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Salt K, Kougiali ZG. "One of Us": Reframed Labels, Compassion and Hope in Voluntary Prison Work With Ex-Servicemen. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2024; 68:1272-1295. [PMID: 36210774 PMCID: PMC11292959 DOI: 10.1177/0306624x221124838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Despite the growing body of literature on Prison Officers and therapeutic practitioners within correctional facilities, comparatively little research exists into prison volunteers. Using semi-structured interviews with caseworkers (n = 5), analyzed via Interpretative Phenomenological Analysis, this study explores the experience of being a Prison In-Reach Caseworker, supporting the male ex-Armed Forces population in Greater London prisons. Through identifying three superordinate themes of the inherent moral values of the shared past, compassion and "in" versus "out" of the prison system, the study concludes that the caseworkers, working outside the boundaries of the correctional system, reject the label of "criminal" and its associated consequences, choosing instead to attribute value and dignity to the prisoners, both as ex-Armed Forces personnel, and as human beings. The findings offer an insight into the consequences of positive labeling for perspectives of redemption and desistance and suggest the need for further investigation into the experiences and impact of prison volunteers working with different populations.
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Wetzler EL, Erbe RG, Cornwell JFM, Wood MD. Dispositional mindfulness moderates the links between potentially morally injurious event exposure and symptoms of anxiety and depression but not suicidal ideation. J Trauma Stress 2024; 37:574-585. [PMID: 38548620 DOI: 10.1002/jts.23032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 01/24/2024] [Accepted: 02/15/2024] [Indexed: 08/02/2024]
Abstract
Exposure to potentially morally injurious events (PMIEs) is a pervasive threat for military service members and may be associated with symptoms of anxiety, depression, and suicidal ideation. However, coping mechanisms, such as mindfulness, may ameliorate symptoms and improve recovery. Two studies were conducted to test dispositional mindfulness as a moderator of the links between PMIEs, as assessed using the Moral Injury Events Scale (i.e., total score and Self-Transgression, Other-Transgression, and Betrayal subscale scores), and symptoms of anxiety, depression, and suicidal ideation among different samples of active-duty soldiers in garrison. In Sample 1 (N = 310), mindfulness buffered the links between PMIE exposure and symptoms of both anxiety, ∆R2 = .02, and depression, ∆R2 = .03. In Sample 2 (N = 669), mindfulness moderated the link between the MIES Betrayal subscale and anxiety symptoms, ∆R2 = .01. The results suggest that dispositional mindfulness may be a protective factor against some of the negative impacts of PMIE exposure. Further implications are discussed.
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Affiliation(s)
- Elizabeth L Wetzler
- United States Military Academy, Department of Behavioral Sciences and Leadership, West Point, New York, USA
| | - Ryan G Erbe
- United States Military Academy, Simon Center for the Professional Military Ethic, West Point, New York, USA
| | - James F M Cornwell
- Wheaton College, School of Psychology, Counseling, and Family Therapy, Wheaton, Illinois, USA
| | - Michael D Wood
- United States Military Academy, Department of Behavioral Sciences and Leadership, West Point, New York, USA
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Schwartz EKC, Palmisano AN, Petrakis IL, Pietrzak RH, Sofuoglu M. Health correlates of experiential and behavioral avoidance among trauma-exposed veterans. J Psychiatr Res 2024; 176:213-217. [PMID: 38878649 DOI: 10.1016/j.jpsychires.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 05/06/2024] [Accepted: 06/08/2024] [Indexed: 07/29/2024]
Abstract
INTRODUCTION Avoidance is a well-documented risk factor for poor mental and physical health outcomes. However, limited research has explored this relationship specifically among trauma-exposed veterans, a population known to be particularly prone to avoidance behavior. Conceptually, avoidance is often divided into two distinct but overlapping constructs - experiential avoidance (resisting distressing internal states) and behavioral avoidance (avoiding or changing experiences that elicit distress). In this exploratory survey study, we examined associations between behavioral and experiential avoidance and mental, physical, and cognitive functioning, as well as quality of life. METHODS Veterans with a trauma history (N = 89) completed a 121-item survey containing validated assessments to examine several mental and physical health and wellness-related variables. Correlations between experiential avoidance and outcome measures, and behavioral avoidance and outcome measures, were explored. Multivariable linear regression analyses were conducted to explore the association between experiential and behavioral avoidance on mental health outcomes. In addition, we conducted exploratory analyses in which we investigated these correlations in those who screened positive for PTSD versus those who did not, and between different types of behavioral avoidance and major outcomes. RESULTS Experiential avoidance was moderately correlated with distress from depressive symptoms, distress related to past trauma, and health-related and cognitive dysfunction. Experiential Avoidance was weakly correlated with distress from anxiety symptoms and poorer quality of life. Behavioral avoidance was moderately correlated with distress from depressive and anxiety symptoms, distress related to past trauma, and cognitive dysfunction, and was weakly correlated with health-related dysfunction and poorer quality of life. Results from multivariable analyses revealed that experiential avoidance was associated with greater distress related to depressive symptoms and past trauma, and behavioral avoidance was associated with greater distress related to anxiety symptoms, depressive symptoms, and past trauma. CONCLUSIONS Results suggest that avoidance negatively influences major domains of mental and physical health as well as functioning and health-related quality of life in trauma-exposed veterans. They further indicate that behavioral and experiential avoidance may be differentially linked to mental health outcomes. The results support the idea that avoidance may be an important marker for psychosocial functioning and may serve as a treatment target in trauma-exposed veterans.
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Affiliation(s)
- Elizabeth K C Schwartz
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA.
| | - Alexandra N Palmisano
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ismene L Petrakis
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; U.S. Department of Veteran Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA.
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French LM, Brickell TA, Lippa SM, Rogers AA, Cristaudo KE, Walker TT, Higgins M, Bailie JM, Kennedy J, Hungerford L, Lange RT. Clinical relevance of subthreshold PTSD versus full criteria PTSD following traumatic brain injury in U.S. service members and veterans. J Affect Disord 2024; 358:408-415. [PMID: 38705525 DOI: 10.1016/j.jad.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/22/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND The purpose of this cross-sectional study was to examine the influence of subthreshold posttraumatic stress disorder (PTSD) and full PTSD on quality of life following mild traumatic brain injury (mTBI). METHODS Participants were 734 service members and veterans (SMV) classified into two injury groups: uncomplicated mild TBI (MTBI; n = 596) and injured controls (IC, n = 139). Participants completed a battery of neurobehavioral measures, 12-or-more months post-injury, that included the PTSD Checklist Civilian version, Neurobehavioral Symptom Inventory, and select scales from the TBI-QOL and MPAI. The MTBI group was divided into three PTSD subgroups: No-PTSD (n = 266), Subthreshold PTSD (n = 139), and Full-PTSD (n = 190). RESULTS There was a linear relationship between PTSD severity and neurobehavioral functioning/quality of life in the MTBI sample. As PTSD severity increased, significantly worse scores were found on 11 of the 12 measures (i.e. , MTBI Full-PTSD > Sub-PTSD > No-PTSD). When considering the number of clinically elevated scores, a linear relationship between PTSD severity and neurobehavioral functioning/quality of life was again observed in the MTBI sample (e.g., 3-or-more elevated scores: Full-PTSD = 92.1 %, Sub-PTSD = 61.9 %, No-PTSD = 19.9 %). LIMITATIONS Limitations included the use of a self-report measure to determine diagnostic status that may under/overcount or mischaracterize individuals. CONCLUSION PTSD symptoms, whether at the level of diagnosable PTSD, or falling short of that because of the intensity or characterization of symptoms, have a significant negative impact on one's quality of life following MTBI. Clinicians' treatment targets should focus on the symptoms that are most troubling for an individual and the individual's perception of quality of life, regardless of the diagnosis itself.
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Affiliation(s)
- Louis M French
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Tracey A Brickell
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; Contractor, General Dynamics Information Technology, Silver Spring, MD, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Sara M Lippa
- Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Alicia A Rogers
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; CICONIX, Annapolis, MD, USA
| | - Kendal E Cristaudo
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; CICONIX, Annapolis, MD, USA
| | - Thomas T Walker
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; CICONIX, Annapolis, MD, USA
| | - Molly Higgins
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; University of Colorado, Colorado Springs, CO, USA
| | - Jason M Bailie
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Contractor, General Dynamics Information Technology, Silver Spring, MD, USA; 33 Area Branch Clinic Camp Pendleton, CA, USA
| | - Jan Kennedy
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Contractor, General Dynamics Information Technology, Silver Spring, MD, USA; Brooke Army Medical Center, Joint Base San Antonio, TX, USA
| | - Lars Hungerford
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Contractor, General Dynamics Information Technology, Silver Spring, MD, USA; Naval Medical Center San Diego, CA, USA
| | - Rael T Lange
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; Contractor, General Dynamics Information Technology, Silver Spring, MD, USA; University of British Columbia, Vancouver, BC, Canada; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Cabrera OA, Trachik BJ, Ganulin ML, Dretsch MN, Adler AB. Longitudinal measurement invariance and growth curve modeling of psychological resilience across the deployment cycle. MILITARY PSYCHOLOGY 2024; 36:393-402. [PMID: 38913767 PMCID: PMC11197912 DOI: 10.1080/08995605.2023.2188846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/21/2023] [Indexed: 03/17/2023]
Abstract
The concept of resilience is embedded within military culture and professional identity. To date, temporal changes in individuals' perceptions of their own resilience have not been systematically assessed in highstakes occupational contexts, like the military. The current study examined change in selfreported resilience over time by: (1) examining the longitudinal measurement invariance of the Brief Resilience Scale (BRS); (2) assessing the longitudinal pattern of resilience across a combat deployment cycle; and (3) examining predictors of postdeployment resilience and change in resilience scores across time. U.S. Army soldiers assigned to a combat brigade completed a survey at four time points over the course of a deployment cycle: (a) prior to deployment to Afghanistan; (b) during deployment; (c) immediately following return to home station; and (d) approximately 2-3 months thereafter. The longitudinal measurement invariance of the BRS was established. Growth curve modeling indicated that, on average, self-reported resilience decreased across the deployment cycle, but there was considerable individual variation in the rate of change. Of note, loneliness, as measured during deployment, predicted the rate of change in self-reported resilience over time. Results have implications for the longitudinal analysis of resilience and for the development of interventions with military personnel.
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Affiliation(s)
- Oscar A. Cabrera
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Benjamin J. Trachik
- U.S. Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Washington
| | - Michelle L. Ganulin
- U.S. Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Washington
| | - Michael N. Dretsch
- U.S. Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Washington
| | - Amy B. Adler
- Walter Reed Army Institute of Research, Silver Spring, Maryland
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Kim JI, Min B, Lee JH, Park H, Kim JH. Patterns of comorbid PTSD, depression, alcohol use disorder, and insomnia symptoms in firefighters: A latent profile analysis. J Affect Disord 2024; 356:338-345. [PMID: 38583597 DOI: 10.1016/j.jad.2024.03.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Firefighters are an at-risk population for multiple psychiatric conditions, including posttraumatic stress disorder (PTSD), depression, alcohol use disorders (AUDs), and insomnia. These disorders are likely to co-occur; however, patterns of comorbidity have scarcely been investigated in firefighters. We aimed to identify subgroups of comorbidity of PTSD, depression, AUDs, and insomnia in a nationwide population of firefighters in South Korea. METHODS A total of 54,054 firefighters responded to an online survey. Latent classes of comorbidity were categorized using latent profile analysis (LPA) based on the symptom scores of PTSD, depression, AUDs, and insomnia. Analysis of variance was performed to compare the characteristics of the identified classes, and multinomial logistic regression was conducted to examine whether anger reactions, resilience, and number of traumatic events predicted class membership. RESULTS The LPA identified four subgroups: minimal symptoms (n = 42,948, 79.5 %), predominant PTSD (n = 2858, 5.3 %), subthreshold symptoms and comorbidity (n = 7003, 13.0 %), and high symptoms and comorbidity (n = 1245, 2.3 %). Three comorbidity classes were defined based on severity and one class showed predominant PTSD symptoms. Number of traumatic exposures predicted predominant PTSD, while resilience and anger reactions predicted severity of comorbidities. LIMITATIONS The cross-sectional design and usage of self-reported questionnaires are limitations of this study. CONCLUSIONS The severity of PTSD, depression, AUDs and insomnia tend to correlate and co-occur in firefighters. Our findings highlight the need to assess comorbid symptoms in firefighters and need to reduce anger reactions and enhance resilience in those with multiple comorbidities.
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Affiliation(s)
- Johanna Inhyang Kim
- Department of Psychiatry, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, Republic of Korea
| | - Beomjun Min
- Chung Psychiatry Clinic, Seocho-daero 77-gil 17 Block 77, Seoul, Republic of Korea
| | - Ji-Hye Lee
- Department of Public Health Medical Services, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Heyeon Park
- Division of General Studies & Teaching Profession, Dongduk Women's University, Seoul, Republic of Korea
| | - Jeong-Hyun Kim
- Department of Public Health Medical Services, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea; Department of Psychiatry, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
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Rojczyk P, Heller C, Seitz-Holland J, Kaufmann E, Sydnor VJ, Berger L, Pankatz L, Rathi Y, Bouix S, Pasternak O, Salat D, Hinds SR, Esopenko C, Fortier CB, Milberg WP, Shenton ME, Koerte IK. Intimate partner violence perpetration among veterans: associations with neuropsychiatric symptoms and limbic microstructure. Front Neurol 2024; 15:1360424. [PMID: 38882690 PMCID: PMC11178105 DOI: 10.3389/fneur.2024.1360424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 05/03/2024] [Indexed: 06/18/2024] Open
Abstract
Background Intimate partner violence (IPV) perpetration is highly prevalent among veterans. Suggested risk factors of IPV perpetration include combat exposure, post-traumatic stress disorder (PTSD), depression, alcohol use, and mild traumatic brain injury (mTBI). While the underlying brain pathophysiological characteristics associated with IPV perpetration remain largely unknown, previous studies have linked aggression and violence to alterations of the limbic system. Here, we investigate whether IPV perpetration is associated with limbic microstructural abnormalities in military veterans. Further, we test the effect of potential risk factors (i.e., PTSD, depression, substance use disorder, mTBI, and war zone-related stress) on the prevalence of IPV perpetration. Methods Structural and diffusion-weighted magnetic resonance imaging (dMRI) data were acquired from 49 male veterans of the Iraq and Afghanistan wars (Operation Enduring Freedom/Operation Iraqi Freedom; OEF/OIF) of the Translational Research Center for TBI and Stress Disorders (TRACTS) study. IPV perpetration was assessed using the psychological aggression and physical assault sub-scales of the Revised Conflict Tactics Scales (CTS2). Odds ratios were calculated to assess the likelihood of IPV perpetration in veterans with either of the following diagnoses: PTSD, depression, substance use disorder, or mTBI. Fractional anisotropy tissue (FA) measures were calculated for limbic gray matter structures (amygdala-hippocampus complex, cingulate, parahippocampal gyrus, entorhinal cortex). Partial correlations were calculated between IPV perpetration, neuropsychiatric symptoms, and FA. Results Veterans with a diagnosis of PTSD, depression, substance use disorder, or mTBI had higher odds of perpetrating IPV. Greater war zone-related stress, and symptom severity of PTSD, depression, and mTBI were significantly associated with IPV perpetration. CTS2 (psychological aggression), a measure of IPV perpetration, was associated with higher FA in the right amygdala-hippocampus complex (r = 0.400, p = 0.005). Conclusion Veterans with psychiatric disorders and/or mTBI exhibit higher odds of engaging in IPV perpetration. Further, the more severe the symptoms of PTSD, depression, or TBI, and the greater the war zone-related stress, the greater the frequency of IPV perpetration. Moreover, we report a significant association between psychological aggression against an intimate partner and microstructural alterations in the right amygdala-hippocampus complex. These findings suggest the possibility of a structural brain correlate underlying IPV perpetration that requires further research.
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Affiliation(s)
- Philine Rojczyk
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Carina Heller
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
- Department of Clinical Psychology, Friedrich Schiller University Jena, Jena, Germany
- German Center for Mental Health (DZPG), Halle-Jena-Magdeburg, Germany
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits underlying Mental Health (C-I-R-C), Halle-Jena-Magdeburg, Germany
| | - Johanna Seitz-Holland
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Elisabeth Kaufmann
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
| | - Valerie J Sydnor
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
| | - Luisa Berger
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Lara Pankatz
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Yogesh Rathi
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
- Department of Software Engineering and IT, École de technologie supérieure, Montreal, QC, Canada
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - David Salat
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, United States
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA, United States
- Massachusetts General Hospital Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Boston, MA, United States
| | - Sidney R Hinds
- Department of Radiology and Neurology, Uniformed Services University, Bethesda, MD, United States
| | - Carrie Esopenko
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Catherine B Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - William P Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, United States
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians-University, Munich, Germany
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Horwitz SD, Millstein RA, McCarthy MD, Vanderweit R, Fernandez J, Hernandez AR, Wilson V, Maggiolo N, Collins E, Hirschberg R, Cefalo P, Sylvia LG. The Feasibility and Efficacy of Warrior Health and Fitness: A 3-Month Fitness and Nutrition Program for Veterans. Mil Med 2024:usae185. [PMID: 38739476 DOI: 10.1093/milmed/usae185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/20/2024] [Accepted: 03/29/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Veterans are at risk for mental and physical health problems but may not seek traditional health care services. Wellness-based interventions, including exercise and nutrition, have been associated with improvements in physical and mental health among this population. This study explores the acceptability, feasibility, and efficacy of a 3-month health and fitness program for veterans. MATERIALS AND METHODS Participants in 2 time-based cohorts from 2019 to 2023 (cohort 1: n = 261; cohort 2: n = 256) were cleared by a physician to participate. Participants then completed a fitness test and self-reported surveys (e.g., quality of life, sleep, and pain) before and after the 3-month program. Participants were recruited to participate at one of three sites: Boston, MA Fort Myers, FL, or Tampa, FL. The 3-month program consisted of weekly, supervised group fitness and one-on-one sessions, nutritional consultations, yoga, and other wellness activities. Primary program outcomes were measured by fitness assessments, self-report surveys, program completion, and program satisfaction. Fitness assessments included measures of weight, body mass index, grip strength, waist to hip ratio, body fat, lean mass, fat mass, heart rate, and blood pressure (BP). Self-report measures included quality of life, depression, loneliness, sleep quality, pain intensity, and pain interference. RESULTS In cohort 1, significant improvements were found for measures of weight (P = .01), left-handed grip strength (P < .01), body fat percent (P < .01), and quality of life (P < .01). In cohort 2, significant improvements were found for measures of waist:hip ratio (P = .02), right and left-handed grip strength (P < .01), body mass index (P = .02), body fat percent (P < .01), and quality of life (P = .02). For both cohorts, pain intensity (cohort 1: P = .01, cohort 2: P < .001) and pain interference (cohort 1: P = .02, cohort 2: P < .001) increased significantly. CONCLUSIONS These data suggest that a 3-month health and fitness program for veterans is acceptable and feasible and may improve physical and mental health outcomes. Considerations for program retention and assessment completion are discussed.
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Affiliation(s)
- Sarah D Horwitz
- Home Base Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Rachel A Millstein
- Home Base Program, Massachusetts General Hospital, Boston, MA 02114, USA
- Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Megan D McCarthy
- Home Base Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Ryan Vanderweit
- Home Base Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jaime Fernandez
- Home Base Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Victoria Wilson
- Home Base Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Nicolette Maggiolo
- Home Base Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Emily Collins
- Home Base Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Ron Hirschberg
- Home Base Program, Massachusetts General Hospital, Boston, MA 02114, USA
- Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02115, USA
| | - Philip Cefalo
- Home Base Program, Massachusetts General Hospital, Boston, MA 02114, USA
- Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02115, USA
| | - Louisa G Sylvia
- Home Base Program, Massachusetts General Hospital, Boston, MA 02114, USA
- Psychiatry, Harvard Medical School, Boston, MA 02115, USA
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McInerney SA, Waldrep E, Benight CC. Resilience enhancing programs in the U.S. military: An exploration of theory and applied practice. MILITARY PSYCHOLOGY 2024; 36:241-252. [PMID: 38661467 PMCID: PMC11057578 DOI: 10.1080/08995605.2022.2086418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/01/2022] [Indexed: 10/18/2022]
Abstract
U.S. service members are at an enhanced risk for developing mental disorders. To address these challenges, while promoting operational readiness and improving mental health outcomes, the Department of Defense directed each service component to develop and implement universal resilience enhancing programs. This paper provides a review of theoretical approaches conceptualizing resilience to trauma, including the theoretical foundations of programs currently in place. The resilience programs of U.S. Army, U.S. Air Force, U.S. Navy and U.S. Marine Corps are described, and available program effectiveness data are reviewed. Gaps between theory and practice are identified and an alternative method of assessing psychological readiness in Army units that is informed by resilience theory is offered as one way to address these gaps and scientific concerns. By comprehensively assessing the stressors affecting Soldiers at regular intervals, military leaders may be able to better identify and mitigate stressors in a systematic way that bolsters individual and unit psychological fitness. An enhanced psychological readiness metric stands to strengthen the validity of current resilience programs, bring clarity to the mechanisms of resilience, and provide a novel way for leaders to promote readiness in their units. Application of this metric within the infrastructure of existing reporting systems stands to improve mental health outcomes for Service Members, enhance the psychological readiness of the force, and reduce healthcare costs over time.
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Affiliation(s)
- Sarah A. McInerney
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, CO, USA
- Lyda Hill Institute for Human Resilience, University of Colorado, Colorado Springs, CO, USA
| | - Edward Waldrep
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, CO, USA
- PFC Floyd K. Lindstrom Department of Veterans Affairs Clinic, Colorado Springs, CO, USA
| | - Charles C. Benight
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, CO, USA
- Lyda Hill Institute for Human Resilience, University of Colorado, Colorado Springs, CO, USA
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Bressington D, Hyland P, Steele H, Byrne M, Mitchell D, Keane C, Shevlin M, Ho G, Murta JCD, Easpaig BNG, Liu X, Zhai J, Murphy D, Karatzias T. ICD-11 post-traumatic stress disorder and complex post-traumatic stress disorder in mental health support-seeking former-serving Australian defence force veterans. Aust N Z J Psychiatry 2024; 58:416-424. [PMID: 38332613 DOI: 10.1177/00048674241230197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND ICD-11 complex post-traumatic stress disorder is a more severe condition than post-traumatic stress disorder, and recent studies indicate it is more prevalent among military samples. In this study, we tested the psychometric properties of the International Trauma Questionnaire, assessed the relative prevalence rates of post-traumatic stress disorder and complex post-traumatic stress disorder in the sample population and explored relationships between complex post-traumatic stress disorder and post-traumatic stress disorder and a range of risk factors. METHODS Survey participants (N = 189) were mental health support-seeking former-serving veterans of the Australian Defence Force (ADF) recruited from primary care. Confirmatory factor analysis was used to test the factorial validity of the International Trauma Questionnaire. RESULTS The latent structure of the International Trauma Questionnaire was best represented by a two-factor second-order model consistent with the ICD-11 model of complex post-traumatic stress disorder. The International Trauma Questionnaire scale scores demonstrated excellent internal reliability. Overall, 9.1% (95% confidence interval = [4.8%, 13.5%]) met diagnostic requirements for post-traumatic stress disorder and an additional 51.4% (95% confidence interval = [44.0%, 58.9%]) met requirements for complex post-traumatic stress disorder. Those meeting diagnostic requirements for complex post-traumatic stress disorder were more likely to have served in the military for 15 years or longer, had a history of more traumatic life events and had the highest levels of depression, anxiety and stress symptoms. CONCLUSION The International Trauma Questionnaire can effectively distinguish between post-traumatic stress disorder and complex post-traumatic stress disorder within primary care samples of Australian Defence Force veterans. A significantly greater proportion of Australian Defence Force veterans met criteria for complex post-traumatic stress disorder than post-traumatic stress disorder. Australian military mental health services should adopt the International Trauma Questionnaire to routinely screen for complex post-traumatic stress disorder and develop complex post-traumatic stress disorder specific interventions to promote recovery in Australian Defence Force veterans with complex post-traumatic stress disorder.
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Affiliation(s)
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | | | - Mitchell Byrne
- Faculty of Health, Charles Darwin University, Darwin, NT, Australia
| | - David Mitchell
- Faculty of Health, Charles Darwin University, Darwin, NT, Australia
- Department of Health, Office of the Chief Psychiatrist, Darwin, NT, Australia
| | - Carol Keane
- Faculty of Health, Charles Darwin University, Darwin, NT, Australia
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Grace Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China SAR
| | | | | | - Xianliang Liu
- Faculty of Health, Charles Darwin University, Darwin, NT, Australia
| | - Jianxia Zhai
- STEM College, RMIT University, Melbourne, VIC, Australia
| | - Dominic Murphy
- Department of Research, Combat Stress, Leatherhead, UK
- King's Centre for Military Health Research, King's College London, London, UK
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
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Quartana PJ, Beymer MR, Gomez SAQ, Adler AB, Santo TJ, Thomas JL, Bell AM. COVID-19 Concerns, Information Needs, and Adverse Mental Health Outcomes among U.S. Soldiers. Mil Med 2024; 189:e878-e887. [PMID: 37715687 DOI: 10.1093/milmed/usad350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/31/2023] [Accepted: 08/24/2023] [Indexed: 09/18/2023] Open
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic disrupted U.S. Military operations and potentially compounded the risk for adverse mental health outcomes by layering unique occupational stress on top of general restrictions, fears, and concerns. The objective of the current study was to characterize the prevalence of COVID-19 concerns and information needs, demographic disparities in these outcomes, and the degree to which COVID-19 concerns and information needs were associated with heightened risk for adverse mental health outcomes among U.S. Army soldiers. MATERIALS AND METHODS Command-directed anonymous surveys were administered electronically to U.S. soldiers assigned to one of three regional commands in the Northwest United States, Europe, and Asia-Pacific Region. Surveys were administered in May to June 2020 to complete (time 1: n = 21,294) and again in December 2020 to January 2021 (time 2: n = 10,861). Only active duty or active reservists/national guard were eligible to participate. Members from other branches of service were also not eligible. RESULTS Highly prevalent COVID-19 concerns included the inability to spend time with friends/family, social activities, and changing rules, regulations, and guidance related to COVID-19. Some information needs were endorsed by one quarter or more soldiers at both time points, including stress management/coping, travel, how to protect oneself, and maintaining mission readiness. COVID-19 concerns and information needs were most prevalent among non-White soldiers. Concerns and information needs did not decline overall between the assessments. Finally, COVID-19 concerns were associated with greater risk of multiple adverse mental health outcomes at both time points. CONCLUSIONS COVID-19 concerns and information needs were prevalent and showed little evidence of decrement over the course of the first 6 months of the pandemic. COVID-19 concerns were consistently associated with adverse mental health outcomes. These data highlight two targets and potential demographic subgroups such that local leadership and Army medicine and public health enterprises can be better prepared to monitor and address to maintain force health and readiness in the face of possible future biomedical threats.
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Affiliation(s)
| | - Matthew R Beymer
- U.S. Army Public Health Center, Aberdeen Proving Ground, MD 21010, USA
| | | | - Amy B Adler
- Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | | | | | - Amy Millikan Bell
- U.S. Army Public Health Center, Aberdeen Proving Ground, MD 21010, USA
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Wang T, Tang H, Li X, Wu L, Li N, Zhang W, Shao Q, Cai M, Shang L. Development and preliminary evaluation of the Comprehensive Health Self-Assessment Questionnaire (CHSAQ) for individuals in the Chinese People Liberation Army. BMC Public Health 2024; 24:610. [PMID: 38408976 PMCID: PMC10895798 DOI: 10.1186/s12889-024-18085-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/13/2024] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVE There is currently no widely accepted multidimensional health assessment questionnaire for individuals in the Chinese People Liberation Army (PLA). This study developed a multidimensional health survey questionnaire (Comprehensive Health Self-Assessment Questionnaire, CHSAQ) suitable for personnel in the PLA and conducted a preliminary examination of its reliability, validity, and discriminative ability. METHODS After 183 items from 32 dimensions were selected to form the initial version of the CHSAQ, three groups of soldiers were selected from May 2022 to April 2023 and completed three survey rounds (with 183, 131, and 55 valid items). The items were screened based on classic test theory. After screening, the final questionnaire entries were formed, the structure of the questionnaire was explored through exploratory factor analysis and confirmatory factor analysis, and its reliability, structural validity, and discriminative ability were evaluated. RESULTS The final questionnaire consisted of 8 dimensions and 55 items on job satisfaction, anxiety and depression, daily activities, physical function, the otolaryngology system, the integumentary system, sleep disorders, and the visual system. The total cumulative variance contribution rate was 64.648% according to exploratory factor analysis. According to the confirmatory factor analysis, the normed fit index (NFI) was 0.880, and the comparison fit index (CFI) was 0.893 (close to 0.90). The Cronbach's α coefficient of the total questionnaire was 0.970, the split half reliability coefficient was 0.937, and the retest reliability coefficient was 0.902. The results are presented as different pairwise comparisons. CONCLUSION Our study developed a self-report questionnaire for evaluating the comprehensive health status of personnel in the PLA in accordance with the standard procedure for questionnaire development. Our findings also showed that the CHSAQ for individuals in the PLA has good reliability and structural validity.
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Affiliation(s)
- Tao Wang
- Department of Health Statistics, School of Public Health, the Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
- The Medical Department, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Han Tang
- Department of Health Statistics, School of Public Health, the Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Xinrui Li
- Department of Health Statistics, School of Public Health, the Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Lin Wu
- Department of Military Medical Psychology, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ning Li
- Department of Psychiatry, Xijing Hospital, the Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Wei Zhang
- Department of Health Statistics, School of Public Health, the Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Qiongjie Shao
- Department of Health Statistics, School of Public Health, the Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
- Department of Thoracic Surgery, Tangdu Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Min Cai
- Department of Psychiatry, Xijing Hospital, the Fourth Military Medical University, 710032, Xi'an, Shaanxi, China.
| | - Lei Shang
- Department of Health Statistics, School of Public Health, the Fourth Military Medical University, 710032, Xi'an, Shaanxi, China.
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Forbes D, LeardMann CA, Lawrence-Wood E, Villalobos J, Madden K, Gutierrez IA, Cowlishaw S, Baur J, Adler AB. Three-Item Dimensions of Anger Reactions Scale. JAMA Netw Open 2024; 7:e2354741. [PMID: 38315485 PMCID: PMC10844994 DOI: 10.1001/jamanetworkopen.2023.54741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/13/2023] [Indexed: 02/07/2024] Open
Abstract
Importance Problematic anger is prevalent and associated with adjustment difficulties in military populations. To facilitate measurement of problematic anger, a very brief valid measure is needed. Objective To reduce the Dimensions of Anger Reactions 5-item (DAR-5) scale to a very brief measure. Design, Setting, and Participants This cross-sectional study used survey data collected between 2014 and 2016 in the Australian Transition and Well-Being Research Programme and US Millennium Cohort Study. Participants were service members who were actively serving or had transitioned out of the military (separated). Statistical analyses were performed from September 2021 to June 2023. Main Outcomes and Measures The DAR-5 was reduced to the 3 experiential items: frequency, intensity, and duration (the DAR-3). Psychometrics for the DAR-3 and DAR-5 were compared in terms of standardized Cronbach α, positive screening result, mean, and SD. Analyses were stratified by Australian and US military service status cohorts (active duty and separated). Results A total of 71 010 participants were included from Australia and the US. Of 10 900 Australian participants (8145 active duty participants [74.7%]; 2755 separated participants [25.3%]), 5893 (55.2%) were aged 40 years or older and 8774 (80.5%) were male; of 60 110 US participants (24 706 active duty participants [41.1%]; 35 404 separated participants [58.9%]), 28 804 (47.9%) were aged 30 to 39 years and 43 475 (72.3%) were male. The DAR-3 demonstrated good internal consistency in the active duty (Australia: mean [SD] score, 4.97 [2.5]; α = 0.90; US: mean [SD] score, 5.04 [2.6]; α = 0.87) and separated (Australia: mean [SD] score, 6.53 [3.4]; α = 0.92; US: mean [SD] score, 6.05 [3.2]; α = 0.91) samples. The cutoff score of 8 or greater on the DAR-3 had optimal sensitivity and specificity across all samples. DAR-3 and DAR-5 were associated with posttraumatic stress disorder (PTSD), depression, aggression, and relationship conflict. While the scales did not significantly differ in their associations with PTSD, depression, and relationship conflict, the magnitude of association for aggression was significantly lower in US samples using the DAR-3 (eg, US active duty sample: DAR-5 OR, 9.96; 95% CI, 9.01-11.00; DAR-3 OR, 8.36; 95% CI, 7.58-9.22). Conclusions and Relevance In this cross-sectional study of a very brief measure of anger, each item contributed to the overall strength of the measure without losing psychometric strength compared with the DAR-5. The consistency of these findings across military and veteran samples in Australian and US populations demonstrated the psychometric robustness of the DAR-3.
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Affiliation(s)
- David Forbes
- Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia
| | - Cynthia A. LeardMann
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
- Leidos, San Diego, California
| | - Ellie Lawrence-Wood
- Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia
| | - Javier Villalobos
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
- Leidos, San Diego, California
| | - Kelsey Madden
- Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia
| | - Ian A. Gutierrez
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Sean Cowlishaw
- Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia
| | - Jenelle Baur
- Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia
| | - Amy B. Adler
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
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Crombach A, Rukundo-Zeller AC, Vukojevic V, Nandi C, Bambonye M, de Quervain DJF, Papassotiropoulos A, Elbert T. Differential methylation of linoleic acid pathway genes is associated with PTSD symptoms - a longitudinal study with Burundian soldiers returning from a war zone. Transl Psychiatry 2024; 14:32. [PMID: 38238325 PMCID: PMC10796347 DOI: 10.1038/s41398-024-02757-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 01/22/2024] Open
Abstract
Soldiers may be exposed to traumatic stress during combat deployment and thus are at risk for developing posttraumatic stress disorder (PTSD). Genetic and epigenetic evidence suggests that PTSD is linked to forming stress-related memories. In the current study, we investigated post-deployment associations of PTSD symptoms with differential DNA methylation in a sample of Burundian soldiers returning from the African Union Mission in Somalia's war zone. We used a matched longitudinal study design to explore epigenetic changes associated with PTSD symptoms in N = 191 participants. PTSD symptoms and saliva samples were collected at 1-3 (t1) and 9-14 months (t2) after the return of the soldiers to their home base. Individuals with either worsening or improving PTSD symptoms were matched for age, stressful, traumatic and self-perpetrated events prior to the post-assessment, traumatic and violent experiences between the post- and the follow-up assessment, and violence experienced during childhood. A mixed model analysis was conducted to identify top nominally significantly differentially methylated genes, which were then used to perform a gene enrichment analysis. The linoleic acid metabolism pathway was significantly associated with post-deployment PTSD symptoms, after accounting for multiple comparisons. Linoleic acid has been linked to memory and immune related processes in previous research. Our findings suggest that differential methylation of linoleic acid pathway genes is associated with PTSD and thus may merit closer inspection as a possible mediator of resilience.
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Affiliation(s)
- Anselm Crombach
- Department of Psychology, Clinical Child and Adolescent Psychology and Psychotherapy, Saarland University,, Saarbrücken, Germany.
- Department of Psychology, Université Lumière de Bujumbura, Bujumbura, Burundi.
| | - Anja C Rukundo-Zeller
- Department of Psychology, Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | - Vanja Vukojevic
- Department of Biomedicine, Research Cluster Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Corina Nandi
- Department of Psychology, Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | - Manassé Bambonye
- Department of Psychology, Université Lumière de Bujumbura, Bujumbura, Burundi
| | - Dominique J-F de Quervain
- Department of Biomedicine, Research Cluster Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Andreas Papassotiropoulos
- Department of Biomedicine, Research Cluster Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Thomas Elbert
- Department of Psychology, Université Lumière de Bujumbura, Bujumbura, Burundi
- Department of Psychology, Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
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Wachen JS, Morris KL, Galovski TE, Dondanville KA, Resick PA, Schwartz C. Massed cognitive processing therapy for combat-related posttraumatic stress disorder: Study design and methodology of a non-inferiority randomized controlled trial. Contemp Clin Trials 2024; 136:107405. [PMID: 38056624 DOI: 10.1016/j.cct.2023.107405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/20/2023] [Accepted: 12/02/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is prevalent among military personnel. Cognitive processing therapy (CPT) is identified as one of the most effective treatments for PTSD, although smaller effects have been found in military populations. High rates of dropout from treatment may contribute to reduced efficacy, and military personnel may face unique barriers to treatment completion. One method of improving efficacy may be to reduce dropout by decreasing the time required to receive a full dose of treatment. This paper describes the design and methodology of the first randomized clinical trial testing whether CPT delivered in an intensive format is non-inferior to standard delivery of CPT. METHOD Participants are 140 active duty service members randomized to receive CPT in a 5-day combined group and individual intensive outpatient format (MCPT) or standard CPT (delivered individually twice weekly over 6 weeks). Participants are assessed at baseline, and 1 month, 4 months, and 1 year following the conclusion of the therapy. Reduction in PTSD symptomatology is the primary outcome of interest. Secondary outcomes include comorbid psychological symptoms, health, and functioning. A secondary objective is to examine predictors of treatment outcome to determine which service members benefit most from which treatment modality. CONCLUSION If determined to be non-inferior, MCPT would provide an efficient and accessible modality of evidence-based PTSD treatment. This therapy format would improve access to care by reducing the amount of time required for treatment and improving symptoms and functioning more rapidly, thereby minimizing interference with work-related activities and disruption to the mission.
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Affiliation(s)
- Jennifer Schuster Wachen
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Ave. (116B-3), Boston, MA 02130, USA; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, 720 Harrison Ave., Boston, MA 02118, USA..
| | - Kris L Morris
- Alexander T. Augusta Military Medical Center, 9300 DeWitt Loop, Fort Belvoir, VA 22060, USA
| | - Tara E Galovski
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Ave. (116B-3), Boston, MA 02130, USA; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, 720 Harrison Ave., Boston, MA 02118, USA
| | - Katherine A Dondanville
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3901, USA
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke University, 2400 Pratt St., Durham, NC 27710, USA
| | - Carey Schwartz
- Alexander T. Augusta Military Medical Center, 9300 DeWitt Loop, Fort Belvoir, VA 22060, USA
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Kirk MA, Nolet JM, Adrian AL, Knust SK. Systematic Improvements to the Army's Deployment Cycle Resilience Training Using a Comprehensive, Iterative Process. Mil Med 2023; 188:246-254. [PMID: 37948235 DOI: 10.1093/milmed/usad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/16/2023] [Accepted: 03/24/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION To support soldier readiness and mitigate the mental health consequences of deployments, Army regulation mandates soldiers to receive Deployment Cycle Resilience Training (DCRT) throughout their deployment cycle. A recent evaluation revealed several issues with the existing version that threatened the relevancy and usefulness of the training. The present article details the systematic approach taken by the Research Transition Office at the Walter Reed Army Institute of Research to revise the DCRT curriculum and presents the revision updates that are now included in DCRT version 3. METHOD Curriculum developers (n = 2) with subject matter expertise relevant to the project followed an iterative process that was critical to the efficacy of the revisions. Developers used the existing DCRT modules as the curriculum framework and utilized several materials to inform the revisions to include Army doctrine, data from the quality improvement evaluation conducted by the Walter Reed Army Institute of Research, and the current research related to the deployment cycle, resilience, and behavior change. Internal and external stakeholders (n = 31) provided iterative feedback to ensure each of the six modules met DCRT revision objectives. RESULTS The revised DCRT curriculum was implemented in August 2021. The resulting revisions included an increase in inclusivity, an emphasis on growth opportunities, an integrative approach to the deployment cycle phases, and greater practical application. Additionally, the curriculum incorporates best practices found to enhance the delivery of resilience-based psychoeducational interventions, specifically within high-risk occupational settings like the military. CONCLUSIONS The revisions outlined in this article enhance the training quality and potential effectiveness of DCRT, which can positively influence soldier and family readiness and mission success. Furthermore, the deliberate and iterative curriculum revision process can serve as a guide to other curriculum development projects, specifically within the military context. Implementation considerations and potential limitations are provided, and future directions are discussed to include the ongoing evaluation.
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Affiliation(s)
- Michelle A Kirk
- Research Transition Office, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Jason M Nolet
- Research Transition Office, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Amanda L Adrian
- Research Transition Office, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Susannah K Knust
- Research Transition Office, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
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Harwood-Gross A, Stern N, Brom D. Exposure to combat experiences: PTSD, somatization and aggression amongst combat and non-combat veterans. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2023; 58:424-432. [PMID: 37199000 DOI: 10.1002/ijop.12917] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 04/30/2023] [Indexed: 05/19/2023]
Abstract
To this date, the prevalence of posttraumatic stress disorder (PTSD) and associated psychological symptom profiles amongst non-combatant community-based veterans in Israel has not been studied. Data were analysed from a web-based survey of veterans via a market research platform during September 2021 and included 522 non-combat (e.g. intelligence, office-based or education corps) veterans and 534 combat (e.g. front-line infantry) veterans. The survey assessed PTSD, depression, anxiety and somatic symptoms in addition to the prevalence of self-reported aggression. A two-way multivariate analysis of covariance indicated that higher PTSD and somatic symptoms were prevalent for those exposed to combat experiences even when not in a combatant role. A logistic regression indicated that of those who did not self-define as aggressive prior to service, those exposed to combat were three times more likely to be aggressive following their service than veterans not exposed to combat. This effect was not demonstrated for combat soldiers compared to non-combat soldiers. Results indicate that mental health outreach would be better targeted towards those who have been exposed to combat-type experiences during their service even in non-combat units. The current study highlights the effect of combat exposure on secondary PTSD symptoms; aggression and somatization.
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Affiliation(s)
- Anna Harwood-Gross
- METIV Israel Psychotrauma Center, Herzog Medical Center, Jerusalem, Israel
- The Paul Baerwald School of Social Work and Social Welfare, Hebrew University, Jerusalem, Israel
| | - Nadav Stern
- METIV Israel Psychotrauma Center, Herzog Medical Center, Jerusalem, Israel
| | - Danny Brom
- METIV Israel Psychotrauma Center, Herzog Medical Center, Jerusalem, Israel
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Wolfgang AS, Hoge CW. Psychedelic-Assisted Therapy in Military and Veterans Healthcare Systems: Clinical, Legal, and Implementation Considerations. Curr Psychiatry Rep 2023; 25:513-532. [PMID: 37682446 DOI: 10.1007/s11920-023-01446-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE OF REVIEW This review discusses the current and projected landscape of psychedelic-assisted therapy (PAT), with a focus on clinical, legal, and implementation considerations in Department of Defense (DoD) and Department of Veterans Affairs (VA) healthcare systems. RECENT FINDINGS 3,4-Methylenedioxymethamphetamine (MDMA)- and psilocybin-assisted therapy have shown promising outcomes in efficacy, safety, tolerability, and durability for PTSD and depression, respectively. MDMA-assisted therapy is already approved by the Food and Drug Administration (FDA) on an Expanded Access ("compassionate use") basis for PTSD, with full approval projected for 2024. Psilocybin-assisted therapy is projected to be FDA-approved for depression soon thereafter. Other psychedelics are in earlier stages of development. The VA is currently conducting PAT clinical trials. Although there are clear legal pathways for the VA and DoD to conduct PAT trials, a number of implementation barriers exist, such as the very high number of clinical hours necessary to treat each patient, resource requirements to support treatment infrastructure, military-specific considerations, and the high level of evidence necessary for PAT to be recommended in clinical practice guidelines. Ongoing considerations are whether and how PAT will be made available to VA and DoD beneficiaries, feasibility and cost-effectiveness, and ethical safeguards that must be implemented to prioritize access to PAT given the likelihood of extremely limited initial availability. However, with imminent FDA approval of PATs and considerable national interest in these treatments, DoD and VA policymakers must be prepared with clearly delineated policies and plans for how these healthcare systems will approach PAT.
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Affiliation(s)
- Aaron S Wolfgang
- Walter Reed National Military Medical Center, 4494 Palmer Rd N, Bethesda, MD, 20814, USA.
- Uniformed Services University, Bethesda, MD, USA.
- Yale University School of Medicine, New Haven, CT, USA.
| | - Charles W Hoge
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
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ER F, DUYAN V. An Overview of the Stigmatization of Soldiers in the Context of Mental Health from a Social Work Perspective. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2023. [DOI: 10.18863/pgy.1163149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Due to its nature, the army is an environment with a high risk of mental illness. Research shows that mental health stigma is a common and serious barrier to early and effective treatment for mental disorders that result from the stress of military operations. Given the need for timely and effective mental health intervention, it is important to understand the barriers to seeking mental health help in a military context. Although there is stigma related to mental health in the studies and compilations carried out in the civil and military context in the national and international literature, there is no literature on mental health stigmatization in the military context, especially in the national literature. This study is a compilation research created by reviewing the national and international literature. In this article, it is aimed to present some innovative social work interventions in order to address the sources of stigma that hinders access to mental health care and the factors that reinforce them, in a military context, to potentially reduce stigma and to maximize the benefit of mental health care.
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Affiliation(s)
- Filiz ER
- Van İl Sağlık Müdürlüğü, İpek Yolu İlçe Sağlık Müdürlüğü
| | - Veli DUYAN
- ANKARA ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ ENSTİTÜSÜ
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20
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Govier DJ, Than CT, Chawla N, Mulcahy AC, Hoggatt KJ, Yano EM, Hynes DM. Veterans Health Administration Healthcare Coverage and Medical Financial Hardship in Low-Income Veterans. Am J Prev Med 2023; 65:406-416. [PMID: 36906192 DOI: 10.1016/j.amepre.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/13/2023]
Abstract
INTRODUCTION The Veterans Health Administration (VA) provides low- to no-cost care to enrolled veterans with low incomes. This study assessed the associations between VA coverage and medical financial hardship among U.S. veterans with low incomes. METHODS Using 2015-2018 National Health Interview Survey data, veterans aged ≥18 years with incomes <200% of the Federal Poverty Level were identified (crude n=2,468, weighted n=3,872,252). Four types of medical financial hardship were assessed: objective, and subjective material, psychologic, and behavioral medical financial hardship. Survey-weighted proportions of veterans with medical financial hardship were calculated, and adjusted probabilities of medical financial hardship that accounted for Veteran characteristics, year-fixed effects, and survey sampling design were estimated. Analyses were conducted from August through December 2022. RESULTS Overall, 34.5% of veterans with low incomes had VA coverage. Among veterans without VA coverage, 38.7% had Medicare insurance, 18.2% had Medicaid insurance, 16.5% had private insurance, 13.5% had other public insurance, and 13.1% were uninsured. In adjusted analyses, veterans with VA coverage had lower probabilities of objective (-8.13 percentage point, p=0.008), subjective material (-6.55 percentage point, p=0.034), subjective psychologic (-10.33 percentage point, p=0.003), and subjective behavioral (-6.72 percentage point, p=0.031) medical financial hardship than veterans with Medicare and no VA coverage. CONCLUSIONS VA coverage was associated with protection against four types of medical financial hardship among veterans with low incomes, yet many are not enrolled. Research is needed to understand reasons these veterans lack VA coverage and to identify strategies to address medical financial hardship.
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Affiliation(s)
- Diana J Govier
- VA Health Services Research & Development (HSR&D) Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon; Department of Health Systems Management & Policy, Oregon Health & Science University - Portland State University School of Public Health, Portland, Oregon.
| | - Claire T Than
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Neetu Chawla
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Abby C Mulcahy
- VA Health Services Research & Development (HSR&D) Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon; Department of Health Systems Management & Policy, Oregon Health & Science University - Portland State University School of Public Health, Portland, Oregon
| | - Katherine J Hoggatt
- San Francisco VA Health Care System, San Francisco, California; Department of Medicine, University of California San Francisco, San Francisco, California
| | - Elizabeth M Yano
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, California; Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California
| | - Denise M Hynes
- VA Health Services Research & Development (HSR&D) Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon; School of Social and Behavioral Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon; Center for Quantitative Life Sciences, Oregon State University, Corvallis, Oregon; School of Nursing, Oregon Health & Science University, Portland, Oregon
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21
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Baker MD, Southard MA, Beymer MR, Riviere LA. National Guard service members decedent recovery and processing operations during the COVID-19 pandemic in New York City. MILITARY PSYCHOLOGY 2023; 35:431-439. [PMID: 37615552 PMCID: PMC10453968 DOI: 10.1080/08995605.2023.2198481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/01/2023] [Indexed: 08/25/2023]
Abstract
In Spring 2020, the New York Army and Air National Guard (NYNG) rapidly deployed to New York City (NYC) to assist in the recovery, processing, and transport of COVID-19 decedents. This study reports on a survey conducted by NYNG service members three to six months post-mission (n = 177). Data showed that there was a dose-response relationship between mission stress exposure and decremented mental health, but certain activities were associated with better mental health outcomes. The paper also reviews resources provided by behavioral health personnel to support service members during the mission and lessons learned to inform future decedent recovery missions.
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Mitchell NA, McCauley M, O’Brien D, Wilson CE. Mental health and resilience in the Irish defense forces during the COVID-19 global pandemic. MILITARY PSYCHOLOGY 2023; 35:383-393. [PMID: 37615557 PMCID: PMC10453996 DOI: 10.1080/08995605.2021.2007728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
The Irish Defense Forces (DF) responded to the COVID-19 pandemic and national public health crisis by deploying personnel to aid domestic civil authorities in medical and care settings, contact tracing, logistics, and operations. Current research on COVID-19 reveals increased psychological distress among frontline workers and the general public. Resilience has previously been associated with lower levels of psychological distress. This study sets out to test these associations, and to examine mental health differences between DF personnel deployed in Ireland on pandemic-related duties (DIPD) and non-DIPD. Participants were 231 DF members who completed the: Connor-Davidson Resilience Scale-10, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Perceived Coronavirus Threat Questionnaire, Brief Trauma Questionnaire, Post-traumatic Stress Disorder Checklist-5, and Alcohol Use Disorder Identification Test. Independent t-tests revealed no differences between DIPD and non-DIPD on measures of psychological distress or on self-rated mental health prior to COVID-19 (PC19) and during COVID-19 (DC19). Results of multiple hierarchical regression analyses revealed that depression predicted lower levels of resilience, while multiple traumatic events predicted higher levels of resilience. The total adjusted variance explained by the model was 25%. Clinical and policy implications for improving access to psychological support within the DF and military populations are discussed.
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Affiliation(s)
- Nicola A. Mitchell
- School of Psychology, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Mathew McCauley
- School of Psychology, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
- Military Clinical Psychology, Office of the DMB, Defence Forces Ireland, Dublin, Ireland
| | - Dorota O’Brien
- Military Clinical Psychology, Office of the DMB, Defence Forces Ireland, Dublin, Ireland
| | - Charlotte E. Wilson
- School of Psychology, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
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23
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Osgood JM, Yates HK, Holzinger JB, Quartana PJ. Cognitive reappraisal moderates the effect of combat or other exposures on negative behavioral health symptoms. MILITARY PSYCHOLOGY 2023:1-11. [PMID: 37643329 DOI: 10.1080/08995605.2023.2250709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
Understanding the individual differences that can buffer the impact of combat and other adverse exposures on deleterious behavioral health outcomes could lead to more targeted prevention and intervention efforts. Cognitive reappraisal, an antecedent-focused emotion regulation strategy, is linked to positive health outcomes such as lower levels of post-traumatic stress disorder, anxiety, and depression. This study examined the moderating effect of individual differences in cognitive reappraisal use on the association between combat exposure and behavioral health outcomes in active-duty U.S. Soldiers (N = 2,290). This study utilized survey data collected approximately 18 months following a combat deployment to Afghanistan in 2014. Results showed that individual differences in cognitive reappraisal use significantly moderated the effect of combat exposure on anxiety and post-traumatic stress symptoms but not depressive symptoms. Specifically, increasing combat exposures predicted a steeper increase in negative behavioral health symptoms for Soldiers reporting lesser (versus greater) cognitive reappraisal use. These findings highlight a role for cognitive reappraisal as a targetable factor that can mitigate the behavioral health consequences of exposure to combat stressors.
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Affiliation(s)
- Jeffrey M Osgood
- US Army Medical Research Directorate West, Walter Reed Army Institute of Research, Joint Base Lewis McChord, WA, USA
| | - Hunter K Yates
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Jayne B Holzinger
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Phillip J Quartana
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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24
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Raz A, Rubinstein R, Shadach E, Chaikin G, Ben Yehuda A, Tatsa-Laur L, Kedem R, Shelef L. Behavioral Self-Blame in PTSD-Etiology, Risk Factors, and Proposed Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6530. [PMID: 37569070 PMCID: PMC10418798 DOI: 10.3390/ijerph20156530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Feeling out of control during a traumatic event may evoke behavioral self-blame (BSB) to avoid feeling helpless following trauma by restoring one's sense of control. BSB is a common, persistent, and treatment-resistant post-traumatic stress symptom. The present study investigates the etiology and risk factors of BSB following a traumatic event and the reasons for its persistence over time. METHOD Subjects were a group of 546 Israeli ex-combat soldiers (M age = 24.93 ± 5.657) registered in an Israel Defense Forces (IDF) combat reaction clinic. All completed the Peritraumatic Dissociative Experiences Questionnaire (PDEQ), the Brief Symptom Inventory (BSI), and the PTSD Checklist for the DSM-5 (PCL-5). Item 10 of the PCL-5 served to measure BSB. The PDEQ and BSI measured distress and feeling out of control during the event. We used descriptive analyses of the data, t-test, and linear regression analysis to reveal the relationship between the research variables. RESULTS Feeling out of control during a traumatic event often increases BSB and post-traumatic stress symptoms. A significant correlation emerged between continuing distress characterizing individuals who experience a persistent lack of control and BSB. Female combat soldiers were at a higher risk of BSB than their male counterparts. CONCLUSION Loss of control experienced during a traumatic event may result in persistent long-term feelings of lack of control over one's behavior.
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Affiliation(s)
- Aviad Raz
- Department of Health and Well-Being, IDF’s Medical Corps, Israel Defense Forces, Ramat Gan 6195001, Israel
| | - Ravit Rubinstein
- Department of Health and Well-Being, IDF’s Medical Corps, Israel Defense Forces, Ramat Gan 6195001, Israel
| | - Eran Shadach
- School of Social Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv Yaffo 6195001, Israel
| | - Gal Chaikin
- Department of Health and Well-Being, IDF’s Medical Corps, Israel Defense Forces, Ramat Gan 6195001, Israel
| | - Ariel Ben Yehuda
- Department of Health and Well-Being, IDF’s Medical Corps, Israel Defense Forces, Ramat Gan 6195001, Israel
| | - Lucian Tatsa-Laur
- Department of Health and Well-Being, IDF’s Medical Corps, Israel Defense Forces, Ramat Gan 6195001, Israel
| | - Ron Kedem
- Department of Health and Well-Being, IDF’s Medical Corps, Israel Defense Forces, Ramat Gan 6195001, Israel
| | - Leah Shelef
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
- School of Social Work, Sapir Academic College, D. N. Hof Ashkelon, Sderot 79165, Israel
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25
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Sampson L, Gradus JL, Cabral HJ, Rosellini AJ, Fink DS, Cohen GH, Liberzon I, Galea S. Stressful life events and incident depression among U.S. military personnel. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1009-1018. [PMID: 36897335 PMCID: PMC10619516 DOI: 10.1007/s00127-023-02445-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/27/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE Although stressful life events (i.e., stressors) and depression are often assumed to be linked, the relation between stressors and incident depression is rarely studied, particularly in the military. The National Guard is a part-time subset of the U.S. military for whom civilian life stressors may be particularly salient, due to the soldiers' dual roles and frequent transitions between military and civilian life. METHODS We used a dynamic cohort study of National Guard members from 2010 to 2016 to investigate the relationship between recent stressful experiences (e.g., divorce) and incident depression, with an exploratory analysis of effect modification by income. RESULTS Respondents endorsing at least one of nine past-year stressful events (a time-varying exposure, lagged by 1 year) had almost twice the adjusted rate of incident depression compared to those with no stressful events (HR = 1.8; 95% CI 1.4, 2.4). This association may be modified by income: among individuals making under $80,000 per year, those with past-year stressors had twice the rate of depression compared to those with no stressors, but among those making over $80,000, past-year stressors were associated with only 1.2 times the rate of depression. CONCLUSION Stressful life events outside of deployment are important determinants of incident depression among National Guard servicemembers, but the effect of these events may be buffered by higher income.
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Affiliation(s)
- Laura Sampson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Jaimie L Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Anthony J Rosellini
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Center for Anxiety and Related Disorders, Department of Psychological and Brain Science, Boston University, Boston, MA, USA
| | - David S Fink
- New York State Psychiatric Institute, New York, NY, USA
| | - Gregory H Cohen
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Israel Liberzon
- Department of Psychiatry, College of Medicine, Texas A&M, College Station, TX, USA
| | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Office of the Dean, Boston University School of Public Health, 715 Albany Street, Boston, MA, USA
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26
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Fujiwara T, Koyama Y, Isumi A, Matsuyama Y, Tani Y, Ichida Y, Kondo K, Kawachi I. " What Did You Do in the War, Daddy?": Paternal Military Conscription During WWII, Economic Hardship and Family Violence in Childhood, and Health in Late Life in Japan. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:8114-8135. [PMID: 36794857 DOI: 10.1177/08862605231153889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Childhood adversity is a risk factor for poor health in late life and includes economic hardship and family violence, whose prevalence is high among offspring of military conscripted father. We assessed the association between paternal military conscription (PMC) and paternal war death (PWD) during Second World War and self-rated health (SRH) among older adults in Japan. Data were obtained from a population-based cohort of functionally independent people aged 65 years or older from 39 municipalities across Japan in 2016. Information on PMC and SRH was obtained through a self-report questionnaire. A total of 20,286 participants were analyzed with multivariate logistic regression to investigate the association between PMC, PWD, and poor health. Causal mediation analysis was performed to see whether childhood economic hardship and family violence mediated the association. Among participants, 19.7% reported PMC (including 3.3% PWD). In the age- and sex-adjusted model, older people with PMC showed higher risk of poor health (odds ratio [OR]: 1.16, 95% confidence interval [CI] [1.06, 1.28]), while those with PWD were not associated (OR: 0.96, 95% CI [0.77, 1.20]). Causal mediation showed a mediation effect of childhood family violence exposure on the association between PMC and poor health (proportion mediated: 6.9%). Economic hardship did not mediate the association. PMC, but not PWD, increased the risk of poor health in older age, which was partially explained by the exposure to family violence in childhood. There appears to be a transgenerational health impact of war which continues to affect the health of offspring as they age.
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Affiliation(s)
- Takeo Fujiwara
- Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yuna Koyama
- Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Aya Isumi
- Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | | | - Yukako Tani
- Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yukinobu Ichida
- Doctoral Institute for Evidence Based Policy, Inc., Tokyo, Japan
| | - Katsunori Kondo
- Chiba University, Chiba, Japan
- Department of Gerontological Evaluation, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu City, Aichi, Japan
| | - Ichiro Kawachi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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27
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Galovski TE, Rossi FS, Fox AB, Vogt D, Duke CC, Nillni YI. Relationship of perceived neighborhood danger with depression and PTSD among veterans: The moderating role of social support and neighborhood cohesion. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 71:395-409. [PMID: 36661400 DOI: 10.1002/ajcp.12655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 06/06/2023]
Abstract
Little is known about the impact of perceived neighborhood danger on military veterans' mental health, a population potentially at higher risk for this experience, or whether interpersonal social support and neighborhood cohesion can help buffer against poor mental health. This study examined: (1) the impact of perceived neighborhood danger on depression and posttraumatic stress disorder (PTSD) among veterans; (2) whether interpersonal social support and neighborhood cohesion can mitigate these effects; and (3) how prior trauma history may interact with these factors. Six moderation models were examined using data from 3049 veterans enrolled in the Longitudinal Investigation of Gender, Health, and Trauma study, a mail-based survey that oversampled for veterans in high crime neighborhoods. Most notably, results indicated that perceived neighborhood danger was associated with increased depression and PTSD (all p < .001). Interpersonal social support or neighborhood cohesion mitigated the effect of perceived neighborhood danger on veterans' depression, but, only for those without prior trauma (all p < .011). For trauma-exposed veterans, interpersonal social support was more effective in mitigating the effect of perceived neighborhood danger on depression than neighborhood cohesion (p = .006). Findings help inform interventions to improve the mental health of veterans living in high crime neighborhoods.
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Affiliation(s)
- Tara E Galovski
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Chobanian and Avedesian School of Medicine at Boston University, Boston, Massachusetts, USA
| | - Fernanda S Rossi
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Annie B Fox
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- School of Healthcare Leadership, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Dawne Vogt
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Chobanian and Avedesian School of Medicine at Boston University, Boston, Massachusetts, USA
| | | | - Yael I Nillni
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Chobanian and Avedesian School of Medicine at Boston University, Boston, Massachusetts, USA
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28
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van der Wal SJ, Geuze E, Vermetten E. Long-term risk for mental health symptoms in Dutch ISAF veterans: the role of perceived social support. Psychol Med 2023; 53:3355-3365. [PMID: 35039095 DOI: 10.1017/s0033291721005389] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Military personnel deployed to combat and peacekeeping missions are exposed to high rates of traumatic events. Accumulating evidence suggests an important association between deployment and the development of other mental health symptoms beyond post-traumatic stress disorder. METHODS This study examined the prevalence of agoraphobia, anxiety, depression, and hostility symptoms in a cohort of Dutch ISAF veterans (N = 978) from pre-deployment up to 10 years after homecoming. The interaction of potential moderating factors with the change in mental health symptoms relative to pre-deployment was investigated at each time point. RESULTS The probable prevalence of agoraphobia, anxiety, depression, and hostility symptoms significantly increased over time to respectively 6.5, 2.7, 3.5, and 6.2% at 10 years after deployment. Except for hostility symptoms, the probable prevalence at 10 years after deployment was the highest compared to all previous follow-up assessments. Importantly, less perceived social support after returning from deployment was found as a risk factor for all different mental health symptoms. Unit support was not associated with the development of mental health problems. CONCLUSIONS This study suggests a probable broad and long-term impact of deployment on the mental health of military service members. Due to the lack of a non-deployed control group, causal effects of deployment could not be demonstrated. Continued effort should nevertheless be made in the diagnosis and treatment of a wide range of mental health symptoms, even a decade after deployment. The findings also underscore the importance of social support after homecoming and its potential for the prevention of long-term mental health problems.
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Affiliation(s)
- Sija J van der Wal
- Brain Research and Innovation Centre, Ministry of Defence, Utrecht, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elbert Geuze
- Brain Research and Innovation Centre, Ministry of Defence, Utrecht, The Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- ARQ National Pyschotrauma Center, Diemen, The Netherlands
- Military Mental Healthcare, Ministry of Defence, Utrecht, The Netherlands
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29
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Nguyen AW, Qin W, Wei W, Keith VM, Mitchell UA. Racial discrimination and 12-month and lifetime anxiety disorders among African American men and women: Findings from the National Survey of American Life. J Affect Disord 2023; 330:180-187. [PMID: 36907462 PMCID: PMC10065954 DOI: 10.1016/j.jad.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND The purpose of this study was to assess the associations between racial discrimination and 12-month and lifetime DSM-IV anxiety disorders among African American men and women. METHODS Data was drawn from the African American sample of the National Survey of American Life (N = 3570). Racial discrimination was assessed with the Everyday Discrimination Scale. 12-month and lifetime DSM-IV outcomes were any anxiety disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD), and agoraphobia (AG). Logistic regressions were utilized to assess the relationships between discrimination and anxiety disorders. RESULTS The data indicated that racial discrimination was associated with increased odds for 12-month and lifetime anxiety disorders, AG, and PD and lifetime SAD among men. Regarding 12-month disorders among women, racial discrimination was associated with increased odds for any anxiety disorder, PTSD, SAD, and PD. With respect to lifetime disorders among women, racial discrimination was associated with increased odds for any anxiety disorder, PTSD, GAD, SAD, and PD. LIMITATIONS The limitations of this study include the utilization of cross-sectional data, self-reported measures, and the exclusion of non-community dwelling individuals. CONCLUSIONS The current investigation showed that African American men and women are not impacted by racial discrimination in the same ways. These findings suggest that the mechanisms through which discrimination operates among men and women to influence anxiety disorders is potentially a relevant target for interventions to address gender disparities in anxiety disorders.
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Affiliation(s)
- Ann W Nguyen
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, United States of America.
| | - Weidi Qin
- Population Studies Center, University of Michigan, United States of America
| | - Wenxing Wei
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, United States of America
| | - Verna M Keith
- Department of Sociology, University of Alabama at Birmingham, United States of America
| | - Uchechi A Mitchell
- School of Public Health, University of Illinois Chicago, United States of America
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30
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Duffy FF, Sudom K, Jones M, Fear NT, Greenberg N, Adler AB, Hoge CW, Wilk JE, Riviere LA. Calibrating the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) for detecting alcohol-related problems among Canadian, UK and US soldiers: cross-sectional pre-deployment and post-deployment survey results. BMJ Open 2023; 13:e068619. [PMID: 37130676 PMCID: PMC10163557 DOI: 10.1136/bmjopen-2022-068619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES Excessive alcohol use can bring about adverse health and work-related consequences in civilian and military populations. Screening for excessive drinking can help identify individuals at risk for alcohol-related problems who may require clinical interventions. The brief validated measures of alcohol use such as the Alcohol Use Disorders Identification Test (AUDIT), or abbreviated AUDIT-Consumption (AUDIT-C), are often included in military deployment screening and epidemiologic surveys, but appropriate cut-points must be used to effectively identify individuals at risk. Although the conventional AUDIT-C cut-points ≥4 for men and ≥3 for women are commonly used, recent validation studies of veterans and civilians recommend higher cut-points to minimise misclassification and overestimation of alcohol-related problems. This study aims to ascertain optimal AUDIT-C cut-points for detecting alcohol-related problems among serving Canadian, UK and US soldiers. DESIGN Cross-sectional pre/post-deployment survey data were used. SETTINGS Comprised Army locations in Canada and UK, and selected US Army units. PARTICIPANTS Included soldiers in each of the above-mentioned settings. OUTCOME MEASURES Soldiers' AUDIT scores for hazardous and harmful alcohol use or high levels of alcohol problems served as a benchmark against which optimal sex-specific AUDIT-C cut-points were assessed. RESULTS Across the three-nation samples, AUDIT-C cut-points of ≥6/7 for men and ≥5/6 for women performed well in detecting hazardous and harmful alcohol use and provided comparable prevalence estimates to AUDIT scores ≥8 for men and ≥7 for women. The AUDIT-C cut-point ≥8/9 for both men and women performed fair-to-good when benchmarked against AUDIT ≥16, although inflated AUDIT-C-derived prevalence estimates and low positive predictive values were observed. CONCLUSION This multi-national study provides valuable information regarding appropriate AUDIT-C cut-points for detecting hazardous and harmful alcohol use, and high levels of alcohol problems among soldiers. Such information can be useful for population surveillance, pre-deployment/post-deployment screening of military personnel, and clinical practice.
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Affiliation(s)
- Farifteh Firoozmand Duffy
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- TechWerks LLC, Arlington Heights, Illinois, USA
| | - Kerry Sudom
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, Ontario, Canada
| | - Margaret Jones
- King's Centre for Military Health Research, King's College London, London, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, King's College London, London, UK
- ADMMH, King's College London, London, UK
| | - Neil Greenberg
- King's Centre for Military Health Research, King's College London, London, UK
| | - Amy B Adler
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Charles W Hoge
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Joshua E Wilk
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Lyndon A Riviere
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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Wood MD, Foran HM, Britt TW. Limitations of benefit finding as a coping mechanism for combat-related PTSD symptoms. MILITARY PSYCHOLOGY 2023; 35:233-244. [PMID: 37133550 PMCID: PMC10197993 DOI: 10.1080/08995605.2022.2112884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 07/18/2022] [Indexed: 05/04/2023]
Abstract
Benefit finding has been identified as a buffer of the combat exposure-PTSD symptom link in soldiers. However, benefit finding may have a limited buffering capacity on the combat-PTSD symptom link over the course of a soldier's post-deployment recovery period. In the present study, soldiers returning from Operation Iraqi Freedom (OIF) were surveyed at two different time periods post-deployment: Time 1 was 4 months post-deployment (n = 1,510), and Time 2 was at 9 months post-deployment (n = 783). The surveys assessed benefit finding, PTSD symptoms, and combat exposure. Benefit finding was a successful buffer of the cross-sectional relationship between combat exposure and PTSD reexperiencing symptoms at Time 1, but not at Time 2. In addition, the benefit finding by combat interaction at time 1 revealed that greater benefit finding was associated with higher symptoms under high combat exposure at Time 2 after controlling for PTSD arousal symptoms at Time 1. The results of the present study indicate that benefit finding may have a buffering capacity in the immediate months following a combat deployment, but also indicates that more time than is allotted during the post-deployment adjustment period is needed to enable recovery from PTSD. Theoretical implications are discussed.
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Affiliation(s)
- Michael D. Wood
- Department of Defense, United States Military Academy, West Point, New York
| | - Heather M. Foran
- Institute for Psychology, University of Klagenfurt, Klagenfurt, Austria
| | - Thomas W. Britt
- Department of Psychology, Clemson University, Clemson, South Carolina
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Morris AT, Temereanca S, Zandvakili A, Thorpe R, Sliva DD, Greenberg BD, Carpenter LL, Philip NS, Jones SR. Fronto-central resting-state 15-29 Hz transient beta events change with therapeutic transcranial magnetic stimulation for posttraumatic stress disorder and major depressive disorder. Sci Rep 2023; 13:6366. [PMID: 37076496 PMCID: PMC10115889 DOI: 10.1038/s41598-023-32801-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 04/03/2023] [Indexed: 04/21/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is an established treatment for major depressive disorder (MDD) and shows promise for posttraumatic stress disorder (PTSD), yet effectiveness varies. Electroencephalography (EEG) can identify rTMS-associated brain changes. EEG oscillations are often examined using averaging approaches that mask finer time-scale dynamics. Recent advances show some brain oscillations emerge as transient increases in power, a phenomenon termed "Spectral Events," and that event characteristics correspond with cognitive functions. We applied Spectral Event analyses to identify potential EEG biomarkers of effective rTMS treatment. Resting 8-electrode EEG was collected from 23 patients with MDD and PTSD before and after 5 Hz rTMS targeting the left dorsolateral prefrontal cortex. Using an open-source toolbox ( https://github.com/jonescompneurolab/SpectralEvents ), we quantified event features and tested for treatment associated changes. Spectral Events in delta/theta (1-6 Hz), alpha (7-14 Hz), and beta (15-29 Hz) bands occurred in all patients. rTMS-induced improvement in comorbid MDD PTSD were associated with pre- to post-treatment changes in fronto-central electrode beta event features, including frontal beta event frequency spans and durations, and central beta event maxima power. Furthermore, frontal pre-treatment beta event duration correlated negatively with MDD symptom improvement. Beta events may provide new biomarkers of clinical response and advance the understanding of rTMS.
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Affiliation(s)
- Alexander T Morris
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence, Providence, RI, USA
| | - Simona Temereanca
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence, Providence, RI, USA.
- Department of Neuroscience, Brown University, Providence, RI, USA.
- Carney Institute for Brain Science, Brown University, Providence, RI, USA.
| | - Amin Zandvakili
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Ryan Thorpe
- Department of Neuroscience, Brown University, Providence, RI, USA
- Carney Institute for Brain Science, Brown University, Providence, RI, USA
| | - Danielle D Sliva
- Department of Neuroscience, Brown University, Providence, RI, USA
- Carney Institute for Brain Science, Brown University, Providence, RI, USA
| | - Benjamin D Greenberg
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- COBRE Center for Neuromodulation, Butler Hospital, Providence, RI, USA
| | - Linda L Carpenter
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- COBRE Center for Neuromodulation, Butler Hospital, Providence, RI, USA
- Carney Institute for Brain Science, Brown University, Providence, RI, USA
| | - Noah S Philip
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- COBRE Center for Neuromodulation, Butler Hospital, Providence, RI, USA
| | - Stephanie R Jones
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence, Providence, RI, USA.
- Department of Neuroscience, Brown University, Providence, RI, USA.
- Carney Institute for Brain Science, Brown University, Providence, RI, USA.
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Morris AT, Temereanca S, Zandvakili A, Thorpe R, Sliva DD, Greenberg BD, Carpenter LL, Philip NS, Jones SR. Fronto-central resting-state 15-29Hz transient beta events change with therapeutic transcranial magnetic stimulation for posttraumatic stress disorder and major depressive disorder. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.11.23286902. [PMID: 36993547 PMCID: PMC10055566 DOI: 10.1101/2023.03.11.23286902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is an established treatment for major depressive disorder (MDD) and shows promise for posttraumatic stress disorder (PTSD), yet effectiveness varies. Electroencephalography (EEG) can identify rTMS-associated brain changes. EEG oscillations are often examined using averaging approaches that mask finer time-scale dynamics. Recent advances show some brain oscillations emerge as transient increases in power, a phenomenon termed "Spectral Events," and that event characteristics correspond with cognitive functions. We applied Spectral Event analyses to identify potential EEG biomarkers of effective rTMS treatment. Resting 8-electrode EEG was collected from 23 patients with MDD and PTSD before and after 5Hz rTMS targeting the left dorsolateral prefrontal cortex. Using an open-source toolbox ( https://github.com/jonescompneurolab/SpectralEvents ), we quantified event features and tested for treatment associated changes. Spectral Events in delta/theta (1-6 Hz), alpha (7-14 Hz), and beta (15-29 Hz) bands occurred in all patients. rTMS-induced improvement in comorbid MDD PTSD were associated with pre-to post-treatment changes in fronto-central electrode beta event features, including frontal beta event frequency spans and durations, and central beta event maxima power. Furthermore, frontal pre-treatment beta event duration correlated negatively with MDD symptom improvement. Beta events may provide new biomarkers of clinical response and advance the understanding of rTMS.
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Campbell-Sills L, Papini S, Norman SB, Choi KW, He F, Sun X, Kessler RC, Ursano RJ, Jain S, Stein MB. Associations of polygenic risk scores with posttraumatic stress symptom trajectories following combat deployment. Psychol Med 2023; 53:1-10. [PMID: 36876647 PMCID: PMC10480347 DOI: 10.1017/s0033291723000211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/30/2022] [Accepted: 01/16/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Identification of genetic risk factors may inform the prevention and treatment of posttraumatic stress disorder (PTSD). This study evaluates the associations of polygenic risk scores (PRS) with patterns of posttraumatic stress symptoms following combat deployment. METHOD US Army soldiers of European ancestry (n = 4900) provided genomic data and ratings of posttraumatic stress symptoms before and after deployment to Afghanistan in 2012. Latent growth mixture modeling was used to model posttraumatic stress symptom trajectories among participants who provided post-deployment data (n = 4353). Multinomial logistic regression models tested independent associations between trajectory membership and PRS for PTSD, major depressive disorder (MDD), schizophrenia, neuroticism, alcohol use disorder, and suicide attempt, controlling for age, sex, ancestry, and exposure to potentially traumatic events, and weighted to account for uncertainty in trajectory classification and missing data. RESULTS Participants were classified into low-severity (77.2%), increasing-severity (10.5%), decreasing-severity (8.0%), and high-severity (4.3%) posttraumatic stress symptom trajectories. Standardized PTSD-PRS and MDD-PRS were associated with greater odds of membership in the high-severity v. low-severity trajectory [adjusted odds ratios and 95% confidence intervals, 1.23 (1.06-1.43) and 1.18 (1.02-1.37), respectively] and the increasing-severity v. low-severity trajectory [1.12 (1.01-1.25) and 1.16 (1.04-1.28), respectively]. Additionally, MDD-PRS was associated with greater odds of membership in the decreasing-severity v. low-severity trajectory [1.16 (1.03-1.31)]. No other associations were statistically significant. CONCLUSIONS Higher polygenic risk for PTSD or MDD is associated with more severe posttraumatic stress symptom trajectories following combat deployment. PRS may help stratify at-risk individuals, enabling more precise targeting of treatment and prevention programs.
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Affiliation(s)
| | - Santiago Papini
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Sonya B. Norman
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Executive Division, National Center for PTSD, White River Junction, VT, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Karmel W. Choi
- Department of Psychiatry, Center for Precision Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute, Boston, MA, USA
| | - Feng He
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Xiaoying Sun
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Sonia Jain
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Murray B. Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- Psychiatry Service, VA San Diego Healthcare System, San Diego, CA, USA
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Cohen-Koren R, Garbi D, Gordon S, Yavnai N, Erlich Shoham Y, Shelef L. Predictors of Emotional Distress in Combat Military Flight Engineers. Mil Med 2023; 188:e301-e310. [PMID: 34050755 DOI: 10.1093/milmed/usab219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/24/2021] [Accepted: 05/20/2021] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Exposure to distressing sights (DSs) during combat missions may cause emotional distress. The present study aimed to investigate the association between exposure to DSs involving severe injuries and fatalities during rescue missions and emotional distress, in Israeli Air Force (IAF) helicopter flight engineers (FEs). METHODS Cross-sectional design using self-report questionnaires. The independent variables included demographics, personal, and military variables-exposure to DSs throughout a whole career service. The dependent variables included Depression (Beck Depression Inventory); State-Trait Anxiety Inventory; Post-traumatic stress disorder (PTSD Checklist-PCL-5); Somatization (Patient Health Questionnaire); Maslach Burnout Inventory; and Coping Strategies (The Brief COPE). The variables PTSD, depression, and anxiety were examined twice: once as dichotomous variables according to the pathology cutoff point and again as a continuous variable to reveal the intensity of symptoms. RESULTS Participants were 106 IAF helicopter FEs (mean age = 39.32, SD = 8.75). Linear regression revealed that initial exposure to distressing battlefield sights (i.e., exposure to severe injuries and fatalities) was a predictor of depression symptoms. Career service FEs aged 31-40 were found to be at the highest risk of emotional distress, with a predictive factor for anxiety symptoms. Use of nonadaptive coping strategies was found to predict depressive symptoms, anxiety symptoms, and post-traumatic stress symptoms. CONCLUSION A significant association was found between exposure to DSs involving severe injuries and fatalities during rescue missions and anxiety, depression, somatization, and burnout. This population is generally perceived as tough and resilient, and this study has a unique contribution in identifying its vulnerabilities. Psychological intervention is crucial after participating in such missions.
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Affiliation(s)
| | - Dror Garbi
- Psychology Branch, Israeli Air Force, Ramat-Gan 5262000, Israel
| | - Shirley Gordon
- Psychology Branch, Israeli Air Force, Ramat-Gan 5262000, Israel
| | - Nirit Yavnai
- Medical Corps, Israel Defense Force, Ramat-Gan 5262000, Israel
| | | | - Leah Shelef
- Psychology Branch, Israeli Air Force, Ramat-Gan 5262000, Israel
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Shaw SB, Nicholson AA, Ros T, Harricharan S, Terpou B, Densmore M, Theberge J, Frewen P, Lanius RA. Increased top-down control of emotions during symptom provocation working memory tasks following a RCT of alpha-down neurofeedback in PTSD. Neuroimage Clin 2023; 37:103313. [PMID: 36669352 PMCID: PMC9868881 DOI: 10.1016/j.nicl.2023.103313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/31/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) has been found to be associated with emotion under-modulation from the prefrontal cortex and a breakdown of the top-down control of cognition and emotion. Novel adjunct therapies such as neurofeedback (NFB) have been shown to normalize aberrant neural circuits that underlie PTSD psychopathology at rest. However, little evidence exists for NFB-linked neural improvements under emotionally relevant cognitive load. The current study sought to address this gap by examining the effects of alpha-down NFB in the context of an emotional n-back task. METHODS We conducted a 20-week double-blind randomized, sham-controlled trial of alpha-down NFB and collected neuroimaging data before and after the NFB protocol. Participants performed an emotional 1-back and 2-back working memory task, with interleaved trauma-neutral and trauma-relevant cues in the fMRI scanner. Data from 35 participants with a primary diagnosis of PTSD were analyzed in this study (n = 18 in the experimental group undergoing alpha-down NFB, n = 17 in the sham-control group). RESULTS Firstly, within-group analyses showed clinically significant reductions in PTSD symptom severity scores at the post-intervention timepoint and 3-month follow-up for the experimental group, and not for the sham-control group. The neuroimaging analyses revealed that alpha-down NFB enhanced engagement of top-down cognitive and emotional control centers, such as the dorsolateral prefrontal cortex (dlPFC), and improved integration of the anterior and posterior parts of the default mode network (DMN). Finally, our results also indicate that increased alpha-down NFB performance correlated with increased activity in brain regions involved in top-down control and bodily consciousness/embodied processing of self (TPJ and posterior insula). CONCLUSION This is the first study to provide mechanistic insights into how NFB may normalize dysfunctional brain activity and connectivity in PTSD under cognitive load with simultaneous symptom provocation, adding to a growing body of evidence supporting the therapeutic neuromodulatory effects of NFB. This preliminary study highlights the benefits of alpha-down NFB training as an adjunctive therapy for PTSD and warrants further investigation into its therapeutic effects on cognitive and emotion control in those with PTSD.
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Affiliation(s)
- Saurabh Bhaskar Shaw
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Vector Institute, Toronto, Ontario, Canada; Homewood Research Institute (HRI), Guelph, Ontario, Canada.
| | - Andrew A Nicholson
- School of Psychology, University of Ottawa, Canada; Atlas Institute for Veterans and Families, Royal Ottawa Hospital, Canada; Department of Psychiatry and Behavioral Neuroscience, McMaster University, Hamilton, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Tomas Ros
- Departments of Neuroscience and Psychiatry, University of Geneva, Geneva, Switzerland
| | - Sherain Harricharan
- Homewood Research Institute (HRI), Guelph, Ontario, Canada; Department of Psychiatry and Behavioral Neuroscience, McMaster University, Hamilton, Ontario, Canada; St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Braeden Terpou
- Homewood Research Institute (HRI), Guelph, Ontario, Canada; Department of Psychiatry and Behavioral Neuroscience, McMaster University, Hamilton, Ontario, Canada
| | - Maria Densmore
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada
| | - Jean Theberge
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; Department of Diagnostic Imaging, St. Joseph's Healthcare, London, Ontario, Canada
| | - Paul Frewen
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ruth A Lanius
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Homewood Research Institute (HRI), Guelph, Ontario, Canada; St. Joseph's Healthcare, Hamilton, Ontario, Canada.
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Vest BM, Hoopsick RA, Homish DL, Homish GG. The Role of Military Identity in Substance Use and Mental Health Outcomes among U.S. Army Reserve and National Guard Soldiers. MILITARY PSYCHOLOGY 2023; 35:85-93. [PMID: 36568407 PMCID: PMC9770498 DOI: 10.1080/08995605.2022.2082812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We investigated how military identity (i.e., veteran identity centrality, the extent to which military service is central to an individual's sense of self) relates to substance use and mental health among U.S. Army Reserve and National Guard (USAR/NG) soldiers. Data were drawn from Operation: SAFETY, a longitudinal survey study of USAR/NG soldiers. Regression models (n=413 soldiers) examined relationships between military identity and substance use (i.e., alcohol problems, past 3-months non-medical use of prescription drugs (NMUPD), illicit drug use, tobacco use), and mental health (i.e., generalized anxiety, anger, depression, PTSD), controlling for sex, race, age, education, years of military service, military status (current/former), and deployment (ever/never). In adjusted models, stronger military identity was not related to alcohol, illicit drug, or tobacco use, but was associated with past 3-months NMUPD (OR: 1.40, 95% CI: 1.12, 1.75, p<.01) and greater symptoms of anger (IRR: 1.02, 95% CI: 1.01, 1.03, p<.01), generalized anxiety (IRR: 1.05, 95% CI: 1.01, 1.10, p<.01), depression (IRR: 1.06, 95% CI: 1.02, 1.10, p<.01), and PTSD (IRR: 1.07, 95% CI: 1.02, 1.12, p<.01). Findings demonstrate the importance of military identity for health-related outcomes. NMUPD suggests potential self-medication and an avoidance of help-seeking, as admitting difficulties may conflict with military identity.
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Affiliation(s)
| | - Rachel A. Hoopsick
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, University at Buffalo
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Bronze L. War, hypertension and post traumatic stress disorder. A personal experience. Blood Press 2022; 31:225-227. [PMID: 36081329 DOI: 10.1080/08037051.2022.2118661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Luís Bronze
- Portuguese Navy.,Cardiovascular Department, University of Beira Interior Medical School, Covilha, Portugal.,Portuguese Society of Hypertension
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Griffith J. Combat events and negative emotions associated with postdeployment illicit drug use among Army National Guard soldiers. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2148580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- James Griffith
- National Center for Veterans Studies, University of Utah
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Merritt VC, Crocker LD, Sakamoto MS, Chanfreau-Coffinier C, Delano-Wood L. Psychiatric symptoms influence social support in VA Million Veteran Program enrollees screening positive for traumatic brain injury. Soc Sci Med 2022; 312:115372. [PMID: 36162363 DOI: 10.1016/j.socscimed.2022.115372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 08/18/2022] [Accepted: 09/12/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To examine measures of social support and associations with neurobehavioral, psychiatric, and cognitive symptoms in Veterans who underwent the Veterans Health Administration's Traumatic Brain Injury (TBI) Screening and Evaluation Program. SETTING Nationally representative sample of U.S. Veterans enrolled in the Veterans Affairs Million Veteran Program. PARTICIPANTS Veterans (N = 9,837) were classified into the following three diagnostic groups based on results from the TBI Screening and Evaluation Program: (1) negative TBI screen (Screen-; n = 6,523), (2) positive TBI screen but no TBI diagnosis (Screen+/TBI-; n = 1,308), or (3) positive TBI screen and TBI diagnosis (Screen+/TBI+; n = 2,006). DESIGN Epidemiological cross-sectional study. MAIN MEASURES Medical Outcomes Study Social Support Survey Instrument (MOS-SSSI), with subscales representing emotional, tangible, and affectionate support and positive social interaction; Neurobehavioral Symptom Inventory (NSI); PTSD Checklist (PCL); Patient Health Questionnaire-4 (PHQ-4); and Medical Outcomes Study Cognitive Functioning-Revised Scale (MOS-Cog-R). RESULTS ANCOVAs showed significant associations between diagnostic group and all aspects of social support. Pairwise comparisons revealed that Veterans in the two Screen+ groups (Screen+/TBI+ and Screen+/TBI-) reported comparable levels of social support, but that both Screen+ groups reported significantly lower levels of social support compared to the Screen- group. Among the Screen+ groups, adjusted linear regression models controlling for age, sex, and race/ethnicity showed significant associations between social support indices and all symptom measures, such that lower levels of social support were associated with more severe neurobehavioral and psychiatric symptoms and worse cognitive functioning. Finally, mediation analyses showed that psychiatric symptoms mediated the association between TBI screen group and social support. CONCLUSIONS Our results are clinically informative and suggest (1) that the relationship between TBI screen status and social support is influenced by psychiatric symptoms and (2) that implementing distress reduction techniques before social support interventions may be most beneficial for Veterans screening positive for TBI.
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Affiliation(s)
- Victoria C Merritt
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States; Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States; Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, United States.
| | - Laura D Crocker
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States; Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, United States
| | - McKenna S Sakamoto
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States
| | - Catherine Chanfreau-Coffinier
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Lisa Delano-Wood
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States; Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States; Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, United States
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Fonda JR, Crowe ML, Levin LK, Jagger-Rickels A, Marx BP, Milberg WP, McGlinchey RE, Fortier CB. Network analysis of mild traumatic brain injury, persistent neurobehavioral and psychiatric symptoms, and functional disability among recent-era United States veterans. J Trauma Stress 2022; 35:1546-1558. [PMID: 35932100 DOI: 10.1002/jts.22860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/11/2022] [Accepted: 05/11/2022] [Indexed: 11/05/2022]
Abstract
Recent-era U.S. veterans are clinically complex, with a high prevalence of co-occurring mild traumatic brain injury (mTBI), psychiatric conditions, and behavioral dysfunction. The current study examined the direct and indirect associations between mTBI and persistent neurobehavioral, psychiatric, and functional disability symptoms among recent-era U.S. veterans and service members (n = 648). We evaluated the postconcussive syndrome (PCS) potential causal model with two network analysis modeling approaches. Separate analyses were conducted for military mTBI and lifetime mTBI. An exploratory factor analysis was conducted to limit topological overlap in the network analysis. The most influential symptoms (i.e., the unique variables most strongly associated with the rest of the network) in the military mTBI network were behavioral disengagement, expected influence (EI) = 1.10; cognitive difficulties, EI = 1.08; agitation/irritability, EI = 1.05; and PTSD-related reexperiencing and avoidance symptoms, EI = 0.98. After accounting for other symptoms, mTBI was only minimally informative, EI = 0.34. Additionally, military mTBI did not moderate the association between symptoms or the overall connectivity of the network. The results for lifetime mTBI were consistent with those for military mTBI. The present analyses identified a variety of behavioral, cognitive, and emotional symptoms that play an important role in understanding comorbidity and daily functioning among recent-era U.S. veterans. Associations between cumulative mTBI that occurred in civilian or military settings were indirect and relatively small in magnitude. The current results add to a growing literature raising doubts about the PCS model.
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Affiliation(s)
- Jennifer R Fonda
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael L Crowe
- National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Laura K Levin
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, Massachusetts, USA
| | - Audreyana Jagger-Rickels
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Brian P Marx
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - William P Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Regina E McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine B Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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42
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Walter KH, McCabe CT, Watrous JR, Kohen CB, Beltran JL, Kirk A, Campbell JS. Psychological comorbidity: Predictors of residential treatment response among U.S. service members with posttraumatic stress disorder. J Trauma Stress 2022; 35:1381-1392. [PMID: 35470514 PMCID: PMC9790433 DOI: 10.1002/jts.22838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/22/2022] [Indexed: 12/30/2022]
Abstract
Residential posttraumatic stress disorder (PTSD) research in military samples generally shows that in aggregate, PTSD symptoms significantly improve over the course of treatment but can remain at elevated levels following treatment. Identifying individuals who respond to residential treatment versus those who do not, including those who worsen, is critical given the extensive resources required for such programs. This study examined predictors of treatment response among 282 male service members who received treatment in a U.S. Department of Defense residential PTSD program. Using established criteria, service members were classified as improved, indeterminate (referent), or worsened in terms of self-reported PTSD symptoms. Multinomial logistic regression results showed that for PTSD symptoms, higher levels of pretreatment PTSD symptom severity were associated with significantly lower odds of being in the improved group, adjusted odds ratio (aOR) = 0.955, p = .018. In addition, service members who completed treatment were significantly more likely to be in the improved group, aOR = 2.488, p = .048. Longer average pretreatment nightly sleep duration, aOR = 1.157, p = .035, and more severe pretreatment depressive symptoms, aOR = 1.109, p = .014, were associated with significantly higher odds of being in the improved group. These findings reveal clinical characteristics better suited for residential PTSD treatment and highlight implications for comorbid conditions.
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Affiliation(s)
- Kristen H. Walter
- Health and Behavioral Sciences DepartmentNaval Health Research CenterSan DiegoCaliforniaUSA
| | - Cameron T. McCabe
- LeidosRestonVirginiaUSA,Medical Modeling, Simulation, and Mission Support DepartmentNaval Health Research CenterSan DiegoCaliforniaUSA
| | - Jessica R. Watrous
- LeidosRestonVirginiaUSA,Medical Modeling, Simulation, and Mission Support DepartmentNaval Health Research CenterSan DiegoCaliforniaUSA
| | - Casey B. Kohen
- Health and Behavioral Sciences DepartmentNaval Health Research CenterSan DiegoCaliforniaUSA,LeidosRestonVirginiaUSA
| | - Jessica L. Beltran
- Health and Behavioral Sciences DepartmentNaval Health Research CenterSan DiegoCaliforniaUSA,LeidosRestonVirginiaUSA
| | - Alex Kirk
- Directorate of Mental HealthNaval Medical Center San DiegoSan DiegoCaliforniaUSA
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43
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Clinical and Administrative Insights From Delivering Massed Trauma-Focused Therapy to Service Members and Veterans. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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44
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Schuler MS, Wong EC, Ramchand R. Military service branch differences in alcohol use, tobacco use, prescription drug misuse, and mental health conditions. Drug Alcohol Depend 2022; 235:109461. [PMID: 35487079 DOI: 10.1016/j.drugalcdep.2022.109461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 03/16/2022] [Accepted: 04/09/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Rates of substance use and mental health conditions vary across military service branches, yet branches also differ notably in terms of demographics and deployment experiences. This study examines whether branch differences in substance use and mental health outcomes persist after adjustment for a comprehensive set of demographic and deployment-related factors. METHODS Data on 16,699 Armed Forces Active Duty service members were from the 2015 Department of Defense Health Related Behaviors Survey. Service branch-specific prevalences were estimated for self-reports of heavy episodic drinking (HED), possible alcohol use disorder (AUD), current smoking, e-cigarette use, smokeless tobacco use, prescription drug misuse, probable post-traumatic stress disorder (PTSD), probable depression, and probable anxiety. Using logistic regression, we assessed whether branch differences persisted after adjusting for an extensive array of demographic factors (among full sample) and deployment/combat factors (among ever-deployed subgroup). RESULTS HED, AUD, smoking, e-cigarette use, smokeless tobacco use, depression, and anxiety were highest in the Marine Corps; prescription drug misuse and PTSD were highest in the Army. HED, AUD, smoking, smokeless tobacco use, PTSD, depression, and anxiety were lowest in the Air Force; e-cigarette use and prescription drug misuse were lowest in the Coast Guard. Demographics and deployment/combat experiences differed across branches. After adjustment, service members in the Army, Marine Corps and Navy exhibited nearly 2-3 times the odds of multiple mental health conditions and substance use behaviors relative to the Air Force. CONCLUSION Service branch differences were not fully explained by variation in demographics and deployment/combat experiences.
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Affiliation(s)
- Megan S Schuler
- RAND Corporation, 1200 S Hayes St, Arlington, VA 22202, USA.
| | - Eunice C Wong
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
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45
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Olatunji BO, Cox RC, Blackford JU. Fear reacquisition and symptoms of combat-related PTSD: Specificity and preliminary examination of the influence of the 5-HT3A receptor gene. Behav Res Ther 2022; 153:104085. [DOI: 10.1016/j.brat.2022.104085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 03/16/2022] [Accepted: 03/29/2022] [Indexed: 11/02/2022]
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46
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Morris KL, Schwartz C, Galovski TE, Dondanville KA, Schuster Wachen J. Massed Cognitive Processing Therapy in Active-Duty Military: A Case Series. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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47
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Brown EM, Salat DH, Milberg WP, Fortier CB, McGlinchey RE. Accelerated longitudinal cortical atrophy in
OEF
/
OIF
/
OND
veterans with severe
PTSD
and the impact of comorbid
TBI. Hum Brain Mapp 2022; 43:3694-3705. [PMID: 35426972 PMCID: PMC9294300 DOI: 10.1002/hbm.25877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/04/2022] [Accepted: 04/05/2022] [Indexed: 12/02/2022] Open
Abstract
Veterans who deployed in support of Operation Enduring Freedom (OEF), Iraqi Freedom (OIF), and New Dawn (OND) commonly experience severe psychological trauma, often accompanied by physical brain trauma resulting in mild traumatic brain injury (mTBI). Prior studies of individuals with posttraumatic stress disorder (PTSD) have revealed alterations in brain structure, accelerated cellular aging, and impacts on cognition following exposure to severe psychological trauma and potential interactive effects of military‐related mTBI. To date, however, little is known how such deployment‐related trauma changes with time and age of injury of the affected veteran. In this study, we explored changes in cortical thickness, volume, and surface area after an average interval of approximately 2 years in a cohort of 254 OEF/OIF/OND Veterans ranging in age from 19 to 67 years. Whole‐brain vertex‐wise analyses revealed that veterans who met criteria for severe PTSD (Clinician‐Administered PTSD Scale ≥60) at baseline showed greater negative longitudinal changes in cortical thickness, volume, and area over time. Analyses also revealed a significant severe‐PTSD by age interaction on cortical measures with severe‐PTSD individuals exhibiting accelerated cortical degeneration with increasing age. Interaction effects of comorbid military‐related mTBI within the severe‐PTSD group were also observed in several cortical regions. These results suggest that those exhibiting severe PTSD symptomatology have accelerated atrophy that is exacerbated with increasing age and history of mTBI.
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Affiliation(s)
- Emma M. Brown
- Neuroimaging Research for Veterans (NeRVe) Center VA Boston Healthcare System Boston Massachusetts USA
- Translational Research Center for TBI and Stress Disorders (TRACTS) VA Boston Healthcare System Boston Massachusetts USA
| | - David H. Salat
- Neuroimaging Research for Veterans (NeRVe) Center VA Boston Healthcare System Boston Massachusetts USA
- Translational Research Center for TBI and Stress Disorders (TRACTS) VA Boston Healthcare System Boston Massachusetts USA
- Brain Aging and Dementia (BAnD) Laboratory, A. A. Martinos Center for Biomedical Imaging, Department of Radiology Massachusetts General Hospital Charlestown Massachusetts USA
| | - William P. Milberg
- Neuroimaging Research for Veterans (NeRVe) Center VA Boston Healthcare System Boston Massachusetts USA
- Translational Research Center for TBI and Stress Disorders (TRACTS) VA Boston Healthcare System Boston Massachusetts USA
- Department of Psychiatry Harvard Medical School Boston Massachusetts USA
- Geriatric Research, Education, and Clinical Center (GRECC) VA Boston Healthcare System Boston Massachusetts USA
| | - Catherine B. Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS) VA Boston Healthcare System Boston Massachusetts USA
- Department of Psychiatry Harvard Medical School Boston Massachusetts USA
- Geriatric Research, Education, and Clinical Center (GRECC) VA Boston Healthcare System Boston Massachusetts USA
| | - Regina E. McGlinchey
- Neuroimaging Research for Veterans (NeRVe) Center VA Boston Healthcare System Boston Massachusetts USA
- Translational Research Center for TBI and Stress Disorders (TRACTS) VA Boston Healthcare System Boston Massachusetts USA
- Department of Psychiatry Harvard Medical School Boston Massachusetts USA
- Geriatric Research, Education, and Clinical Center (GRECC) VA Boston Healthcare System Boston Massachusetts USA
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48
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Olatunji BO, Liu Q, Zald DH, Cole DA. Emotional induced attentional blink in trauma-exposed veterans: associations with trauma specific and nonspecific symptoms. J Anxiety Disord 2022; 87:102541. [PMID: 35121157 DOI: 10.1016/j.janxdis.2022.102541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/29/2021] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
Although theoretical models suggest that an attentional bias for threat contributes to the development of post-traumatic stress disorder (PTSD) symptoms, this bias has not been consistently observed in the literature. In the present study, trauma exposed veterans (N = 114) performed an emotional attentional blink task in which task-irrelevant combat-related, disgust, positive, or neutral distractor images appeared 200 ms, 400 ms, 600 ms, or 800 ms (i.e., lag 2, 4, 6, and 8, respectively) before the target. Relative to neutral distractors, impaired target detection was observed following combat distractors and disgust distractors, but not positive distractors. However, veterans were less accurate following disgust distractors compared to combat distractors. As predicted, combat distractors and disgust distractors were also associated with a stronger linear increase in trial accuracy reflecting task improvement with increasing lag before the target. However, the linear trend in trial accuracy for combat distractors and disgust distractors did not significantly differ from each other. Contrary to predictions, trauma specific (i.e., PTSD symptoms and diagnosis) and nonspecific processes (i.e., attentional control) were unrelated to trial accuracy. These data suggest that while initial attentional capture by cues of war is observed among trauma exposed veterans independent of individual differences in trauma specific and nonspecific symptoms, this attentional capture is less robust compared to attentional capture by disgust-eliciting stimuli. The implications of these findings for the theorized role of attentional biases for threat in the development and maintenance of PTSD are discussed.
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49
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Shea MT, Stout RL, Reddy MK, Sevin E, Presseau C, Lambert J, Cameron A. Treatment of anger problems in previously deployed post-911 veterans: A randomized controlled trial. Depress Anxiety 2022; 39:274-285. [PMID: 34878695 PMCID: PMC9299859 DOI: 10.1002/da.23230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/08/2021] [Accepted: 11/20/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Problems with anger and aggression affect many veterans who have deployed to a warzone, resulting in serious impairment in multiple aspects of functioning. Controlled studies are needed to improve treatment options for these veterans. This randomized controlled trial compared an individually delivered cognitive behavioral therapy adapted from Novaco's Anger Control Therapy to a manualized supportive therapy to control for common therapeutic factors. METHODS Ninety-two post-911 veterans deployed during Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), or Operation New Dawn (OND) with moderate to severe anger problems were randomized to receive the cognitive behavioral intervention (CBI) or the supportive intervention (SI). Anger, aggression, multiple areas of functioning and quality of life were assessed at multiple time points inclu\ding 3- and 6-month follow-up. RESULTS Hierarchical linear modeling (HLM) analyses showed significant treatment effects favoring CBI for anger severity, social and interpersonal functioning, and quality of life. The presence of a PTSD diagnosis did not affect outcomes. CONCLUSIONS CBI is an effective treatment for OEF/OIF/OND veterans with anger problems following deployment, regardless of PTSD diagnosis.
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Affiliation(s)
- M. Tracie Shea
- VA Providence Healthcare SystemProvidenceRhode IslandUSA,Department of Psychiatry and Human BehaviorAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Robert L. Stout
- Pacific Institute for Research and EvaluationPawtucketRhode IslandUSA
| | | | | | - Candice Presseau
- VA Connecticut Health Care SystemWest HavenConnecticutUSA,Department of PsychiatryYale University School of MedicineNew HavenConnecticutUSA
| | - Jennifer Lambert
- VA Providence Healthcare SystemProvidenceRhode IslandUSA,Department of Psychiatry and Human BehaviorAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Amy Cameron
- VA Providence Healthcare SystemProvidenceRhode IslandUSA,Department of Psychiatry and Human BehaviorAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
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50
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Tamman AJF, Wendt FR, Pathak GA, Krystal JH, Southwick SM, Sippel LM, Gelernter J, Polimanti R, Pietrzak RH. Attachment Style Moderates Polygenic Risk for Incident Posttraumatic Stress in U.S. Military Veterans: A 7-Year, Nationally Representative, Prospective Cohort Study. Biol Psychiatry 2022; 91:637-646. [PMID: 34955171 DOI: 10.1016/j.biopsych.2021.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/11/2021] [Accepted: 09/26/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) develops consequent to complex gene-by-environment interactions beyond the precipitating trauma. To date, however, no known study has used a prospective design to examine how polygenic risk scores (PRSs) interact with social-environmental factors such as attachment style to predict PTSD development. METHODS PRSs were derived from a genome-wide association study of PTSD symptoms (N = 186,689; Million Veteran Program cohort). We evaluated combined effects of PRS and attachment style in predicting incident PTSD in a 7-year, nationally representative cohort of trauma-exposed, European-American U.S. military veterans without PTSD (N = 1083). We also conducted multivariate gene-by-environment interaction and drug repositioning analyses to identify loci that interact with multiple environmental factors and potential pharmacotherapies that may be repurposed for this disorder. RESULTS Veterans with higher PTSD PRS were more likely to have an incident-positive screen for PTSD over 7 years. A gene-by-environment interaction was also observed, such that higher PRS only predicted incident PTSD in veterans with an insecure attachment style and not those with a secure attachment style. At an individual locus level, the strongest gene-by-environment interaction was observed for the rs4702 variant of the FURIN gene with cumulative lifetime trauma burden. Drug repositioning revealed that genes implicated in PRS are perturbated by the drug doxylamine. CONCLUSIONS Attachment style moderates polygenic risk for the development of PTSD in European-American veterans. These findings may inform PTSD prevention and treatment for veterans with high polygenic risk for PTSD and suggest a potential pharmacotherapeutic target for risk genes moderated by social-environmental factors.
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Affiliation(s)
- Amanda J F Tamman
- Department of Psychology, St John's University, Queens, New York; Mood and Anxiety Disorders Program, Baylor College of Medicine, Houston, Texas.
| | - Frank R Wendt
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut
| | - Gita A Pathak
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut
| | - John H Krystal
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; Clinical Neurosciences Division, National Center for PTSD, West Haven, Connecticut
| | - Steven M Southwick
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Lauren M Sippel
- Executive Division, National Center for PTSD, White River Junction, Vermont; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Joel Gelernter
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut; Clinical Neurosciences Division, National Center for PTSD, West Haven, Connecticut
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