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Bagg MK, Hicks AJ, Hellewell SC, Ponsford JL, Lannin NA, O'Brien TJ, Cameron PA, Cooper DJ, Rushworth N, Gabbe BJ, Fitzgerald M. The Australian Traumatic Brain Injury Initiative: Statement of Working Principles and Rapid Review of Methods to Define Data Dictionaries for Neurological Conditions. Neurotrauma Rep 2024; 5:424-447. [PMID: 38660461 PMCID: PMC11040195 DOI: 10.1089/neur.2023.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
The Australian Traumatic Brain Injury Initiative (AUS-TBI) aims to develop a health informatics approach to collect data predictive of outcomes for persons with moderate-severe TBI across Australia. Central to this approach is a data dictionary; however, no systematic reviews of methods to define and develop data dictionaries exist to-date. This rapid systematic review aimed to identify and characterize methods for designing data dictionaries to collect outcomes or variables in persons with neurological conditions. Database searches were conducted from inception through October 2021. Records were screened in two stages against set criteria to identify methods to define data dictionaries for neurological conditions (International Classification of Diseases, 11th Revision: 08, 22, and 23). Standardized data were extracted. Processes were checked at each stage by independent review of a random 25% of records. Consensus was reached through discussion where necessary. Thirty-nine initiatives were identified across 29 neurological conditions. No single established or recommended method for defining a data dictionary was identified. Nine initiatives conducted systematic reviews to collate information before implementing a consensus process. Thirty-seven initiatives consulted with end-users. Methods of consultation were "roundtable" discussion (n = 30); with facilitation (n = 16); that was iterative (n = 27); and frequently conducted in-person (n = 27). Researcher stakeholders were involved in all initiatives and clinicians in 25. Importantly, only six initiatives involved persons with lived experience of TBI and four involved carers. Methods for defining data dictionaries were variable and reporting is sparse. Our findings are instructive for AUS-TBI and can be used to further development of methods for defining data dictionaries.
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Affiliation(s)
- Matthew K. Bagg
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health Sciences, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Amelia J. Hicks
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Sarah C. Hellewell
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
| | - Jennie L. Ponsford
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Natasha A. Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Terence J. O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Peter A. Cameron
- National Trauma Research Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - D. Jamie Cooper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Nick Rushworth
- Brain Injury Australia, Sydney, New South Wales, Australia
| | - Belinda J. Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, United Kingdom
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
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Cooper DC, Campbell MS, Case SR, Fraine MC, Jones RA, Klein IF, Hoyt T. Outcome metrics utilized in evaluations of programs and interventions for combat and operational stress: A review of psychometric properties. MILITARY PSYCHOLOGY 2024; 36:227-237. [PMID: 38377250 PMCID: PMC10880499 DOI: 10.1080/08995605.2022.2117537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 08/23/2022] [Indexed: 10/15/2022]
Abstract
The Department of Defense has mandated combat and operational stress control (COSC) efforts for the Services since 1999. Although several COSC-related programs have been implemented, few have undergone evaluation, and no standardized metrics have been established to assess their effectiveness and utility. The purpose of this review was to characterize the content and psychometrics of measures that have been utilized as outcome metrics in evaluations of COSC-related programs and interventions. Systematic literature searches were conducted for publications that: a) evaluated at least one measure from U.S. service members who participated in a program or intervention to prevent or reduce the adverse effects of combat and operational stress; and b) reported U.S. data on the internal consistency, test-retest reliability, convergent validity, and sensitivity/specificity of the identified measures. This process identified 15 measures for which psychometric properties were reviewed for acceptability based on recommended criteria. Identified measures varied from well-validated measures to newer instruments for which more data is needed on one or more of the target psychometric properties. Aside from internal consistency, psychometric data from U.S. military samples were sparse. Results further suggested that some measures might have reduced sensitivity in service members under certain conditions, such as large-scale screening. Additional studies are needed to validate COSC-relevant measures in service members. Future evaluations of programs and interventions for combat and operational stress should select measures that will increase the consistency of the literature, allow comparisons across studies, and ensure alignment with the objectives of identified programs.
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Affiliation(s)
- Denise C. Cooper
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia
| | - Marjorie S. Campbell
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia
| | - Spencer R. Case
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia
| | - Melissa C. Fraine
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia
| | - Rebecca A. Jones
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia
| | - Ilene F. Klein
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia
| | - Tim Hoyt
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia
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Chen Y, Dai J, Wang Y, Guo L, Huang Q. Postpartum post-traumatic stress disorder symptoms in high-risk pregnancies: Associated resilience and social support. J Psychosom Res 2023; 165:111098. [PMID: 36470754 DOI: 10.1016/j.jpsychores.2022.111098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Ying Chen
- Nanjing Stomatological Hospital, Medicine School of Nanjing University, China.
| | - Jiayang Dai
- Yangzhou University, School of Nursing, School of Public Health, China
| | - Yuanyuan Wang
- Yangzhou University, School of Nursing, School of Public Health, China
| | - Lu Guo
- Yangzhou University, School of Nursing, School of Public Health, China
| | - Qian Huang
- Nanjing Stomatological Hospital, Medicine School of Nanjing University, China
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Leighton SC, Nieforth LO, O’Haire ME. Assistance dogs for military veterans with PTSD: A systematic review, meta-analysis, and meta-synthesis. PLoS One 2022; 17:e0274960. [PMID: 36129950 PMCID: PMC9491613 DOI: 10.1371/journal.pone.0274960] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/07/2022] [Indexed: 11/30/2022] Open
Abstract
Psychiatric assistance dogs for military veterans with posttraumatic stress disorder (PTSD) currently make up over 19% of assistance dog partnerships globally. We conducted a systematic review of the literature relating to these partnerships, with specific aims to (1) summarize their characteristics, (2) evaluate the quality of existing evidence, and (3) summarize outcomes. A total of 432 records were independently screened (Cohen's kappa = 0.90). Of these, 41 articles (29 peer-reviewed publications and 12 unpublished dissertations) met inclusion criteria. Data extraction was conducted to address the research aims, including a meta-analysis (quantitative outcomes) and meta-synthesis (qualitative outcomes). All peer-reviewed publications on the topic of psychiatric assistance dogs for veterans with PTSD were published within the last five years. The majority of included articles were quantitative (53%), 41% were qualitative, and 6% employed mixed methods. Mean methodological rigor scores were 80% for peer reviewed articles and 71% for dissertations, where higher scores represent more rigorous methodology. Quantitative articles reported significant improvements in the domains of PTSD severity, mental health, and social health. Impacts on physical health and global quality of life appear inconclusive. Meta-analysis (9 articles) revealed that partnership with an assistance dog had a clinically meaningful, significant, and large effect on PTSD severity scores (g = -1.129; p<0.0001). Qualitative meta-synthesis identified two third order constructs: (1) Impact on the individual: mental & physical health and (2) Impact beyond the individual: building relationships & connection. This synthesis of increasingly prevalent research on assistance dogs for veterans with PTSD provides support for the impact of this complementary and integrative health intervention on PTSD symptom severity, and signs of meaningful improvements in adjacent domains including mental and social health. Gaps between quantitative and qualitative findings, along with the need to report greater demographic detail, highlight key opportunities for future research.
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Affiliation(s)
- Sarah C. Leighton
- Center for the Human-Animal Bond, Department of Comparative Pathobiology, Purdue University, West Lafayette, IN, United States of America
| | - Leanne O. Nieforth
- College of Veterinary Medicine, University of Arizona, Oro Valley, AZ, United States of America
| | - Marguerite E. O’Haire
- College of Veterinary Medicine, University of Arizona, Oro Valley, AZ, United States of America
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Tate DF, Dennis EL, Adams JT, Adamson MM, Belanger HG, Bigler ED, Bouchard HC, Clark AL, Delano-Wood LM, Disner SG, Eapen BC, Franz CE, Geuze E, Goodrich-Hunsaker NJ, Han K, Hayes JP, Hinds SR, Hodges CB, Hovenden ES, Irimia A, Kenney K, Koerte IK, Kremen WS, Levin HS, Lindsey HM, Morey RA, Newsome MR, Ollinger J, Pugh MJ, Scheibel RS, Shenton ME, Sullivan DR, Taylor BA, Troyanskaya M, Velez C, Wade BS, Wang X, Ware AL, Zafonte R, Thompson PM, Wilde EA. Coordinating Global Multi-Site Studies of Military-Relevant Traumatic Brain Injury: Opportunities, Challenges, and Harmonization Guidelines. Brain Imaging Behav 2021; 15:585-613. [PMID: 33409819 PMCID: PMC8035292 DOI: 10.1007/s11682-020-00423-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 12/19/2022]
Abstract
Traumatic brain injury (TBI) is common among military personnel and the civilian population and is often followed by a heterogeneous array of clinical, cognitive, behavioral, mood, and neuroimaging changes. Unlike many neurological disorders that have a characteristic abnormal central neurologic area(s) of abnormality pathognomonic to the disorder, a sufficient head impact may cause focal, multifocal, diffuse or combination of injury to the brain. This inconsistent presentation makes it difficult to establish or validate biological and imaging markers that could help improve diagnostic and prognostic accuracy in this patient population. The purpose of this manuscript is to describe both the challenges and opportunities when conducting military-relevant TBI research and introduce the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Military Brain Injury working group. ENIGMA is a worldwide consortium focused on improving replicability and analytical power through data sharing and collaboration. In this paper, we discuss challenges affecting efforts to aggregate data in this patient group. In addition, we highlight how "big data" approaches might be used to understand better the role that each of these variables might play in the imaging and functional phenotypes of TBI in Service member and Veteran populations, and how data may be used to examine important military specific issues such as return to duty, the late effects of combat-related injury, and alteration of the natural aging processes.
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Affiliation(s)
- David F Tate
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA.
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA.
| | - Emily L Dennis
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, Los Angeles, CA, USA
| | - John T Adams
- Western University of Health Sciences, Pomona, CA, USA
| | - Maheen M Adamson
- Defense and Veterans Brain Injury Center, VA Palo Alto, Palo Alto, CA, USA
- Neurosurgery, Stanford School of Medicine, Stanford, CA, USA
| | - Heather G Belanger
- United States Special Operations Command (USSOCOM), Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- St Michaels Inc, Tampa, FL, USA
| | - Erin D Bigler
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Heather C Bouchard
- Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA
| | - Alexandra L Clark
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Lisa M Delano-Wood
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, USA
| | - Seth G Disner
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
- Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Blessen C Eapen
- Department of Physical Medicine and Rehabilitation, VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Carol E Franz
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, USA
| | - Elbert Geuze
- University Medical Center Utrecht, Utrecht, Netherlands
- Brain Research and Innovation Centre, Ministry of Defence, Utrecht, The Netherlands
| | - Naomi J Goodrich-Hunsaker
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Kihwan Han
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Jasmeet P Hayes
- Psychology Department, The Ohio State University, Columbus, OH, USA
- Chronic Brain Injury Program, The Ohio State University, Columbus, OH, USA
| | - Sidney R Hinds
- Department of Defense/United States Army Medical Research and Materiel Command, Fort Detrick, Frederick, MD, USA
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Cooper B Hodges
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Elizabeth S Hovenden
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Andrei Irimia
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Kimbra Kenney
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - William S Kremen
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, USA
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, USA
| | - Harvey S Levin
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Hannah M Lindsey
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Rajendra A Morey
- Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Mary R Newsome
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - John Ollinger
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Mary Jo Pugh
- Information Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City, Salt Lake City, UT, USA
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Randall S Scheibel
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
- Brockton Division, VA Boston Healthcare System, Brockton, MA, USA
| | - Danielle R Sullivan
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Brian A Taylor
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
- C. Kenneth and Dianne Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Maya Troyanskaya
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Carmen Velez
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Benjamin Sc Wade
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Xin Wang
- Department of Psychiatry, University of Toledo, Toledo, OH, USA
| | - Ashley L Ware
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital/Brigham & Women's Hospital, Boston, MA, USA
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, Los Angeles, CA, USA
- Department of Neurology, USC, Los Angeles, CA, USA
- Department of Pediatrics, USC, Los Angeles, CA, USA
- Department of Psychiatry, USC, Los Angeles, CA, USA
- Department of Radiology, USC, Los Angeles, CA, USA
- Department of Engineering, USC, Los Angeles, CA, USA
- Department of Ophthalmology, USC, Los Angeles, CA, USA
| | - Elisabeth A Wilde
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
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Golden TL, Springs S, Kimmel HJ, Gupta S, Tiedemann A, Sandu CC, Magsamen S. The Use of Music in the Treatment and Management of Serious Mental Illness: A Global Scoping Review of the Literature. Front Psychol 2021; 12:649840. [PMID: 33868127 PMCID: PMC8044514 DOI: 10.3389/fpsyg.2021.649840] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/01/2021] [Indexed: 12/25/2022] Open
Abstract
Mental and substance use disorders have been identified as the leading cause of global disability, and the global burden of mental illness is concentrated among those experiencing disability due to serious mental illness (SMI). Music has been studied as a support for SMIs for decades, with promising results; however, a lack of synthesized evidence has precluded increased uptake of and access to music-based approaches. The purpose of this scoping review was to identify the types and quantity of research at intersections of music and SMIs, document evidentiary gaps and opportunities, and generate recommendations for improving research and practice. Studies were included if they reported on music's utilization in treating or mitigating symptoms related to five SMIs: schizophrenia, bipolar disorder, generalized anxiety disorder, major depressive disorder, or post-traumatic stress disorder. Eight databases were searched; screening resulted in 349 included studies for data extraction. Schizophrenia was the most studied SMI, with bipolar disorder studied the least. Demographics, settings, and activity details were found to be inconsistently and insufficiently reported; however, listening to recorded music emerged as the most common musical activity, and activity details appeared to have been affected by the conditions under study. RCTs were the predominant study design, and 271 unique measures were utilized across 289 primary studies. Over two-thirds of primary studies (68.5%) reported positive results, with 2.8% reporting worse results than the comparator, and 12% producing indeterminate results. A key finding is that evidence synthesis is precluded by insufficient reporting, widely varied outcomes and measures, and intervention complexity; as a result, widespread changes are necessary to reduce heterogeneity (as feasible), increase replicability and transferability, and improve understandings of mechanisms and causal pathways. To that end, five detailed recommendations are offered to support the sharing and development of information across disciplines.
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Affiliation(s)
| | - Stacey Springs
- Department of Health Services, Policy and Practice, Brown University, Providence, RI, United States
| | - Hannah J. Kimmel
- Medical School, University of Michigan, Ann Arbor, MI, United States
| | - Sonakshi Gupta
- Department of Pharmacy, Birla Institute of Technology and Science, Pilani, India
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Ben Barnes J, Presseau C, Jordan AH, Kline NK, Young-McCaughan S, Keane TM, Peterson AL, Litz BT. Common Data Elements in the Assessment of Military-Related PTSD Research Applied in the Consortium to Alleviate PTSD. Mil Med 2020; 184:e218-e226. [PMID: 30252077 DOI: 10.1093/milmed/usy226] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/24/2018] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Driven by the need to share data, sufficiently power studies, and allow for cross-study comparisons of medical and psychiatric diseases, the President's National Research Action Plan issued in 2013 called for the use of state-of-the-art common data elements (CDEs) for research studies. CDEs are variables measured across independent studies that facilitate methodologically sound data aggregation and study replication. Researchers in the field of military-related post-traumatic stress disorder (PTSD) have suggested applicable CDEs; however, to date, these recommendations have been conceptual and not field-tested. The Consortium to Alleviate PTSD (CAP) - an interdisciplinary and multi-institutional, military-related PTSD research consortium funded by the Departments of Defense and Veterans Affairs - generated and applied CDEs that can be used to combine data from disparate studies to improve the methodological and statistical capabilities of study findings. We provide a description and rationale for the CAP CDEs and details about administration with two main goals: (1) to encourage military-related PTSD researchers to use these measures in future studies and (2) to facilitate comparison, replication, and data aggregation. MATERIALS AND METHODS The CAP compiled mandated (core) and optional CDEs based on the following criteria: (1) construct applicability to military-related PTSD; (2) precedence (use) in prior, related research; (3) published and strong psychometric evidence; (4) no cost (public domain); and (5) brevity, to limit participant burden. We provided descriptive statistics and internal consistency reliabilities for mandated measures from an initial cohort of around 400 participants enrolled in CAP studies. RESULTS Mandated CDEs in the CAP were found to have very good internal consistency reliability. CONCLUSION Although further research is needed to determine the incremental validity of these CDEs, preliminary analyses indicated that each mandated measure has very good internal consistency reliability. Investigators designing military-related PTSD research should consider using these field-tested CDEs to facilitate future data aggregation. Feedback based on empirical evidence or practical concerns to improve these CDEs is welcome.
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Affiliation(s)
- J Ben Barnes
- Massachusetts Veterans Epidemiology Research and Information Center, MAVERIC, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA
| | - Candice Presseau
- Massachusetts Veterans Epidemiology Research and Information Center, MAVERIC, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA
| | - Alexander H Jordan
- Massachusetts Veterans Epidemiology Research and Information Center, MAVERIC, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA.,Department of Psychiatry, Boston University School of Medicine, 72 East Concord Street, Boston, MA
| | - Nora K Kline
- Massachusetts Veterans Epidemiology Research and Information Center, MAVERIC, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA
| | - Stacey Young-McCaughan
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX
| | - Terence M Keane
- Department of Psychiatry, Boston University School of Medicine, 72 East Concord Street, Boston, MA.,Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA
| | - Alan L Peterson
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX.,Research and Development Service, South Texas Veterans Health Care System, 7400 Merton Minter, San Antonio, TX.,Department of Psychology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX
| | - Brett T Litz
- Massachusetts Veterans Epidemiology Research and Information Center, MAVERIC, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA.,Department of Psychiatry, Boston University School of Medicine, 72 East Concord Street, Boston, MA.,Department of Psychological and Brain Sciences, Boston University, 64 Cummington Mall, Boston, MA
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8
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McLean CP, Zandberg L, Brown L, Zang Y, Benhamou K, Dondanville KA, Yarvis JS, Litz BT, Mintz J, Young-McCaughan S, Peterson AL, Foa EB. Guilt in the Treatment of Posttraumatic Stress Disorder Among Active Duty Military Personnel. J Trauma Stress 2019; 32:616-624. [PMID: 31356703 DOI: 10.1002/jts.22416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 02/01/2019] [Accepted: 02/14/2019] [Indexed: 11/09/2022]
Abstract
The current study examined the role of trauma-related guilt on posttraumatic stress disorder (PTSD) symptom change during prolonged exposure therapy (PE) as well as the efficacy of PE in reducing three dimensions of guilt (responsibility, wrongdoing, and lack of justification) during treatment. Participants were 331 active duty U.S. military personnel seeking treatment for PTSD who were randomized to one of four groups: massed PE (10 sessions delivered over 2 weeks), spaced PE (10 sessions delivered over 8 weeks), present-centered therapy (PCT; 10 sessions delivered over 8 weeks), or minimal contact control (MCC; weekly therapist phone check-in for 4 weeks). The results showed that baseline guilt did not predict reductions in PTSD symptoms for spaced PE or for PCT, ps = .178-.387, ds = -0.02-0.07. Treatment condition (massed PE vs. MCC; spaced PE vs. PCT) did not moderate reductions in guilt for spaced PE versus PCT. Guilt decreased significantly over treatment in all groups, p < .001 to p = .038, ds = -0.19 to -0.42, except concerning justification in the spaced PE and PCT groups, p = .140, d = -0.10. The findings suggest that guilt may be reduced significantly following active PTSD treatment and attention control and that PTSD recovery is not impacted by baseline levels of trauma-related guilt in military personnel with PTSD, although reported levels of guilt were low to moderate in this sample.
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Affiliation(s)
- Carmen P McLean
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California, USA.,Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laurie Zandberg
- Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lily Brown
- Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yinyin Zang
- Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kathy Benhamou
- Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Katherine A Dondanville
- Department of Psychiatry, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Jeffrey S Yarvis
- Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, Texas, USA
| | - Brett T Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jim Mintz
- Department of Psychiatry, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Department of Epidemiology and Biostatistics, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Alan L Peterson
- Department of Psychiatry, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,South Texas Veterans Health Care System, San Antonio, Texas, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Edna B Foa
- Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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9
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McLean CP, Zandberg L, Roache JD, Fitzgerald H, Pruiksma KE, Taylor DJ, Dondanville KA, Litz BT, Mintz J, Young-McCaughan S, Yarvis JS, Peterson AL, Foa EB, Strong Star Consortium FT. Caffeine Use in Military Personnel With PTSD: Prevalence and Impact on Sleep. Behav Sleep Med 2019; 17:202-212. [PMID: 28609150 DOI: 10.1080/15402002.2017.1326920] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Caffeine use is highly prevalent among active duty military personnel and can be beneficial to performance in the short term. However, regular caffeine use has been found to contribute to sleep disturbances, which are elevated among the significant number of military personnel with posttraumatic stress disorder (PTSD). The current study is the first to examine caffeine use and its relationship with sleep disturbances in military personnel seeking treatment for PTSD. Participants: Active duty military personnel (N = 366) who had returned from deployments to Afghanistan or Iraq and were seeking treatment for PTSD. Methods: Pearson correlations were used to examine the relationships between caffeine use, sleep disturbances, and PTSD symptom clusters. Results: The majority of the sample (89%) reported some caffeine use, with coffee being the largest contributor to total caffeine intake. Contrary to hypotheses, higher caffeine use was associated with lower insomnia symptom severity; follow-up analysis indicated that this was due to elevated insomnia symptom severity in those reporting no caffeine use. Caffeine use was not associated with any other measures of sleep disturbance or with PTSD symptoms. Conclusions: Caffeine use was not associated with greater reported sleep disturbances in this sample, possibly because those with elevated insomnia symptom severity abstained from any caffeine, or because insomnia symptoms were elevated in this sample.
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Affiliation(s)
- Carmen P McLean
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laurie Zandberg
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John D Roache
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Hayley Fitzgerald
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristi E Pruiksma
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Daniel J Taylor
- Department of Psychology, University of North Texas, Denton, Texas
| | - Katherine A Dondanville
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Brett T Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts.,Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Jim Mintz
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas.,Department of Epidemiology & Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Stacey Young-McCaughan
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Jeffrey S Yarvis
- Headquarters, Carl R. Darnall Army Medical Center, Fort Hood, Texas
| | - Alan L Peterson
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas.,Research & Development Service, South Texas Veterans Health Care System, San Antonio, Texas.,Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
| | - Edna B Foa
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
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10
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Lawlor MW, Iannaccone ST, Mathews K, Muntoni F, Alai-Hansen S, Odenkirchen JC, S Feldman R. NINDS Common Data Elements for Congenital Muscular Dystrophy Clinical Research: A National Institute for Neurological Disorders and Stroke Project. J Neuromuscul Dis 2018; 5:75-84. [PMID: 29480213 DOI: 10.3233/jnd-170248] [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: 11/15/2022]
Abstract
BACKGROUND A Congenital Muscular Dystrophy (CMD) Working Group (WG) consisting of international experts reviewed common data elements (CDEs) previously developed for other neuromuscular diseases (NMDs) and made recommendations for all types of studies on CMD. OBJECTIVES To develop a comprehensive set of CDEs, data definitions, case report forms and guidelines for use in CMD clinical research to facilitate interoperability of data collection, as part of the CDE project at the National Institute of Neurological Disorders and Stroke (NINDS). METHODS One working group composed of ten experts reviewed existing NINDS CDEs and outcome measures, evaluated the need for new elements, and provided recommendations for CMD clinical research. The recommendations were compiled, internally reviewed by the CMD working group, and posted online for external public comment. The CMD working group and the NIH CDE team reviewed the final version before release. RESULTS The NINDS CMD CDEs and supporting documents are publicly available on the NINDS CDE website (https://www.commondataelements.ninds.nih.gov/CMD.aspx#tab=Data_Standards). Content areas include demographics, social status, health history, physical examination, diagnostic tests, and guidelines for a variety of specific outcomes and endpoints. The CMD CDE WG selected these documents from existing versions that were generated by other disease area working groups. Some documents were tailored to maximize their suitability for the CMD field. CONCLUSIONS Widespread use of CDEs can facilitate CMD clinical research and trial design, data sharing and retrospective analyses. The CDEs that are most relevant to CMD research are like those generated for other NMDs, and CDE documents tailored to CMD are now available to the public. The existence of a single source for these documents facilitates their use in research studies and offers a clear mechanism for the discussion and update of the information as knowledge is gained.
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Affiliation(s)
| | | | | | - Francesco Muntoni
- University College London Great Ormond Street Institute of Child Health, London, UK
| | | | - Joanne C Odenkirchen
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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11
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TJALVIN G, MAGERØY N, BRÅTVEIT M, LYGRE SHL, HOLLUND BE, MOEN BE. Odour as a determinant of persistent symptoms after a chemical explosion, a longitudinal study. INDUSTRIAL HEALTH 2017; 55:127-137. [PMID: 27916759 PMCID: PMC5383410 DOI: 10.2486/indhealth.2016-0155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/28/2016] [Indexed: 06/06/2023]
Abstract
Foul-smelling environmental pollution was a major concern following a chemical workplace explosion. Malodorous pollution has previously been associated with aggravated physical and psychological health, and in persons affected by a trauma, an incidence-related odour can act as a traumatic reminder. Olfaction may even be of significance in the development and persistence of post-traumatic stress symptoms (PTSS). The present longitudinal study assessed whether perceived smell related to malodorous environmental pollution in the aftermath of the explosion was a determinant of subjective health complaints (SHC) and PTSS among gainfully employed adults, when the malodorous pollution was present, and after pollution clean-up. Questionnaire data from validated instruments were analysed using mixed effects models. Individual odour scores were computed, and the participants (n=486) were divided into high and low odour score groups, respectively. Participants in the high odour score group (n=233) reported more SHC and PTSS than those in the low odour score group (n=253), before and even after the pollution was eliminated. These associations lasted for at least three years after the pollution was removed, and might indicate that prompt clean-up is important to avoid persistent health effects after malodorous chemical spills.
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Affiliation(s)
- Gro TJALVIN
- Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Norway
- Department of Occupational Medicine, Haukeland University Hospital, Norway
| | - Nils MAGERØY
- Department of Occupational Medicine, Haukeland University Hospital, Norway
| | - Magne BRÅTVEIT
- Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Norway
| | | | - Bjørg Eli HOLLUND
- Department of Occupational Medicine, Haukeland University Hospital, Norway
| | - Bente Elisabeth MOEN
- Centre for International Health, Faculty of Medicine and Dentistry, University of Bergen, Norway
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12
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Zang Y, Gallagher T, McLean CP, Tannahill HS, Yarvis JS, Foa EB. The impact of social support, unit cohesion, and trait resilience on PTSD in treatment-seeking military personnel with PTSD: The role of posttraumatic cognitions. J Psychiatr Res 2017; 86:18-25. [PMID: 27886636 DOI: 10.1016/j.jpsychires.2016.11.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/04/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The personal resources of social support, unit cohesion, and trait resilience have been found to be associated with posttraumatic stress disorder (PTSD) severity among military personnel. However, the underlying mechanisms of these relationships are unclear. We hypothesized that negative posttraumatic cognitions, which are associated with PTSD, mediate the relationships between these personal resources and PTSD. METHODS The relationship between PTSD symptom severity and a latent factor comprised of social support, unit cohesion, and trait resilience was evaluated using cross-sectional data from 366 treatment-seeking active duty military personnel with PTSD following deployments to or near Iraq or Afghanistan. Structural equation modeling (SEM) was used to test whether posttraumatic cognitions mediated this relationship. RESULTS The SEM model indicated that (1) a robust latent variable named personal resources (indicated by social support, unit cohesion, and trait resilience) was negatively associated with PTSD severity; (2) personal resources were negatively associated with negative posttraumatic cognitions; (3) negative posttraumatic cognitions fully mediated the association between personal resources and PTSD severity. The final SEM mediation model showed a highly satisfactory fit [χ2 (22) = 16.344, p = 0.798; χ2/df = 0.743; CFI = 1; RMSEA = 0.000]. CONCLUSIONS These findings suggest that among active duty military personnel seeking treatment for PTSD, personal resources (social support, unit cohesion, and trait resilience) may mitigate PTSD severity by reducing negative posttraumatic cognitions.
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Affiliation(s)
- Yinyin Zang
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
| | - Thea Gallagher
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Carmen P McLean
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Hallie S Tannahill
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey S Yarvis
- Headquarters, Carl R. Darnall Army Medical Center, Fort Hood, TX, USA
| | - Edna B Foa
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
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13
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McLean CP, Zang Y, Zandberg L, Bryan CJ, Gay N, Yarvis JS, Foa EB. Predictors of suicidal ideation among active duty military personnel with posttraumatic stress disorder. J Affect Disord 2017; 208:392-398. [PMID: 27810723 DOI: 10.1016/j.jad.2016.08.061] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/24/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Given the alarming rate of military suicides, it is critical to identify the factors that increase risk of suicidal thoughts and behaviors among active duty military personnel. METHODS This study examined a predictive model of suicidal ideation among 366 treatment-seeking active duty military personnel with posttraumatic stress disorder (PTSD) following deployments to or near Iraq or Afghanistan. Structural equation modeling was employed to examine the relative contribution of combat exposure, social support, PTSD severity, depressive symptoms, guilt, and trauma-related cognitions on suicidal ideation. RESULTS The final structural equation model had a highly satisfactory fit [χ2 (2) =2.023, p=.364; RMSEA =.006; CFI =1; GFI =.998]. PTSD severity had an indirect effect on suicidal ideation via trauma-related cognitions. Depression had a direct positive effect on suicidal ideation; it also had an indirect effect via trauma-related cognitions and interpersonal support. Among participants who had made a previous suicide attempt, only depression symptom severity was significantly linked to suicidal ideation. LIMITATIONS Data are cross-sectional, precluding causal interpretations. Findings may only generalize to treatment seeking active duty military personnel with PTSD reporting no more than moderate suicidal ideation. CONCLUSIONS These findings suggest that depression and trauma-related cognitions, particularly negative thoughts about the self, play an important role in suicidal ideation among active duty military personnel with PTSD. Negative cognitions about the self and interpersonal support may be important targets for intervention to decrease suicidal ideation.
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Affiliation(s)
- Carmen P McLean
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Yinyin Zang
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States.
| | - Laurie Zandberg
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Craig J Bryan
- National Center for Veterans Studies, Salt Lake City, UT, United States; Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Natalie Gay
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Jeffrey S Yarvis
- Headquarters, Carl R. Darnall Army Medical Center, Fort Hood, TX, United States
| | - Edna B Foa
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
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14
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Kaczkurkin AN, Asnaani A, Hall-Clark B, Peterson AL, Yarvis JS, Foa EB. Ethnic and racial differences in clinically relevant symptoms in active duty military personnel with posttraumatic stress disorder. J Anxiety Disord 2016; 43:90-98. [PMID: 27639110 DOI: 10.1016/j.janxdis.2016.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/27/2016] [Accepted: 09/08/2016] [Indexed: 11/16/2022]
Abstract
Previous research has shown racial/ethnic differences in Vietnam veterans on symptoms related to posttraumatic stress disorder (PTSD). The current study explored racial/ethnic differences in PTSD symptoms and clinically relevant symptoms. Resilience and social support were tested as potential moderators of racial/ethnic differences in symptoms. The sample included 303 active duty male service members seeking treatment for PTSD. After controlling for age, education, military grade, and combat exposure, Hispanic/Latino and African American service members reported greater PTSD symptoms compared to non-Hispanic White service members. Higher alcohol consumption was endorsed by Hispanic/Latino service members compared to non-Hispanic White or African American service members, even after controlling for PTSD symptom severity. No racial/ethnic differences were found with regard to other variables. These results suggest that care should be made to thoroughly assess PTSD patients, especially those belonging to minority groups, for concurrent substance use problems that may impede treatment utilization or adherence.
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Affiliation(s)
- Antonia N Kaczkurkin
- Department of Psychiatry, University of Pennsylvania, 3535 Market St., Philadelphia, PA, 19104, USA.
| | - Anu Asnaani
- Department of Psychiatry, University of Pennsylvania, 3535 Market St., Philadelphia, PA, 19104, USA.
| | - Brittany Hall-Clark
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA.
| | - Alan L Peterson
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA; South Texas Veterans Health Care System, 7400 Merton Minter, San Antonio, TX 78229, USA; University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA.
| | - Jeffrey S Yarvis
- Carl R. Darnall Army Medical Center, 36000 Darnall Loop, Fort Hood, TX, 76544, USA.
| | - Edna B Foa
- Department of Psychiatry, University of Pennsylvania, 3535 Market St., Philadelphia, PA, 19104, USA.
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15
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Haarbauer-Krupa J, Taylor CA, Yue JK, Winkler EA, Pirracchio R, Cooper SR, Burke JF, Stein MB, Manley GT. Screening for Post-Traumatic Stress Disorder in a Civilian Emergency Department Population with Traumatic Brain Injury. J Neurotrauma 2016; 34:50-58. [PMID: 26936513 DOI: 10.1089/neu.2015.4158] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) is a condition associated with traumatic brain injury (TBI). While the importance of PTSD and TBI among military personnel is widely recognized, there is less awareness of PTSD associated with civilian TBI. We examined the incidence and factors associated with PTSD 6 months post-injury in a civilian emergency department population using measures from the National Institute of Neurological Disorders and Stroke TBI Common Data Elements Outcome Battery. Participants with mild TBI (mTBI) from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study with complete 6-month outcome batteries (n = 280) were analyzed. Screening for PTSD symptoms was conducted using the PTSD Checklist-Civilian Version. Descriptive measures are summarized and predictors for PTSD were examined using logistic regression. Incidence of screening positive for PTSD was 26.8% at 6 months following mTBI. Screening positive for PTSD was significantly associated with concurrent functional disability, post-concussive and psychiatric symptomatology, decreased satisfaction with life, and decreased performance in visual processing and mental flexibility. Multi-variable regression showed injury mechanism of assault (odds ratio [OR] 3.59; 95% confidence interval [CI] 1.69-7.63; p = 0.001) and prior psychiatric history (OR 2.56; 95% CI 1.42-4.61; p = 0.002) remained significant predictors of screening positive for PTSD, while education (per year OR 0.88; 95% CI 0.79-0.98; p = 0.021) was associated with decreased odds of PTSD. Standardized data collection and review of pre-injury education, psychiatric history, and injury mechanism during initial hospital presentation can aid in identifying patients with mTBI at risk for developing PTSD symptoms who may benefit from closer follow-up after initial injury care.
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Affiliation(s)
- Juliet Haarbauer-Krupa
- 1 Division of Unintentional Injury, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Christopher A Taylor
- 1 Division of Unintentional Injury, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - John K Yue
- 2 Department of Neurological Surgery, University of California , San Francisco, San Francisco, California.,3 Brain and Spinal Injury Center, San Francisco General Hospital , San Francisco, California
| | - Ethan A Winkler
- 2 Department of Neurological Surgery, University of California , San Francisco, San Francisco, California.,3 Brain and Spinal Injury Center, San Francisco General Hospital , San Francisco, California
| | - Romain Pirracchio
- 4 Department of Anesthesia and Perioperative Care, University of California , San Francisco, San Francisco, California
| | - Shelly R Cooper
- 2 Department of Neurological Surgery, University of California , San Francisco, San Francisco, California.,3 Brain and Spinal Injury Center, San Francisco General Hospital , San Francisco, California.,5 Department of Psychology, Washington University in St. Louis , St. Louis, Missouri
| | - John F Burke
- 2 Department of Neurological Surgery, University of California , San Francisco, San Francisco, California.,3 Brain and Spinal Injury Center, San Francisco General Hospital , San Francisco, California
| | - Murray B Stein
- 6 Department of Psychiatry, University of California , San Diego, San Diego, California.,7 Department of Family and Preventive Medicine, University of California , San Diego, San Diego, California
| | - Geoffrey T Manley
- 2 Department of Neurological Surgery, University of California , San Francisco, San Francisco, California.,3 Brain and Spinal Injury Center, San Francisco General Hospital , San Francisco, California
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16
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Bryan CJ, Clemans TA, Hernandez AM, Mintz J, Peterson AL, Yarvis JS, Resick PA. EVALUATING POTENTIAL IATROGENIC SUICIDE RISK IN TRAUMA-FOCUSED GROUP COGNITIVE BEHAVIORAL THERAPY FOR THE TREATMENT OF PTSD IN ACTIVE DUTY MILITARY PERSONNEL. Depress Anxiety 2016; 33:549-57. [PMID: 26636426 DOI: 10.1002/da.22456] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 11/03/2015] [Accepted: 11/06/2015] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To determine whether group cognitive processing therapy-cognitive only version (CPT-C) is associated with iatrogenic suicide risk in a sample of active duty US Army personnel diagnosed with posttraumatic stress disorder (PTSD). Possible iatrogenic effects considered include the incidence and severity of suicide ideation, worsening of preexisting suicide ideation, incidence of new-onset suicide ideation, and incidence of suicide attempts among soldiers receiving group CPT-C. Comparison with group present-centered therapy (PCT) was made to contextualize findings. METHOD One hundred eight soldiers (100 men, eight women) diagnosed with PTSD were randomized to receive either group CPT-C or group PCT. PTSD diagnosis was confirmed via structured clinician interview. Suicide ideation, depression severity, and PTSD severity were assessed at pretreatment, weekly during treatment, and 2 weeks, 6 months, and 12 months posttreatment. RESULTS Rates of suicide ideation significantly decreased across both treatments. Among soldiers with pretreatment suicide ideation, severity of suicide ideation significantly decreased across both treatments and was maintained for up to 12 months posttreatment. Exacerbation of preexisting suicide ideation was uncommon in both treatments. New-onset suicide ideation was rare and similar across both treatments (<16%). There were no suicide attempts during treatment or follow-up in either group. Change in depression symptoms predicted change in suicide risk. CONCLUSIONS Suicide-related outcomes were similar across both treatments and primarily associated with comorbid depression. Suicide-related outcomes in group CPT-C were rare and comparable to patterns observed in an active, nontrauma-focused therapy, even among soldiers who entered treatment with suicide ideation. GOV IDENTIFIER NCT01286415, https://clinicaltrials.gov/ct2/show/NCT01286415.
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Affiliation(s)
- Craig J Bryan
- National Center for Veterans Studies, Salt Lake City, Utah.,Department of Psychology, The University of Utah, Salt Lake City, Utah
| | | | - Ann Marie Hernandez
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Jim Mintz
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Alan L Peterson
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas.,South Texas Veterans Health Care System, San Antonio, Texas.,Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
| | - Jeffrey S Yarvis
- Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, Texas
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
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17
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Dondanville KA, Blankenship AE, Molino A, Resick PA, Wachen JS, Mintz J, Yarvis JS, Litz BT, Borah EV, Roache JD, Young-McCaughan S, Hembree EA, Peterson AL. Qualitative examination of cognitive change during PTSD treatment for active duty service members. Behav Res Ther 2016; 79:1-6. [PMID: 26874683 DOI: 10.1016/j.brat.2016.01.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 01/29/2016] [Accepted: 01/30/2016] [Indexed: 10/22/2022]
Abstract
The current study investigated changes in service members' cognitions over the course of Cognitive Processing Therapy (CPT) for posttraumatic stress disorder (PTSD). Sixty-three active duty service members with PTSD were drawn from 2 randomized controlled trials of CPT-Cognitive Only (CPT-C). Participants wrote an impact statement about the meaning of their index trauma at the beginning and again at the end of therapy. Clauses from each impact statement were qualitatively coded into three categories for analysis: assimilation, accommodation, and overaccommodation. The PTSD Checklist, Posttraumatic Symptom Scale-Interview Version, and the Beck Depression Inventory-II were administered at baseline and posttreatment. Repeated measures analyses documented a significant decrease in the percentage of assimilated or overaccommodated statements and an increase in the percentage of accommodated statements from the beginning to the end of treatment. Changes in accommodated statements over the course of treatment were negatively associated with PTSD and depression symptom severity, while statements indicative of overaccommodation were positively associated with both PTSD and depression symptom severity. Treatment responders had fewer overaccommodated and more accommodated statements. Findings suggest that CPT-C changes cognitions over the course of treatment. Methodological limitations and the lack of association between assimilation and PTSD symptom severity are further discussed.
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Affiliation(s)
| | | | - Alma Molino
- University of Texas Health Science Center at San Antonio, United States
| | | | - Jennifer Schuster Wachen
- National Center for PTSD, United States; VA Boston Healthcare System, United States; Boston University, United States
| | - Jim Mintz
- University of Texas Health Science Center at San Antonio, United States
| | - Jeffrey S Yarvis
- Carl R. Darnall Army Medical Center, Fort Hood, TX, United States
| | - Brett T Litz
- VA Boston Healthcare System, United States; Boston University School of Medicine, United States
| | - Elisa V Borah
- University of Texas Health Science Center at San Antonio, United States
| | - John D Roache
- University of Texas Health Science Center at San Antonio, United States
| | | | | | - Alan L Peterson
- University of Texas Health Science Center at San Antonio, United States; South Texas Veterans Health Care System, United States
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18
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Consumer Information and Treatment Resources for Posttraumatic Stress Disorder: Within Reach but Not Grasp. Harv Rev Psychiatry 2015; 23:426-37. [PMID: 26544093 DOI: 10.1097/hrp.0000000000000056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In the context of multiple treatment options for posttraumatic stress disorder (PTSD) and a large, growing need for consumer information regarding accessible and effective treatments, this article identifies and reviews available information and treatment resources. Multiple search strategies identified a suite of information sources, including meta-analyses and systematic reviews of PTSD treatments, the program evaluation and implementation literature, the economics literature, Internet sites, and other resources for veteran and civilian consumers. Resources were evaluated with regard to their target audiences, depth and breadth of treatment options covered, nature of the information provided, and accessibility to consumers. A large body of research covers the various treatments and sets of treatment guidelines for PTSD. Despite the extensive scientific information targeted at providers and researchers, the quality, accessibility, and usability of the published research varies widely. The Veterans Health Administration provides the most extensive information on various treatment options and where to obtain treatment within that system. Publicly available websites provide information on multiple treatment options, but information to help nonveterans navigate treatment choices is limited. Published reports of PTSD program-evaluation and implementation studies are sparse. Information on PTSD treatment options available to consumers can be overwhelming and confusing, which places an unnecessary burden on an already vulnerable group of patients and their families. Exacerbating the situation is the shortage of program-evaluation and implementation research. The dearth of centralized and accessible information related to nonveteran PTSD patient groups needs to be addressed.
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19
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Yue JK, Vassar MJ, Lingsma HF, Cooper SR, Okonkwo DO, Valadka AB, Gordon WA, Maas AIR, Mukherjee P, Yuh EL, Puccio AM, Schnyer DM, Manley GT. Transforming research and clinical knowledge in traumatic brain injury pilot: multicenter implementation of the common data elements for traumatic brain injury. J Neurotrauma 2013; 30:1831-44. [PMID: 23815563 DOI: 10.1089/neu.2013.2970] [Citation(s) in RCA: 242] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Traumatic brain injury (TBI) is among the leading causes of death and disability worldwide, with enormous negative social and economic impacts. The heterogeneity of TBI combined with the lack of precise outcome measures have been central to the discouraging results from clinical trials. Current approaches to the characterization of disease severity and outcome have not changed in more than three decades. This prospective multicenter observational pilot study aimed to validate the feasibility of implementing the TBI Common Data Elements (TBI-CDEs). A total of 650 subjects who underwent computed tomography (CT) scans in the emergency department within 24 h of injury were enrolled at three level I trauma centers and one rehabilitation center. The TBI-CDE components collected included: 1) demographic, social and clinical data; 2) biospecimens from blood drawn for genetic and proteomic biomarker analyses; 3) neuroimaging studies at 2 weeks using 3T magnetic resonance imaging (MRI); and 4) outcome assessments at 3 and 6 months. We describe how the infrastructure was established for building data repositories for clinical data, plasma biomarkers, genetics, neuroimaging, and multidimensional outcome measures to create a high quality and accessible information commons for TBI research. Risk factors for poor follow-up, TBI-CDE limitations, and implementation strategies are described. Having demonstrated the feasibility of implementing the TBI-CDEs through successful recruitment and multidimensional data collection, we aim to expand to additional study sites. Furthermore, interested researchers will be provided early access to the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) data set for collaborative opportunities to more precisely characterize TBI and improve the design of future clinical treatment trials. (ClinicalTrials.gov Identifier NCT01565551.).
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Affiliation(s)
- John K Yue
- 1 Brain and Spinal Injury Center, San Francisco General Hospital , San Francisco, California
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Gibbons SW, Barnett SD, Hickling EJ. Family stress and posttraumatic stress: the impact of military operations on military health care providers. Arch Psychiatr Nurs 2012; 26:e31-9. [PMID: 22835755 DOI: 10.1016/j.apnu.2012.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 03/06/2012] [Accepted: 04/01/2012] [Indexed: 11/18/2022]
Abstract
This study uses data from the 2005 Department of Defense Survey of Health-Related Behaviors Among Military Personnel to examine relationships between family stress and posttraumatic stress symptoms across 4 subgroups of Operation Iraqi Freedom-deployed (i.e., war in Iraq) or Operation Enduring Freedom-deployed (i.e., war in Afghanistan) active-duty military service members. Results suggest the following: (a) the greatest positive correlation of family stressors with posttraumatic stress symptoms was found within the military health care officer group, and (b) these military health care officers differed in family stressors mediating posttraumatic stress with divorce and financial problems accounting for significant and unique portions of the variance. Implications for care of service members and their families are discussed.
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Affiliation(s)
- Susanne W Gibbons
- Uniformed Services University of the Health Sciences, Graduate School of Nursing, Bethesda, MD 20814, USA.
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Stein NR, Mills MA, Arditte K, Mendoza C, Borah AM, Resick PA, Litz BT. A scheme for categorizing traumatic military events. Behav Modif 2012; 36:787-807. [PMID: 22679239 DOI: 10.1177/0145445512446945] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A common assumption among clinicians and researchers is that war trauma primarily involves fear-based reactions to life-threatening situations. However, the authors believe that there are multiple types of trauma in the military context, each with unique perievent and postevent response patterns. To test this hypothesis, they reviewed structured clinical interviews of 122 active duty service members and assigned the reported index (principal, most currently distressing) events to one or more of the following categories: Life Threat to Self, Life Threat to Others, Aftermath of Violence, Traumatic Loss, Moral Injury by Self, and Moral Injury by Others. They found high interrater reliability for the coding scheme and support for the construct validity of the categorizations. In addition, they discovered that certain categories were related to psychiatric symptoms (e.g., reexperiencing of the traumatic event, guilt, anger) and negative thoughts about the world. Their study provides tentative support for use of these event categories.
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Hoffman JM, Dikmen S, Temkin N, Bell KR. Development of Posttraumatic Stress Disorder After Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2012; 93:287-92. [DOI: 10.1016/j.apmr.2011.08.041] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 08/31/2011] [Accepted: 08/31/2011] [Indexed: 11/25/2022]
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Gibbons SW, Barnett SD, Hickling EJ, Herbig-Wall PL, Watts DD. Stress, coping, and mental health-seeking behaviors: gender differences in OEF/OIF health care providers. J Trauma Stress 2012; 25:115-9. [PMID: 22354515 DOI: 10.1002/jts.21661] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Health care providers (HCPs) are often placed in positions of heightened stress when serving in military operations. As military HCPs have a large number of female providers, there is a concern that gender may influence both risk and resiliency within the health care provider subgroup. The purpose of this secondary analysis of the 2005 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel (data collected April through August 2005) is to describe stress, coping, and health-seeking behaviors of Operation Enduring Freedom and Operation Iraqi Freedom deployed military health care providers and the role gender may have for both health care officers and specialists. Female HCP responses indicate the lives of these women are significantly impacted by their family responsibilities. Reluctance of females to seek mental health care is concerning with perhaps more concern over career than personal well-being. Findings included (a) concern about performance, odds ratio (OR) = 1.86, 95% confidence interval (CI) [0.43, 8.12] for enlisted females, OR = 2.83, 95% CI [0.31, 25.66] for female officers; (b) problems with money, OR = 1.6 CI [0.69, 3.7] for enlisted females; (c) having a drink to cope, OR = 3.26, 95% CI [0.22, 48.68] for enlisted females; and (d) damage military career to seek mental health care, OR = 1.78, 95% CI [0.59, 5.39] for female officers. Results indicate needed provider awareness concerning mental health-seeking behavior and sensitivity toward gender differences that contribute to unique manifestations of operational stress outcomes.
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Affiliation(s)
- Susanne W Gibbons
- Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA.
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Gibbons SW, Hickling EJ, Barnett SD, Herbig-Wall PL, Watts DD. Gender differences in response to deployment among military healthcare providers in Afghanistan and Iraq. J Womens Health (Larchmt) 2012; 21:496-504. [PMID: 22224844 DOI: 10.1089/jwh.2011.3097] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite their growing numbers in the United States military, little has been published on healthcare providers (HCP) or female service members from conflicts in Afghanistan and Iraq. The purpose of this secondary analysis of data from the 2005 Department of Defense (DoD) Survey of Health Related Behaviors Among Active Duty Military Personnel was to determine gender differences in reaction to the impact of operational stress in deployed military healthcare providers. METHODS The unweighted study sample selected for this data analysis included results from female and male active duty military personnel over the age of 18 years (n=16,146) deployed at least once to Operation Enduring Freedom (OEF) or Operation Iraqi Freedom (OIF) within the past 3 years (n=1,425), for a final sample consisting of either officer (healthcare officer) or enlisted (healthcare specialist) personnel (n=455) (weighted n=23,440). Indices of psychologic distress and social relations were explored and compared. RESULTS Enlisted female HCPs were more likely to be African American (42.3%) and single (63.0%) and represented the greater percentage with significant psychologic difficulties, as shown by serious psychologic distress endorsement (11.3%) and positive screen results for depression (32.2%). More harmful drinking patterns (Alcohol Use Disorders Identifications Test [AUDIT] score 8-15) were found in more female HCPs (enlisted 61.8%, officers 76.4%) compared with males (enlisted 41.1%, officers 67.1%). CONCLUSIONS Female HCPs serving in the current military conflicts are reporting significant psychologic distress that may adversely impact their performance within the military, in theaters of operations, and in their lives at home. Implications for clinical care of female service members and veterans of current wars are addressed.
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Affiliation(s)
- Susanne W Gibbons
- Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA.
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Hickling EJ, Gibbons S, Barnett SD, Watts D. The psychological impact of deployment on OEF/OIF healthcare providers. J Trauma Stress 2011; 24:726-34. [PMID: 22139677 DOI: 10.1002/jts.20703] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The psychological impact of military experience on healthcare providers has received little attention to date. The 2005 Department of Defense Survey of Health Related Behaviors Among Active Duty Personnel was used as a secondary data source, and deployed healthcare officers and healthcare specialists were identified and compared to deployed non-healthcare officers and enlisted personnel: 6,116 respondents were surveyed. Findings revealed clinically significant psychological distress among deployed military healthcare provider respondents including posttraumatic stress symptoms, depression, anxiety, and adverse psychosocial impact, more prominent in the deployed healthcare specialist group. Based upon findings, possible factors for resilience and increased risk, as well as potential intervention needs in this healthcare provider group of service members are offered. Implications for future prospective studies are suggested.
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Affiliation(s)
- Edward J Hickling
- James A. Haley Veterans Hospital and HSR&D/RR&D Research Center of Excellence, Tampa, FL 33647, USA.
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Peterson AL, Luethcke CA, Borah EV, Borah AM, Young-McCaughan S. Assessment and Treatment of Combat-Related PTSD in Returning War Veterans. J Clin Psychol Med Settings 2011; 18:164-75. [DOI: 10.1007/s10880-011-9238-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nash WP, Vasterling J, Ewing-Cobbs L, Horn S, Gaskin T, Golden J, Riley WT, Bowles SV, Favret J, Lester P, Koffman R, Farnsworth LC, Baker DG. Consensus recommendations for common data elements for operational stress research and surveillance: report of a federal interagency working group. Arch Phys Med Rehabil 2010; 91:1673-83. [PMID: 21044711 DOI: 10.1016/j.apmr.2010.06.035] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 06/11/2010] [Accepted: 06/21/2010] [Indexed: 12/15/2022]
Abstract
Empirical studies and surveillance projects increasingly assess and address potentially adverse psychological health outcomes from the stress of military operations, but no standards yet exist for common concept definitions, variable categories, and measures. This article reports the consensus recommendations of the federal interagency Operational Stress Working Group for common data elements to be used in future operational stress research and surveillance with the goal of improving comparability across studies. Operational stress encompasses more than just combat; it occurs everywhere service members and their families live and work. Posttraumatic stress is not the only adverse mental or behavioral health outcome of importance. The Operational Stress Working Group contends that a primary goal of operational stress research and surveillance is to promote prevention of adverse mental and behavioral outcomes, especially by recognizing the preclinical and subclinical states of distress and dysfunction that portend a risk for failure of role performance or future mental disorders. Recommendations for data elements are divided into 3 tiers: core, supplemental, and emerging, including variable domains and specific measures for assessing operational stressor exposures, stress outcomes, moderating factors, and mediating processes. Attention is drawn to the emerging construct of stress injury as a generic term for subclinical operational stress, and to emerging data elements addressing biological, psychological, and spiritual mediators of risk. Methodologies are needed for identifying preclinical and subclinical states of distress or dysfunction that are markers of risk for failure of role performance and future clinical mental disorders, so that targeted prevention interventions can be developed and evaluated.
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Affiliation(s)
- William P Nash
- Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, Arlington, USA.
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Wilde EA, Whiteneck GG, Bogner J, Bushnik T, Cifu DX, Dikmen S, French L, Giacino JT, Hart T, Malec JF, Millis SR, Novack TA, Sherer M, Tulsky DS, Vanderploeg RD, von Steinbuechel N. Recommendations for the use of common outcome measures in traumatic brain injury research. Arch Phys Med Rehabil 2010; 91:1650-1660.e17. [PMID: 21044708 DOI: 10.1016/j.apmr.2010.06.033] [Citation(s) in RCA: 321] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 06/09/2010] [Accepted: 06/11/2010] [Indexed: 11/28/2022]
Abstract
This article summarizes the selection of outcome measures by the interagency Traumatic Brain Injury (TBI) Outcomes Workgroup to address primary clinical research objectives, including documentation of the natural course of recovery from TBI, prediction of later outcome, measurement of treatment effects, and comparison of outcomes across studies. Consistent with other Common Data Elements Workgroups, the TBI Outcomes Workgroup adopted the standard 3-tier system in its selection of measures. In the first tier, core measures included valid, robust, and widely applicable outcome measures with proven utility in TBI from each identified domain, including global level of function, neuropsychological impairment, psychological status, TBI-related symptoms, executive functions, cognitive and physical activity limitations, social role participation, and perceived health-related quality of life. In the second tier, supplemental measures were recommended for consideration in TBI research focusing on specific topics or populations. In the third tier, emerging measures included important instruments currently under development, in the process of validation, or nearing the point of published findings that have significant potential to be superior to some older ("legacy") measures in the core and supplemental lists and may eventually replace them as evidence for their utility emerges.
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Affiliation(s)
- Elisabeth A Wilde
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.
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