023; 118:2342-2351. [PMID: 37488997 PMCID: PMC10805959 DOI: 10.1111/add.16300] [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: 12/19/2022] [Accepted: 06/20/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND AND AIMS There is little RCT evidence that brief interventions improve treatment seeking in individuals with severe alcohol use disorder (AUD) or treatment seeking reduces alcohol use. The aim was to test the efficacy of a brief intervention to increase treatment seeking in treatment naïve adults with severe AUD and measure its effects on alcohol use. DESIGN Parallel group, non-pharmacologic RCT with intervention (n = 197) and active control (n = 203) conditions, with blinded assessors conducting follow-ups at 1, 3 and 6 months. SETTING Online recruitment in a 17-county region of upstate New York, USA. PARTICIPANTS Inclusion criteria consisted of ages ≥18 years, Alcohol Use Disorders Identification Test score ≥16, exceeds recommended limits for alcohol use and no history of AUD treatment. n = 400; 50% female; 79% white; mean age, 40.7; mean education, 14.6 years. INTERVENTION AND COMPARATOR One-session telephone-delivered interventions: Cognitive-Behavioral Therapy for Treatment Seeking (CBT-TS; intervention), review of a National Institute on Alcohol Abuse and Alcoholism pamphlet on AUD treatment (control). MEASUREMENTS Self-report of any AUD treatment use over 3 months (primary outcome) and two standard measures of alcohol use over 6 months (secondary outcomes). FINDINGS Intent-to-treat analyses were used. Assessment follow-up rates were ≥93%. Any alcohol-related treatment use over 3-month follow-up was obtained by 38 (19%) intervention participants and 36 (18%) control participants, a non-significant difference, χ2 [1] = 0.16, P = 0.689. Secondary analysis showed a significant interaction term between sex and intervention assignment (β = -1.197, P = 0.027). The interaction suggested CBT-TS was effective in men (22% vs 13%), although the evidence was somewhat weak (P = 0.071), and it was not effective in women (17% vs 24%). CONCLUSIONS A one-session cognitive-behavioral therapy intervention to increase treatment seeking in treatment naïve adults with severe alcohol use disorder did not increase treatment seeking.
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Affiliation(s)
- Kenneth R Conner
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Sarah Szafranski
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrew Chiang
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Morica Hutchison
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Aileen Aldalur
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Tracy Stecker
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
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Stecker T, Allan NP, Hoge C, Ashrafioun L, Conner KR. Efficacy of CBT for Treatment Seeking (CBT-TS) in Untreated Veterans and Service Members at Risk for Suicidal Behavior. J Gen Intern Med 2023; 38:2639-2646. [PMID: 36964422 PMCID: PMC10506992 DOI: 10.1007/s11606-023-08129-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 03/01/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE Military members and Veterans at-risk for suicide are often unlikely to seek behavioral health treatment. The primary aim of this study was to test the efficacy of brief CBT for Treatment Seeking (CBT-TS) to improve behavioral health treatment utilization among U.S. military service members and Veterans at-risk for suicide. METHODS A total of 841 participants who served in the U.S. military since 9/11 and who reported suicidality but were not in behavioral health treatment were recruited to participate in this trial. Participants were randomly assigned to either brief CBT-TS delivered by phone or an assessment-only control condition. Follow-up assessments were conducted at baseline and months 1, 3, 6, and 12 to track treatment utilization and symptoms. RESULTS CBT-TS resulted in significantly greater behavioral health treatment initiation within 1 month compared to the control condition (B = .93, p < .001); and the higher treatment initiation persisted for 12 months post intervention. CONCLUSIONS This study employed a low-cost, easily implementable one-session intervention administered by phone. The study provides evidence that CBT-TS is efficacious in promoting behavioral health treatment initiation in an adult population at risk for suicidal behavior and showed enduring benefits for 6-12 months. CBT-TS provides a unique strategy for treatment engagement for at-risk adults unlikely to seek treatment. TRIAL REGISTRATION Clinicaltrials.gov NCT05077514.
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Affiliation(s)
- Tracy Stecker
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA.
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, NY, USA.
| | - Nicholas P Allan
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, NY, USA
- Department of Psychology, Ohio State University, Columbus, OH, USA
| | - Charles Hoge
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Lisham Ashrafioun
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, NY, USA
- Departments of Emergency Medicine and Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Kenneth R Conner
- Departments of Emergency Medicine and Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Britton PC, Karras E, Stecker T, Klein J, Crasta D, Brenner LA, Pigeon WR. Veterans Crisis Line Call Outcomes: Treatment Contact and Utilization. Am J Prev Med 2023; 64:658-665. [PMID: 36805255 DOI: 10.1016/j.amepre.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 02/19/2023]
Abstract
INTRODUCTION Crisis lines are a central component of suicide prevention strategies in the U.S. and for the Department of Veterans Affairs. The purpose of this study is to evaluate the impact of calling the Veterans Crisis Line on treatment contact and utilization. METHODS Call records from 599 veterans who called in 2019 were linked with medical records and analyzed in 2020. Multilevel generalized linear modeling examined pre-post changes in treatment contact (yes/no) and utilization (number of days of care). RESULTS In the month after the call, 85% of callers made contact with health care, and 79% made contact with behavioral health care. Callers were more likely to make contact with health care in the month after the call than in the preceding month (AOR=6.27, 95% CI=4.22, 9.32) and more likely to make contact with behavioral health care (AOR=10.21, 95% CI=6.66, 15.67). Days of health care nearly doubled to 4.82, and days of behavioral health care more than doubled to 3.52. CONCLUSIONS Among veteran callers who are linked to medical records, calling the Veterans Crisis Line may increase contact and utilization of health care and behavioral health care. These findings support crisis lines that are linked with healthcare systems in public health strategies for suicide prevention.
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Affiliation(s)
- Peter C Britton
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York.
| | - Elizabeth Karras
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Tracy Stecker
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York; College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - John Klein
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York
| | - Dev Crasta
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Lisa A Brenner
- Rocky Mountain MIRECC for Suicide Prevention, Denver, Colorado; Department of Psychiatry, School of Medicine, University of Colorado, Denver, Colorado
| | - Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Saulnier KG, Volarov M, Velimirović M, Bauer BW, Kolnogorova K, Ashrafioun L, Stecker T, Allan NP. Risk factors of suicidal behaviors in a high-risk longitudinal veteran sample: A network analysis. Suicide Life Threat Behav 2023; 53:4-15. [PMID: 36029133 DOI: 10.1111/sltb.12918] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/17/2022] [Accepted: 08/12/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Suicide is a substantial public health burden, particularly among veterans. Risk factors have been delineated for suicide; however, the dynamic interrelations between risk factors have not been fully examined. Such research has the potential to elucidate processes that contribute to suicide risk between individuals with a past suicide attempt (attempters) and those without a past suicide attempt (nonattempters). METHODS In the current study, network analysis was used to compare networks between attempters and nonattempters in a high-risk veteran sample (N = 770; Mage = 32.3 years, SD = 6.8; 326 with a past suicide attempt) who were followed over 1 year. Networks were estimated to examine (1) concurrent relations of suicide risk factors at baseline and (2) predictability of prospective suicidal behavior (SB). RESULTS There were no differences in the overall connectivity of attempter and nonattempter networks. Perceived burdensomeness and posttraumatic stress disorder (PTSD) symptoms were most central in the attempters' network, whereas PTSD symptoms and insomnia were most central in the nonattempters' network. The risk factors prospective SB in either network. However, attempters were more likely to engage in SB over the course of the study. CONCLUSION These findings highlight the difficulty in predicting who will attempt suicide.
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Affiliation(s)
- Kevin G Saulnier
- Department of Psychology, Ohio University, Athens, Ohio, USA.,Department of Psychiatry and Behavioral Health, College of Medicine, Penn State University, Hershey, Pennsylvania, USA
| | - Marija Volarov
- Department of Psychology, University of Novi Sad, Novi Sad, Serbia
| | - Mina Velimirović
- Department of Psychology, University of Novi Sad, Novi Sad, Serbia
| | - Brian W Bauer
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | | | - Lisham Ashrafioun
- VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Tracy Stecker
- VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York, USA.,College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nicholas P Allan
- Department of Psychology, Ohio University, Athens, Ohio, USA.,VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York, USA
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Conner KR, Abar B, Aldalur A, Chiang A, Hutchison M, Maisto SA, Stecker T. Alcohol-related consequences and the intention to seek care in treatment naïve women and men with severe alcohol use disorder. Addict Behav 2022; 131:107337. [PMID: 35483181 PMCID: PMC9717617 DOI: 10.1016/j.addbeh.2022.107337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/18/2022] [Accepted: 04/11/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Research on treatment utilization for alcohol use disorder (AUD) is based primarily on clinical samples and community samples of low AUD severity that may not need formal care. Using a community sample of adults with untreated but severe AUD symptoms, we tested the hypothesis that alcohol-related consequences, but not alcohol consumption levels, are associated with the intention to seek AUD treatment, examined associations of specific types of alcohol-related consequences with intention, and explored sex differences in these associations. METHODS The sample was recruited using social media ads for a randomized controlled trial to test a brief intervention to promote AUD treatment seeking. This report is based on analysis of baseline data collected prior to treatment intervention. Multiple linear regressions examined associations of measures of alcohol consumption, alcohol-related consequences broadly, and specific alcohol-related consequences with the intention to seek treatment. Moderating effects of sex on associations were explored. RESULTS Subjects (n = 349) averaged 41 years of age, 48% were female, 6% were Latinx, 80% were white, 15% were Black, and 92% met criteria for severe AUD. Alcohol consumption measures were not associated with intention to seek treatment whereas interpersonal- and intrapersonal- consequences were associated with intention. Sex served as a moderator, with intrapersonal consequences (e.g., sad mood) showing a stronger association with intention in women and social responsibility consequences (particularly financial) associated with intention in men. CONCLUSION Select alcohol-related consequences may be keys to understanding increased intention to seek AUD treatment including intrapersonal consequences in women and financial consequences in men.
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Affiliation(s)
- Kenneth R Conner
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 655C, Rochester, NY 14642, USA.
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 655C, Rochester, NY 14642, USA
| | - Aileen Aldalur
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 655C, Rochester, NY 14642, USA
| | - Andrew Chiang
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 655C, Rochester, NY 14642, USA.
| | - Morica Hutchison
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642, USA.
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244, USA.
| | - Tracy Stecker
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, Room 431, Charleston, SC 29425, USA.
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Maisto SA, Aldalur A, Abar B, Stecker T, Chiang A, Conner K. Heterogeneity in Alcohol-Related Severity and Interests in Going to Treatment in Community Adults with Alcohol Use Disorder (AUD). Subst Use Misuse 2022; 57:1626-1632. [PMID: 35869665 PMCID: PMC10518904 DOI: 10.1080/10826084.2022.2102192] [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] [Indexed: 10/16/2022]
Abstract
RATIONALE Alcohol use disorder (AUD) is highly prevalent among adults in the US and is associated with substantial personal and societal costs. Yet only a small percentage of adults with AUD initiate treatment, including those with severe AUD symptoms who are most in need of treatment. In this paper we use latent profile analysis (LPA) to describe differences in symptoms of AUD severity and alcohol-related consequences among untreated adults with severe AUD symptoms who were recruited from the community. Identification of such differences will result in better understanding of this population and will improve methods of treatment outreach. METHOD The LPAs were conducted on the baseline data of 403 (50% male, 77% White, M age = 40.74 with severe AUD recruited from the community and enrolled in a trial of an intervention designed to encourage treatment initiation. Participants reported no prior AUD treatment history. The LPAs were based on indicators of AUD severity, alcohol-related negative consequences, and self-reported intention to initiate AUD treatment. RESULTS The LPAs revealed 4 profiles. Profile membership was predicted by baseline participant sex and whether they were living with a partner and was associated with baseline past 30-days alcohol consumption. CONCLUSIONS The findings characterize and describe the variability among adults in the community with untreated severe AUD on variables that tend to motivate such individuals to seek treatment, which could significantly advance treatment outreach efforts.
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Affiliation(s)
- Stephen A. Maisto
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Aileen Aldalur
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Tracy Stecker
- Department of Psychiatry, University of South Carolina, Columbia, South Carolina, USA
| | - Andrew Chiang
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Kenneth Conner
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
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Hutchison M, Aldalur A, Maisto SA, Chiang A, Abar B, Stecker T, Conner KR. Alcohol Use During COVID-19 in Adults with Severe Untreated AUD. Alcoholism Treatment Quarterly 2022; 40:299-310. [PMID: 35937159 PMCID: PMC9355046 DOI: 10.1080/07347324.2022.2060156] [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: 10/18/2022]
Abstract
Evidence demonstrating increased alcohol use during COVID-19 comes from low- to moderate-alcohol use samples and has yet to use adults with severe but untreated AUD. Using a community sample of adults with severe AUD, this exploratory, cross-sectional study examined associations of COVID-19 alcohol use. Participants were recruited for a phase-II RCT. Only baseline measures, completed prior to randomization, were analyzed in the present study. Key variables were alcohol consumption, COVID-19-related worries and experiences, and qualitative responses of 1) alcohol use and 2) positive changes during COVID-19. 176 pariticpants recruited since COVID-19 were on average 41.4 years old, 49.1% female, and 79% White. Participants drank alcohol nearly 23 of the past 30 days, consumed 7 standard drinks per drinking day, and nearly 90% reported increased alcohol use. More heavy episodic drinking was reported in the first six-months of COVID-19 and more COVID-related concerns in the most recent six-months. Participants reported drinking increased due to "more time on their hands", but the pandemic also "strengthened relationships". Results affirm an increase in alcohol use during COVID-19 in adults with severe, untreated AUD. Findings underscore the need to understand how alcohol use and pandemic-related circumstances may influence one another for adults with severe AUD.
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Affiliation(s)
- Morica Hutchison
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Aileen Aldalur
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Stephen A. Maisto
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Andrew Chiang
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Tracy Stecker
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kenneth R. Conner
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
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Ashrafioun L, Saulnier KG, Allan NP, Bishop TM, Stecker T. Pain intensity trajectories among veterans seeking mental health treatment: Association with mental health symptoms and suicidal thoughts and behaviors. J Affect Disord 2022; 297:586-592. [PMID: 34728278 DOI: 10.1016/j.jad.2021.10.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 07/21/2021] [Accepted: 10/23/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of this study was to identify classes of pain intensity trajectories among veterans reporting suicidal ideation with no prior mental health treatment experience. We were interested in also assessing factors associated with the pain trajectory classes. METHODS A total 747 participants completed measures of pain, depression, suicide ideation and behaviors, insomnia, substance use, and PTSD. Follow-up assessments were completed at 1-, 3-, 6-, and 12-months post-baseline. Growth mixture modeling was conducted, and pain trajectories were modeled from baseline to month 12. RESULTS Three classes were identified: mild pain intensity that increased over time to severe pain intensity (Increasing-Severe; n = 9), low pain intensity that decreased over time (Mild-Decreasing; n = 172), and moderate pain intensity that remained relatively stable over time (Moderate-Stable; n = 566). The Moderate-Stable trajectory had more severe PTSD symptoms, more frequent depression symptoms, and more severe insomnia. The odds of endorsing suicide ideation at month 12 were significantly higher in the Moderate-Stable trajectory compared to the Mild-Decreasing trajectory. CONCLUSIONS This was the first study to assess classes of pain intensity trajectories among individuals who were treatment naïve for mental health issues. The findings suggest that a moderate stable trajectory of pain intensity over the course of 12 months is common and associated with a more severe clinical profile, including suicide ideation. This study underscores the importance of addressing pain intensity among individuals seeking mental health treatment, particularly for those with pain intensity that is moderate and stable over time.
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Affiliation(s)
- Lisham Ashrafioun
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY, United States; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States.
| | - Kevin G Saulnier
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Nicholas P Allan
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY, United States; Department of Psychology, Ohio University, Athens, OH, United States
| | - Todd M Bishop
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY, United States; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
| | - Tracy Stecker
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY, United States; College of Nursing, Medical University of South Carolina, Charleston, SC, United States
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11
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Allan NP, Volarov M, Koscinski B, Pizzonia KL, Potter K, Accorso C, Saulnier KG, Ashrafioun L, Stecker T, Suhr J, Allan DM. Lonely, anxious, and uncertain: Critical risk factors for suicidal desire during the COVID-19 pandemic. Psychiatry Res 2021; 304:114144. [PMID: 34364010 PMCID: PMC8442981 DOI: 10.1016/j.psychres.2021.114144] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/17/2021] [Accepted: 07/25/2021] [Indexed: 11/24/2022]
Abstract
Public health measures enacted early in response to the COVID-19 pandemic resulted in unprecedented physical isolation. Social isolation, or the objective experience of being alone, and loneliness, the subjective feeling of being lonely, are both implicated in suicidal ideation. Anxiety sensitivity (i.e., fear of somatic anxiety) and intolerance of uncertainty (distress due to uncertainty), may also be heightened in response to the pandemic increasing risk for suicidal ideation in response to social isolation and loneliness. The direct and interactive relations loneliness, anxiety sensitivity, and intolerance of uncertainty shared with suicidal ideation were examined using structural equation modeling across two samples. Sample 1 comprised 635 people (M age = 38.52, SD = 10.00; 49.0% female) recruited using Mechanical Turk in May 2020. Sample 2 comprised 435 people (M age = 34.92, SD = 14.98; 76.2% female) recruited from faculty, staff, and students at a midwestern university in June 2020. Loneliness and anxiety sensitivity were positively, uniquely associated with suicidal ideation across samples. Results of this study were cross-sectional and included only self-report measures. These findings highlight loneliness and anxiety sensitivity as important correlates of suicidal ideation. Modular treatments should be employed to target these mechanisms to reduce COVID-19-related suicidal ideation.
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Affiliation(s)
- Nicholas P Allan
- Department of Psychology, Ohio University, Athens, OH, United States; VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, United States.
| | - Marija Volarov
- Department of Psychology, University of Novi Sad, Novi Sad, Serbia
| | - Brandon Koscinski
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Kendra L Pizzonia
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Kaley Potter
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Catherine Accorso
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Kevin G Saulnier
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Lisham Ashrafioun
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, United States; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Tracy Stecker
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, United States; College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Julie Suhr
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Darcey M Allan
- Department of Psychology, Ohio University, Athens, OH, United States
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12
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Bishop T, Walsh P, Stecker T, Speed K, Ashrafioun L, Stepnowsky C, Kuna S, Pigeon W. 435 Single Session CBT to Improve PAP Initiation and Adherence among Veterans with OSA. Sleep 2021. [DOI: 10.1093/sleep/zsab072.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Obstructive sleep apnea (OSA) is a condition that is prevalent, pernicious, and linked to the development and exacerbation of several disease processes. Positive airway pressure (PAP) is a highly efficacious intervention; however, initiation and adherence rates are poor. This represents a critical gap in care and a missed opportunity to reduce morbidity and mortality associated with OSA. The present study piloted a single session of cognitive behavioral therapy for treatment seeking (CBT-TS) among veterans diagnosed with obstructive sleep apnea and newly prescribed PAP.
Methods
Participants were asked to complete assessments at baseline and at two- and four-weeks post-intervention. A sample of 40 Veterans were enrolled in the study and completed a baseline interview, 27 completed CBT-TS. A matched comparison group of 64 veterans who did not receive the intervention was constructed using electronic medical record and PAP adherence data. Mann Whitney U and Chi Square tests were used to examine group differences in initiation and adherence.
Results
Participants who completed the CBT-TS session were more likely to initiate PAP (at least 3 consecutive nights of use) as compared to those receiving treatment as usual (TAU) [(CBT-TS; 96.3%; 26/27) versus (TAU; 64.1%; 41/64); X2(1, N = 91) = 10.16, p = .001]. Participants in the CBT-TS group also used their PAP devices for a greater number of nights over the first month than the comparison group [(CBT-TS; M = 21.7 (SD = 8.9), Mdn = 26.0) versus (TAU; M = 14.4 (SD = 12.6), Mdn = 15.5); U = 555.0, p = .007] and were more likely to use the device in an adherent manner (i.e., ≥4 hours use in an evening); [(CBT-TS; M = 15.1 (SD = 11.2); Mdn = 15.0) versus (TAU; M = 10.3 (SD = 11.2), Mdn = 6.5); U =630.0, p = .038].
Conclusion
These preliminary data suggest that CBT-TS may have utility in increasing initiation of PAP and subsequent treatment adherence among Veterans diagnosed with OSA and newly prescribed PAP.
Support (if any)
This work was supported by the VA Center of Excellence for Suicide Prevention in the Finger Lakes Healthcare System.
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Affiliation(s)
- Todd Bishop
- VA Center of Excellence for Suicide Prevention
| | - Patrick Walsh
- Department of Psychiatry, University of Rochester Medical Center
| | | | | | | | | | - Samuel Kuna
- Corporal Michael J. Crescenz VA Medical Center
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13
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Kolnogorova K, Allan NP, Moradi S, Stecker T. Perceived burdensomeness, but not thwarted belongingness, mediates the impact of PTSD symptom clusters on suicidal ideation modeled longitudinally. J Affect Disord 2021; 282:133-140. [PMID: 33418359 DOI: 10.1016/j.jad.2020.12.079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 12/08/2020] [Accepted: 12/21/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Studies examining Posttraumatic Stress Disorder symptom clusters, suicidal ideation, and variables described in the Joiner's interpersonal theory of suicidal behavior were cross-sectional. METHODS We tested whether the relation between the Posttraumatic Stress Disorder symptom clusters and suicidal ideation is mediated by perceived burdensomeness and thwarted belongingness (variables of the interpersonal theory of suicidal behavior) in military personnel with current suicidal ideation using longitudinal design. DSM-IV model with reexperiencing, avoidance, numbing, and hyperarousal clusters was used. Structural equation modelling was used to test separate models for each symptom cluster with a symptom cluster at baseline, month 1 perceived burdensomeness and thwarted belongingness, and month 3 suicidal ideation, controlling for baseline values of the month 1 and month 3 variables. RESULTS Analysis of direct non-mediation models showed that baseline reexperiencing (p = .08) and avoidance (p = .07) symptom clusters marginally predicted month 3 suicidal ideation. The mediation analyses showed indirect effects from baseline reexperiencing, avoidance, and hyperarousal to suicidal ideation at month 3 through perceived burdensomeness at month 1. Thwarted belongingness did not mediate the relations between symptom clusters and suicidal ideation. LIMITATIONS The mechanism driving development of suicidal ideation in military personnel with PTSD may be different from the mechanism in other samples. Doing a phone interview limited us to use questionnaires instead of a clinical interview. CONCLUSIONS Our findings suggest that interventions targeting perceived burdensomeness in military personnel with reexperiencing, avoidance, and hyperarousal symptoms may be beneficial to reduce suicidal ideation.
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Affiliation(s)
| | | | | | - Tracy Stecker
- VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY USA; College of Nursing, Medical University of South Carolina, Charleston, SC USA
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14
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Raines AM, Allan NP, Franklin CL, Huet A, Constans JI, Stecker T. Correlates of Suicidal Ideation and Behaviors Among Former Military Personnel Not Enrolled in the Veterans Health Administration. Arch Suicide Res 2020; 24:517-533. [PMID: 33250005 DOI: 10.1080/13811118.2019.1660286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/25/2022]
Abstract
The current study sought to explore suicidal concomitants, both demographic and psychological, among former military personal. The sample included 645 veterans who are at increased risk for suicide but have not yet pursued Veterans Health Administration (VHA) services. Descriptive statistics revealed that these veterans are primarily young Caucasian males who served in the U.S. Army. In terms of psychological characteristics, the current sample reported clinically significant levels of depression, post-traumatic stress, and insomnia. Furthermore, respondents acknowledged use of various substances and high levels of perceived burdensomeness and thwarted belongingness. The demographic and psychological makeup of our sample was somewhat similar to that of VHA-connected veterans except that our sample was slightly more educated and reported less physical pain.
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Obeid JS, Dahne J, Christensen S, Howard S, Crawford T, Frey LJ, Stecker T, Bunnell BE. Identifying and Predicting Intentional Self-Harm in Electronic Health Record Clinical Notes: Deep Learning Approach. JMIR Med Inform 2020; 8:e17784. [PMID: 32729840 PMCID: PMC7426805 DOI: 10.2196/17784] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/25/2020] [Accepted: 05/21/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Suicide is an important public health concern in the United States and around the world. There has been significant work examining machine learning approaches to identify and predict intentional self-harm and suicide using existing data sets. With recent advances in computing, deep learning applications in health care are gaining momentum. OBJECTIVE This study aimed to leverage the information in clinical notes using deep neural networks (DNNs) to (1) improve the identification of patients treated for intentional self-harm and (2) predict future self-harm events. METHODS We extracted clinical text notes from electronic health records (EHRs) of 835 patients with International Classification of Diseases (ICD) codes for intentional self-harm and 1670 matched controls who never had any intentional self-harm ICD codes. The data were divided into training and holdout test sets. We tested a number of algorithms on clinical notes associated with the intentional self-harm codes using the training set, including several traditional bag-of-words-based models and 2 DNN models: a convolutional neural network (CNN) and a long short-term memory model. We also evaluated the predictive performance of the DNNs on a subset of patients who had clinical notes 1 to 6 months before the first intentional self-harm event. Finally, we evaluated the impact of a pretrained model using Word2vec (W2V) on performance. RESULTS The area under the receiver operating characteristic curve (AUC) for the CNN on the phenotyping task, that is, the detection of intentional self-harm in clinical notes concurrent with the events was 0.999, with an F1 score of 0.985. In the predictive task, the CNN achieved the highest performance with an AUC of 0.882 and an F1 score of 0.769. Although pretraining with W2V shortened the DNN training time, it did not improve performance. CONCLUSIONS The strong performance on the first task, namely, phenotyping based on clinical notes, suggests that such models could be used effectively for surveillance of intentional self-harm in clinical text in an EHR. The modest performance on the predictive task notwithstanding, the results using DNN models on clinical text alone are competitive with other reports in the literature using risk factors from structured EHR data.
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Affiliation(s)
- Jihad S Obeid
- Medical University of South Carolina, Charleston, SC, United States
| | - Jennifer Dahne
- Medical University of South Carolina, Charleston, SC, United States
| | - Sean Christensen
- Medical University of South Carolina, Charleston, SC, United States
| | - Samuel Howard
- Medical University of South Carolina, Charleston, SC, United States
| | - Tami Crawford
- Medical University of South Carolina, Charleston, SC, United States
| | - Lewis J Frey
- Medical University of South Carolina, Charleston, SC, United States
| | - Tracy Stecker
- Medical University of South Carolina, Charleston, SC, United States
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16
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Allan NP, Holm-Denoma J, Conner KR, Zuromski KL, Saulnier KG, Stecker T. Profiles of Risk for Suicidal Behavior in Past and Current United States Military Personnel: Latent Profile Analysis of Current Risk Factors. Arch Suicide Res 2020; 24:1-17. [PMID: 30118632 DOI: 10.1080/13811118.2018.1506843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/28/2022]
Abstract
Person-centered approaches are underutilized to identify people with shared risk profiles. In this study, an at-risk sample of 773 past/current military personnel (Mage = 31.3 years, SD = 6.8) with current ideation (90.6%) and/or a prior suicide attempt (43.9%) were assessed using latent profile analysis. Variables included prior suicide attempts, suicidal ideation, alcohol/drug use, insomnia, depression, belongingness, burdensomeness, and post-traumatic stress disorder symptoms. Three classes emerged: Low Symptoms (N = 502), Elevated Suicidality (N = 176), and Elevated Substance Use (N = 95). At 1-month follow-up, the Elevated Suicidality and Elevated Substance Use classes had the highest odds of suicidal behavior. The finding concerning the Elevated Substance Use class suggests it may represent a distinct short-term risk group in military personnel.
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Allan NP, Ashrafioun L, Kolnogorova K, Raines AM, Hoge CW, Stecker T. Interactive effects of PTSD and substance use on suicidal ideation and behavior in military personnel: Increased risk from marijuana use. Depress Anxiety 2019; 36:1072-1079. [PMID: 31475423 DOI: 10.1002/da.22954] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 06/18/2019] [Accepted: 07/27/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The current study examines the unique and interactive effects of posttraumatic stress disorder (PTSD) symptoms and days using alcohol, opioids, and marijuana on PTSD symptoms, suicidal ideation, and suicidal behavior up to 1 year, later in a high-risk sample of military personnel not active in mental health treatment. METHODS Current and former military personnel at risk for suicide (N = 545; M age = 31.91 years, standard deviation = 7.27; 88.2% male) completed self-report measures of PTSD symptoms, past 30 days heavy alcohol use, opioid use, marijuana use, and current suicidal ideation via telephone at baseline and 1, 3, 6, and 12 months later. PTSD symptoms and the substance use variables (and relevant covariates) were entered as predictors of changes in PTSD symptoms, the likelihood of suicidal ideation, suicidal ideation severity, and the likelihood of suicidal behavior during the 11-month follow-up period. RESULTS PTSD symptoms predicted PTSD symptoms 1 month later. PTSD symptoms and marijuana use predicted the likelihood of suicidal ideation 1 month later and suicidal behavior during the 11-month follow-up period. The interaction between PTSD symptoms and marijuana use significantly predicted increased PTSD symptoms over time and suicidal behavior. At high, but not low levels of PTSD symptoms, more days using marijuana predicted increased PTSD symptoms over time and the likelihood of suicidal behavior. CONCLUSIONS Results suggest marijuana, especially for military personnel experiencing elevated PTSD symptoms may negatively impact suicidal thoughts and behavior. These results are relevant to suggestions that medical marijuana could be used in treating or augmenting treatment for PTSD.
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Affiliation(s)
| | - Lisham Ashrafioun
- VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York.,Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - Amanda M Raines
- Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana.,South Central Mental Illness Research, Education, and Clinical Center (MIRECC), New Orleans, Louisiana
| | - Charles W Hoge
- Center for Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland.,Behavioral Health Division, Office of the Army Surgeon General, Falls Church, Virginia
| | - Tracy Stecker
- VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York.,College of Nursing, Medical University of South Carolina, Charleston, South Carolina
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18
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Allan NP, Gros DF, Lancaster CL, Saulnier KG, Stecker T. Heterogeneity in Short-Term Suicidal Ideation Trajectories: Predictors of and Projections to Suicidal Behavior. Suicide Life Threat Behav 2019; 49:826-837. [PMID: 29938818 DOI: 10.1111/sltb.12480] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 11/09/2017] [Accepted: 03/02/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Little is known about suicidal ideation stability, including whether stability is heterogeneous or homogeneous between individuals. Studies of this kind are necessary to understand the progression from suicidal ideation to action. METHOD This study examined suicidal ideation trajectories, using growth mixture modeling, in a sample of 359 past/current military service members (M age = 32.1 years, SD = 7.7; 88.3% male). Self-reported suicidal ideation information was collected at baseline and follow-up sessions at months 1, 3, 6, and 12. Following extraction of the best-fitting solution, predictors of trajectory status were examined and trajectory status was used to predict suicidal behavior between baseline and month 12 assessments. RESULTS Results revealed four trajectories, Low-Stable (n = 125), Moderate-Stable (n = 101), High-Stable (n = 76), and High-Rapidly Declining (n = 57). In general, the High-Stable trajectory had the highest levels of perceived burdensomeness, thwarted belongingness, PTSD symptoms, and drug use. The High- and Moderate-Stable trajectories had the highest rates of suicidal behavior between baseline and month 12. CONCLUSIONS Suicidal ideation, even in individuals with elevated ideation, is not a homogeneous construct over time. Stability of suicidal ideation might be an important risk factor, even if ideation is only moderately elevated.
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Affiliation(s)
| | - Daniel F Gros
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Cynthia L Lancaster
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | | | - Tracy Stecker
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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19
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Short NA, Allan NP, Oglesby ME, Moradi S, Schmidt NB, Stecker T. Prospective associations between insomnia symptoms and alcohol use problems among former and current military service personnel. Drug Alcohol Depend 2019; 199:35-41. [PMID: 30981047 DOI: 10.1016/j.drugalcdep.2019.02.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 08/20/2018] [Revised: 01/28/2019] [Accepted: 02/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite evidence that insomnia symptoms exacerbate alcohol use disorder symptoms, there is a dearth of prospective research testing bidirectional associations between these variables. Furthermore, no studies have prospectively examined these associations among military personnel, a vulnerable population for sleep- and alcohol-related problems. Thus, the current study examined whether insomnia symptoms prospectively predicted increased alcohol use disorder symptoms among a sample of military service members and veterans over a 6-month follow-up period, as well as whether alcohol use disorder symptoms led to increases in insomnia. METHOD Hypotheses were tested among a sample of 274 current and past military service members who participated in a baseline and 6-month assessment using self-report measures. RESULTS Path analyses revealed that insomnia symptoms significantly prospectively predicted increased month-6 heavy drinking and alcohol-related problems, but not days drinking or being bothered by drinking. None of the alcohol variables significantly predicted insomnia. CONCLUSION Results support a model in which insomnia symptoms exacerbate alcohol use disorder symptoms, specifically heavy drinking and alcohol-related problems. Future research should seek to examine these findings in diverse populations and test potential mechanisms and clinical implications of these results.
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Affiliation(s)
- Nicole A Short
- Department of Psychology, Florida State University, 1107 W Call St, Tallahassee, FL, 32304, USA
| | - Nicholas P Allan
- Department of Psychology, Ohio University, Porter Hall 200, Athens, OH, 45701, USA
| | - Mary E Oglesby
- Department of Psychology, Florida State University, 1107 W Call St, Tallahassee, FL, 32304, USA
| | - Shahrzad Moradi
- Department of Psychology, Ohio University, Porter Hall 200, Athens, OH, 45701, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, 1107 W Call St, Tallahassee, FL, 32304, USA.
| | - Tracy Stecker
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC, 29425, USA
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20
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Law KC, Allan NP, Kolnogorova K, Stecker T. An examination of PTSD symptoms and their effects on suicidal ideation and behavior in non-treatment seeking veterans. Psychiatry Res 2019; 274:12-19. [PMID: 30776707 DOI: 10.1016/j.psychres.2019.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 01/07/2023]
Abstract
This study sought to examine the effect of general PTSD symptoms as well as specific PTSD symptom clusters on suicidal ideation and suicidal attempts. We first compared a correlated factors solution consistent with the DSM-5 symptom clusters for PTSD with a bifactor solution comprising a General PTSD factor and orthogonal specific factors. Using the best fitting model (i.e., bifactor solution), we then investigated the effect of specific PTSD symptom clusters on severity of suicidal ideation and suicide attempts above and beyond the effect of general PTSD symptoms. A sample of 773 veterans who have never sought professional mental health treatment were screened for suicidal ideation within the past two weeks. One month after the baseline measurement, the participants completed a follow-up assessment, again by telephone. A bi-factor solution was used to account for a general PTSD factor as well as the specific DSM-5 PTSD symptom clusters. After controlling for baseline suicidal ideation and behavior, it appeared that the Anxious Arousal factor was predictive of changes in the magnitude of severity of suicidal ideation and the General PTSD factor was predictive of the onset of new suicidal behavior at the one-month follow-up. Additionally, the Re-experiencing factor of PTSD also significantly predicted new suicidal behavior at the one-month follow-up. These results suggest that it may beneficial for clinicians, who are assessing individuals with PTSD for suicidality, to be aware of the frequency, duration, and content of their clients' repetitive, intrusive thoughts as these thoughts may increase their capability to inflict non-lethal or lethal forms of self-injury.
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Affiliation(s)
- Keyne C Law
- Department of Nursing, Medical University of South Carolina, Charleston, SC, USA; Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA
| | | | | | - Tracy Stecker
- Department of Nursing, Medical University of South Carolina, Charleston, SC, USA
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21
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Possemato K, Johnson EM, Wray LO, Webster B, Stecker T. The implementation and testing of a referral management system to address barriers to treatment seeking among primary care veterans with PTSD. Psychol Serv 2018; 15:457-469. [DOI: 10.1037/ser0000150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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Gros DF, Allan NP, Silva C, Lancaster CL, Conner KR, Stecker T. Relations Between Thwarted Belongingness, Perceived Burdensomeness, and History of Suicide Attempts and Readiness for Mental Health Treatment in High-Risk Veterans, Reserves, and Active Duty Service Members. Mil Behav Health 2018; 6:326-333. [PMID: 38264674 PMCID: PMC10805456 DOI: 10.1080/21635781.2018.1486760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 03/29/2018] [Accepted: 05/29/2018] [Indexed: 01/25/2024]
Abstract
Suicide rates for service members and veterans are growing rapidly in the United States. Despite availability of evidence-based approaches, a large number of high-risk individuals are reluctant to seek out treatment. The present study used the interpersonal theory of suicide, involving 3 primary predictors of death by suicide to investigate treatment readiness in high-risk U. S. veterans, reserves, and active duty service members. Four hundred and two service members were recruited. Inclusion criteria involved (a) reporting active suicidal ideation and (b) denying active behavioral health treatment. All participants completed a self-report battery that assessed burdensomeness, thwarted belongingness, lifetime suicide attempts, and perceptions about treatment. Regression analyses revealed that thwarted belongingness was significantly predictive of treatment perceptions and readiness, in that higher or more severe scores on the thwarted belongingness scale were significantly related to lower or less likely treatment perceptions and readiness scores. The findings suggested that, in high-risk service members, thwarted belongingness is predictive of lower treatment readiness, and contributes to the growing literature on perceived stigmas, treatment barriers and readiness, and suicidal behaviors and risk factors.
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Affiliation(s)
- Daniel F. Gros
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | | | - Caroline Silva
- Department of Emergency Medicine and Psychiatry, University of Rochester Medical Center, Rochester, New York
| | | | - Kenneth R. Conner
- Department of Emergency Medicine and Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Tracy Stecker
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
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Affiliation(s)
- Emily M. Johnson
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York
| | - Kyle Possemato
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York
| | - Kimberly A. Barrie
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York
| | - Brad Webster
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York
| | - Michael Wade
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York
| | - Tracy Stecker
- Medical University of South Carolina, and Charleston Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
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24
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Allan NP, Conner KR, Pigeon WR, Gros DF, Salami TK, Stecker T. Insomnia and suicidal ideation and behaviors in former and current U.S. service members: Does depression mediate the relations? Psychiatry Res 2017; 252:296-302. [PMID: 28301827 DOI: 10.1016/j.psychres.2017.03.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 06/24/2016] [Revised: 02/24/2017] [Accepted: 03/06/2017] [Indexed: 01/30/2023]
Abstract
Insomnia is a risk factor for Suicidal Ideation (SI) and Behavior (SB), yet the nature of the relations is unclear, including the potential mediating role of cognitive and affective/somatic symptoms of depression. It was hypothesized that the impact of insomnia on SI would be mediated through depressive symptoms and that insomnia would directly impact SB. Current and former military service members (N =405; M age =31.6 years, SD =7.3; 90.4% male, 76.5% White) who endorsed recent suicidal ideation and/or a history of suicide attempt completed measures of insomnia, depression, SI, and SB at baseline and at month 12 follow-up. Mediation models were conducted using structural equation modeling. Significant mediation from insomnia to baseline SI and month 12 SI was found through cognitive/affective depression. Insomnia was directly related to SB occurring between baseline and month 12 follow-up. These findings suggest that cognitive/affective depression mediates the association with SI but not SB. Results build on research showing the importance of depressive symptoms in SI in particular. The direct and indirect pathways from insomnia to SI/SB suggest that clinicians should be aware of these relations when treating patients reporting insomnia.
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Affiliation(s)
- Nicholas P Allan
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Department of Psychology, Ohio University, Athens, OH, USA.
| | - Kenneth R Conner
- Departments of Emergency Medicine and Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua Veterans Affairs Medical Center, Canandaigua, NY, USA; Departments of Emergency Psychiatry and Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Daniel F Gros
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | - Tracy Stecker
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Zuromski KL, Allan N, Wilkerson AK, Stecker T. 1111 INSOMNIA AND SUICIDAL IDEATION AMONG MILITARY PERSONNEL: EXPLORING JOINT SYMPTOM TRAJECTORIES OVER A 12-MONTH PERIOD. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1110] [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: 11/12/2022] Open
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Stecker T, Adams L, Carpenter-Song E, Nicholson J, Streltzov N, Xie H. Intervention Efficacy in Engaging Black and White Veterans with Post-traumatic Stress Disorder into Treatment. Soc Work Public Health 2016; 31:481-489. [PMID: 27210830 PMCID: PMC5012529 DOI: 10.1080/19371918.2016.1160340] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study examined racial differences among Black and White Veterans who screened positive for post-traumatic stress disorder (PTSD) but were not in PTSD treatment and were participating in an intervention trial. Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans with PTSD but not yet engaged in treatment were recruited and randomly assigned to control or intervention conditions. Intervention participants received a cognitive-behavioral engagement intervention by phone. All participants received follow-up calls to assess symptoms and utilization of treatment. Black and White participants were compared to assess differences in treatment utilization. Intervention session notes were analyzed qualitatively for explanatory themes. Participants of both races who received the intervention had higher PTSD treatment initiation than their respective control groups (Blacks: 85% vs. 58% and Whites: 53% vs. 45%, respectively). However, Blacks completed fewer PTSD treatment sessions compared to Whites overall (M = 2.06 [SD = 2.3] vs. M = 3.77 [SD = 9.9]; p < .05). Within the intervention condition, Blacks were significantly more likely to initiate treatment (odds ratio = 2.3, p < .04), and had a greater reduction in PTSD symptom compared to Whites (PTSD Checklist - Military Version [PCL] scores: 12.75 vs. 9.68). Based on qualitative analysis of intervention session notes, themes emerged that may suggest cultural differences involving social connection, attitudes towards treatment, and the desire to appear "okay." Blacks had a higher initiation rate and greater reduction in PTSD severity but completed fewer treatment sessions than Whites. These are promising results with respect to other studies which demonstrate that Black Veterans are less likely to seek treatment for PTSD.
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Affiliation(s)
- Tracy Stecker
- Psychiatric Research Center, The Geisel School of Medicine at Dartmouth
- VA Health Services Research and Development, White River Junction Veterans Administration
| | | | | | - Joanne Nicholson
- Psychiatric Research Center, The Geisel School of Medicine at Dartmouth
| | | | - Haiyi Xie
- Psychiatric Research Center, The Geisel School of Medicine at Dartmouth
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Watson R, Morris J, Isitt J, Barrio P, Ortega L, Gual A, Conner K, Stecker T, Maisto S, Paroz S, Graap C, Grazioli VS, Daeppen JB, Collins SE, Bertholet N, McNeely J, Kushnir V, Cunningham JA, Crombie IK, Cunningham KB, Irvine L, Williams B, Sniehotta FF, Norrie J, Melson A, Jones C, Briggs A, Rice P, Achison M, McKenzie A, Dimova E, Slane PW, Grazioli VS, Collins SE, Paroz S, Graap C, Daeppen JB, Baggio S, Dupuis M, Studer J, Gmel G, Magill M, Grazioli VS, Tait RJ, Teoh L, Kelty E, Geelhoed E, Mountain D, Hulse GK, Renko E, Mitchell SG, Lounsbury D, Li Z, Schwartz RP, Gryczynski J, Kirk AS, Oros M, Hosler C, Dusek K, Brown BS, Finnell DS, Holloway A, Wu LT, Subramaniam G, Sharma G, Wallhed Finn S, Andreasson S, Dvorak RD, Kramer MP, Stevenson BL, Sargent EM, Kilwein TM, Harris SK, Sherritt L, Copelas S, Knight JR, Mdege ND, McCambridge J, Bischof G, Bischof A, Freyer-Adam J, Rumpf HJ, Fitzgerald N, Schölin L, Toner P, Böhnke JR, Veach LJ, Currin O, Dongre LZ, Miller PR, White E, Williams EC, Lapham GT, Bobb JJ, Rubinsky AD, Catz SL, Shortreed S, Bensley KM, Bradley KA, Milward J, Deluca P, Khadjesari Z, Watson R, Fincham-Campbell S, Drummond C, Angus K, Bauld L, Baumann S, Haberecht K, Schnuerer I, Meyer C, Rumpf HJ, John U, Gaertner B, Barrault-Couchouron M, Béracochéa M, Allafort V, Barthélémy V, Bonnefoi H, Bussières E, Garguil V, Auriacombe M, Saint-Jacques M, Dorval M, M’Bailara K, Segura-Garcia L, Ibañez-Martinez N, Mendive-Arbeloa JM, Anoro-Perminger M, Diaz-Gallego P, Piñar-Mateos MA, Colom-Farran J, Deligianni M, Yersin B, Adam A, Weisner C, Chi F, Lu W, Sterling S, Kraemer KL, McGinnis KA, Fiellin DA, Skanderson M, Gordon AJ, Robbins J, Zickmund S, Korthuis PT, Edelman EJ, Hansen NB, Cutter CJ, Dziura J, Fiellin LE, O’Connor PG, Maisto SA, Bedimo R, Gilbert C, Marconi VC, Rimland D, Rodriguez-Barradas M, Simberkoff M, Justice AC, Bryant KJ, Berman AH, Shorter GW, Bray JW, Barbosa C, Johansson M, Hester R, Campbell W, Souza Formigoni MLO, Andrade ALM, Sartes LMA, Sundström C, Eék N, Kraepelien M, Kaldo V, Fahlke C, Hernandez L, Becker SJ, Jones RN, Graves HR, Spirito A, Diestelkamp S, Wartberg L, Arnaud N, Thomasius R, Gaume J, Grazioli V, Fortini C, Malan Z, Mash B, Everett-Murphy K, Grazioli VS, Studer J, Mohler-Kuo M, Bertholet N, Gmel G, Doi L, Cheyne H, Jepson R, Luna V, Echeverria L, Morales S, Barroso T, Abreu Â, Aguiar C, Stewart D, Abreu A, Brites RM, Jomar R, Marinho G, Parreira P, Seale JP, Johnson JA, Henry D, Chalmers S, Payne F, Tuck L, Morris A, Gonçalves C, Besser B, Casajuana C, López-Pelayo H, Balcells MM, Teixidó L, Miquel L, Colom J, Hepner KA, Hoggatt KJ, Bogart A, Paddock SM, Hardoon SL, Petersen I, Hamilton FL, Nazareth I, White IR, Marston L, Wallace P, Godfrey C, Murray E, Sovinová H, Csémy L. Proceedings of the 13th annual conference of INEBRIA. Addict Sci Clin Pract 2016; 11:13. [PMID: 27654147 PMCID: PMC5032602 DOI: 10.1186/s13722-016-0062-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Allan NP, Gros DF, Hom MA, Joiner TE, Stecker T. Suicidal Ideation and Interpersonal Needs: Factor Structure of a Short Version of the Interpersonal Needs Questionnaire in an At-Risk Military Sample. Psychiatry 2016; 79:249-261. [PMID: 27880629 DOI: 10.1080/00332747.2016.1185893] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The interpersonal-psychological theory of suicide posits that perceived burdensomeness (PB; i.e., the belief that others would be better off if one were dead) and thwarted belongingness (TB; i.e., the belief that one lacks meaningful social connections) are both necessary risk factors for the development of suicidal ideation. To test these relations, measures are needed that are well validated, especially in samples of at-risk adults. METHOD The current study was designed to examine the factor structure of an eight-item version of the Interpersonal Needs Questionnaire (INQ) in a sample of 405 U.S. past and current military personnel (Mage = 31.57 years, SD = 7.28; 90.4% male) who endorsed either current suicidal ideation and/or a past suicide attempt. Analyses were conducted using confirmatory factor analysis (CFA). RESULTS A bifactor model comprising a general factor, labeled interpersonal needs, and two specific factors, labeled PB and TB, fit the data best. The general factor captured a high proportion of overall variance (81.9%). In contrast, the TB factor captured only a modest amount of variance in items meant to capture this factor (59.1%) and the PB factor captured very little variance in items meant to capture this factor (13.5%). Further, only the interpersonal needs factor was associated with lifetime and past-week suicidal ideation as well as suicidal ideation frequency and duration. CONCLUSIONS The current findings indicate that, for the INQ-8 in high-risk military personnel, a general interpersonal needs factor accounted for the relations PB and TB share with suicidal ideation.
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Gallegos AM, Wolff KB, Streltzov NA, Adams LB, Carpenter-Song E, Nicholson J, Stecker T. Gender Differences in Service Utilization among OEF/OIF Veterans with Posttraumatic Stress Disorder after a Brief Cognitive-Behavioral Intervention to Increase Treatment Engagement: A Mixed Methods Study. Womens Health Issues 2015; 25:542-7. [PMID: 26051022 DOI: 10.1016/j.whi.2015.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 04/16/2015] [Accepted: 04/20/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Women veterans who served in Iraq and Afghanistan (Operation Enduring Freedom and Operation Iraqi Freedom [OEF/OIF]) have a moderately higher risk of developing posttraumatic stress disorder (PTSD) than male veterans. However, gender disparities in treatment engagement may prevent women veterans from initiating the care they need. Understanding gender differences in predictors of and barriers to treatment is essential to improving engagement and mental health outcomes. The purpose of this study was to examine gender differences in treatment utilization after a brief, cognitive-behavioral therapy (CBT) intervention among male and female OEF/OIF veterans. METHODS Participants were assigned randomly to either the intervention or control conditions. Intervention participants received the telephone-based CBT intervention. Participants were 35 female and 238 male OEF/OIF veterans who screened positive for PTSD and had never initiated PTSD treatment. Participants were asked about treatment utilization, beliefs about PTSD treatment, and symptoms at months 1, 3, and 6 months subsequent to the baseline telephone assessment. The PTSD Checklist-Military Version was used to assess PTSD and the Patient's Health Questionnaire was used to assess symptoms of depression. FINDINGS Female veterans who received an intervention were significantly more likely to have attended treatment over the 6-month follow-up period than male veterans who received an intervention (χ(2) = 7.91; df = 3; odds ratio, 3.93; p = .04). CONCLUSIONS The CBT intervention may be a critical mechanism to engage female veterans in treatment. Further research is needed to understand how to engage male veterans with PTSD in treatment.
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Affiliation(s)
- Autumn M Gallegos
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York.
| | - Kristina B Wolff
- Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Nicholas A Streltzov
- Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Leslie B Adams
- Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Elizabeth Carpenter-Song
- Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Joanne Nicholson
- Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Tracy Stecker
- Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; White River Junction VA Medical Center, White River Junction, Vermont
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Stecker T, McHugo G, Xie H, Whyman K, Jones M. RCT of a brief phone-based CBT intervention to improve PTSD treatment utilization by returning service members. Psychiatr Serv 2014; 65:1232-7. [PMID: 24933496 PMCID: PMC4182109 DOI: 10.1176/appi.ps.201300433] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Many service members do not seek care for mental health and addiction problems, often with serious consequences for them, their families, and their communities. This study tested the effectiveness of a brief, telephone-based, cognitive-behavioral intervention designed to improve treatment engagement among returning service members who screened positive for posttraumatic stress disorder (PTSD). METHODS Service members who had served in Operation Enduring Freedom or Operation Iraqi Freedom who screened positive for PTSD but had not engaged in PTSD treatment were recruited (N=300), randomly assigned to either control or intervention conditions, and administered a baseline interview. Intervention participants received a brief cognitive-behavioral therapy intervention; participants in the control condition had access to usual services. All participants received follow-up phone calls at months 1, 3, and 6 to assess symptoms and service utilization. RESULTS Participants in both conditions had comparable rates of treatment engagement and PTSD symptom reduction over the course of the six-month trial, but receiving the telephone-based intervention accelerated service utilization (treatment engagement and number of sessions) and PTSD symptom reduction. CONCLUSIONS A one-time brief telephone intervention can engage service members in PTSD treatment earlier than conventional methods and can lead to immediate symptom reduction. There were no differences at longer-term follow-up, suggesting the need for additional intervention to build upon initial gains.
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Stecker T, Shiner B, Watts BV, Jones M, Conner KR. Treatment-seeking barriers for veterans of the Iraq and Afghanistan conflicts who screen positive for PTSD. Psychiatr Serv 2013; 64:280-3. [PMID: 23450385 DOI: 10.1176/appi.ps.001372012] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [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: 11/30/2022]
Abstract
OBJECTIVES Barriers associated with the decision not to seek treatment for symptoms of combat-related posttraumatic stress disorder (PTSD) were examined. METHODS Participants were 143 military men and women who served in Operation Enduring Freedom or Operation Iraqi Freedom (OEF/OIF) and who screened positive for posttraumatic stress disorder (PTSD), as assessed by the PTSD Checklist-Military Version, and who had not sought treatment for PTSD. During a cognitive-behavioral telephone intervention, participants were asked about their beliefs concerning seeking PTSD treatment. RESULTS Four categories of beliefs were associated with the decision to seek treatment, including concerns about treatment (40%), emotional readiness for treatment (35%), stigma (16%), and logistical issues (8%). CONCLUSIONS This work suggests areas for intervention efforts to minimize barriers to treatment for PTSD for OEF/OIF veterans.
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Affiliation(s)
- Tracy Stecker
- Psychiatric Research Center, Dartmouth Medical School, Lebanon, NH 03766, USA.
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Stecker T, McGovern MP, Herr B. An intervention to increase alcohol treatment engagement: a pilot trial. J Subst Abuse Treat 2011; 43:161-7. [PMID: 22138200 DOI: 10.1016/j.jsat.2011.10.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 09/26/2011] [Accepted: 10/25/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Previous research has documented the difficulty individuals with alcohol use disorders have initiating alcohol treatment. This study assessed the feasibility of a brief, cognitive-behavioral intervention designed to increase treatment initiation among individuals with alcohol use disorders. METHODS This randomized controlled trial included 196 participants who screened positive for a possible alcohol use disorder on the alcohol use disorders identification test. Randomly assigned intervention participants were administered a brief cognitive-behaviorally-based intervention by telephone designed to modify beliefs that may interfere with treatment-seeking behavior. Beliefs about treatment and treatment-seeking behavior were assessed postintervention. RESULTS Participants receiving the intervention had significantly improved their attitudes toward addiction treatment (p < .002) and increased their reported intention-to-seek treatment (p < .000) postintervention. Further, intervention participants were almost three times more likely to attend treatment within a 3-month period (odds ratio = 2.60, p < .025) than participants in the control group. CONCLUSIONS A brief, cognitive-behavioral intervention delivered by telephone and focused on modifying treatment-interfering beliefs holds promise for increasing alcohol treatment seeking among individuals in need.
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Affiliation(s)
- Tracy Stecker
- Psychiatric Research Center, Dartmouth Medical School, Lebanon, NH 03766, USA.
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Stecker T, Fortney JC, Sherbourne CD. An Intervention to Increase Mental Health Treatment Engagement Among OIF Veterans: A Pilot Trial. Mil Med 2011; 176:613-9. [DOI: 10.7205/milmed-d-10-00428] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [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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Fortney JC, Pyne JM, Edlund MJ, Stecker T, Mittal D, Robinson DE, Henderson KL. Reasons for antidepressant nonadherence among veterans treated in primary care clinics. J Clin Psychiatry 2011; 72:827-34. [PMID: 21208579 DOI: 10.4088/jcp.09m05528blu] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 12/08/2009] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine the experiences of veterans (mostly middle-aged and elderly men) prescribed antidepressants, specifically with regard to different types of nonadherence, reasons for nonadherence, and side effects. METHOD A mixed-methods analysis of Department of Veterans Affairs primary care patients (N = 395) with depression (9-item depression scale of the Patient Health Questionnaire criteria) enrolled in a randomized collaborative care trial was conducted. Adherence was measured from patient self-report and pharmacy data. Qualitative interviews elicited in-depth information regarding adherence. The study was conducted from April 2003 to September 2005. RESULTS The intervention significantly improved self-reported adherence at 6 months (OR = 2.1; 95% CI, 1.0-4.4; P = .04) and 12 months (OR = 2.7; 95% CI, 1.4-5.4; P < .01), as well as medication possession at 12 months (OR = 1.82; 95% CI, 1.0-3.2; P = .04). The most common type of nonadherence at 6 months was discontinuation (12.2%), followed by not taking as prescribed (10.9%) and never took (4.8%). For patients discontinuing their antidepressant in the first 6 months, the most common and important reason was that it was not helping. Only 19.4% of patients with self-reported adherence ≥ 80% responded to treatment by 6 months. Side effects were also a commonly reported reason for discontinuation at 6 months, with 82% reporting experiencing side effects. One-third (31.4%) reported difficulty with sexual activity at 6 months, with 66.1% reporting that it was severe. Qualitative interviews supported the finding that side effects, and generally not feeling like oneself, are important adherence barriers. CONCLUSIONS In this sample of mostly middle-aged and elderly men with depression, treatment nonresponse and side effects were the rule rather than the exception. These findings suggest that nonadherence may have resulted primarily from patients' negative experiences with antidepressants rather than structural barriers or noncompliant behaviors. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT00105690.
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Affiliation(s)
- John C Fortney
- VA HSR&D Center for Mental Health Outcomes and Research (152/NLR), Little Rock VA Medical Center, 2200 Fort Roots Dr, North Little Rock, AR 72114, USA.
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Stecker T, Fortney J, Owen R, McGovern MP, Williams S. Co-occurring medical, psychiatric, and alcohol-related disorders among veterans returning from Iraq and Afghanistan. Psychosomatics 2011; 51:503-7. [PMID: 21051682 DOI: 10.1176/appi.psy.51.6.503] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Soldiers often return from war with a variety of combat-related mental health conditions, including posttraumatic stress disorder, depression, and substance-use disorders. OBJECTIVE The authors investigated common co-occurring medical and psychiatric conditions and patterns of conditions among returning Iraq/Afghanistan veterans using the Veterans Administration (VA) healthcare systems. METHOD Common clusters of ICD-9 diagnostic-related conditions among returning soldiers (N=293,861) were extracted from the VA data center. RESULTS Diagnoses involving pain are extremely common among returning veterans seeking health care at the VA. In addition to pain-related conditions, psychiatric disorders rank second most prevalent. Psychiatric disorders, and in particular the multimorbid triad of pain, posttraumatic stress disorder, and depression frequently overlap. CONCLUSION As more veterans return from war, there will be greater need for effective services. Given the findings of high rates of comorbidity and multimorbidity, VA services should be reorganized so as to co-locate psychiatric staff in pain centers, simultaneously targeting pain and psychiatric disorders.
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Affiliation(s)
- Tracy Stecker
- Dartmouth Medical School, 2 Whipple Place Suite 202, Lebanon, NH 03766, USA.
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Stecker T, Fortney J, Owen R, McGovern MP, Williams S. Co-Occurring Medical, Psychiatric, and Alcohol-Related Disorders Among Veterans Returning From Iraq and Afghanistan. Psychosomatics 2010. [DOI: 10.1016/s0033-3182(10)70743-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
OBJECTIVES Many veterans return from combat experiencing a variety of mental health concerns. Previous research has documented a stigma associated with seeking treatment that interferes with the decision to seek treatment. This study, conceptualized using the theory of planned behavior, assessed beliefs about mental health treatment in order to understand mental health treatment seeking behavior among a group of returning National Guard soldiers who served in the war in Iraq. METHODS Participants were one hundred and fifty Operation Iraqi Freedom National Guard soldiers who screened positive for depression, posttraumatic stress disorder, generalized anxiety disorder, panic disorder or alcohol abuse disorder on the Mini International Neuropsychiatric Interview (MINI). Participants were asked to complete a questionnaire assessing beliefs about mental health treatment and treatment-seeking behavior. RESULTS Beliefs related to symptom reduction and work were significantly related to mental health treatment-seeking behavior. CONCLUSIONS Interventions developed to engage veterans into care must be directed toward cognitive factors that motivate treatment seeking in addition to traditionally targeted structural barriers.
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Affiliation(s)
- Tracy Stecker
- Psychiatric Research Center, Dartmouth Medical School, Lebanon, NH, USA
- VA Health Services Research and Development, White River Junction Veterans Administration, White River Junction, VT, USA
| | - John Fortney
- VA Health Services Research and Development (HRS&D), Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
- Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Francis Hamilton
- Psychiatric Research Center, Dartmouth Medical School, Lebanon, NH, USA
- VA Health Services Research and Development, White River Junction Veterans Administration, White River Junction, VT, USA
| | | | - Icek Ajzen
- Department of Psychology, University of Massachusetts, Amherst, MA, USA
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Stecker T, Han X, Curran GM, Booth BM. Characteristics of women seeking intensive outpatient substance use treatment in the VA. J Womens Health (Larchmt) 2008; 16:1478-84. [PMID: 18062763 DOI: 10.1089/jwh.2006.0237] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To investigate gender differences among veterans receiving intensive outpatient (IOP) substance use treatment in a national VA sample and to compare women attending IOP with women with substance use disorders in VA primary care. METHODS VA national databases were used to identify all veterans receiving intensive IOP substance use treatment in 1999 along with a matched cohort of individuals with substance use disorders attending primary care but not in treatment. RESULTS Few women (2.8%) were treated in IOP at the VA. Among the women who did receive treatment, substantial clinical differences were found compared with men in IOP treatment. Women with substance use disorders were younger, more likely to have cocaine abuse or dependence disorders, and more likely to have extensive psychiatric and medical comorbidities than men with substance use disorders in the VA. Women in treatment were also found to be significantly different from women with substance use disorders not in treatment. CONCLUSIONS Outreach and new programming for women veterans with substance use disorders in the VA is critical in order to treat these issues early and potentially prevent multiple, severe comorbid illnesses.
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Affiliation(s)
- Tracy Stecker
- VA Health Services Research and Development (HSR&D), Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas 72114, USA.
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Curran GM, Stecker T, Han X, Booth BM. Individual and program predictors of attrition from VA substance use treatment. J Behav Health Serv Res 2008; 36:25-34. [PMID: 18188705 DOI: 10.1007/s11414-007-9093-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Accepted: 10/04/2007] [Indexed: 11/27/2022]
Abstract
The study investigated patient- and program-level variables associated with attrition from intensive outpatient (IOP) substance use treatment in a national VA sample. National databases were used to identify a recent cohort of veterans receiving intensive IOP substance use treatment. Attrition was defined as receiving less than five visits of IOP treatment. Patient-level variables examined included age, gender, race, and psychiatric and medical comorbidities. Program-level variables examined included the number of hours of treatment offered, the percentage of patients living on-campus, and extent of staff cuts in the past year. Twenty-seven percent of veterans left treatment early. Being older, female, and having a psychotic disorder was associated with attrition. Program-level factors associated with attrition were the number of hours the program offered treatment, in that more treatment offered was associated with higher attrition. Focus on individual and program level factors associated with attrition is crucial to retaining individuals in treatment.
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Affiliation(s)
- Geoffrey M Curran
- VA Health Services Research and Development, Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR 72114, USA.
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Abstract
OBJECTIVE This study assessed beliefs about mental health treatment in a group of soldiers newly returning from the war in Iraq. METHODS Participants were 20 National Guard soldiers who had served in Operation Iraqi Freedom. Soldiers who in phone interviews screened positive for a mental disorder were asked about advantages and disadvantages of seeking treatment, who would or would not support treatment seeking, and facilitators and barriers to treatment seeking. RESULTS Stigma was portrayed as a major disadvantage to treatment seeking. Yet most participants indicated that people would be supportive of treatment seeking. Reducing symptoms was a major advantage of care. Barriers, especially those viewed as "self-induced," such as pride, not being able to ask for help, and not being able to admit to having a problem, were considered major impediments. CONCLUSIONS The findings suggest that interventions developed to engage veterans in care must be directed toward cognitive factors that motivate treatment seeking.
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Affiliation(s)
- Tracy Stecker
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72114, USA.
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Abstract
Many individuals with depression want treatment, and most believe that psychotherapy will treat symptoms of depression, yet many do not initiate care beyond their primary care physicians. This becomes critical given the low to moderate adherence rate to antidepressant medications among depressed patients treated in primary care. Many are left untreated or under-treated. The purpose of this study was to investigate whether attitudes toward psychotherapy in a population of primary care patients newly diagnosed with depression influenced the likelihood that they initiated psychotherapy. Participants were asked to complete two attitudinal questionnaires and respond to a three-month follow-up phone call regarding therapy initiation. Reported attitudes toward psychotherapy were positive. Many perceived therapy as both effective and preferred over medications. Despite positive attitudes, the rate of initiation into psychotherapy remained alarmingly low.
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Affiliation(s)
- Tracy Stecker
- VA Health Services Research and Development, Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA.
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Stecker T, Curran GM, Han X, Booth BM. Patterns of Health Services Use Associated With Veterans Affairs Outpatient Substance-Use Treatment. J Stud Alcohol Drugs 2007; 68:510-8. [PMID: 17568954 DOI: 10.15288/jsad.2007.68.510] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study examined service use and costs associated with receiving intensive outpatient (IOP) substance-use treatment. METHOD Veterans Affairs national databases were used to identify all veterans receiving IOP substance-use treatment in fiscal year (FY) 1999. Changes in the use of health services (2 years pretreatment compared with 2 years posttreatment) were examined. Three IOP treatment groups were defined: (1) veterans attending 1-5 IOP visits (n=2,384), (2) 6-14 IOP visits (n=2,940), and (3) >or= 15 IOP visits (n=3,005). In addition, a demographically matched no-treatment group was defined as veterans in primary care with a substance-use diagnosis and no substance-use treatment in FY 1999 (n = 7,328). General medical, psychiatric, and substance-use encounters in inpatient and outpatient settings were retrieved for the 4 years. Generalized estimating equations analyses were used to compare changes in service use across the three IOP groups controlling for demographic characteristics and comorbidity. RESULTS Total outpatient visits increased in all three treatment groups after IOP, with the largest increase observed in the group with >or= 15 visits (mean visits = 5, 44, and 57, respectively). In comparison, total visits decreased in the no-treatment group (-7). This pattern was similar across settings (general medical, psychiatric, and substance use). Total inpatient days decreased among the four groups, with the no-treatment group having the least amount of decrease (mean change in days = .34, .32, .18, and .03, respectively). Analysis of cost data showed similar findings. CONCLUSIONS Results indicated that more intense IOP treatment is associated with increases in subsequent psychiatric, substance-use, medical, and total outpatient care and decreases in expensive inpatient care.
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Affiliation(s)
- Tracy Stecker
- Veterans Affairs Health Services Research and Development, Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, 152/NLR, 2200 Fort Roots Drive, North Little Rock, Arkansas 72114, USA.
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Abstract
The authors investigated the interrelationships between race, obesity, depression, and chronic disease by abstracting data from all primary-care patients seen at a family-medicine clinic over a 3-year period. A total of 8,197 patients were included in the analysis. Sixty-three percent of patients were either overweight (26%) or obese (37%). African-American race, obesity, and having a diagnosis of depression each independently and significantly increased the likelihood of having a chronic disease. Also, these risk factors interacted to create an increased likelihood of disease prevalence. Thus, obesity, race, and depression interacted to create a "triple threat" of developing certain chronic diseases.
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Affiliation(s)
- Tracy Stecker
- Veterans Affairs Health Services Research and Development (HRS&D) Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72114, USA.
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Stecker T, Fortney JC, Prajapati S. How Depression Influences The Receipt of Primary Care Services among Women: A Propensity Score Analysis. J Womens Health (Larchmt) 2007; 16:198-205. [PMID: 17388736 DOI: 10.1089/jwh.2006.0105] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Many patients with psychiatric disorders do not receive appropriate medical services, whereas others receive unnecessary medical services. This study investigated whether female primary care patients with depression were more or less likely to receive preventive/diagnostic tests. METHODS Preventive/diagnostic tests for females with depression or hypertension or both over a 5-year period were extracted from an electronic medical record (EMR) used at a university-based family practice clinic. Tests extracted included cholesterol screening, mammogram, Pap smear, and colonoscopy. RESULTS Of 860 included in the analysis, 270 were diagnosed with depression, 380 with hypertension, and 210 with both conditions. Women with depression were significantly more likely to receive colonoscopies and Pap smears than women with hypertension. Hypertensive patients were significantly more likely to have their cholesterol checked. CONCLUSIONS Somatization associated with depression may lead to more preventive and diagnostic testing among female primary care patients.
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Affiliation(s)
- Tracy Stecker
- VA Health Services Research and Development (HRS&D), Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas 72114, USA.
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Prajapati SH, Kahn RF, Stecker T, Pulley L. Curriculum planning: a needs assessment for complementary and alternative medicine education in residency. Fam Med 2007; 39:190-4. [PMID: 17323210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND AND OBJECTIVES The curricular needs in complementary and alternative medicine (CAM) of family medicine residents are unknown. Our objective was to assess perceptions of knowledge, attitudes, practice behaviors, and interest toward CAM by family medicine residents. METHODS A questionnaire was administered to family medicine residents (n=153) throughout one state. RESULTS The response rate was 77% (118/153), with an equal distribution of first-, second-, and third-year residents. Respondents reported minimal knowledge of CAM and low awareness of CAM resources. Many do not routinely ask patients about their CAM usage. Most respondents reported discomfort advising their patients of the risks and benefits of CAM therapies, and most were interested in learning about CAM. While prior training made a difference in responses, gender and training level did not. Whites were more likely to have had prior training in CAM than non-whites. CONCLUSIONS Family medicine residents in Arkansas may not have enough training in CAM. Given the growing popularity of these modalities among the general public, residents might benefit from training and education in CAM.
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Affiliation(s)
- Sarita H Prajapati
- Department of Family and Preventive Medicine, University of Arkansas, Little Rock, AR 72205-7199, USA.
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Abstract
OBJECTIVE Previous research has addressed the relationship between BMI and chronic disease in primary care; however, little has been done with regard to the association between obesity and depression in primary care. The purpose of this paper is to assess the relationship between obesity and chronic conditions including depression. RESEARCH METHODS AND PROCEDURES Data from primary care patients seen at a university-based family medicine clinic in the southeastern United States were extracted for the time between January 1, 1999 and January 1, 2002. Data extracted included most recent height and weight, age, ethnicity, pregnancy status, number of office visits, blood pressure, cholesterol, hemoglobin A1C, current diagnoses, and medications. RESULTS A total of 8197 patients were included in the analysis. Sixty-nine percent of patients seen in a 3-year period were either overweight or obese. Comparing blood pressure, cholesterol, diagnoses, and medications between BMI groups found differences in virtually all categories. Diagnoses of high cholesterol, hypertension, diabetes, and depression significantly increased for obese patients. DISCUSSION Obese patients are over-represented in primary care, and this over-representation of obesity correlates with several diagnoses, including depression. Depression is a chronic disease that may interfere with health-related behaviors and must be addressed within the health care system.
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Affiliation(s)
- Tracy Stecker
- Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, USA.
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Abstract
PURPOSE Due to the high volume and acuity of mental health issues presented by graduate and professional students nationwide, this study explored specific mental health needs in students in order to identify credible areas for intervention. METHODS An assessment tool was created for this project, which identified satisfaction with current services, stress, coping, sleeping, eating, exercise, high risk sexual behaviours, social support, depression and substance use. Students at top ranking academic medical centres within the USA received a copy of the instrument on 2 separate occasions. RESULTS Results indicated that graduate and professional students reported alarming symptoms of depression, stress and substance use. Increased symptoms of depression were associated with high levels of stress and low social support. CONCLUSION Given the high rates of depression symptoms in this setting, along with inadequate services and long waiting lists, interventions must be found to address need. Need assessment is a proactive method of exploring need in specific populations in order to provide preventive and clinical services efficiently. Based on the relationship between stress, social support and symptoms of depression, forming groups aimed at preventing depression may be the best method of reducing the severity and frequency of symptoms in students.
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Affiliation(s)
- Tracy Stecker
- University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
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Hecht H, Oesker M, Kaiser A, Civelek H, Stecker T. A perception experiment with time-critical graphics animation on the World-Wide Web. Behav Res Methods Instrum Comput 1999; 31:439-45. [PMID: 10502867 DOI: 10.3758/bf03200724] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The World-Wide Web offers a potentially interesting tool to collect data from a large and heterogeneous audience. While questionnaires have become rather common on the Internet, its potential reaches far beyond text processing. In principle, it is possible not only to perform interactive, dynamic experiments on the Web, but also to include graphical animation and time-critical responses, such as reaction times. We implemented a visual motion extrapolation task on the Web using the programming language Java, which can be interpreted by standard Web browsers such as Netscape or Internet Explorer. The data collected with this method turned out to be reliable and differed little from data obtained in a controlled laboratory setting, with the exception of conditions with fixation instruction. Thus, the Web can, generally speaking, be used for data collection of large sample sizes. The strengths and weaknesses of dynamic visual simulation experiments on the Internet are discussed.
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Affiliation(s)
- H Hecht
- Universität Bielefeld, Germany.
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Abstract
In the context of studying the medicalization of women, we sought insight into the reflexive and mutually influential relationships between the prevailing social agenda and the formal knowledge base by analyzing the content, purpose and funding source of the scholarly work published in the three major, English-language obstetrics and gynecology journals. Our analysis of the 6103 articles published in 1975, 1980, 1985, 1990, and 1993 led us to the conclusion that, rather than responding to changing social needs and life-styles, the obstetrics and gynecology specialty has continued to emphasize the reproductive nature of women rather than the health and well-being requirements of non-pregnant and non-fertile women. The social values and attitudes toward women inferred from the priorities evident in these data are ideologically consistent with the view that women's primary role is that of reproduction. The implied importance of certain themes and the consequent allocation of resources may serve to perpetuate the politically oppressive view of women as biologically motivated and determined.
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Affiliation(s)
- L Gannon
- Department of Psychology and Behavioral and Social Science Division, Medical School, Southern Illinois University, Carbondale 62901, USA
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