151
|
Postrehabilitation Mental Health Treatment Utilization in Veterans With Traumatic Brain Injury: A VA TBI Model Systems Study. J Head Trauma Rehabil 2019; 33:E1-E9. [PMID: 29084107 DOI: 10.1097/htr.0000000000000357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To identify preinjury variables related to mental health treatment utilization at 2 years post-traumatic brain injury (TBI). SETTING Veterans Affairs (VA) TBI Model Systems includes 5 VA Polytrauma Rehabilitation Centers. PARTICIPANTS Veterans and service members enrolled in TBI Model Systems who completed the year 2 follow-up assessment and provided mental health information. Sample was largely male (97%) and White (72%), with median age of 30 years. DESIGN Participants with elevated mental health symptoms were identified by measures of depression, anxiety, and posttraumatic distress; suicide attempt in the past year; or problematic substance use in the past year. Forty-seven percent of participants had elevated mental health symptoms at 2 years postinjury. Among those with elevated symptoms, comparisons were made between those who sought mental health treatment in past year and those who did not. MAIN MEASURES Demographic, historic, environmental, psychological/mental health, and injury/rehabilitation variables. RESULTS Within the sample, 23% denied utilizing mental health services. Nonutilizers were more likely to deny a preinjury mental health treatment history, to report problematic substance use at year 2, and to report lower levels of internalizing symptoms than the treatment utilizers. CONCLUSION Veterans and service members with elevated mental health symptoms may require tailored tactics to promote treatment utilization post-TBI.
Collapse
|
152
|
Tan C, Abdin E, Liang W, Poon LY, Poon NY, Verma S. Medication adherence in first-episode psychosis patients in Singapore. Early Interv Psychiatry 2019. [PMID: 29521010 DOI: 10.1111/eip.12559] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Early intervention programmes for first episode psychosis (FEP) aim to reduce the duration of untreated psychosis (DUP) and improve functional outcomes. The sustained maintenance of improved outcomes depends largely on patients' adherence to prescribed treatment. This paper examines the prevalence of non-adherence in a cohort of patients with FEP and the sociodemographic and clinical factors associated with non-adherent behaviour. METHODS The sample included consecutive patients accepted from 2007 to 2012 into the Early Psychosis Intervention Programme (EPIP) in Singapore. Sociodemographic variables as well as DUP, insight, severity of psychopathology and clinical diagnoses were collected. Patients were assessed at baseline and 1 year with the PANSS and Global Assessment of Functioning Scale (GAF). Medication adherence was grouped into 3 categories: no-adherence, partial adherence and regular adherence. RESULTS Of the 445 patients included, 51% were male with a mean age of 26.3 years, 74.6% had schizophrenia spectrum and delusional disorders, 14% had affective psychosis and 11.3% had brief psychotic disorder or psychotic disorder not otherwise specified. At 1 year follow up, 65.5% reported regular adherence, 18.7% were partially adherent and 15.8% were non-adherent. Non-adherence was correlated with male gender, living alone and having poorer judgement and insight. Partial adherence was associated with Malay ethnicity and having undergone national service. CONCLUSION Medication adherence is prevalent in FEP and associated with a variety of factors. This study supports the use of culturally appropriate interventions in addressing barriers to adherence. Further studies would need to be done to address specific factors affecting adherence outcomes.
Collapse
Affiliation(s)
- Chunzhen Tan
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
| | | | - Wilfred Liang
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
| | - Lye Yin Poon
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
| | - Ngar Yee Poon
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
| | - Swapna Verma
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
| |
Collapse
|
153
|
Locci A, Pinna G. Social isolation as a promising animal model of PTSD comorbid suicide: neurosteroids and cannabinoids as possible treatment options. Prog Neuropsychopharmacol Biol Psychiatry 2019; 92:243-259. [PMID: 30586627 DOI: 10.1016/j.pnpbp.2018.12.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/18/2018] [Accepted: 12/21/2018] [Indexed: 02/07/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a psychiatric condition characterized by drastic alterations in mood, emotions, social abilities and cognition. Notably, one aspect of PTSD, particularly in veterans, is its comorbidity with suicide. Elevated aggressiveness predicts high-risk to suicide in humans and despite the difficulty in reproducing a complex human suicidal behavior in rodents, aggressive behavior is a well reproducible behavioral trait of suicide. PTSD animal models are based on a peculiar phenotype, including exaggerated fear memory and impaired fear extinction associated with neurochemical dysregulations in the brain circuitry regulating emotion. The endocannabinoid and the neurosteroid systems regulate emotions and stress responses, and recent evidence shows these two systems are interrelated and critically compromised in neuropsychiatric disorders. For instance, levels of the neurosteroid, allopregnanolone, as well as those of the endocannabinoids, anandamide and its congener, palmitoylethanolamide are decreased in PTSD. Similarly, the endocannabinoid system and neurosteroid biosynthesis are altered in suicidal individuals. Selective serotonin reuptake inhibitors (SSRIs), the only FDA-approved treatments for PTSD, fail to help half of the treatment-seeking patients. This highlights the need for developing biomarker-based efficient therapies. One promising alternative to SSRIs points to stimulation of allopregnanolone biosynthesis as a treatment and a valid end-point to predict treatment response in PTSD patients. This review highlights running findings on the role of the endocannabinoid and neurosteroid systems in PTSD and suicidal behavior both in a preclinical and clinical perspective. A specific focus is given to predictive PTSD/suicide animal models. Ultimately, we discuss the idea that disruption of neurosteroid and endocannabinoid biosynthesis may offer a novel promising biomarker axis to develop new treatments for PTSD and, perhaps, suicidal behavior.
Collapse
Affiliation(s)
- Andrea Locci
- The Psychiatric Institute, Department of Psychiatry, College of Medicine, University of Illinois at Chicago, 1601 W. Taylor St., Chicago, IL 60612, USA
| | - Graziano Pinna
- The Psychiatric Institute, Department of Psychiatry, College of Medicine, University of Illinois at Chicago, 1601 W. Taylor St., Chicago, IL 60612, USA.
| |
Collapse
|
154
|
Hoopsick RA, Benson KR, Homish DL, Homish GG. Resiliency factors that protect against post-deployment drug use among male US Army Reserve and National Guard soldiers. Drug Alcohol Depend 2019; 199:42-49. [PMID: 30981048 PMCID: PMC7370314 DOI: 10.1016/j.drugalcdep.2019.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Service members who have been deployed are at risk for substance use, especially Reserve/Guard troops. However, it is unclear what modifiable factors protect against substance use in this at-risk population. Our objective was to examine the effects of pre-, peri-, and post-deployment resiliency factors on post-deployment drug use. METHODS Data were drawn from Operation: SAFETY (Soldiers and Families Excelling Through the Years), an ongoing study examining the health of US Army Reserve/National Guard (USAR/NG) soldiers. This sample consisted of male USAR/NG soldiers with at least one combat deployment (N = 228). At baseline, we assessed the following as potential protective factors: deployment preparation, unit support and support from family/friends during soldiers' most recent deployment, and marital satisfaction. We examined the relations between each of these resiliency factors with drug use at the first follow-up assessment using the NIDA modified ASSIST 2.0. RESULTS Greater unit support (AOR = 0.56, 95% CI: 0.34, 0.92; p < 0.05) and support from family/friends during deployment (AOR = 0.64, 95% CI: 0.43, 0.96; p < 0.05) were associated with lower odds of drug use, controlling for age, rank, years of military service, combat exposure, traumatic brain injury, time since last deployment, and baseline drug use. Deployment preparation and marital satisfaction were not associated with drug use (ps > 0.05). CONCLUSIONS Social support provided to soldiers during deployment, either by his unit or his family/friends, showed evidence of protection against post-deployment drug use. In addition to existing post-deployment efforts, we recommend interventions that facilitate stronger interpersonal relationships during deployment.
Collapse
Affiliation(s)
- Rachel A. Hoopsick
- Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA,Corresponding Author: Rachel A. Hoopsick, MS, MPH, CHES, Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, 3435 Main Street, 335 Kimball Tower, Buffalo, NY 14214, USA. Phone: 716-829-4731,
| | - Katelyn R. Benson
- Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - D. Lynn Homish
- Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Gregory G. Homish
- Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| |
Collapse
|
155
|
Risbrough VB, Glynn LM, Davis EP, Sandman CA, Obenaus A, Stern HS, Keator DB, Yassa MA, Baram TZ, Baker DG. Does Anhedonia Presage Increased Risk of Posttraumatic Stress Disorder? : Adolescent Anhedonia and Posttraumatic Disorders. Curr Top Behav Neurosci 2019; 38:249-265. [PMID: 29796839 PMCID: PMC9167566 DOI: 10.1007/7854_2018_51] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Anhedonia, the reduced ability to experience pleasure, is a dimensional entity linked to multiple neuropsychiatric disorders, where it is associated with diminished treatment response, reduced global function, and increased suicidality. It has been suggested that anhedonia and the related disruption in reward processing may be critical precursors to development of psychiatric symptoms later in life. Here, we examine cross-species evidence supporting the hypothesis that early life experiences modulate development of reward processing, which if disrupted, result in anhedonia. Importantly, we find that anhedonia may confer risk for later neuropsychiatric disorders, especially posttraumatic stress disorder (PTSD). Whereas childhood trauma has long been associated with increased anhedonia and increased subsequent risk for trauma-related disorders in adulthood, here we focus on an additional novel, emerging direct contributor to anhedonia in rodents and humans: fragmented, chaotic environmental signals ("FRAG") during critical periods of development. In rodents, recent data suggest that adolescent anhedonia may derive from aberrant pleasure/reward circuit maturation. In humans, recent longitudinal studies support that FRAG is associated with increased anhedonia in adolescence. Both human and rodent FRAG exposure also leads to aberrant hippocampal function. Prospective studies are underway to examine if anhedonia is also a marker of PTSD risk. These preliminary cross-species studies provide a critical construct for future examination of the etiology of trauma-related symptoms in adults and for and development of prophylactic and therapeutic interventions. In addition, longitudinal studies of reward circuit development with and without FRAG will be critical to test the mechanistic hypothesis that early life FRAG modifies reward circuitry with subsequent consequences for adolescent-emergent anhedonia and contributes to risk and resilience to trauma and stress in adulthood.
Collapse
Affiliation(s)
- Victoria B Risbrough
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
- Center of Excellence for Stress and Mental Health, San Diego Veterans Administration, La Jolla, CA, USA.
| | - Laura M Glynn
- Department of Psychology, Chapman University, Orange, CA, USA
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - Elysia P Davis
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
- Department of Psychology, University of Denver, Denver, CO, USA
| | - Curt A Sandman
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - Andre Obenaus
- Department of Pediatrics, University of California, Irvine, CA, USA
| | - Hal S Stern
- Department of Statistics, University of California, Irvine, CA, USA
| | - David B Keator
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
- Department of Computer Science, University of California, Irvine, CA, USA
- Department of Neurology, University of California, Irvine, CA, USA
| | - Michael A Yassa
- Department of Neurobiology and Behavior, University of California, Irvine, CA, USA
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA, USA
| | - Tallie Z Baram
- Department of Pediatrics, University of California, Irvine, CA, USA
- Department of Neurology, University of California, Irvine, CA, USA
- Department of Anatomy/Neurobiology, University of California, Irvine, CA, USA
| | - Dewleen G Baker
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, San Diego Veterans Administration, La Jolla, CA, USA
| |
Collapse
|
156
|
Goldberg SB, Simpson TL, Lehavot K, Katon JG, Chen JA, Glass JE, Schnurr PP, Sayer NA, Fortney JC. Mental Health Treatment Delay: A Comparison Among Civilians and Veterans of Different Service Eras. Psychiatr Serv 2019; 70:358-366. [PMID: 30841842 PMCID: PMC6510540 DOI: 10.1176/appi.ps.201800444] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study compared delay of treatment for posttraumatic stress disorder (PTSD), major depressive disorder, and alcohol use disorder among post-9/11 veterans versus pre-9/11 veterans and civilians. METHODS The 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), a nationally representative survey of U.S. noninstitutionalized adults, was used. Participants included 13,528 civilians, 1,130 pre-9/11 veterans, and 258 post-9/11 veterans with lifetime diagnoses of PTSD, major depression, or alcohol use disorder. Cox proportional hazard models, controlling for relevant demographic characteristics, were used to estimate differences in treatment delay (i.e., time between diagnosis and treatment). RESULTS Post-9/11 veterans were less likely to delay treatment for PTSD and depression than pre-9/11 veterans (adjusted hazard ratios [AHRs]=0.69 and 0.74, respectively) and civilians (AHRs=0.60 and 0.67, respectively). No differences in treatment delay were observed between post-9/11 veterans and pre-9/11 veterans or civilians for alcohol use disorder. In an exploratory analysis, post-9/11 veterans with past-year military health care coverage (e.g., Veterans Health Administration) had shorter delays for depression treatment compared with post-9/11 veterans without military coverage, pre-9/11 veterans regardless of health care coverage, and civilians, although past-year coverage did not predict treatment delay for PTSD or alcohol use disorder. CONCLUSIONS Post-9/11 veterans were less likely to delay treatment for some common psychiatric conditions compared with pre-9/11 veterans or civilians, which may reflect efforts to engage recent veterans in mental health care. All groups exhibited low initiation of treatment for alcohol use disorder, highlighting the need for further engagement efforts.
Collapse
Affiliation(s)
- Simon B Goldberg
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin (Goldberg); Health Services Research & Development (HSR&D) Center of Innovation (Goldberg, Lehavot, Katon, Chen, Fortney) and Center of Excellence in Substance Abuse Treatment and Education (CESATE) (Simpson), U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle; Department of Psychiatry and Behavioral Sciences (Lehavot, Fortney, Simpson) and Department of Health Services (Katon, Chen), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (Glass); National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Schnurr); Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, and Department of Medicine and Psychiatry, University of Minnesota, Minneapolis (Sayer)
| | - Tracy L Simpson
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin (Goldberg); Health Services Research & Development (HSR&D) Center of Innovation (Goldberg, Lehavot, Katon, Chen, Fortney) and Center of Excellence in Substance Abuse Treatment and Education (CESATE) (Simpson), U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle; Department of Psychiatry and Behavioral Sciences (Lehavot, Fortney, Simpson) and Department of Health Services (Katon, Chen), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (Glass); National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Schnurr); Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, and Department of Medicine and Psychiatry, University of Minnesota, Minneapolis (Sayer)
| | - Keren Lehavot
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin (Goldberg); Health Services Research & Development (HSR&D) Center of Innovation (Goldberg, Lehavot, Katon, Chen, Fortney) and Center of Excellence in Substance Abuse Treatment and Education (CESATE) (Simpson), U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle; Department of Psychiatry and Behavioral Sciences (Lehavot, Fortney, Simpson) and Department of Health Services (Katon, Chen), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (Glass); National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Schnurr); Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, and Department of Medicine and Psychiatry, University of Minnesota, Minneapolis (Sayer)
| | - Jodie G Katon
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin (Goldberg); Health Services Research & Development (HSR&D) Center of Innovation (Goldberg, Lehavot, Katon, Chen, Fortney) and Center of Excellence in Substance Abuse Treatment and Education (CESATE) (Simpson), U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle; Department of Psychiatry and Behavioral Sciences (Lehavot, Fortney, Simpson) and Department of Health Services (Katon, Chen), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (Glass); National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Schnurr); Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, and Department of Medicine and Psychiatry, University of Minnesota, Minneapolis (Sayer)
| | - Jessica A Chen
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin (Goldberg); Health Services Research & Development (HSR&D) Center of Innovation (Goldberg, Lehavot, Katon, Chen, Fortney) and Center of Excellence in Substance Abuse Treatment and Education (CESATE) (Simpson), U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle; Department of Psychiatry and Behavioral Sciences (Lehavot, Fortney, Simpson) and Department of Health Services (Katon, Chen), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (Glass); National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Schnurr); Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, and Department of Medicine and Psychiatry, University of Minnesota, Minneapolis (Sayer)
| | - Joseph E Glass
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin (Goldberg); Health Services Research & Development (HSR&D) Center of Innovation (Goldberg, Lehavot, Katon, Chen, Fortney) and Center of Excellence in Substance Abuse Treatment and Education (CESATE) (Simpson), U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle; Department of Psychiatry and Behavioral Sciences (Lehavot, Fortney, Simpson) and Department of Health Services (Katon, Chen), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (Glass); National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Schnurr); Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, and Department of Medicine and Psychiatry, University of Minnesota, Minneapolis (Sayer)
| | - Paula P Schnurr
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin (Goldberg); Health Services Research & Development (HSR&D) Center of Innovation (Goldberg, Lehavot, Katon, Chen, Fortney) and Center of Excellence in Substance Abuse Treatment and Education (CESATE) (Simpson), U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle; Department of Psychiatry and Behavioral Sciences (Lehavot, Fortney, Simpson) and Department of Health Services (Katon, Chen), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (Glass); National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Schnurr); Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, and Department of Medicine and Psychiatry, University of Minnesota, Minneapolis (Sayer)
| | - Nina A Sayer
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin (Goldberg); Health Services Research & Development (HSR&D) Center of Innovation (Goldberg, Lehavot, Katon, Chen, Fortney) and Center of Excellence in Substance Abuse Treatment and Education (CESATE) (Simpson), U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle; Department of Psychiatry and Behavioral Sciences (Lehavot, Fortney, Simpson) and Department of Health Services (Katon, Chen), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (Glass); National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Schnurr); Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, and Department of Medicine and Psychiatry, University of Minnesota, Minneapolis (Sayer)
| | - John C Fortney
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin (Goldberg); Health Services Research & Development (HSR&D) Center of Innovation (Goldberg, Lehavot, Katon, Chen, Fortney) and Center of Excellence in Substance Abuse Treatment and Education (CESATE) (Simpson), U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle; Department of Psychiatry and Behavioral Sciences (Lehavot, Fortney, Simpson) and Department of Health Services (Katon, Chen), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (Glass); National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Schnurr); Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, and Department of Medicine and Psychiatry, University of Minnesota, Minneapolis (Sayer)
| |
Collapse
|
157
|
An Intensive Outpatient Program for Veterans With Posttraumatic Stress Disorder and Traumatic Brain Injury. COGNITIVE AND BEHAVIORAL PRACTICE 2019. [DOI: 10.1016/j.cbpra.2018.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
158
|
Sipos ML, Kim PY, Thomas SJ, Adler AB. U.S. Service Member Deployment in Response to the Ebola Crisis: The Psychological Perspective. Mil Med 2019. [PMID: 29514338 DOI: 10.1093/milmed/usx042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Introduction In the fall of 2014, the United States and other nations responded to the worst outbreak of the Ebola virus disease in history. As part of this effort, U.S. service members deployed to West Africa to support a spectrum of activities that did not involve direct patient care. Although previous studies identified the psychological impact of responding to an outbreak, these studies were limited to retrospective data, small sample sizes, and medical personnel. The goals of the present study were to (a) document the mental health and well-being of troops deploying in response to an infectious disease outbreak; (b) identify their stressors, attitudes toward deployment, and health risk concerns; and (c) understand the role of combat experience in adjusting to these types of missions. Materials and Methods Study participants at both pre- and during deployment were active duty U.S. soldiers in a combat aviation battalion from a large U.S. military installation. U.S. soldiers were surveyed (n = 251) 3 wk before deploying to Liberia (October 2014) and surveyed again during their deployment (February 2015; n = 173). Participants were primarily male (86.1%), junior ranking (56.0%), and just over half had previous combat deployment experience (51.2%). Surveys were anonymous and not linked to one another over time. Results Overall rates of mental health problems were low (2.4% at pre-deployment and 5.8% during deployment), whereas sleep problems were reported by 4.9% at pre-deployment and 12% during deployment. At pre-deployment, top stressors focused on health threats; fewer stressors were reported during deployment. Soldiers were relatively less concerned about contracting Ebola than other more prevalent diseases. Soldiers with combat experience reported more somatic and sleep problems at pre-deployment than those without previous combat experience. There were no significant differences during deployment between those with and without previous combat experience. Conclusion Overall, a small proportion of respondents reported significant rates of mental health problems. In contrast, sleep problems were reported by 12% during deployment. In terms of attitudes toward the mission, the vast majority reported that they knew what to do to protect themselves from disease and that they understood the potential risk involved. The study also confirmed previous findings that soldiers with previous combat experience had more somatic symptoms at pre-deployment than those without, although this distinction appeared limited to the pre-deployment phase. Results can be used to address anxiety by personnel during pre-deployment and to inform leadership preparing personnel to deploy in response to future infectious disease outbreaks.
Collapse
Affiliation(s)
- Maurice L Sipos
- Department of Command, Leadership, and Management, U.S. Army War College, 122 Forbes Avenue, Carlisle Barracks, Carlisle, PA 17013
| | - Paul Y Kim
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD 20910
| | - Stephen J Thomas
- Division of Infectious Diseases, State University of New York Upstate Medical University, 725 Irving Ave., Suite 311, Syracuse, NY 13210
| | - Amy B Adler
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD 20910
| |
Collapse
|
159
|
Dillon KH, LoSavio ST, Henry TR, Murphy RA, Resick PA. The Impact of Military Status on Cognitive Processing Therapy Outcomes in the Community. J Trauma Stress 2019; 32:330-336. [PMID: 30892748 DOI: 10.1002/jts.22396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/29/2018] [Accepted: 12/09/2018] [Indexed: 11/08/2022]
Abstract
Military-affiliated individuals (i.e., active duty personnel and veterans) exhibit high rates of posttraumatic stress disorder (PTSD). Although existing evidence-based treatments for PTSD, such as cognitive processing therapy (CPT), have demonstrated effectiveness with military-affiliated patients, there is evidence to suggest these individuals do not benefit as much as civilians. However, few studies have directly compared the effects of PTSD treatment between civilian and military-affiliated participants. The current study compared treatment outcomes of military-affiliated and civilian patients receiving CPT. Participants with PTSD who were either civilians (n = 136) or military-affiliated (n = 63) received CPT from community-based providers in training for CPT. Results indicated that military-affiliated participants were equally likely to complete treatment, Log odds ratio (OR) = 0.14, p = .648. Although military-affiliated participants exhibited reductions in PTSD, B = -2.53, p < .001; and depression symptoms, B = -0.65, p < .001, they experienced smaller reductions in symptoms relative to civilians: B = 1.15, p = .015 for PTSD symptoms and B = 0.29, p = .029 for depression symptoms. Furthermore, variability estimates indicated there was more variability in providers' treatment of military-affiliated versus civilian participants (i.e., completion rates and symptom reduction). These findings suggest that military-affiliated patients can be successfully retained in trauma-focused treatment in the community at the same rate as civilian patients, and they significantly improve in PTSD and depression symptoms although not as much as civilians. These findings also highlight community providers' variability in treatment of military-affiliated patients, providing support for more military-cultural training.
Collapse
Affiliation(s)
- Kirsten H Dillon
- Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Stefanie T LoSavio
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Teague R Henry
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert A Murphy
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA.,Center for Child and Family Health, Durham, North Carolina, USA
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
160
|
Start AR, Allard Y, Adler A, Toblin R. Predicting Suicide Ideation in the Military: The Independent Role of Aggression. Suicide Life Threat Behav 2019; 49:444-454. [PMID: 29498089 DOI: 10.1111/sltb.12445] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/30/2017] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to examine the longitudinal relationship between aggression and suicide ideation when controlling for other externalizing (i.e., alcohol misuse and risk-taking) and internalizing (i.e., depression and sleep problems) risk factors in an active duty, military sample. Preexisting data from a longitudinal study were analyzed to assess the wellness of service members across the deployment cycle. Participants were 944 active duty service members (95% male, 48% between 18 and 24 years old) who completed surveys upon initial return from deployment and approximately 3 months later. After controlling for other externalizing (alcohol misuse, risk-taking) and internalizing (depression, sleep problems) risk factors, service members reporting aggression were significantly more likely to report suicide ideation than those reporting no aggression (OR = 3.19; OR 95% CI: 1.16-8.80). The independent nature of the relationship between anger and suicidality suggests aggression may be an important indicator of suicidality for service members. Understanding the role of aggression in suicidality may improve the ability to identify at-risk service members and to develop effective interventions to reduce suicide risk.
Collapse
Affiliation(s)
- Amanda R Start
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Yvonne Allard
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Amy Adler
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Robin Toblin
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| |
Collapse
|
161
|
Cameron KL, Sturdivant RX, Baker SP. Trends in the incidence of physician-diagnosed posttraumatic stress disorder among active-duty U.S. military personnel between 1999 and 2008. Mil Med Res 2019; 6:8. [PMID: 30905323 PMCID: PMC6432759 DOI: 10.1186/s40779-019-0198-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The impact of combat operations in Iraq and Afghanistan on the incidence of post-traumatic stress disorder (PTSD) in military service members has been poorly quantified. The purpose of this study was to examine trends in the incidence rate of physician-diagnosed PTSD in active-duty military personnel between 1999 and 2008. METHODS We conducted a retrospective cohort study utilizing data extracted from the Defense Medical Surveillance System to identify incident cases of PTSD within the study population. The incidence rate of physician-diagnosed PTSD was the primary outcome of interest. Multivariable Poisson regression was used to analyze the data. RESULTS The overall incidence rate of PTSD among all active-duty US military personnel was 3.84 (95% CI: 3.81, 3.87) cases per 1000 person-years. The adjusted average annual percentage increase in the incidence rate of PTSD prior to the initiation of Operation Iraqi Freedom (OIF) was a modest 5.02% (95% CI: 1.85, 8.29%). Following the initiation of OIF, the average annual percentage increase in the rate of PTSD was 43.03% (95% CI: 40.55, 45.56%). Compared to the baseline period between 1999 and 2002, the incidence rate of PTSD in 2008 was nearly 7 times higher (RR = 6.85, 95% CI: 6.49, 7.24). Significant increases in the incidence rate of PTSD were observed following the initiation of OIF regardless of sex, age, race, marital status, military rank, or branch of military service. Notably, the rate of PTSD among females was 6-7 times higher prior to OIF, but there was no difference by gender by 2008. CONCLUSIONS Overall, these data quantify the significant increase in the incidence rate of PTSD following the initiation of combat operations in Iraq and Afghanistan within the active-duty military population during the study period.
Collapse
Affiliation(s)
- Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York, 10996, USA.
| | - Rodney X Sturdivant
- Department of Mathematics, Physics, and Statistics, Azusa Pacific University, Azusa, California, USA
| | - Susan P Baker
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
162
|
Ursano RJ, Wang J, Fullerton CS, Ramsawh H, Gifford RK, Russell D, Cohen GH, Sampson L, Galea S. Post-deployment Mental Health in Reserve and National Guard Service Members: Deploying With or Without One's Unit and Deployment Preparedness. Mil Med 2019; 183:e51-e58. [PMID: 29401326 DOI: 10.1093/milmed/usx002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Indexed: 11/14/2022] Open
Abstract
Background Given the greater prevalence of post-deployment mental health concerns among reservists, the higher likelihood of deploying without their regular unit, and potentially lower rates of deployment preparedness, we examined associations between deploying with or without one's regular unit (individual augmentee status, IAS), deployment preparedness, and mental health problems including post-traumatic stress disorder (PTSD), depression (MDD), and binge drinking in a nationally representative sample of Reserve Component (RC) Army and Marine-enlisted males (n = 705). Methods A series of multivariate regressions examined the association of mental health with IAS and deployment preparedness, adjusting for demographics. To examine whether deployment preparedness varied by IAS, an IAS × deployment preparedness interaction was included. Findings In an adjusted model, being an individual augmentee and low deployment preparedness were associated with any mental health problem (screening positive for PTSD, MDD, binge drinking, or any combination of the three). There was a significant IAS × deployment preparedness interaction. Mental health problems did not vary by preparedness among individual augmentees. Participants deploying with regular units with low-medium preparedness had greater risk for mental health problems (odds ratio [OR] = 3.69, 95% confidence interval [CI] = 1.78-7.62 and OR = 2.29, 95% CI = 1.12-4.71), than those with high preparedness. RC-enlisted male personnel who deployed without their regular unit were five times more likely to have a mental health problem, and were 61% more likely to report binge drinking. Additionally, those with lower levels of deployment preparedness were up to three times more likely to have a mental health problem and up to six times more likely to report PTSD. Discussion The current investigation found that both IAS and deployment preparedness were associated with negative mental health outcomes in a large representative sample of previously deployed RC-enlisted male personnel. In particular, low deployment preparedness was associated with an increased likelihood of PTSD, and deploying without one's regular unit was associated with increased rates of binge drinking. There were also significant main and interaction effects of IAS and deployment preparedness on having a mental health problem. It is possible that limiting the number of RC personnel deploying without their regular unit may help to decrease alcohol misuse among U.S. Armed Services reservists during and after future conflicts. Also, to the extent that deployment preparedness is a modifiable risk factor, future studies should examine whether increasing deployment preparedness could mitigate some of the correlates of deployment-related trauma exposure. Finally, future investigation is needed to explain why those who deploy without their regular unit, but who report high deployment preparedness, remain at elevated risk for mental health problems. It is possible that individual augmentees can benefit from a specific preparation for deployment. Those deploying without their regular unit had higher rates of mental health problems regardless of preparedness. These findings have implications for deployment preparedness training for those deploying without their regular unit.
Collapse
Affiliation(s)
- Robert J Ursano
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Jing Wang
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Carol S Fullerton
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Holly Ramsawh
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Robert K Gifford
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Dale Russell
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Gregory H Cohen
- School of Public Health, Boston University, 715 Albany Street-Talbot 301, Boston, MA 02118
| | - Laura Sampson
- School of Public Health, Boston University, 715 Albany Street-Talbot 301, Boston, MA 02118
| | - Sandro Galea
- School of Public Health, Boston University, 715 Albany Street-Talbot 301, Boston, MA 02118
| |
Collapse
|
163
|
Ford J, Littleton H, Lutes L, Wuensch K, Benton C, Cahill J, Hudson C, Nekkanti R, Gehi A, Sears S. Evaluation of an Internet‐based intervention for ICD patients with elevated symptoms of posttraumatic stress disorder. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:521-529. [DOI: 10.1111/pace.13654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 01/08/2019] [Accepted: 03/02/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Jessica Ford
- Department of PsychologyEast Carolina University Greenville North Carolina
| | - Heather Littleton
- Department of PsychologyEast Carolina University Greenville North Carolina
| | - Lesley Lutes
- Department of PsychologyUniversity of British Columbia Kelowna BC Canada
| | - Karl Wuensch
- Department of PsychologyEast Carolina University Greenville North Carolina
| | - Christie Benton
- Department of Cardiovascular SciencesEast Carolina University, East Carolina Heart Institute Greenville North Carolina
| | - John Cahill
- Department of Cardiovascular SciencesEast Carolina University, East Carolina Heart Institute Greenville North Carolina
| | | | | | - Anil Gehi
- Department of MedicineUniversity of North Carolina at Chapel Hill Chapel Hill North Carolina
| | - Samuel Sears
- Department of PsychologyEast Carolina University Greenville North Carolina
- Department of Cardiovascular SciencesEast Carolina University, East Carolina Heart Institute Greenville North Carolina
| |
Collapse
|
164
|
Diehle J, Williamson V, Greenberg N. Out of sight out of mind: an examination of mental health problems in UK military reservists and veterans. J Ment Health 2019; 30:601-606. [PMID: 30862220 DOI: 10.1080/09638237.2019.1581348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Reservists often have different experiences to regular military personnel which may impact their mental health. AIMS To investigate the incidence of mental health problems in both active and veteran reservists and determine how this compares to regular service personnel and ex-regular veterans. METHOD Five studies which included reservist and/or veteran participants, a validated assessment of mental health problems, and provided primary data were included in the synthesis. Common mental health disorders, post-traumatic stress disorder and alcohol use disorder were examined. RESULTS Nondeployed mobilized reservists were significantly less likely to report common mental health disorders than nondeployed regulars. There were no other significant differences between groups. Regardless deployed reservists reported more mental health problems than nondeployed reservists. Similarly, ex-regular deployed veterans were more likely to experience mental health difficulties than nondeployed ex-regular veterans. Notably, a large proportion of non-deployed reservists reported probable alcohol use disorders, indicating that problematic alcohol consumption may not be due to deployment in this group. CONCLUSION These results highlight the need for ongoing support for military regular, ex-regular and reservist personnel. Additional research is needed to examine potential risk and protective factors for mental health problems in both deployed and nondeployed reservists. Key points Overall, mobilized deployed reservists were more likely to experience mental health problems than non-deployed reservists. Nondeployed regulars reported significantly more common mental health problems than nondeployed mobilized reservists. Reservists and (ex-)regulars reported similar rates of PTSD. This suggests reservists are vulnerable to developing PTSD following non-combat related trauma that may not lead to PTSD in regulars and this warrants future research. Reservists were less likely to report problematic alcohol consumption compared to regular personnel and ex-regular veterans. The greatest amount of reservist problematic drinking was reported in non-deployed veteran reservists. This indicates problematic alcohol consumption is not deployment related in this group and highlights the need for ongoing formal support for alcohol use disorders in the UK Armed Forces.
Collapse
Affiliation(s)
- Julia Diehle
- a King's Centre for Military Health Research , Institute of Psychology, Psychiatry and Neuroscience, King's College London , London , UK
| | - Victoria Williamson
- a King's Centre for Military Health Research , Institute of Psychology, Psychiatry and Neuroscience, King's College London , London , UK
| | - Neil Greenberg
- a King's Centre for Military Health Research , Institute of Psychology, Psychiatry and Neuroscience, King's College London , London , UK
| |
Collapse
|
165
|
Adams RE, Urosevich TG, Hoffman SN, Kirchner HL, Figley CR, Withey CA, Boscarino JJ, Dugan RJ, Boscarino JA. Social and Psychological Risk and Protective Factors for Veteran Well-Being: The Role of Veteran Identity and Its Implications for Intervention. ACTA ACUST UNITED AC 2019; 7:304-314. [PMID: 31363423 PMCID: PMC6666406 DOI: 10.1080/21635781.2019.1580642] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Social psychological theory hypothesizes that one’s identity, self-definitions, and meanings used for a particular social role fosters individual purpose in life and affects behavior in specific social situations. As such, it can be protective against the onset of psychological disorders. We examined this hypothesis with data collected from 1,730 military veterans recruited to study the health effects of warzone deployments. The sample was primarily male, older, and White. Our key independent variable was a Likert scale rating the prominence of a respondent’s veteran identity: how important it is to the person. Outcome variables included posttraumatic stress disorder (PTSD), suicide ideation, depression, alcohol misuse, and use of VA services. Bivariate analysis suggested that veterans with a prominent veteran identity are older, noncollege graduates, have less income, and had their first deployment to Vietnam. In multivariate analyses, study participants with a prominent veteran identity were less likely to exhibit suicide ideation, but more likely to misuse alcohol and use VA services. We found no differences for PTSD, self-rated health, or depression by veteran identity. Veterans who scored higher on the veteran identity scale appeared to be protected from suicidal thoughts, although they had an elevated risk for alcohol misuse.
Collapse
Affiliation(s)
| | | | | | - H Lester Kirchner
- Department of Biomedical and Translational Informatics, Geisinger Clinic, Danville, Pennsylvania
| | - Charles R Figley
- Traumatology Institute and School of Social Work, Tulane University, New Orleans, Louisiana
| | - Carrie A Withey
- Department of Epidemiology & Health Services Research, Geisinger Clinic, Danville, Pennsylvania
| | - Joseph J Boscarino
- Department of Clinical Psychology, William James College, Newton, Massachusetts
| | - Ryan J Dugan
- Department of Epidemiology & Health Services Research, Geisinger Clinic, Danville, Pennsylvania
| | - Joseph A Boscarino
- Department of Epidemiology & Health Services Research, Geisinger Clinic, Danville, Pennsylvania
| |
Collapse
|
166
|
Johnson JM, Capehart BP. Psychiatric Care of the Post-September 11 Combat Veteran: A Review. PSYCHOSOMATICS 2019; 60:121-128. [PMID: 30580807 DOI: 10.1016/j.psym.2018.11.008] [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: 09/19/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Post-September 11, 2001 combat veterans represent a growing cohort of patients with unique mental health needs, particularly around post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). The United States (US) remains engaged in conflicts around the globe, so this patient cohort will continue to grow in number. With around 40% of American combat veterans from Iraq and Afghanistan seeking mental health care outside of the Veterans Affairs, understanding the psychiatric needs of the post-September 11 combat veteran is an important goal for all psychiatrists. These patients are relevant to consultation-liaison (C-L) psychiatrists because of their high comorbidity of conditions such as TBI, obstructive sleep apnea, insomnia, and chronic pain. This article reviews the current literature on mental health care for the post-September 11 combat veteran, emphasizing PTSD and TBI treatment, and culling evidence-based recommendations from randomized controlled trials of combat veterans. Emphasis is also placed on the Veterans Affairs/Department of Defense Clinical Practice Guidelines. The authors also bring unique clinical expertise of having served on active duty as psychiatrists for the US Army, including in a combat zone, and both currently work in a Veterans Affairs Iraq and Afghanistan combat veteran mental health clinic. OBJECTIVE This review outlines useful treatment approaches for PTSD and TBI and briefly covers the comorbid conditions of major depression, chronic pain, and substance use disorders. This review will prepare C-L psychiatrists to care for this challenging patient cohort.
Collapse
MESH Headings
- Afghan Campaign 2001-
- Brain Injuries, Traumatic/epidemiology
- Brain Injuries, Traumatic/psychology
- Brain Injuries, Traumatic/therapy
- Chronic Pain/epidemiology
- Chronic Pain/psychology
- Combat Disorders/epidemiology
- Combat Disorders/psychology
- Combat Disorders/therapy
- Comorbidity
- Depressive Disorder, Major/epidemiology
- Depressive Disorder, Major/psychology
- Depressive Disorder, Major/therapy
- Humans
- Iraq War, 2003-2011
- Psychiatry
- Sex Offenses/psychology
- Sex Offenses/statistics & numerical data
- Stress Disorders, Post-Traumatic/epidemiology
- Stress Disorders, Post-Traumatic/psychology
- Stress Disorders, Post-Traumatic/therapy
- Substance-Related Disorders/epidemiology
- Substance-Related Disorders/psychology
- Substance-Related Disorders/therapy
- United States
- Veterans/psychology
Collapse
Affiliation(s)
- Justin M Johnson
- Durham VA Medical Center (J.M.J., B.P.C.), Duke University School of Medicine, Durham, NC 27705.
| | - Bruce P Capehart
- Durham VA Medical Center (J.M.J., B.P.C.), Duke University School of Medicine, Durham, NC 27705
| |
Collapse
|
167
|
Penix EA, Whitmer DL, Thomas JL, Wilk JE, Adler AB. Behavioral health of US military veterinary personnel deployed to Afghanistan. J Am Vet Med Assoc 2019; 254:520-529. [PMID: 30714870 DOI: 10.2460/javma.254.4.520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare symptoms of compromised behavioral health (BH symptoms) and factors protecting against those symptoms (protective factors) in military veterinary and nonveterinary health-care personnel deployed to Afghanistan. DESIGN Cross-sectional survey. SAMPLE 237 deployed military health-care personnel (21 veterinary and 216 nonveterinary). PROCEDURES Surveys were administered to participants during combat deployment in Afghanistan in 2013 to collect information on BH symptoms and protective factors. Data were compared between veterinary and nonveterinary health-care personnel by use of regression models controlling for demographic characteristics and deployment experiences. Partial correlations were computed to assess relationships between protective factors and BH symptoms, controlling for personnel type. RESULTS Less than 15% of veterinary and nonveterinary health-care personnel were at risk for suicidal ideation, major depressive disorder, generalized anxiety disorder, and posttraumatic stress disorder. After adjusting for covariates, both personnel types had similar levels of depression, posttraumatic stress disorder, and anxiety symptoms; however, veterinary personnel reported more distressing secondary traumatic stress symptoms and a greater number of anger reactions. Self-care, team support, and perceived supportive leadership were inversely associated with BH symptoms regardless of personnel type. Veterinary personnel engaged in less self-care, provided less team care, and rated leadership behaviors less positively than nonveterinary health-care personnel. CONCLUSIONS AND CLINICAL RELEVANCE Compared with nonveterinary health-care personnel, deployed veterinary personnel were at greater risk of generalized anxiety disorder and reported more secondary traumatic stress and anger reactions, but were less likely to be engaged in and exposed to protective factors. Interventions designed to promote self-care and team support for veterinary personnel and their leaders may reduce the occupational risk of BH symptoms in deployment and perhaps other settings.
Collapse
|
168
|
Meshberg-Cohen S, Black AC, DeViva JC, Petrakis IL, Rosen MI. Trauma treatment for veterans in buprenorphine maintenance treatment for opioid use disorder. Addict Behav 2019; 89:29-34. [PMID: 30243036 DOI: 10.1016/j.addbeh.2018.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/12/2018] [Accepted: 09/08/2018] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Opioid use disorder (OUD) rates are high among veterans. PTSD is also prevalent among veterans; those with comorbidity have worse outcomes than those without comorbidity. This study assessed buprenorphine retention rates in veterans initiating OUD treatment, comparing veterans without PTSD to veterans with PTSD who were receiving versus not receiving concurrent trauma treatment. METHODS This retrospective chart review examined consecutive referrals to buprenorphine maintenance (N = 140). PTSD diagnosis was identified by chart review and retention was defined as continuous buprenorphine maintenance 6-months post-admission. Logistic regression analyses compared buprenorphine retention for veterans without PTSD and PTSD-diagnosed veterans who received concurrent trauma treatment to a reference group of PTSD-diagnosed veterans who did not receive trauma treatment. Models adjusted for opioid type, age, and service-connected status. RESULTS Sixty-seven (47.9%) buprenorphine-seeking veterans carried a PTSD diagnosis; only 31.3% (n = 21) received trauma treatment while in buprenorphine maintenance, with 11.9% (n = 8) receiving evidence-based psychotherapy for PTSD. Among PTSD-diagnosed veterans who received trauma treatment, 90.5% (n = 19/21) were in buprenorphine maintenance at 6-months, compared to 23.9% (n = 11/46) of PTSD-diagnosed veterans without trauma treatment, and 46.6% (n = 34/73) of veterans without PTSD. In the full model, veterans with trauma treatment had 43.36 times greater odds of remaining in buprenorphine treatment than the reference group. CONCLUSIONS Most PTSD-diagnosed veterans in buprenorphine treatment were not receiving trauma treatment. Those receiving concurrent trauma treatment had better retention, suggesting OUD and trauma can be simultaneously addressed. Future clinical trials should investigate trauma-focused treatment for veterans with comorbid PTSD who are seeking buprenorphine for OUD.
Collapse
Affiliation(s)
- Sarah Meshberg-Cohen
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A, West Haven, CT 06516, United States; Yale University School of Medicine, Department of Psychiatry, United States.
| | - Anne C Black
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A, West Haven, CT 06516, United States; Yale University School of Medicine, Department of Psychiatry, United States
| | - Jason C DeViva
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A, West Haven, CT 06516, United States; Yale University School of Medicine, Department of Psychiatry, United States
| | - Ismene L Petrakis
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A, West Haven, CT 06516, United States; Yale University School of Medicine, Department of Psychiatry, United States
| | - Marc I Rosen
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A, West Haven, CT 06516, United States; Yale University School of Medicine, Department of Psychiatry, United States
| |
Collapse
|
169
|
Contribution of traumatic deployment experiences to the burden of mental health problems in Canadian Armed Forces personnel: exploration of population attributable fractions. Soc Psychiatry Psychiatr Epidemiol 2019; 54:145-156. [PMID: 30027449 DOI: 10.1007/s00127-018-1562-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Mental health problems are prevalent after combat; they are also common in its absence. Estimates of deployment-attributability vary. This paper quantifies the contribution of different subtypes of occupational trauma to post-deployment mental health problems. METHODS Participants were a cohort of 16,193 Canadian personnel undergoing post-deployment mental health screening after return from the mission in Afghanistan. The screening questionnaire assessed post-traumatic stress disorder, depression, panic disorder, generalized anxiety disorder, and exposure to 30 potentially traumatic deployment experiences. Logistic regression estimated adjusted population attributable fractions (PAFs) for deployment-related trauma, which was treated as count variables divided into several subtypes of experiences based on earlier factor analytic work. RESULTS The overall PAF for overall deployment-related trauma exposure was 57.5% (95% confidence interval 44.1, 67.7) for the aggregate outcome of any of the four assessed problems. Substantial PAFs were seen even at lower levels of exposure. Among subtypes of trauma, exposure to a dangerous environment (e.g., receiving small arms fire) and to the dead and injured (e.g., handling or uncovering human remains) had the largest PAFs. Active combat (e.g., calling in fire on the enemy) did not have a significant PAF. CONCLUSIONS Military deployments involving exposure to a dangerous environment or to the dead or injured will have substantial impacts on mental health in military personnel and others exposed to similar occupational trauma. Potential explanations for divergent findings in the literature on the extent to which deployment-related trauma contributes to the burden of mental disorders are discussed.
Collapse
|
170
|
Dreer LE, Cox MK, McBrayer A, Neumeier WH, Herman C, Malone LA. Resilience Among Caregivers of Injured Service Members: Finding the Strengths in Caregiving. Arch Phys Med Rehabil 2019; 100:S76-S84. [PMID: 30684488 DOI: 10.1016/j.apmr.2018.12.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 12/07/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the relationships between caregiver resilience and a comprehensive set of sociodemographic and health-related quality of life (HRQOL) predictors among both caregivers and injured service members. DESIGN Cross-sectional analysis of an observational cohort. SETTING Community dwelling. PARTICIPANTS Caregivers (n=87) who provide instrumental or emotional support to injured service members (n=73)(N=160). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The Connor-Davidson Resilience Scale 25-item version. RESULTS Higher caregiver resilience scores were related to lower depressive symptom severity, greater health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, stress management, and problem-solving orientation. A multivariable regression model showed that spiritual growth and aspects of problem-solving orientation were significantly related to resilience. CONCLUSIONS Results highlight the relationships between resilience and spirituality, problem-solving orientation, and aspects of HRQOL among caregivers of injured service members. These findings have important implications for caregiver behavioral health programs designed to promote resilience and draw upon caregiver strengths when taking on a caregiver role. Approaches that include a more integrative medicine or strengths-based emphasis may be particularly beneficial when working with families of injured military.
Collapse
Affiliation(s)
- Laura E Dreer
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Alabama, the United States.
| | - Molly K Cox
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Alabama, the United States
| | - Alexandra McBrayer
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Alabama, the United States
| | - William H Neumeier
- School of Health Professions, UAB-Lakeshore Research Collaborative, University of Alabama at Birmingham, Birmingham, Alabama, the United States
| | - Cassandra Herman
- School of Health Professions, UAB-Lakeshore Research Collaborative, University of Alabama at Birmingham, Birmingham, Alabama, the United States; Department of Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama, the United States
| | - Laurie A Malone
- School of Health Professions, UAB-Lakeshore Research Collaborative, University of Alabama at Birmingham, Birmingham, Alabama, the United States
| |
Collapse
|
171
|
McCabe CT, Mohr CD, Hammer LB, Carlson KF. PTSD Symptomology and Motivated Alcohol Use Among Military Service Members: Testing a Conditional Indirect Effect Model of Social Support. Subst Use Misuse 2019; 54:257-270. [PMID: 30372358 DOI: 10.1080/10826084.2018.1517176] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and problematic alcohol use commonly co-occur among military service members. It remains critical to understand why these patterns emerge, and under what conditions. OBJECTIVES This study examined whether PTSD symptoms (PTSS) and alcohol involvement (quantity and frequency of use, heavy episodic drinking, and alcohol problems) are indirectly related through four distinct drinking motivations. A secondary aim was to identify factors, specifically forms of social support, which buffer these associations. METHODS Using baseline data from a randomized-controlled trial of health and well-being among civilian-employed separated service members and reservists, the present study examined these issues using a subsample of 398 current drinkers. RESULTS Parallel mediation models revealed PTSS-alcohol consumption associations were indirect through coping and enhancement motivations. PTSS was only related to alcohol problems through coping motivations. In addition, the indirect effect of PTSS on average level of consumption via coping motives was conditional on perceived support from friends and family, whereas the indirect effect for alcohol problems was conditional only on friend support. In contrast, the indirect effects of PTSS on alcohol consumption variables (but not problems) via enhancement motives were conditional on perceived support from friends and family. Conclusions/Importance: Future research and screening efforts should attend to individual motivations for drinking as important factors related to alcohol use and problems among service members experiencing PTSS, and emphasize the importance of communication, trust, and effective supports among military and nonmilitary friends and family.
Collapse
Affiliation(s)
- Cameron T McCabe
- a Department of Psychology , Portland State University , Portland , Oregon , USA
| | - Cynthia D Mohr
- a Department of Psychology , Portland State University , Portland , Oregon , USA
| | - Leslie B Hammer
- a Department of Psychology , Portland State University , Portland , Oregon , USA.,b Oregon Institute of Occupational Health Sciences , Oregon Health & Science University , Portland , Oregon , USA
| | - Kathleen F Carlson
- c Veterans Affairs (VA) Portland Healthcare System , Oregon Health & Science University , Portland , Oregon , USA.,d School of Public Health , Oregon Health & Science University , Portland , Oregon , USA
| |
Collapse
|
172
|
King G, Baker KD, Bisby MA, Chan D, Cowan CSM, Stylianakis AA, Zimmermann KS, Richardson R. A precision medicine approach to pharmacological adjuncts to extinction: a call to broaden research. Psychopharmacology (Berl) 2019; 236:143-161. [PMID: 30116858 DOI: 10.1007/s00213-018-4999-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/07/2018] [Indexed: 12/21/2022]
Abstract
There is a pressing need to improve treatments for anxiety. Although exposure-based therapy is currently the gold-standard treatment, many people either do not respond to this therapy or experience a relapse of symptoms after treatment has ceased. In recent years, there have been many novel pharmacological agents identified in preclinical research that have potential as adjuncts for exposure therapy, yet very few of these are regularly integrated into clinical practice. Unfortunately, the robust effects observed in the laboratory animal often do not translate to a clinical population. In this review, we discuss how age, sex, genetics, stress, medications, diet, alcohol, and the microbiome can vary across a clinical population and yet are rarely considered in drug development. While not an exhaustive list, we have focused on these factors because they have been shown to influence an individual's vulnerability to anxiety and alter the neurotransmitter systems often targeted by pharmacological adjuncts to therapy. We argue that for potential adjuncts to be successfully translated from the lab to the clinic empirical research must be broadened to consider how individual difference factors will influence drug efficacy.
Collapse
Affiliation(s)
- Gabrielle King
- School of Psychology, The University of New South Wales, Sydney, Australia.
| | - Kathryn D Baker
- School of Psychology, The University of New South Wales, Sydney, Australia
| | - Madelyne A Bisby
- School of Psychology, The University of New South Wales, Sydney, Australia
| | - Diana Chan
- School of Psychology, The University of New South Wales, Sydney, Australia
| | | | | | | | - Rick Richardson
- School of Psychology, The University of New South Wales, Sydney, Australia
| |
Collapse
|
173
|
Sheerin CM, Amstadter AB, Kurtz ED, Bountress KE, Stratton KJ, McDonald SD, Mid-Atlantic Va Mirecc Workgroup. The association of resilience on psychiatric, substance use, and physical health outcomes in combat trauma-exposed military service members and veterans. Eur J Psychotraumatol 2019; 10:1625700. [PMID: 31263518 PMCID: PMC6598486 DOI: 10.1080/20008198.2019.1625700] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/23/2019] [Accepted: 05/20/2019] [Indexed: 11/17/2022] Open
Abstract
Objective: Although Combat exposure is associated with a range of psychiatric outcomes, many veterans do not develop psychopathology. Resilience is a multifaceted construct associated with reduced risk of distress and psychopathology; however, few studies have examined the relationship of resilience with a broader spectrum of health outcomes following combat exposure. It also remains important to determine the association of resilience above and beyond other documented risk and protective factors. Method: In a sample of combat-exposed veterans (N = 1,046) deployed to Iraq and Afghanistan, we examined a quantitative method for exploring relative psychological resilience (discrepancy-based psychiatric resilience; DBPR) and tested the hypothesis that resilience would be associated with reduced risk for psychiatric diagnosis count, substance use, and physical health outcomes, above and beyond other known correlates (e.g. combat exposure, social support). Results: In the final model, results suggested an inverse association of discrepancy-based psychiatric resilience with current psychiatric diagnosis count (β = -0.57, p < .001), alcohol use (β = -0.16, p < .001), drug use (β = -0.13, p < .001), and physical health concerns (β = -0.42, p < .001) after accounting for other relevant risk and protective factors. Conclusions: Results extend the nomological net of this quantitative resilience construct to include other relevant health outcomes, and demonstrate that resilience may have more of a buffering relationship with psychiatric and physical health concerns compared to substance use outcomes.
Collapse
Affiliation(s)
- Christina M Sheerin
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Ananda B Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Erin D Kurtz
- Psychology Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Kaitlin E Bountress
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Kelcey J Stratton
- Resiliency and Well-Being Services, University of Michigan, Ann Arbor, MI, USA
| | - Scott D McDonald
- Psychology Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Mid-Atlantic Va Mirecc Workgroup
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA.,Psychology Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.,Resiliency and Well-Being Services, University of Michigan, Ann Arbor, MI, USA.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
174
|
Goodell EMA, Homish DL, Homish GG. Characteristics of U.S. Army Reserve and National Guard couples who use family readiness programs. MILITARY BEHAVIORAL HEALTH 2018; 7:185-197. [PMID: 31763064 PMCID: PMC6874377 DOI: 10.1080/21635781.2018.1515131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Use of family readiness programs (FRPs) by military families is not well understood. This work uses the Gelberg-Andersen Behavioral Model to identify characteristics of Reserve and National Guard (R/NG) couples who access FRPs. Data are from Operation: SAFETY, a study of R/NG soldiers and partners. Logistic regression models examined odds of accessing FRPs based on predisposing, enabling, and need factors. Greater length of military service, greater presence of non-military social ties, and civilian partner reports of adequate support during deployment were associated with higher likelihood of accessing FRPs. Results provide information on FRP utilization and may help inform outreach efforts.
Collapse
Affiliation(s)
- Erin M. Anderson Goodell
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo – The State University of New York, Buffalo, NY
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo – The State University of New York, Buffalo, NY
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo – The State University of New York, Buffalo, NY
| |
Collapse
|
175
|
Akiki TJ, Averill LA, Abdallah CG. Neurobiological studies of trauma-related psychopathology: a public health perspective. Eur J Psychotraumatol 2018; 9:1556554. [PMID: 30637093 PMCID: PMC6319465 DOI: 10.1080/20008198.2018.1556554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/23/2018] [Accepted: 11/28/2018] [Indexed: 01/30/2023] Open
Abstract
The societal burden of psychiatric disorders that result after exposure to psychological trauma is enormous. The study of trauma-related disorders using neurobiological and public health approaches is often disjointed. It is critical to emphasize the translational potential of neurobiological work and its relevance to the public health burden of psychological trauma. Applying a public health model to traumatology that includes primary, secondary, and tertiary levels, we highlight ways in which advancing the field of neurobiology can pave the way for scalable interventions that can improve outcomes and help to address the public health problem.
Collapse
Affiliation(s)
- Teddy J. Akiki
- Clinical Neurosciences Division National Center for PTSD, United States Department of Veterans Affairs, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Lynnette A. Averill
- Clinical Neurosciences Division National Center for PTSD, United States Department of Veterans Affairs, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Chadi G. Abdallah
- Clinical Neurosciences Division National Center for PTSD, United States Department of Veterans Affairs, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
176
|
Hoopsick RA, Homish DL, Vest BM, Homish GG. Alcohol Use Among Never-Deployed U.S. Army Reserve and National Guard Soldiers: The Effects of Nondeployment Emotions and Sex. Alcohol Clin Exp Res 2018; 42:2413-2422. [PMID: 30381833 PMCID: PMC6286239 DOI: 10.1111/acer.13901] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/30/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Limited research shows that mental health problems are prevalent among never-deployed soldiers and many experience negative emotions related to their nondeployment. U.S. Army Reserve/National Guard (USAR/NG) soldiers are also at high risk for alcohol misuse. However, it is not known if nondeployment emotions contribute to an increased risk of alcohol misuse among never-deployed USAR/NG soldiers. METHODS Data are from Operation: SAFETY (Soldiers and Families Excelling Through the Years), an ongoing study of USAR/NG soldiers. We used regression models to examine the relations between nondeployment emotions, assessed by the Non-Deployment Emotions (NDE) Questionnaire, and a range of alcohol use outcomes, assessed by the Alcohol Use Disorders Identification Test and standard quantity and frequency questions, among a sample of never-deployed soldiers who were partnered at baseline (N = 174). Final models controlled for years of military service, current number of close military friends in the social network, marital satisfaction, and depression. We also tested for potential differences in these associations by sex. RESULTS Nondeployment emotions were associated with frequency of getting drunk (adjusted risk ratio [aRR] = 1.02, 95% CI: 1.01, 1.04; p < 0.05) and typical number of drinks consumed during a drinking episode (aRR = 1.03, 95% CI: 1.01, 1.04; p < 0.01). Nondeployment emotions had a trend-level association with percent of days drinking (adjusted odds ratio = 1.05, 95% CI: 1.00, 1.11; p = 0.055). Nondeployment emotions had a significant interaction with sex (p < 0.05) on the likelihood of alcohol problems, such that only male soldiers experienced a greater likelihood of alcohol problems when they had highly negative nondeployment emotions. There was no relation between nondeployment emotions and alcohol problems among female soldiers. CONCLUSIONS Findings demonstrate that greater nondeployment emotions are associated with increased alcohol use among never-deployed USAR/NG soldiers. The NDE Questionnaire may assist in identifying those at highest risk for alcohol problems.
Collapse
Affiliation(s)
- Rachel A. Hoopsick
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York
| | - Bonnie M. Vest
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York
| |
Collapse
|
177
|
Donoho CJ, LeardMann C, O'Malley CA, Walter KH, Riviere LA, Curry JF, Adler AB. Depression among military spouses: Demographic, military, and service member psychological health risk factors. Depress Anxiety 2018; 35:1137-1144. [PMID: 30103266 DOI: 10.1002/da.22820] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 06/20/2018] [Accepted: 07/01/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND More than a decade of war has strained service members and their families and the psychological health of military spouses is a concern. This study uses data from the largest study of military families in the United States to examine the demographic, military-specific, and service member mental health correlates of probable diagnosis of major depressive disorder (MDD) among military spouses. METHODS Data were from service member-spouse dyads from all branches of the U.S. military. Demographic and military-specific factors were assessed using administrative personnel records and survey data. RESULTS Of the 9,038 spouses, 4.9% had a probable diagnosis of MDD. In unadjusted models, spouses of service members who deployed and experiencecd combat-related events, were enlisted, had a probable posttraumatic stress disorder (PTSD) diagnosis, or screened positive for alcohol misuse were more likely to screen positive for MDD. In adjusted models, only spouses married to enlisted service members or those with PTSD had increased risk for MDD. Other demographic and military-related factors associated with MDD in spouses included less educational attainment, unemployment, having four or more children, and having prior military service (although not currently serving in the military) in the adjusted models. CONCLUSIONS Findings characterize demographic, military, and service member psychological health factors that are associated with depression among military spouses. These findings imply that deployment alone may not negatively affect military spouses, but rather it may be the mental health impact on the service member, especially PTSD that increases the odds for MDD among military spouses.
Collapse
Affiliation(s)
- Carrie J Donoho
- Deployment Health Research Department, Naval Health Research Center, San Diego, California.,Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Cynthia LeardMann
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Christopher A O'Malley
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | | | | | - John F Curry
- Veterans Integrated Service Network-6 Mental Illness Research, Education and Clinical Center, Durham, North Carolina
| | - Amy B Adler
- Walter Reed Army Institute of Research, Silver Spring, Maryland
| |
Collapse
|
178
|
Cogan AM, Huang J, Philip J. Military Service Member Perspectives About Occupational Therapy Treatment in a Military Concussion Clinic. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2018; 39:232-238. [PMID: 30465460 DOI: 10.1177/1539449218813849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study is to describe important features of occupational therapy practice for treatment of military service members with chronic symptoms and a history of mild traumatic brain injury (mTBI) in a military concussion care clinic from service members' perspectives with support from occupational therapy practitioners. Two series of focus groups were conducted with service members with chronic mTBI-related symptoms (n = 6) and practitioners (n = 5). Data were analyzed concurrently with collection. We identified five main themes: therapeutic relationship, consistent inclusion of family members, combat versus noncombat injuries, loss of military identity, and assessment against population norms. The findings of this study suggest that service members' evaluations of occupational therapy are based on the overall experience of the encounter, centered by the therapeutic relationship, rather than specific intervention strategies or technology.
Collapse
Affiliation(s)
| | - Janice Huang
- Naval Hospital Camp Pendleton, Salt Lake City, UT, USA
| | - Joyce Philip
- Naval Hospital Camp Pendleton, Salt Lake City, UT, USA
| |
Collapse
|
179
|
Military sexual trauma and suicidal behavior among National Guard personnel. Compr Psychiatry 2018; 87:1-6. [PMID: 30172073 DOI: 10.1016/j.comppsych.2018.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/13/2018] [Accepted: 08/17/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Preliminary evidence suggests military sexual trauma (MST) may be associated with increased risk for suicidal behaviors among active duty military personnel and veterans. Among National Guard personnel, a high-risk subgroup, MST and suicide risk have not received much empirical attention. PURPOSE To examine the association of MST with suicide ideation and suicide attempts among National Guard personnel. PROCEDURES N = 997 National Guard personnel from Idaho and Utah participated in an anonymous online survey. Weighted analyses were conducted to minimize sampling bias. MAIN FINDINGS 9% of participants had a history of MST (6% of men, 28% of women). Among participants reporting MST, 68% reported a service member perpetrator and 44% reported a civilian perpetrator (12% reported both). A history of MST was associated with significantly increased risk for lifetime suicide attempt. MST remained a significant predictor of lifetime suicide attempt even when restricting the sample to the subgroup with a history of suicidal thoughts (n = 257, 27% of full sample). When adjusting for premilitary sexual victimization, MST was no longer significantly associated with lifetime suicide attempts, but premilitary sexual victimization was. CONCLUSIONS The rate of MST among National Guard personnel is comparable to rates among active duty military personnel, although the perpetrators of MST are less likely to be service members. MST is a risk factor for suicide attempts, but premilitary sexual victimization is a relatively stronger risk factor.
Collapse
|
180
|
Sytine AI, Britt TW, Pury CLS, Rosopa PJ. Savouring as a moderator of the combat exposure-mental health symptoms relationship. Stress Health 2018; 34:582-588. [PMID: 29882382 DOI: 10.1002/smi.2822] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 04/26/2018] [Accepted: 05/08/2018] [Indexed: 11/10/2022]
Abstract
Engaging in firefights or witnessing death and other types of combat experiences are occupational hazards associated with Post Traumatic Stress Disorder (PTSD) and depression in military personnel returning from combat deployments. The present study examined savouring beliefs as a moderator of the relationship between combat exposure and mental health symptoms among U.S. Army soldiers deployed to Operation Iraqi Freedom and Operation Enduring Freedom. Soldiers (N = 885) completed measures of combat exposure, savouring beliefs, PTSD, and depression. Savouring was negatively related to symptoms of PTSD and depression and moderated the relationship between combat exposure and PTSD and depression among military personnel. These findings demonstrate that savouring positive life experiences may be beneficial to overall positive mental health and potentially buffer negative mental health symptoms related to traumatic experiences. Discussion focuses on the possibility of training individuals exposed to trauma in savouring techniques.
Collapse
|
181
|
Butler O, Herr K, Willmund G, Gallinat J, Zimmermann P, Kühn S. Neural correlates of response bias: Larger hippocampal volume correlates with symptom aggravation in combat-related posttraumatic stress disorder. Psychiatry Res Neuroimaging 2018; 279:1-7. [PMID: 30014966 DOI: 10.1016/j.pscychresns.2018.06.010] [Citation(s) in RCA: 6] [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] [Received: 11/30/2017] [Revised: 06/25/2018] [Accepted: 06/26/2018] [Indexed: 01/04/2023]
Abstract
The diagnosis of posttraumatic stress disorder (PTSD) is vulnerable to the simulation or exaggeration of symptoms as it depends on the individual's self-report of symptoms. The use of symptom validity tests is recommended to detect malingering in PTSD. However, in neuroimaging research, PTSD diagnosis is often taken at face validity. To date, no neuroimaging study has compared credible PTSD patients with those identified as malingering, and the potential impacts of including malingerers along with credible patients on results is unclear. We classified male patients with combat-related PTSD as either credible (n = 37) or malingerers (n = 9) based on the Morel Emotional Numbing Test and compared structural neuroimaging and psychological questionnaire data. Patients identified as malingerers had larger gray matter volumes in the hippocampus, right inferior frontal gyrus and thalamus, and reported higher PTSD symptoms than credible PTSD patients. This is the first structural neuroimaging study to compare credible PTSD patients and malingerers. We find evidence of structural differences between these groups, in regions implicated in PTSD, inhibition and deception. These results emphasize the need for the inclusion of SVTs in neuroimaging studies of PTSD to ensure future findings are not confounded by an unknown mix of valid PTSD patients and malingerers.
Collapse
Affiliation(s)
- Oisin Butler
- Max Planck Institute for Human Development, Center for Lifespan Psychology, Lentzeallee 94, Berlin 14195, Germany.
| | - Kerstin Herr
- Center for Military Mental Health, Military Hospital Berlin, Scharnhorststr. 13, Berlin 10115, Germany
| | - Gerd Willmund
- Center for Military Mental Health, Military Hospital Berlin, Scharnhorststr. 13, Berlin 10115, Germany
| | - Jürgen Gallinat
- University Medical Centre Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistrasse 52, Hamburg 20246, Germany
| | - Peter Zimmermann
- Center for Military Mental Health, Military Hospital Berlin, Scharnhorststr. 13, Berlin 10115, Germany
| | - Simone Kühn
- Max Planck Institute for Human Development, Center for Lifespan Psychology, Lentzeallee 94, Berlin 14195, Germany; University Medical Centre Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistrasse 52, Hamburg 20246, Germany
| |
Collapse
|
182
|
Shared gray matter reductions across alcohol use disorder and posttraumatic stress disorder in the anterior cingulate cortex: A dual meta-analysis. Neurobiol Stress 2018; 10:100132. [PMID: 30627600 PMCID: PMC6302237 DOI: 10.1016/j.ynstr.2018.09.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/18/2018] [Accepted: 09/21/2018] [Indexed: 02/08/2023] Open
Abstract
The considerable comorbidity of posttraumatic stress disorder (PTSD) and alcohol use disorders (AUD) poses a greater public health burden than either condition alone. Although there is a substantial body of evidence linking the direct neurotoxic effect of heavy drinking to gray matter (GM) deficits, as well as a growing body of literature supporting a strong association between PTSD and GM alterations, there is scant research interrogating the direct interaction of the two disorders. In order to generate data-driven, specific hypotheses regarding the overlapping neural substrates of PTSD and AUD, we conducted a meta-analysis of GM volumes in each disorder relative to healthy control subjects. We found shared GM deficits in the anterior cingulate cortex (ACC) across both disorders relative to healthy control participants. These findings suggest that reduced volumes of the ACC across PTSD and AUD may have implications for the development, expression, or treatment of symptoms linked to these frequently co-existing disorders. Recommendations are made for future work aimed at delineating the specific and shared effects of traumatic stress and alcoholism on neural integrity.
Collapse
|
183
|
Abstract
PURPOSE OF REVIEW We review the published literature over the last 24 months in the treatment of PTSD for our military men and women. We examined the updated clinical practice guidelines published in June 2017 by the Veteran's administration and Department of Defense and contrasted the guidelines with the most recent literature. We also discuss new directions in PTSD research. RECENT FINDINGS Psychotherapy remains one of the most effective treatments for PTSD; unfortunately, few participants remain in treatment to completion. Many of the emerging therapies target NMDA receptor antagonists, cannabinoid receptor modulators, glucocorticoid receptor agonists, non-SSRI antidepressants, and opioid receptor agonists. The newer therapies fall into the drug classes of anti-hypertensives, glutamate modulators, oxytocin, and medication targeting insomnia/hyperarousal. PTSD symptoms are often chronic in our veteran population. While current treatments are helpful, there are often significant residual symptoms. We reviewed the most recent improvements in treatment and discuss therapies that are in the research phase.
Collapse
Affiliation(s)
- Durga Bestha
- Department of Psychiatry, Atrium Health, Charlotte, NC, USA
| | - Layla Soliman
- Department of Psychiatry, Atrium Health, Charlotte, NC, USA
| | | | - James Rachal
- Department of Psychiatry, Atrium Health, Charlotte, NC, USA.
| |
Collapse
|
184
|
Steenkamp MM, Corry NH, Qian M, Li M, McMaster HS, Fairbank JA, Stander VA, Hollahan L, Marmar CR. Prevalence of psychiatric morbidity in United States military spouses: The Millennium Cohort Family Study. Depress Anxiety 2018; 35:815-829. [PMID: 29745445 DOI: 10.1002/da.22768] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 03/08/2018] [Accepted: 03/31/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Approximately half of US service members are married, equating to 1.1 million military spouses, yet the prevalence of psychiatric morbidity among military spouses remains understudied. We assessed the prevalence and correlates of eight mental health conditions in spouses of service members with 2-5 years of service. METHOD We employed baseline data from the Millennium Cohort Family Study, a 21-year longitudinal survey following 9,872 military-affiliated married couples representing all US service branches and active duty, Reserve, and National Guard components. Couples were surveyed between 2011 and 2013, a period of high military operational activity associated with Operation Iraqi Freedom and Operation Enduring Freedom. Primary outcomes included depression, anxiety, posttraumatic stress disorder (PTSD), panic, alcohol misuse, insomnia, somatization, and binge eating, all assessed with validated self-report questionnaires. RESULTS A total of 35.90% of military spouses met criteria for at least one psychiatric condition. The most commonly endorsed conditions were moderate-to-severe somatization symptoms (17.63%) and moderate-to-severe insomnia (15.65%). PTSD, anxiety, depression, panic, alcohol misuse, and binge eating were endorsed by 9.20%, 6.65%, 6.05%, 7.07%, 8.16%, and 5.23% of spouses, respectively. Having a partner who deployed with combat resulted in higher prevalence of anxiety, insomnia, and somatization. Spouses had lower prevalence of PTSD, alcohol misuse, and insomnia but higher rates of panic and binge eating than service members. Both members of a couple rarely endorsed having the same psychiatric problem. CONCLUSIONS One third of junior military spouses screened positive for one or more psychiatric conditions, underscoring the need for high-quality prevention and treatment services.
Collapse
Affiliation(s)
- Maria M Steenkamp
- New York University School of Medicine,, Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, New York, USA, NY
| | | | - Meng Qian
- New York University School of Medicine,, Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, New York, USA, NY
| | - Meng Li
- New York University School of Medicine,, Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, New York, USA, NY
| | - Hope Seib McMaster
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - John A Fairbank
- Mid-Atlantic (VISN 6) Mental Illness Research, Education and Clinical Center (MIRECC), Durham VA Medical Center, and UCLA-Duke University National Center for Child Traumatic Stress (NCCTS), Duke University School of Medicine, Durham, NC, USA
| | | | - Laura Hollahan
- New York University School of Medicine,, Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, New York, USA, NY
| | - Charles R Marmar
- New York University School of Medicine,, Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, New York, USA, NY
| |
Collapse
|
185
|
Wang J, Ursano RJ, Gonzalez OI, Russell DW, Dinh H, Hernandez L, Gifford RK, Cohen GH, Sampson L, Galea S, Fullerton CS. Association of suicidal ideation with trajectories of deployment-related PTSD symptoms. Psychiatry Res 2018; 267:455-460. [PMID: 29980124 DOI: 10.1016/j.psychres.2018.06.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 06/13/2018] [Accepted: 06/13/2018] [Indexed: 11/25/2022]
Abstract
This study examined the association between suicidal ideation and posttraumatic stress disorder (PTSD) symptom trajectories in a nationally representative sample of United States Reserve Component soldiers. PTSD symptoms related to a traumatic event during the most recent deployment were assessed in four annual waves in 2010-2013 among 682 Reserve Component soldiers. Latent Growth Mixture Modeling (LGMM) was used to examine the longitudinal trajectories of PTSD symptoms. The association between the PTSD trajectories and suicidal ideation at waves 2 to 4 was examined in logistic regression analyses. Four trajectories were identified: resilience (73.0%), recovery (11.7%), late onset (11.6%) and chronic (3.6%). Pairwise comparisons demonstrated significant differences between trajectories in risk of suicidal ideation. Among the chronic trajectory group, 50.9% reported suicidal ideation (25.8% late onset group; 11.3% recovery group; 4.0% resilience group). After controlling for baseline characteristics, the late onset and chronic trajectory groups were more likely to have suicidal ideation than the resilience and recovery trajectories, respectively. Findings suggest the late onset and chronic trajectories of PTSD symptoms are associated with higher risk of suicidal ideation. They support the importance of follow-up assessment of suicide risk even among individuals with low PTSD symptoms at homecoming.
Collapse
Affiliation(s)
- Jing Wang
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Robert J Ursano
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Oscar I Gonzalez
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Dale W Russell
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Hieu Dinh
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Lizabelle Hernandez
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Robert K Gifford
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Gregory H Cohen
- School of Public Health, Boston University, 715 Albany Street - Talbot 301, Boston, MA 02118, USA
| | - Laura Sampson
- School of Public Health, Boston University, 715 Albany Street - Talbot 301, Boston, MA 02118, USA
| | - Sandro Galea
- School of Public Health, Boston University, 715 Albany Street - Talbot 301, Boston, MA 02118, USA
| | - Carol S Fullerton
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| |
Collapse
|
186
|
Vest BM, Homish DL, Fillo J, Homish GG. Military status and alcohol problems: Former soldiers may be at greater risk. Addict Behav 2018; 84:139-143. [PMID: 29679924 PMCID: PMC5975126 DOI: 10.1016/j.addbeh.2018.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/11/2018] [Accepted: 04/11/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The goal of this study was to explore differences in alcohol problems as a function of military status (current soldier, previous soldier and civilian spouses), and the possible interaction between sex and military status. We hypothesized that 1) soldiers would be at greater risk for alcohol problems than civilian spouses, and 2) former soldiers would be at greater risk compared to current soldiers. METHODS Data were drawn from Operation: SAFETY, a longitudinal study examining physical and mental health among U.S. Army Reserve and National Guard soldiers and their partners. The analytic sample included male and female participants who completed both the baseline and first follow-up assessments (N = 772). Negative binomial regression models were used to examine differences between military status group on alcohol problems at follow-up, controlling for sex and alcohol consumption at baseline. Interactions between military status and sex were also examined. RESULTS Among current soldiers, males experienced significantly more alcohol problems compared to women (4.47, 3.46; p = 0.005). Likewise, among previous soldiers, males experienced significantly more alcohol problems compared to women (6.69, 2.92; p = 0.002). Male previous soldiers had significantly more alcohol problems compared to both male current soldiers and male civilian spouses (6.69, 4.47, p = 0.04; 6.69, 3.96; p = 0.02). Among women, there were no significant differences by military status. CONCLUSIONS Our results indicate that male previous soldiers are at greater risk of alcohol problems than both current soldiers and civilian spouses. Health care and service providers should consider screening and monitoring soldiers who separate from the military, as alcohol use may increase.
Collapse
Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, University at Buffalo, 77 Goodell Street, Suite 220, Buffalo, NY 14203, United States.
| | - D Lynn Homish
- Department of Community Health & Health Behavior, University at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo, NY 14214, United States
| | - Jennifer Fillo
- Research Institute on Addictions, 1021 Main Street, Buffalo, NY 14203, United States
| | - Gregory G Homish
- Department of Community Health & Health Behavior, University at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo, NY 14214, United States
| |
Collapse
|
187
|
Longitudinal patterns of PTSD symptom classes among US National Guard service members during reintegration. Soc Psychiatry Psychiatr Epidemiol 2018; 53:911-920. [PMID: 29947860 DOI: 10.1007/s00127-018-1542-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 05/28/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE The purpose of this study was to identify posttraumatic stress disorder (PTSD) symptom groups and assess their longitudinal progression during their first year of reintegration among United States (US) National Guard (NG) service members. METHODS A cohort of NG service members (n = 886) completed surveys at 6 and 12 months following their return from deployment to Iraq or Afghanistan. Latent class analysis (LCA) and latent transition analysis (LTA) were used to empirically derive groups based on their PTSD symptoms and examine their longitudinal course, respectively. RESULTS The best fitting model at both assessments was the four-class model, comprising an asymptomatic class (6 months = 54%; 12 months = 55%), a mild symptom class with elevated hyperarousal symptoms (6 months = 22%; 12 months = 17%), a moderate symptom class (6 months = 15%; 12 months = 15%), and a severe symptom class (6 months = 10%; 12 months = 13%). Based on LTA, stability of class membership at the two assessments was 0.797 for the asymptomatic class, 0.453 for the mild class, 0.560 for the moderate class, and 0.580 for the severe class. Estimated transition probabilities were greater with respect to transitioning to less severe, rather than more severe, classes over time. CONCLUSIONS The four latent PTSD classes were distinguished primarily by severity; however, the mild symptom class was characterized by higher levels of hyperarousal than other symptoms. Although the absolute number of individuals within classes remained fairly constant between 6 and 12 months, there was movement between severity classes. Most NG service members without symptoms continued to do well during the first year, with only an estimated 7% moving to the moderate or severe class.
Collapse
|
188
|
Toblin RL, Adrian AL, Hoge CW, Adler AB. Energy Drink Use in U.S. Service Members After Deployment: Associations With Mental Health Problems, Aggression, and Fatigue. Mil Med 2018; 183:e364-e370. [DOI: 10.1093/milmed/usy205] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Amanda L Adrian
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD
| | - Charles W Hoge
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD
| | - Amy B Adler
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD
| |
Collapse
|
189
|
Rosenblatt AS, Li R, Fortier C, Liu X, Fonda JR, Villalon A, McGlinchey RE, Jorge RE. Latent factor structure of PTSD symptoms in veterans with a history of mild traumatic brain injury and close-range blast exposure. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2018; 11:442-450. [PMID: 30113187 DOI: 10.1037/tra0000399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Confirmatory factor analysis (CFA) has previously been employed to examine the latent factor structure of posttraumatic stress disorder (PTSD) symptoms with mixed results. A limited number of studies examined PTSD factor structure among veterans of recent military conflicts. This study examined the relationship between PTSD factor structure and the hallmark conditions of these conflicts, mild traumatic brain injury (mTBI) and close-range blast exposure (CBE). METHOD The fit of previously proposed PTSD factor models was compared in a cohort of 387 combat-exposed veterans, with stratified analyses comparing factor structure models between those with a history of military-related mTBI and CBE (n = 106) and those without either of these antecedents (n = 151). CFAs were conducted using criteria from the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994). RESULTS The 4-factor emotional numbing (EN) model yielded the best fit when using a clinician-administered assessment of PTSD symptoms regardless of mTBI/CBE exposure status. However, when using a self-report measure of PTSD symptom severity, the EN model yielded best fit for those with mTBI/CBE exposure history while the 5-factor dysphoric arousal (DA) model was preferable among combat-exposed veterans with no history of mTBI/CBE exposure. CONCLUSIONS Factors including mTBI and blast exposure and type of assessment tools must be considered when determining preferable PTSD latent factor structure models. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Ruosha Li
- School of Public Health, University of Texas Health Science Center
| | | | - Xiangyu Liu
- School of Public Health, University of Texas Health Science Center
| | | | - Audri Villalon
- Translational Research Center for TBI and Stress Disorders
| | | | | |
Collapse
|
190
|
Britt TW, McGhee JS, Quattlebaum MD. Common mental disorders among US army aviation personnel: Prevalence and return to duty. J Clin Psychol 2018; 74:2173-2186. [PMID: 30088828 DOI: 10.1002/jclp.22688] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 05/21/2018] [Accepted: 06/19/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Assess the prevalence of US Army aviation personnel with common mental disorders, the percentage that return to duty following mental health treatment, and predictors of return to duty. METHODS Examined the prevalence over a 5-year period. The percentage of personnel who were granted a waiver to return to flying duty following treatment was also determined. RESULTS The results revealed a 5-year prevalence of 0.036 (95% CI = 0.034-0.038) for personnel experiencing one or more of the mental disorders (N = 1,155). Prevalence was highest for adjustment disorders and for nonpilot participants. Overall, personnel were granted a waiver 55.3% of the time and suspended or disqualified 44.7% of the time. Waivers were more likely to be granted for an adjustment disorder and for pilots. CONCLUSIONS Discussion focuses on the importance of aviation personnel receiving mental health treatment when problems are not severe to maximize the likelihood of returning to duty.
Collapse
Affiliation(s)
- Thomas W Britt
- United States Army Aeromedical Research Laboratory, Fort Rucker, Alabama
| | - James S McGhee
- United States Army Aeromedical Research Laboratory, Fort Rucker, Alabama
| | | |
Collapse
|
191
|
Ribeiro SP, LaCroix JM, De Oliveira F, Novak LA, Lee-Tauler SY, Darmour CA, Perera KU, Goldston DB, Weaver J, Soumoff A, Ghahramanlou-Holloway M. The Link between Posttraumatic Stress Disorder and Functionality among United States Military Service Members Psychiatrically Hospitalized Following a Suicide Crisis. Healthcare (Basel) 2018; 6:E95. [PMID: 30087239 PMCID: PMC6164520 DOI: 10.3390/healthcare6030095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 07/18/2018] [Accepted: 07/30/2018] [Indexed: 11/25/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is one of the most commonly diagnosed psychiatric disorders in the United States and has been linked to suicidal thoughts and behaviors, yet the role of a PTSD diagnosis on functional impairment among suicidal individuals remains unknown. This study examined the association between PTSD status and functional impairment among military psychiatric inpatients admitted for acute suicide risk (N = 166) with a lifetime history of at least one suicide attempt. Measures of functionality included: (1) alcohol use; (2) sleep quality; (3) social problem-solving; and (4) work and social adjustment. Thirty-eight percent of the sample met criteria for PTSD. Women were more likely than men to meet criteria for PTSD (p = 0.007), and participants who met PTSD criteria had significantly more psychiatric diagnoses (p < 0.001). Service members who met PTSD criteria reported more disturbed sleep (p = 0.003) and greater difficulties with work and social adjustment (p = 0.004) than those who did not meet PTSD criteria. However, functionality measures were not significantly associated with PTSD status after controlling for gender and psychiatric comorbidity. Gender and number of psychiatric comorbidities other than PTSD were significant predictors of PTSD in logistic regression models across four functionality measures. Future studies should assess the additive or mediating effect of psychiatric comorbidities in the association between impaired functioning and PTSD. Clinicians are encouraged to assess and address functionality during treatment with suicidal individuals, paying particular attention to individuals with multiple psychiatric diagnoses.
Collapse
Affiliation(s)
- Sissi Palma Ribeiro
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
| | - Jessica M LaCroix
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
| | - Fernanda De Oliveira
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
| | - Laura A Novak
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
| | - Su Yeon Lee-Tauler
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
| | - Charles A Darmour
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
| | - Kanchana U Perera
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
| | - David B Goldston
- Department of Psychiatry, Duke University, Durham, NC 27708, USA.
| | - Jennifer Weaver
- Inpatient Psychiatry, Fort Belvoir Community Hospital, VA 22060, USA.
| | - Alyssa Soumoff
- Department of Psychiatry, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
| | - Marjan Ghahramanlou-Holloway
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
| |
Collapse
|
192
|
Hawn SE, Kurtz ED, Brown E, Brown RC, Berenz EC, McDonald S, Pickett T, Kmett Danielson C, Amstadter A. A cluster-analytic approach to determining drinking motives and personality typologies: Trauma group differences and respective relations to PTSD and problematic alcohol use. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2018; 32:528-539. [PMID: 30024187 PMCID: PMC6383725 DOI: 10.1037/adb0000382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Veterans with posttraumatic stress disorder (PTSD) are at elevated risk for alcohol use problems, a relationship commonly explained by using alcohol to cope with unpleasant symptoms of PTSD. However, patterns of alcohol use motives, more broadly, have not been well characterized in veteran samples, nor have they been evaluated in the context of other relevant factors, such as normative personality traits. The aims of the present study were to identify empirically derived drinking motive and personality typologies to determine whether these typologies differ as a function of PTSD status (i.e., nontrauma control, trauma exposed-no PTSD, and PTSD) and to evaluate associations between typology and PTSD symptom severity and alcohol consumption, respectively. Cluster analyses identified a 4-cluster solution. Results indicated that these typologies differed significantly according to trauma group as well as across levels of PTSD symptom severity and alcohol use. Specifically, Cluster 4 represented individuals at highest risk for both PTSD symptom severity and alcohol use compared to all the other typologies; Cluster 1 demonstrated lowest risk for PTSD symptom severity and alcohol use compared to all other typologies; and although Clusters 2 and 3 did not differ according to PTSD symptom severity, individuals in Cluster 2 had significantly higher alcohol use. These results represent certain "at risk" versus "protective" typologies that may facilitate the identification of individuals at risk for comorbid PTSD and problematic alcohol use. (PsycINFO Database Record
Collapse
Affiliation(s)
- Sage E Hawn
- Virginia Institute for Psychiatric and Behavioral Genetics
| | | | - Emily Brown
- Virginia Institute for Psychiatric and Behavioral Genetics
| | - Ruth C Brown
- Virginia Institute for Psychiatric and Behavioral Genetics
| | | | | | | | | | | |
Collapse
|
193
|
Carpenter LL, Conelea C, Tyrka AR, Welch ES, Greenberg BD, Price LH, Niedzwiecki M, Yip AG, Barnes J, Philip NS. 5 Hz Repetitive transcranial magnetic stimulation for posttraumatic stress disorder comorbid with major depressive disorder. J Affect Disord 2018; 235:414-420. [PMID: 29677606 PMCID: PMC6567988 DOI: 10.1016/j.jad.2018.04.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/26/2018] [Accepted: 04/02/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Standard clinical protocols for repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder (MDD) apply 10 Hz pulses over left prefrontal cortex, yet little is known about the effects of rTMS in more diagnostically complex depressed patients. OBJECTIVE/HYPOTHESIS Posttraumatic stress disorder (PTSD) is commonly comorbid with MDD, and while rTMS has been shown to alleviate PTSD symptoms in preliminary studies, ideal parameters remain unclear. We conducted a prospective, open-label study of 5 Hz rTMS for patients with comorbid PTSD + MDD and hypothesized stimulation would reduce symptoms of both disorders. METHODS Outpatients (N = 40) with PTSD + MDD and at least moderate global severity were enrolled. 5 Hz rTMS included up to 40 daily sessions followed by a 5-session taper. Symptoms were measured using the PTSD Checklist (PCL-5) and Inventory of Depressive Symptomatology, Self-Report (IDS-SR). Baseline-to-endpoint changes were analyzed. RESULTS The intent-to-treat population included 35 participants. Stimulation significantly reduced PTSD symptoms (PCL-5 baseline mean ± SD score 52.2 ± 13.1 versus endpoint 34.0 ± 21.6; p < .001); 23 patients (48.6%) met a pre-defined categorical PTSD response criteria. MDD symptoms also improved significantly (IDS-SR, baseline 47.8 ± 11.9 to endpoint 30.9 ± 18.9; p < .001); 15 patients (42.9%) demonstrated categorical response and 12 (34.3%) remitted. PTSD and MDD symptom change was highly correlated (r = 0.91, p < .001). LIMITATIONS Unblinded single-arm study, with modest sample size. CONCLUSION Significant and clinically meaningful reductions in both MDD and PTSD symptoms were observed following stimulation. The preliminary efficacy of 5 Hz rTMS for both symptom domains in patients with comorbid disorders supports future controlled studies.
Collapse
Affiliation(s)
- Linda L. Carpenter
- Butler Hospital, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University,Address correspondence to Linda L. Carpenter, M.D., Butler Hospital, 345 Blackstone Blvd, Providence RI 02906; 401.455.6349;
| | - Christine Conelea
- Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence RI,Bradley Hospital, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Audrey R. Tyrka
- Butler Hospital, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Emma S. Welch
- Butler Hospital, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Benjamin D. Greenberg
- Butler Hospital, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University,Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence RI
| | - Lawrence H. Price
- Butler Hospital, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Matthew Niedzwiecki
- Butler Hospital, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Agustin G. Yip
- Butler Hospital, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Jennifer Barnes
- Butler Hospital, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Noah S. Philip
- Butler Hospital, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University,Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence RI
| |
Collapse
|
194
|
Levin-Rector A, Hourani LL, Van Dorn RA, Bray RM, Stander VA, Cartwright JK, Morgan JK, Trudeau J, Lattimore PK. Predictors of Posttraumatic Stress Disorder, Anxiety Disorders, Depressive Disorders, and Any Mental Health Condition Among U.S. Soldiers and Marines, 2001-2011. J Trauma Stress 2018; 31:568-578. [PMID: 30025180 DOI: 10.1002/jts.22316] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 04/27/2018] [Accepted: 04/28/2018] [Indexed: 11/10/2022]
Abstract
Understanding mental health disorder diagnosis and treatment seeking among active-duty military personnel is a topic with both clinical and policy implications. It has been well documented in military populations that individual-level military experience, including deployment history and combat exposure, influences mental health outcomes, but the impact of unit-level factors is less well understood. In the current study, we used administrative longitudinal data to examine a comprehensive set of unit- and individual-level predictors of posttraumatic stress disorder (PTSD), non-PTSD anxiety disorders, depressive disorders, and overall mental health diagnoses among Army and Marines Corps personnel. Using Cox survival models for time-dependent variables, we analyzed time from military accession (between January 1, 2001 and December 31, 2011) until first mental health diagnosis for 773,359 soldiers and 332,093 Marines. Prior diagnosis of a substance abuse disorder during one's military career, hazard ratios (HRs) = 1.68-3.10, and cumulative time spent deployed, HRs = 1.11-2.04, were the most predictive risk factors for all outcomes. Male sex, HRs = 0.35-0.57, and officer rank, HRs = 0.13-0.23, were the most protective factors. Unit-level rate of high deployment stress was a small but significant predictor of all outcomes after controlling for individual-level deployment history and other predictors, HRs = 1.01-1.05. Findings suggest both unit- and individual-level risk and protective factors of mental health diagnoses associated with treatment seeking. Clinical, including mental health assessment and management, and policy implications related to the military environment and the individual as it relates to mental health disorders are discussed.
Collapse
Affiliation(s)
| | | | | | - Robert M Bray
- RTI International, Research Triangle Park, North Carolina, USA
| | | | | | | | - James Trudeau
- RTI International, Research Triangle Park, North Carolina, USA
| | | |
Collapse
|
195
|
Stowell DR, Owens GP, Burnett A. A pilot horticultural therapy program serving veterans with mental health issues: Feasibility and outcomes. Complement Ther Clin Pract 2018; 32:74-78. [PMID: 30057063 DOI: 10.1016/j.ctcp.2018.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/16/2018] [Accepted: 05/24/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE Veterans face challenges when returning from deployment. Many have mental health difficulties because of their service and may have significant effects on veterans' lives. Horticultural therapy has been shown to be an effective treatment for these mental health conditions. MATERIALS AND METHODS The current study was a 5-week pilot conducted in the United States to assess a horticultural therapy program for veterans with mental health issues. RESULTS Eight veterans completed the full 5-week pilot program. Participants reported significantly lower depression [M = 6.25 (SD = 5.23); t = 3.38, p = .01] and stress [M = 5.00 (SD = 2.56); t = 5.52, p = .001] on the Depression, Anxiety, Stress Scales. CONCLUSION Participants provided positive feedback about the program and indicated that it was beneficial for them. Future research should be conducted with a larger sample size and control group to further validate these results.
Collapse
Affiliation(s)
- Derrick R Stowell
- Department of Plant Sciences, University of Tennessee Gardens, University of Tennessee Institute of Agriculture, Knoxville, TN, USA.
| | - Gina P Owens
- Department of Psychology, University of Tennessee, Knoxville, TN, USA
| | - Amelia Burnett
- Department of Plant Sciences, University of Tennessee Gardens, University of Tennessee Institute of Agriculture, Knoxville, TN, USA
| |
Collapse
|
196
|
Ursano RJ, Naifeh JA, Kessler RC, Gonzalez OI, Fullerton CS, Mash HH, Riggs-Donovan CA, Ng THH, Wynn GH, Dinh HM, Kao TC, Sampson NA, Heeringa SG, Stein MB. Nonfatal Suicidal Behaviors in the Administrative Records of Activated U.S. Army National Guard and Army Reserve Soldiers, 2004-2009. Psychiatry 2018; 81:173-192. [PMID: 30028239 PMCID: PMC6880748 DOI: 10.1080/00332747.2018.1460716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The U.S. Army suicide rate increased sharply during the wars in Iraq and Afghanistan. There is limited information about medically documented, nonfatal suicidal behaviors among soldiers in the Army's Reserve Component (RC), which is composed of the Army National Guard and Army Reserve. Here we examine trends and sociodemographic correlates of suicide attempts, suspicious injuries, and suicide ideation among activated RC soldiers. METHODS Data come from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) Historical Administrative Data Study (HADS), which integrates administrative records for all soldiers on active duty for the years 2004 through 2009 (n = 1.66 million). RESULTS We identified 2,937 unique RC soldiers on active duty with a nonfatal suicidal event documented at some point during the HADS study period. There were increases in the annual incidence rates of suicide attempts (71 to 204/100,000 person-years) and suicide ideation (326 to 425/100,000 person-years). Incidence rates for suspicious injuries also generally increased but were more variable. Using hierarchical classification rules, we identified the first instance of each soldier's most severe behavior (suicide attempt versus suspicious injury versus suicide ideation). For each of those suicide- or injury-related outcomes, we found increased risk among those who were female, younger, non-Hispanic White, less educated, never married, and lower-ranking enlisted. These sociodemographic associations significantly differed across outcomes, although the patterns were similar. CONCLUSION Results provide a broad overview of nonfatal suicidal trends in the RC during the period 2004 through 2009. They also demonstrate that integration of multiple administrative data systems enriches analysis of the predictors of such events.
Collapse
|
197
|
Blakey SM, Wagner HR, Naylor J, Brancu M, Lane I, Sallee M, Kimbrel NA, Elbogen EB. Chronic Pain, TBI, and PTSD in Military Veterans: A Link to Suicidal Ideation and Violent Impulses? THE JOURNAL OF PAIN 2018; 19:797-806. [PMID: 29526669 PMCID: PMC6026045 DOI: 10.1016/j.jpain.2018.02.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/07/2018] [Accepted: 02/27/2018] [Indexed: 12/17/2022]
Abstract
The polytrauma clinical triad refers to the co-occurrence of chronic pain, traumatic brain injury (TBI), and posttraumatic stress disorder (PTSD). Despite research implicating dyadic relationships between these conditions and adverse outcomes, scant research has examined the polytrauma clinical triad's relation to suicide or violence. The present cross-sectional study was designed to examine whether this complex clinical presentation increases risk of suicidal ideation and violent impulses after accounting for other established risk factors. Veterans who served in the military since September 11, 2001 (N = 667) who reported chronic pain completed an interview and self-report battery. Bivariate analyses showed that suicidal ideation and violent impulses both correlated with PTSD, TBI+PTSD, pain intensity and interference, drug abuse, and major depressive disorder (MDD). Multiple regression analyses showed that: 1) race, chronic pain with PTSD, alcohol abuse, and MDD significantly predicted suicidal ideation, 2) pain interference, chronic pain with TBI, chronic pain with PTSD, chronic pain with TBI+PTSD, drug abuse, and MDD significantly predicted violent impulses, and 3) pain interference was a more critical predictor of suicidal and violent ideation than pain intensity. Implications for risk assessment and treatment are discussed. PERSPECTIVE This article presents results from a study examining predictors of suicide and violence risk among a sample of post-9/11 U.S. Veterans with chronic pain. Health care professionals should assess for pain interference, TBI, PTSD, depression, and alcohol/drug abuse when conducting risk assessments with this population.
Collapse
Affiliation(s)
- Shannon M Blakey
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - H Ryan Wagner
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Jennifer Naylor
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Mira Brancu
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Ilana Lane
- Durham VA Medical Center, Durham, North Carolina
| | | | - Nathan A Kimbrel
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Eric B Elbogen
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
198
|
Lee DJ, Kearns JC, Wisco BE, Green JD, Gradus JL, Sloan DM, Nock MK, Rosen RC, Keane TM, Marx BP. A longitudinal study of risk factors for suicide attempts among Operation Enduring Freedom and Operation Iraqi Freedom veterans. Depress Anxiety 2018; 35:609-618. [PMID: 29637667 DOI: 10.1002/da.22736] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 11/21/2017] [Accepted: 01/25/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Suicide rates among veterans have increased markedly since the onset of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF; LeardMann et al., 2013). Identification of factors with the greatest contribution to suicide risk among veterans is needed to inform risk assessment and to identify intervention targets. METHODS This study examined predictors of suicide attempts among participants in the Veterans After-Discharge Longitudinal Registry; a nationwide cohort of OEF/OIF veterans enrolled in Department of Veterans Affairs (VA) services. Veterans with and without probable posttraumatic stress disorder (PTSD) were sampled at a 3:1 ratio, and male and female veterans were sampled at a 1:1 ratio. Participants (N = 1,649) were assessed at two time points, roughly 2 years apart (M = 28.74 months, SD = 8.72). RESULTS Seventy-four participants (4.49%) attempted suicide during the follow-up period. The strongest predictors of suicide attempts among the full sample were suicidal intent, attempt history, suicide ideation, PTSD symptoms, alcohol use disorder (AUD) symptoms, and depression. Veterans with multiple risk factors were particularly vulnerable; of veterans with 0, ≥1, ≥2, ≥3, or ≥ 4 of these risk factors, 0%, 7.81%, 10.31%, 18.45%, and 20.51% made a suicide attempt, respectively. CONCLUSIONS This prospective study identified several strong predictors of suicide attempts among OEF/OIF veterans which may be important targets for suicide prevention efforts. Further, co-occurrence of multiple risk factors was associated with markedly greater risk for suicide attempts; veterans with multiple risk factors appear to be at the highest risk among OEF/OIF veterans enrolled in VA care.
Collapse
Affiliation(s)
- Daniel J Lee
- National Center for PTSD, Boston, MA, USA.,VA Boston Healthcare System, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Jaclyn C Kearns
- VA Boston Healthcare System, Boston, MA, USA.,Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester, NY, USA
| | - Blair E Wisco
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Jonathan D Green
- VA Boston Healthcare System, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Jaimie L Gradus
- National Center for PTSD, Boston, MA, USA.,VA Boston Healthcare System, Boston, MA, USA
| | - Denise M Sloan
- National Center for PTSD, Boston, MA, USA.,VA Boston Healthcare System, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | | | - Terence M Keane
- National Center for PTSD, Boston, MA, USA.,VA Boston Healthcare System, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Brian P Marx
- National Center for PTSD, Boston, MA, USA.,VA Boston Healthcare System, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
199
|
Masheb RM, Ruser CB, Min KM, Bullock AJ, Dorflinger LM. Does food addiction contribute to excess weight among clinic patients seeking weight reduction? Examination of the Modified Yale Food Addiction Survey. Compr Psychiatry 2018; 84:1-6. [PMID: 29654930 DOI: 10.1016/j.comppsych.2018.03.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/05/2018] [Accepted: 03/16/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite controversy surrounding the construct of food addiction, its relationship with obesity and the validity of the Yale Food Addiction Scale (YFAS), have become emerging fields of study. No prior research has examined the prevalence and correlates of food addiction, and validation of the Modified Yale Food Addiction Scale (mYFAS), in a non-research based weight management clinic setting. OBJECTIVE The current study sought to examine the validity of a brief version of the Yale Food Addiction Scale in weight loss seeking patients, and to determine whether food addiction contributes to excess weight in this patient population. PARTICIPANTS The sample consisted of 126 Veterans with overweight/obesity who attended an orientation session for a weight management program. Participants (mean age = 61.8 years, mean BMI = 38.0, male = 89.7%, Caucasian = 76.0%) completed questionnaires related to food addiction, weight and eating, and mental health and behavior. RESULTS Ten percent of the sample met diagnostic threshold for food addiction. Correlational analysis revealed that food addiction was significantly and highly correlated with BMI, emotional eating, night eating and screens for depression and insomnia (p's < 0.001); significantly correlated with eating pathology, and screening for PTSD (p's < 0.05); and inversely correlated with screening for alcohol use disorders (p < 0.01). The prevalence of food addiction was significantly higher in participants with Binge Eating Disorder (75%) compared to participants without (5.4%; p < 0.001). Food addiction uniquely accounted for 15% of the variance of BMI, almost three times more than general eating disorder pathology. DISCUSSION This study provides further evidence for the validity of the mYFAS, and clinical significance of the food addiction construct among weight loss seeking patients in non-research based weight management settings. Findings confirm that food addiction contributes to excess weight among clinic patients seeking weight reduction above and beyond the effects of disordered eating. It is recommended that clinicians and researchers consider an addiction framework for addressing comorbid overweight and food addiction among afflicted individuals seeking weight loss.
Collapse
Affiliation(s)
- Robin M Masheb
- VA Connecticut Healthcare System, West Haven, CT, United States; Yale School of Medicine, New Haven, CT, United States.
| | - Christopher B Ruser
- VA Connecticut Healthcare System, West Haven, CT, United States; Yale School of Medicine, New Haven, CT, United States
| | - Kathryn M Min
- VA Connecticut Healthcare System, West Haven, CT, United States
| | | | | |
Collapse
|
200
|
Campbell-Sills L, Ursano RJ, Kessler RC, Sun X, Heeringa SG, Nock MK, Sampson NA, Jain S, Stein MB. Prospective risk factors for post-deployment heavy drinking and alcohol or substance use disorder among US Army soldiers. Psychol Med 2018; 48:1624-1633. [PMID: 29039285 PMCID: PMC6620021 DOI: 10.1017/s0033291717003105] [Citation(s) in RCA: 12] [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] [Indexed: 01/12/2023]
Abstract
BACKGROUND Investigations of drinking behavior across military deployment cycles are scarce, and few prospective studies have examined risk factors for post-deployment alcohol misuse. METHODS Prevalence of alcohol misuse was estimated among 4645 US Army soldiers who participated in a longitudinal survey. Assessment occurred 1-2 months before soldiers deployed to Afghanistan in 2012 (T0), upon their return to the USA (T1), 3 months later (T2), and 9 months later (T3). Weights-adjusted logistic regression was used to evaluate associations of hypothesized risk factors with post-deployment incidence and persistence of heavy drinking (HD) (consuming 5 + alcoholic drinks at least 1-2×/week) and alcohol or substance use disorder (AUD/SUD). RESULTS Prevalence of past-month HD at T0, T2, and T3 was 23.3% (s.e. = 0.7%), 26.1% (s.e. = 0.8%), and 22.3% (s.e. = 0.7%); corresponding estimates for any binge drinking (BD) were 52.5% (s.e. = 1.0%), 52.5% (s.e. = 1.0%), and 41.3% (s.e. = 0.9%). Greater personal life stress during deployment (e.g., relationship, family, or financial problems) - but not combat stress - was associated with new onset of HD at T2 [per standard score increase: adjusted odds ratio (AOR) = 1.20, 95% CI 1.06-1.35, p = 0.003]; incidence of AUD/SUD at T2 (AOR = 1.54, 95% CI 1.25-1.89, p < 0.0005); and persistence of AUD/SUD at T2 and T3 (AOR = 1.30, 95% CI 1.08-1.56, p = 0.005). Any BD pre-deployment was associated with post-deployment onset of HD (AOR = 3.21, 95% CI 2.57-4.02, p < 0.0005) and AUD/SUD (AOR = 1.85, 95% CI 1.27-2.70, p = 0.001). CONCLUSIONS Alcohol misuse is common during the months preceding and following deployment. Timely intervention aimed at alleviating/managing personal stressors or curbing risky drinking might reduce risk of alcohol-related problems post-deployment.
Collapse
Affiliation(s)
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of
Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD,
USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School,
Boston, MA, USA
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University
of California San Diego, La Jolla, CA, USA
| | - Steven G. Heeringa
- University of Michigan, Institute for Social Research, Ann
Arbor, MI, USA
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge,
MA, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School,
Boston, MA, USA
| | - Sonia Jain
- Department of Family Medicine and Public Health, University
of California San Diego, La Jolla, CA, USA
| | - Murray B. Stein
- Department of Psychiatry, University of California San
Diego, La Jolla, CA, USA
- Department of Family Medicine and Public Health, University
of California San Diego, La Jolla, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| |
Collapse
|