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Jazowski SA, Sico IP, Lindquist JH, Smith VA, Bosworth HB, Danus S, Provenzale D, Kelley MJ, Zullig LL. Transportation as a barrier to colorectal cancer care. BMC Health Serv Res 2021; 21:332. [PMID: 33849524 PMCID: PMC8045363 DOI: 10.1186/s12913-021-06339-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 03/31/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Transportation barriers limit access to cancer care services and contribute to suboptimal clinical outcomes. Our objectives were to describe the frequency of Veterans reporting and the factors associated with transportation barriers to or from colorectal cancer (CRC) care visits. METHODS Between November 2015 and September 2016, Veterans with incident stage I, II, or III CRC completed a mailed survey to assess perceived barriers to recommended care. Participants who reported difficulty with transportation to or from CRC care appointments were categorized as experiencing transportation barriers. We assessed pairwise correlations between transportation barriers, transportation-related factors (e.g., mode of travel), and chaotic lifestyle (e.g., predictability of schedules), and used logistic regression to examine the association between the reporting of transportation difficulties, distance traveled to the nearest Veterans Affairs (VA) facility, and life chaos. RESULTS Of the 115 Veterans included in this analysis, 18% reported experiencing transportation barriers. Distance to the VA was not strongly correlated with the reporting of transportation barriers (Spearman's ρ = 0.12, p = 0.19), but chaotic lifestyle was both positively and significantly correlated with experiencing transportation barriers (Spearman's ρ = 0.22, p = 0.02). Results from the logistic regression model modestly supported the findings from the pairwise correlations, but were not statistically significant. CONCLUSIONS Transportation is an important barrier to or from CRC care visits, especially among Veterans who experience greater life chaos. Identifying Veterans who experience chaotic lifestyles would allow for timely engagement in behavioral interventions (e.g., organizational skills training) and with support services (e.g., patient navigation).
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Affiliation(s)
- Shelley A Jazowski
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27701, USA
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Isabelle P Sico
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27701, USA
| | - Jennifer H Lindquist
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Valerie A Smith
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27701, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Hayden B Bosworth
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27701, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Division of General Internal Medicine, Duke University, Durham, NC, USA
- School of Nursing, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Susanne Danus
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Dawn Provenzale
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine, Division of Gastroenterology, Duke University School of Medicine, Durham, NC, USA
- Cooperative Studies Program Epidemiology Center, Durham, NC, USA
| | - Michael J Kelley
- Department of Veterans Affairs, Specialty Care Services, Washington, DC, USA
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Division of Medical Oncology, Duke University School of Medicine, Durham, NC, USA
| | - Leah L Zullig
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27701, USA.
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA.
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Pfeiffer PN, Pope B, Houck M, Benn-Burton W, Zivin K, Ganoczy D, Kim HM, Walters H, Emerson L, Nelson CB, Abraham KM, Valenstein M. Effectiveness of Peer-Supported Computer-Based CBT for Depression Among Veterans in Primary Care. Psychiatr Serv 2020; 71:256-262. [PMID: 31931686 DOI: 10.1176/appi.ps.201900283] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study tested whether computerized cognitive-behavioral therapy for depression supported by a peer specialist with lived experience of depression (PS-cCBT) improves mental health-related outcomes for primary care patients. METHODS In the U.S. Department of Veterans Affairs, primary care patients with a new diagnosis of depression (N=330) were randomly assigned to 3 months of PS-cCBT or a usual-care control condition. Linear mixed-effects models were used to assess differences in depression symptoms, general mental health status, quality of life, and mental health recovery measured at baseline and 3 and 6 months. RESULTS In adjusted analyses, participants who received PS-cCBT experienced 1.4 points' (95% confidence interval [CI]=0.3-2.5, p=0.01) greater improvement in depression symptoms on the Quick Inventory of Depression Symptomatology-Self Report at 3 months, compared with the control group, but no significant difference was noted at 6 months. PS-cCBT recipients also had 2.6 points' (95% CI=0.5-4.8, p=0.02) greater improvement in quality of life at 3 months on the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form and greater improvement in recovery on the Recovery Assessment Scale at 3 months (3.6 points; 95% CI=0.9-6.2, p=0.01) and 6 months (4.5 points; 95% CI=1.2-7.7, p=0.01). CONCLUSIONS PS-cCBT is an effective option for improving short-term depression symptoms and longer-term recovery among primary care patients newly diagnosed as having depression.
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Affiliation(s)
- Paul N Pfeiffer
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
| | - Brooke Pope
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
| | - Marc Houck
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
| | - Wendy Benn-Burton
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
| | - Kara Zivin
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
| | - Dara Ganoczy
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
| | - H Myra Kim
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
| | - Heather Walters
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
| | - Lauren Emerson
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
| | - C Beau Nelson
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
| | - Kristen M Abraham
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
| | - Marcia Valenstein
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
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Kotzias V, Engel CC, Ramchand R, Ayer L, Predmore Z, Ebener P, Haas GL, Kemp JE, Karras E. Mental Health Service Preferences and Utilization Among Women Veterans in Crisis: Perspectives of Veterans Crisis Line Responders. J Behav Health Serv Res 2019; 46:29-42. [PMID: 30298442 DOI: 10.1007/s11414-018-9635-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Women military veterans are at increased risk of suicide compared to non-veterans, but little is known about the mental health service preferences and needs of women veterans in crisis. This study used qualitative, secondary source key informant interviews to ascertain the experiences of women veterans in crisis from 54 responders working at the Veterans Crisis Line. Responders indicated that women veterans reported different experiences with Veterans Administration (VA) and non-VA care, though drivers of satisfaction or dissatisfaction were similar. Availability of specialty care, sensitivity to veterans' issues or Military Sexual Trauma, strong provider relationships, and continuity of care contributed to satisfaction; lengthy appointment wait times, limited service options, and insensitivity to veterans' issues contributed to dissatisfaction. Responders suggested that barriers limiting VA access for women veterans are perceived as similar to non-VA care. Findings suggest that caller experiences with providers drive satisfaction with VA and non-VA mental health services.
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Affiliation(s)
| | - Charles C Engel
- RAND Corporation, 20 Park Plaza, 9th Floor, Suite 920, Boston, MA, 02116, USA
| | - Rajeev Ramchand
- RAND Corporation, 1200 S. Hayes St., Arlington, VA, 22202, USA
| | - Lynsay Ayer
- RAND Corporation, 1200 S. Hayes St., Arlington, VA, 22202, USA
| | | | - Patricia Ebener
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401-3208, USA
| | - Gretchen L Haas
- VISN 4 MIRECC, Department of Veterans Affairs, 323 North Shore Drive, Suite 400, Pittsburgh, PA, 15212, USA
| | - Janet E Kemp
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, 400 Fort Hill Ave, Canandaigua, NY, 14424, USA
| | - Elizabeth Karras
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, 400 Fort Hill Ave, Canandaigua, NY, 14424, USA
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Pfeiffer PN, Valenstein M, Ganoczy D, Henry J, Dobscha SK, Piette JD. Pilot study of enhanced social support with automated telephone monitoring after psychiatric hospitalization for depression. Soc Psychiatry Psychiatr Epidemiol 2017; 52:183-191. [PMID: 27783130 DOI: 10.1007/s00127-016-1288-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 10/10/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Following discharge, patients hospitalized for depression are at high risk for poor retention in outpatient care and adverse outcomes. AIMS Pilot tests a post-hospital monitoring and enhanced support program for depression. METHOD 48 patients at a Veterans Affairs Medical Center discharged following a depression-related inpatient stay received weekly visits or phone calls for 6 months from their choice of either a family member/friend (n = 19) or a certified peer support specialist (n = 29). Participants also completed weekly automated telephone monitoring calls assessing depressive symptoms and antidepressant medication adherence. RESULTS Over 90% of participants were more satisfied with their care due to the service. The mean change from baseline to 6 months in depression symptoms was -7.9 (p < 0.05) according to the Patient Health Questionnaire and -11.2 (p < 0.05) according to the Beck Depression Inventory-II for those supported by a family member/friend, whereas those supported by a peer specialist had mean changes of -3.5 (p < 0.05) and -1.7 (p > 0.10), respectively. CONCLUSIONS Increased contact with a chosen support person coupled with automated telephone monitoring after psychiatric hospitalization is an acceptable service for patients with depression. Those who received the service, and particularly those supported by a family member/friend, experienced reductions in symptoms of depression.
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Affiliation(s)
- Paul N Pfeiffer
- University of Michigan Medical School, Ann Arbor, MI, USA. .,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
| | - Marcia Valenstein
- University of Michigan Medical School, Ann Arbor, MI, USA.,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Dara Ganoczy
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jennifer Henry
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Steven K Dobscha
- VA Center for Veteran Involvement in Care, Portland Veterans Affairs Medical Center, Portland, MI, USA.,Oregon Health & Science University, Portland, OR, USA
| | - John D Piette
- University of Michigan Medical School, Ann Arbor, MI, USA.,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,University of Michigan School of Public Health, Ann Arbor, MI, USA
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Sripada RK, Bowersox NW, Ganoczy D, Valenstein M, Pfeiffer PN. Self-Determination Theory and Outpatient Follow-Up After Psychiatric Hospitalization. Community Ment Health J 2016; 52:662-6. [PMID: 26319610 DOI: 10.1007/s10597-015-9929-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 08/11/2015] [Indexed: 11/28/2022]
Abstract
The objective of this study was to assess whether the constructs of self-determination theory-autonomy, competence, and relatedness-are associated with adherence to outpatient follow-up appointments after psychiatric hospitalization. 242 individuals discharged from inpatient psychiatric treatment within the Veterans Health Administration completed surveys assessing self-determination theory constructs as well as measures of depression and barriers to treatment. Medical records were used to count the number of mental health visits and no-shows in the 14 weeks following discharge. Logistic regression models assessed the association between survey items assessing theory constructs and attendance at mental healthcare visits. In multivariate models, none of the self-determination theory factors predicted outpatient follow-up attendance. The constructs of self-determination theory as measured by a single self-report survey may not reliably predict adherence to post-hospital care. Need factors such as depression may be more strongly predictive of treatment adherence.
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Affiliation(s)
- Rebecca K Sripada
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48109, USA. .,VA Ann Arbor Health Care System, Ann Arbor, MI, USA. .,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
| | - Nicholas W Bowersox
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48109, USA.,VA Ann Arbor Health Care System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Dara Ganoczy
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48109, USA.,VA Ann Arbor Health Care System, Ann Arbor, MI, USA
| | - Marcia Valenstein
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48109, USA.,VA Ann Arbor Health Care System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Paul N Pfeiffer
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48109, USA.,VA Ann Arbor Health Care System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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