1
|
Hooshmand Zaferanieh M, Shi L, Jindal M, Chen L, Zhang L, Lopes S, Jones K, Wang Y, Meggett K, Walker CB, Falgoust G, Zinzow H. Web-Based Mindfulness-Based Cognitive Therapy for Adults With a History of Depression: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e53966. [PMID: 38888958 DOI: 10.2196/53966] [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: 10/31/2023] [Revised: 03/03/2024] [Accepted: 03/21/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Depression poses a major threat to public health with an increasing prevalence in the United States. Mindfulness-based interventions, such as mindfulness-based cognitive therapy (MBCT), are effective methods for managing depression symptoms and may help fortify existing efforts to address the current disease burden. The in-person group format of MBCT, however, incurs barriers to care such as expenses, childcare needs, and transportation issues. Alternate delivery modalities such as MBCT delivered via the web can be investigated for their capacity to overcome these barriers and still reduce symptoms of depression with adequate feasibility and efficacy. OBJECTIVE This study protocol aims to examine the feasibility and efficacy of MBCT delivered via the web for the treatment of depression. METHODS To attain study aims, 2 phases will be implemented using a waitlist control design. A total of 128 eligible participants will be randomized into either an 8-week MBCT intervention group plus treatment as usual (MBCT + TAU; group 1) or an 8-week waitlist control group (group 2). In phase I (8 weeks), group 1 will complete the intervention and group 2 will proceed with TAU. In phase II (8 weeks), group 2 will complete the intervention and group 1 will continue with TAU until reaching an 8-week follow-up. TAU may consist of receiving psychotherapy, pharmacotherapy, or combined treatment. Data collection will be completed at baseline, 8 weeks (postintervention for group 1 and preintervention for group 2), and 16 weeks (follow-up for group 1, postintervention for group 2). The primary outcomes will include (1) current, residual, or chronic depression symptoms and (2) psychiatric distress. Secondary outcomes will include perceived stress and facets of mindfulness. The feasibility will be measured by assessing protocol adherence, retention, attendance, and engagement. Finally, the extent of mindfulness self-practice and executive functioning skills will be assessed as mediators of intervention outcomes. RESULTS This study began screening and recruitment in December 2022. Data collection from the first cohort occurred in January 2023. By November 2023, a total of 30 participants were enrolled out of 224 who received screening. Data analysis began in February 2024, with an approximate publication of results by August 2024. Institutional review board approval took place on September 11, 2019. CONCLUSIONS This trial will contribute to examining mindfulness-based interventions, delivered via the web, for improving current, residual, or chronic depression symptoms. It will (1) address the feasibility of MBCT delivered via the web; (2) contribute evidence regarding MBCT's efficacy in reducing depression symptoms and psychiatric distress; and (3) assess the impact of MBCT on several important secondary outcomes. Findings from this study will develop the understanding of the causal pathways between MBCT delivered via the web and depression symptoms further, elucidating the potential for future larger-scale designs. TRIAL REGISTRATION ClinicalTrials.gov NCT05347719; https://www.clinicaltrials.gov/ct2/show/NCT05347719. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53966.
Collapse
Affiliation(s)
| | - Lu Shi
- Department of Health Sciences, College of Health Professions, Pace University, New York, NY, United States
| | - Meenu Jindal
- Department of Internal Medicine, Prisma Health, Greenville, SC, United States
| | - Liwei Chen
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
| | - Lingling Zhang
- Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, United States
| | - Snehal Lopes
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States
| | - Karyn Jones
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States
| | - Yucheng Wang
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States
| | - Kinsey Meggett
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States
| | - Cari Beth Walker
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States
| | - Grace Falgoust
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States
| | - Heidi Zinzow
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States
| |
Collapse
|
2
|
Chen JA, Shofer J, Barnes ML, Livingston WS, Upham M, Simpson TL. Military Sexual Trauma As a Risk Factor for Treatment Non-Response from an Online, Self-Management Posttraumatic Stress Disorder Treatment for Women Veterans. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:2214-2237. [PMID: 38073465 DOI: 10.1177/08862605231216722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Women veterans are exposed to high rates of trauma, including military sexual trauma (MST), and face unique barriers to posttraumatic stress disorder (PTSD) treatment. Telehealth interventions that are tailored to women veterans' unique lived experiences may improve treatment engagement and outcomes. It is important to ascertain how beneficial new telehealth interventions are in the context of different patient characteristics and trauma types, particularly for lower-intensity telehealth interventions (e.g., web-based programs or apps). This secondary analysis of a randomized clinical trial conducted in a sample of 102 women veterans examines predictors of treatment response to a self-management, telehealth intervention for PTSD: Delivery of Self Training and Education for Stressful Situations-Women Veterans (DESTRESS-WV). In the trial, women veterans with PTSD received either an online cognitive behavioral intervention with phone coaching, or phone monitoring alone. We examined associations between baseline patient characteristics (demographics, trauma types, and clinical symptoms) and treatment outcome at post-treatment, 3 months, and 6 months, focusing on the association between treatment outcome and MST. Our primary outcomes were changes in PTSD (PTSD Symptom Checklist, Version 5, PCL-5) and depression (8-item Patient Health Questionnaire, PHQ-8) in the full sample, adjusting for treatment condition. Women veterans who identified MST as the primary trauma for which they were seeking PTSD treatment experienced a nearly nine-point lesser improvement on the PCL-5 than those seeking PTSD treatment for other trauma types (e.g., childhood abuse, combat trauma; p = .0073). Similar patterns were found for depression symptoms. To our knowledge, this is the first study to examine the association between trauma type and treatment outcomes within the context of a self-management, telehealth treatment for PTSD. While the study was not powered to examine differential treatment response for patient subgroups, our exploratory findings suggest that gaps remain in providing effective PTSD care for women veterans who experienced MST.Trial registration: The trial and analysis plan were preregistered in ClinicalTrials.gov (Identifier: NCT02917447).
Collapse
Affiliation(s)
- Jessica A Chen
- VA Puget Sound Healthcare System, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
| | - Jane Shofer
- VA Puget Sound Healthcare System, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
| | | | - Whitney S Livingston
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Jamaica Plain, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | | | - Tracy L Simpson
- VA Puget Sound Healthcare System, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
- Center of Excellence in Substance Addiction Treatment & Education, VA Puget Sound Healthcare System, Seattle, WA, USA
| |
Collapse
|
3
|
Hardeberg Bach M, Ahrens C, Olff M, Armour C, Krogh SS, Hansen M. EHealth for Sexual Assault: A Systematic Scoping Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:102-116. [PMID: 36632639 DOI: 10.1177/15248380221143355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Providing efficient psychosocial support for survivors of sexual assault is of critical societal importance. Around the globe, technology-based solutions (eHealth) are increasingly being used to accomplish this task, especially following COVID-19. Despite increased importance and reliance on eHealth for sexual assault, minimal efforts have been made to systematically synthesize research in this area. The present study therefore sought to synthesize what is known about eHealth targeting sexual assault survivors' psychosocial needs using a systematic scoping review methodology. To this end, five databases (CINAHL, Embase, PsycINFO, MEDLINE, and Scopus) were systematically searched for studies published from 2010 onwards using terms such as "sexual assault", "eHealth", "digital health", "telehealth", and variations thereof. Of the 6,491 records screened for eligibility, 85 studies were included in the review. We included empirical studies from all countries pertaining to eHealth for sexual assault for survivors 13 years or older. Many innovative eHealth applications for sexual assault exist today, and the included studies suggested that survivors generally experience eHealth positively and seem to benefit from it. Nevertheless, much more clinical and empirical work is needed to ensure accessible and effective solutions for all.
Collapse
Affiliation(s)
| | | | | | | | | | - Maj Hansen
- University of Southern Denmark, Odense, Denmark
| |
Collapse
|
4
|
Rauch SA, Venners MR, Ragin C, Ruhe G, Lamp K, Burton M, Pomerantz A, Bernardy N, Schnurr PP, Hamblen JL, Possemato K, Sripada R, Wray LO, Dollar K, Wade M, Astin MC, Cigrang JA. Treatment of posttraumatic stress disorder with prolonged exposure for primary care (PE-PC): Effectiveness and patient and therapist factors related to symptom change and retention. Psychol Serv 2023; 20:745-755. [PMID: 37326566 PMCID: PMC10721715 DOI: 10.1037/ser0000783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Prolonged exposure (PE) is a first-line treatment for posttraumatic stress disorder (PTSD) available in specialty mental health. PE for primary care (PE-PC) is a brief version of PE adapted for primary care mental health integration, composed of four-eight, 30-min sessions. Using retrospective data of PE-PC training cases from 155 Veterans Health Administration (VHA) providers in 99 VHA clinics who participated in a 4- to 6-month PE-PC training and consultation program, we examined patients' PTSD and depression severity across sessions via mixed effects multilevel linear modeling. Additionally, hierarchical logistic regression analysis was conducted to assess predictors of treatment dropout. Among 737 veterans, medium-to-large reductions in PTSD (intent-to-treat, Cohen's d = 0.63; completers, Cohen's d = 0.79) and small-to-medium reductions in depression (intent-to-treat, Cohen's d = 0.40; completers, Cohen's d = 0.51) were observed. The modal number of PE-PC sessions was five (SD = 1.98). Providers previously trained in both PE and cognitive processing therapy (CPT) were more likely than providers who were not trained in either PE or CPT to have veterans complete PE-PC (OR = 1.54). Veterans with military sexual trauma were less likely to complete PE-PC than veterans with combat trauma (OR = 0.42). Asian American and Pacific Islander veterans were more likely than White veterans to complete treatment (OR = 2.93). Older veterans were more likely than younger veterans to complete treatment (OR = 1.11). (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
- Sheila A.M. Rauch
- Research Service Line, Atlanta VA Medical Center, Decatur, GA, 30033
- Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA, 30033
- Emory University School of Medicine, Atlanta, GA, 30029
| | - Margaret R. Venners
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, 94025
| | - Carly Ragin
- Research Service Line, Atlanta VA Medical Center, Decatur, GA, 30033
| | - Gretchen Ruhe
- Research Service Line, Atlanta VA Medical Center, Decatur, GA, 30033
| | - Kristen Lamp
- Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA, 30033
| | - Mark Burton
- Emory University School of Medicine, Atlanta, GA, 30029
| | - Andrew Pomerantz
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington DC
| | - Nancy Bernardy
- National Center for PTSD, White River Junction VA Medical Center, White River Junction, VT, 05009
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755
| | - Paula P. Schnurr
- National Center for PTSD, White River Junction VA Medical Center, White River Junction, VT, 05009
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755
| | - Jessica L. Hamblen
- National Center for PTSD, White River Junction VA Medical Center, White River Junction, VT, 05009
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755
| | - Kyle Possemato
- VA Center for Integrated Healthcare, VA Medical Center, Syracuse, NY 13204
- Department of Psychology, Syracuse University, Syracuse, NY, 13244
| | - Rebecca Sripada
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, 48105
| | - Laura O. Wray
- VA Center for Integrated Healthcare, VA Medical Center, Syracuse, NY 13204
- Department of Psychology, Syracuse University, Syracuse, NY, 13244
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo NY
| | - Katherine Dollar
- VA Center for Integrated Healthcare, VA Medical Center, Syracuse, NY 13204
- Department of Psychology, Syracuse University, Syracuse, NY, 13244
| | - Michael Wade
- VA Center for Integrated Healthcare, VA Medical Center, Syracuse, NY 13204
| | - Millie C. Astin
- Research Service Line, Atlanta VA Medical Center, Decatur, GA, 30033
- Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA, 30033
| | - Jeffrey A. Cigrang
- School of Professional Psychology, Wright State University, Dayton, OH, 45402
| |
Collapse
|
5
|
O'Doherty L, Whelan M, Carter GJ, Brown K, Tarzia L, Hegarty K, Feder G, Brown SJ. Psychosocial interventions for survivors of rape and sexual assault experienced during adulthood. Cochrane Database Syst Rev 2023; 10:CD013456. [PMID: 37795783 PMCID: PMC10552071 DOI: 10.1002/14651858.cd013456.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Exposure to rape, sexual assault and sexual abuse has lifelong impacts for mental health and well-being. Prolonged Exposure (PE), Cognitive Processing Therapy (CPT) and Eye Movement Desensitisation and Reprocessing (EMDR) are among the most common interventions offered to survivors to alleviate post-traumatic stress disorder (PTSD) and other psychological impacts. Beyond such trauma-focused cognitive and behavioural approaches, there is a range of low-intensity interventions along with new and emerging non-exposure based approaches (trauma-sensitive yoga, Reconsolidation of Traumatic Memories and Lifespan Integration). This review presents a timely assessment of international evidence on any type of psychosocial intervention offered to individuals who experienced rape, sexual assault or sexual abuse as adults. OBJECTIVES To assess the effects of psychosocial interventions on mental health and well-being for survivors of rape, sexual assault or sexual abuse experienced during adulthood. SEARCH METHODS In January 2022, we searched CENTRAL, MEDLINE, Embase, 12 other databases and three trials registers. We also checked reference lists of included studies, contacted authors and experts, and ran forward citation searches. SELECTION CRITERIA Any study that allocated individuals or clusters of individuals by a random or quasi-random method to a psychosocial intervention that promoted recovery and healing following exposure to rape, sexual assault or sexual abuse in those aged 18 years and above compared with no or minimal intervention, usual care, wait-list, pharmacological only or active comparison(s). We classified psychosocial interventions according to Cochrane Common Mental Disorders Group's psychological therapies list. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We included 36 studies (1991 to 2021) with 3992 participants randomly assigned to 60 experimental groups (3014; 76%) and 23 inactive comparator conditions (978, 24%). The experimental groups consisted of: 32 Cognitive Behavioural Therapy (CBT); 10 behavioural interventions; three integrative therapies; three humanist; five other psychologically oriented interventions; and seven other psychosocial interventions. Delivery involved 1 to 20 (median 11) sessions of traditional face-to-face (41) or other individual formats (four); groups (nine); or involved computer-only interaction (six). Most studies were conducted in the USA (n = 26); two were from South Africa; two from the Democratic Republic of the Congo; with single studies from Australia, Canada, the Netherlands, Spain, Sweden and the UK. Five studies did not disclose a funding source, and all disclosed sources were public funding. Participants were invited from a range of settings: from the community, through the media, from universities and in places where people might seek help for their mental health (e.g. war veterans), in the aftermath of sexual trauma (sexual assault centres and emergency departments) or for problems that accompany the experience of sexual violence (e.g. sexual health/primary care clinics). Participants randomised were 99% women (3965 participants) with just 27 men. Half were Black, African or African-American (1889 participants); 40% White/Caucasian (1530 participants); and 10% represented a range of other ethnic backgrounds (396 participants). The weighted mean age was 35.9 years (standard deviation (SD) 9.6). Eighty-two per cent had experienced rape or sexual assault in adulthood (3260/3992). Twenty-two studies (61%) required fulfilling a measured PTSD diagnostic threshold for inclusion; however, 94% of participants (2239/2370) were reported as having clinically relevant PTSD symptoms at entry. The comparison of psychosocial interventions with inactive controls detected that there may be a beneficial effect at post-treatment favouring psychosocial interventions in reducing PTSD (standardised mean difference (SMD) -0.83, 95% confidence interval (CI) -1.22 to -0.44; 16 studies, 1130 participants; low-certainty evidence; large effect size based on Cohen's D); and depression (SMD -0.82, 95% CI -1.17 to -0.48; 12 studies, 901 participants; low-certainty evidence; large effect size). Psychosocial interventions, however, may not increase the risk of dropout from treatment compared to controls, with a risk ratio of 0.85 (95% CI 0.51 to 1.44; 5 studies, 242 participants; low-certainty evidence). Seven of the 23 studies (with 801 participants) comparing a psychosocial intervention to an inactive control reported on adverse events, with 21 events indicated. Psychosocial interventions may not increase the risk of adverse events compared to controls, with a risk ratio of 1.92 (95% CI 0.30 to 12.41; 6 studies; 622 participants; very low-certainty evidence). We conducted an assessment of risk of bias using the RoB 2 tool on a total of 49 reported results. A high risk of bias affected 43% of PTSD results; 59% for depression symptoms; 40% for treatment dropout; and one-third for adverse events. The greatest sources of bias were problems with randomisation and missing outcome data. Heterogeneity was also high, ranging from I2 = 30% (adverse events) to I2 = 87% (PTSD). AUTHORS' CONCLUSIONS Our review suggests that survivors of rape, sexual violence and sexual abuse during adulthood may experience a large reduction in post-treatment PTSD symptoms and depressive symptoms after experiencing a psychosocial intervention, relative to comparison groups. Psychosocial interventions do not seem to increase dropout from treatment or adverse events/effects compared to controls. However, the number of dropouts and study attrition were generally high, potentially missing harms of exposure to interventions and/or research participation. Also, the differential effects of specific intervention types needs further investigation. We conclude that a range of behavioural and CBT-based interventions may improve the mental health of survivors of rape, sexual assault and sexual abuse in the short term. Therefore, the needs and preferences of individuals must be considered in selecting suitable approaches to therapy and support. The primary outcome in this review focused on the post-treatment period and the question about whether benefits are sustained over time persists. However, attaining such evidence from studies that lack an active comparison may be impractical and even unethical. Thus, we suggest that studies undertake head-to-head comparisons of different intervention types; in particular, of novel, emerging therapies, with one-year plus follow-up periods. Additionally, researchers should focus on the therapeutic benefits and costs for subpopulations such as male survivors and those living with complex PTSD.
Collapse
Affiliation(s)
- Lorna O'Doherty
- Institute for Health and Wellbeing, Coventry University, Coventry, UK
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - Maxine Whelan
- Institute for Health and Wellbeing, Coventry University, Coventry, UK
| | - Grace J Carter
- Institute for Health and Wellbeing, Coventry University, Coventry, UK
| | - Katherine Brown
- Department of Psychology and Sports Science, University of Hertfordshire, Hatfield, UK
| | - Laura Tarzia
- Department of General Practice, The University of Melbourne, Melbourne, Australia
- The Royal Women's Hospital, Victoria, Australia
| | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne, Melbourne, Australia
- The Royal Women's Hospital, Victoria, Australia
| | - Gene Feder
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah J Brown
- Faculty of Arts, Business and Law, Law School, USC: University of the Sunshine Coast, Sippy Downs, Australia
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| |
Collapse
|
6
|
COVID-19 and the opportunity for gender-responsive virtual and remote substance use treatment and harm reduction services. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 108:103815. [PMID: 35969920 PMCID: PMC9359504 DOI: 10.1016/j.drugpo.2022.103815] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/26/2022] [Accepted: 07/31/2022] [Indexed: 11/21/2022]
Abstract
The COVID-19 pandemic has increased the uptake of virtual and remote service delivery in the substance use field, which was previously uncommon. This swift uptake of virtual services provides an opportunity to improve service design to meet the diverse needs of women and gender-diverse people. Such services have the potential to better meet the needs of women and gender-diverse people by allowing for increased choice, control, and autonomy, enabling empowerment, facilitating greater considerations of power relations, violence, childcare responsibilities, and fostering greater inclusion of trans and non-binary people. This commentary aims to identify how virtual and remote delivery of substance use treatment and harm reduction services can be gender-responsive. We highlight the role gender transformative services play in meeting the unique needs of women and gender-diverse people who use drugs both during and after the COVID-19 pandemic. By using the unique window of opportunity COVID-19 has created to develop and deliver gender-transformative programs, we can help address the detrimental gaps in service accessibility and effectiveness that have persistently been experienced by women and gender-diverse people who use drugs.
Collapse
|
7
|
Orshak J, Alexander L, Gilmore-Bykovskyi A, Lauver D. Interventions for Women Veterans with Mental Health Care Needs: Findings from a Scoping Review. Issues Ment Health Nurs 2022; 43:516-527. [PMID: 35025699 DOI: 10.1080/01612840.2021.2011506] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Experts have prioritized research on women veterans' mental health and the delivery of gender-sensitive care. The purpose of this study was to conduct a scoping review of the literature to summarize interventions for women veterans with mental health care needs designed in the Department of Veterans Affairs (VA). We identified 1,073 articles; eight were eligible for full review and represented seven unique interventions. Four studies focused on individual-level interventions; three studies focused on interpersonal-level interventions. Some attributes of gender-sensitive care included modifying the treatment environment and offering same gender clinicians. In designing interventions, clinicians and researchers can: (a) create interprofessional teams which include nurses, (b) use participatory methods to improve study designs, (c) assess participants' barriers to care prior to designing interventions, (d) incorporate and evaluate attributes of gender-sensitive care, and (e) utilize and clearly delineate how theory guides research. With improved intervention research, clinicians and researchers can support women veterans with mental health care needs.
Collapse
Affiliation(s)
- Jennifer Orshak
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Veterans Affairs Advanced Fellowship in Women's Health, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Lacey Alexander
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Andrea Gilmore-Bykovskyi
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Division of Geriatrics, Department of Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA.,Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Diane Lauver
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| |
Collapse
|
8
|
Computerized Intervention in Primary Care for Women Veterans with Sexual Assault Histories and Psychosocial Health Risks: a Randomized Clinical Trial. J Gen Intern Med 2022; 37:1097-1107. [PMID: 34013470 PMCID: PMC8971224 DOI: 10.1007/s11606-021-06851-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022]
Abstract
IMPORTANCE Sexual assault is a public health concern for women and is associated with subsequent psychosocial health risks of posttraumatic stress disorder (PTSD), hazardous drinking, and intimate partner violence (IPV). Sexual assault is associated with social stigma and other barriers shown to inhibit one from seeking mental health care. Digital health technologies may overcome these barriers. OBJECTIVE To test the impact of a brief computerized intervention delivered in primary care to reduce health risks and increase mental health treatment utilization among women with histories of sexual assault and current health risks. DESIGN, SETTING, AND PARTICIPANTS The Safe and Healthy Experiences (SHE) program was tested in a randomized controlled trial with N = 153 women veterans at a Veterans Health Administration (VHA) medical center, and they completed assessments at baseline, 2 months, and 4 months. INTERVENTION SHE is a brief motivational interviewing and psychoeducation-based computerized intervention. SHE was compared to a screen and referral-only control condition. MAIN MEASURES Health risks were measured via validated self-report instruments. Treatment initiation and utilization were measured via self-report and chart review. RESULTS SHE did not impact women's number of health risks (all p's > .05). However, women randomized to SHE showed significantly greater increases in treatment use compared to women in the control group, as measured by chart review (χ2 (1, n = 153) = 4.38, p = .036, rs = .16), and self-report (χ2 (1, n = 130) = 5.89, p = .015, rs = .21). SHE was found to be an acceptable intervention. CONCLUSIONS SHE was effective in improving mental health treatment initiation and utilization compared to a control group. Computer-based interventions to address sexual trauma and its consequences are acceptable, are highly scalable, and can add value to primary care with little cost or increase in provider time. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT02957747.
Collapse
|
9
|
Leroux J, Johnston N, Brown AA, Mihic A, DuBois D, Trudell A. Delivery of Distance Counselling to Survivors of Sexual Violence: A Scoping Review of Promising and Best Practices. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221097427. [PMID: 35514077 PMCID: PMC9082742 DOI: 10.1177/00469580221097427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Distance counselling holds immense potential for improving access to trauma supports for survivors of sexual violence (SV), and particularly for under-served groups who disproportionately experience violence and myriad barriers to accessing in-person supports. And yet, the evidence-base for the practice and delivery of distance counselling remains under-developed. In the context of COVID-19, where telehealth applications have undergone a rapid uptake, we undertook a scoping review of existing evidence of therapeutic and organizational practices related to the real-time (synchronous) delivery of distance counselling to survivors of SV. We based our scoping review methods on Arksey and O’Malley framework and in accordance with the guidance on scoping reviews from the Joanna Briggs Institute (JBI) and PRISMA reporting guidelines for scoping reviews. A comprehensive search of MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Sociological Abstracts was undertaken in October 2020, and again in March 2022. Searching, reviewing, appraisal, and data extraction was undertaken by two reviewers. In total, 1094 records were identified that resulted in 20 studies included. Descriptions, findings, and recommendations were gleaned and synthesized into potential practices using inductive thematic analysis. While many studies have an appreciative orientation to distance counselling, these benefits tend to be framed as non-universal, and conditional on survivor safety, flexibility, anonymity, survivor choice, strong and inclusive technology, and a supported workforce. Despite the limited evidence-base, we present several clusters of findings that, taken together, can be used to support current COVID-19 distance counselling initiatives with survivors, as well as guide the future development of best practices.
Collapse
Affiliation(s)
- Janette Leroux
- Sexual Assault Centre Kingston, Kingston, Ontario, Canada
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Natalie Johnston
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | | | - Alanna Mihic
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Denise DuBois
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - AnnaLise Trudell
- Anova, Gender-Based Violence Shelter and Sexual Assault Centre London, Ontario, Canada
| |
Collapse
|
10
|
Acierno R, Jaffe AE, Gilmore AK, Birks A, Denier C, Muzzy W, Lopez CM, Tuerk P, Grubaugh AL. A randomized clinical trial of in-person vs. home-based telemedicine delivery of Prolonged Exposure for PTSD in military sexual trauma survivors. J Anxiety Disord 2021; 83:102461. [PMID: 34391978 DOI: 10.1016/j.janxdis.2021.102461] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 11/26/2022]
Abstract
Posttraumatic stress disorder (PTSD) is common in women who experienced Military Sexual Trauma (MST). Despite Veterans Affairs Medical Center-wide screening and tailored MST services, substantial barriers to care exist, and about 50 % of those who start evidence-based treatment for PTSD drop out prematurely. Home-based telemedicine (HBT) may reduce logistical and stigma related barriers to mental health care, thereby reducing dropout. The current randomized clinical trial (NCT02417025) for women veterans with MST-related PTSD (N = 136) compared the efficacy of HBT delivery of Prolonged Exposure (PE) to in-person delivery of PE on measures of PTSD and depression, as well as on "PE dose" received. Hypotheses predicted that women in the HBT PE group would complete more sessions, and evince greater PTSD and depression symptom reduction compared to in-person PE. Results revealed that there were no differences in dose received or PTSD symptom reduction between in-person and HBT conditions; however, dose (i.e., more sessions) was related to reduced PTSD symptom severity. Future research should examine other factors associated with high PTSD treatment dropout among MST patients.
Collapse
Affiliation(s)
- Ron Acierno
- Faillace Department of Psychiatry, University of Texas Health Science Center at Houston, United States; Ralph H. Johnson VA Medical Center, Charleston, SC, United States.
| | - Anna E Jaffe
- Department of Psychology, University of Nebraska-Lincoln, NE, United States
| | - Amanda K Gilmore
- Department of Psychology, Georgia State University, GA, United States
| | - Anna Birks
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States
| | - Carol Denier
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States
| | - Wendy Muzzy
- Department of Psychiatry, Medical University of South Carolina, United States
| | - Cristina M Lopez
- College of Nursing, Medical University of South Carolina, United States
| | - Peter Tuerk
- School of Education and Human Development, University of Virginia, United States
| | - Anouk L Grubaugh
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States; Department of Psychiatry, Medical University of South Carolina, United States
| |
Collapse
|
11
|
Burgess DJ, Evans R, Allen KD, Bangerter A, Bronfort G, Cross LJ, Ferguson JE, Haley A, Hagel Campbell EM, Mahaffey MR, Matthias MS, Meis LA, Polusny MA, Serpa JG, Taylor SL, Taylor BC. Learning to Apply Mindfulness to Pain (LAMP): Design for a Pragmatic Clinical Trial of Two Mindfulness-Based Interventions for Chronic Pain. PAIN MEDICINE 2021; 21:S29-S36. [PMID: 33313730 DOI: 10.1093/pm/pnaa337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Mindfulness-based interventions (MBIs) are evidence-based nonpharmacological treatments for treating chronic pain. However, the predominant MBI, mindfulness-based stress reduction, has features that pose significant implementation barriers. OBJECTIVES This study will test two approaches to delivering MBIs for improving Veterans' chronic pain and mental health comorbidities. These two approaches address key implementation barriers. METHODS We will conduct a four-site, three-arm pragmatic randomized controlled trial, Learning to Apply Mindfulness to Pain (LAMP), to test the effectiveness of two MBIs at improving pain and mental health comorbidities. Mobile+Group LAMP consists of prerecorded modules presented by a mindfulness instructor that are viewed in an online group setting and interspersed with discussions led by a facilitator. Mobile LAMP consists of the same prerecorded modules but does not include a group component. We will test whether either of these MBIs will be more effective than usual care at improving chronic pain and whether the Mobile+Group LAMP will be more effective than Mobile LAMP at improving chronic pain. Comparisons for the primary hypotheses will be conducted with continuous outcomes (Brief Pain Inventory interference score) repeated at 10 weeks, 6 months, and 12 months. The secondary hypotheses are that Mobile+Group LAMP and Mobile LAMP will be more effective than usual care at improving secondary outcomes (e.g., post-traumatic stress disorder, depression). We will also confirm the comparisons for the primary and secondary hypotheses in gender-specific strata. IMPLICATIONS This trial is expected to result in two approaches for delivering MBIs that will optimize engagement, adherence, and sustainability and be able to reach large numbers of Veterans.
Collapse
Affiliation(s)
- Diana J Burgess
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, USA.,University of Minnesota Medical School
| | - Roni Evans
- Integrative Health & Wellbeing Research Program, Center for Spirituality & Healing.,School of Nursing, University of Minnesota
| | - Kelli D Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System.,Thurston Arthritis Research Center, University of North Carolina at Chapel Hill
| | - Ann Bangerter
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, USA
| | - Gert Bronfort
- Integrative Health & Wellbeing Research Program, Center for Spirituality & Healing.,School of Nursing, University of Minnesota
| | - Lee J Cross
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, USA
| | - John E Ferguson
- University of Minnesota Medical School.,Minneapolis VA Medical Center
| | - Alex Haley
- Integrative Health & Wellbeing Research Program, Center for Spirituality & Healing.,School of Nursing, University of Minnesota
| | - Emily M Hagel Campbell
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, USA
| | - Mallory R Mahaffey
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, USA
| | - Marianne S Matthias
- Center for Health Information and Communication, Roudebush VA Medical Center.,Regenstrief Institute.,Indiana University School of Medicine
| | - Laura A Meis
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, USA.,University of Minnesota Medical School
| | - Melissa A Polusny
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, USA.,University of Minnesota Medical School
| | - J Greg Serpa
- Greater Los Angeles VA Healthcare System, Los Angeles, California, USA.,Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Healthcare System, Los Angeles, California, USA
| | - Stephanie L Taylor
- Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Healthcare System, Los Angeles, California, USA.,Department of Health Policy and Management, UCLA School of Public Health and UCLA School of Medicine, Los Angeles, California, USA
| | - Brent C Taylor
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, USA.,University of Minnesota Medical School
| |
Collapse
|
12
|
Military Sexual Trauma: An Update for Nurse Practitioners. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
13
|
Gilmore AK, Lopez C, Muzzy W, Brown WJ, Grubaugh A, Oesterle DW, Acierno R. Emotion Dysregulation Predicts Dropout from Prolonged Exposure Treatment among Women Veterans with Military Sexual Trauma-Related Posttraumatic Stress Disorder. Womens Health Issues 2020; 30:462-469. [PMID: 32843240 DOI: 10.1016/j.whi.2020.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 03/19/2020] [Accepted: 07/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Military sexual trauma (MST) is notably prevalent among military personnel and can result in mental and physical health problems, including post-traumatic stress disorder (PTSD). Although there are several evidence-based treatments for MST-related PTSD, including prolonged exposure (PE) therapy, it is unclear what factors are associated with premature termination (i.e., dropout) from this treatment. Given the popularity of PE as an evidence-based treatment for PTSD, the examination of variables that influence dropout from PE among women veterans with MST is warranted. Identification of these specific factors may assist clinicians in addressing the unique symptom profiles and potential barriers to treatment access for individual MST survivors. METHODS The current study presents secondary data analyses from an ongoing randomized clinical trial that compared the effectiveness of PE delivered in person to delivery via telemedicine for women veterans with MST-related PTSD (n = 136). RESULTS A total of 50% of participants dropped out from the study (n = 68). Difficulties with emotion regulation at baseline were associated with treatment dropout (odds ratio, 1.03; p < .01), whereas baseline PTSD and demographic factors were not. CONCLUSIONS Findings from the current study indicate that emotion regulation skills deficits contribute to PE dropout and may be an appropriate target to address in future clinical trials for PTSD treatment.
Collapse
Affiliation(s)
- Amanda K Gilmore
- Department of Health Policy and Behavioral Sciences and Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, Georgia.
| | - Cristina Lopez
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Wendy Muzzy
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Wilson J Brown
- School of Humanities & Social Sciences, Pennsylvania State University, The Behrend College, Erie, Pennsylvania
| | - Anouk Grubaugh
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina; Military Sciences Division, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Daniel W Oesterle
- Department of Health Policy and Behavioral Sciences and Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, Georgia; Department of Psychological Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana
| | - Ron Acierno
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina; University of Texas Health Science Center at Houston, Houston, Texas
| |
Collapse
|
14
|
Fleuty K, Almond MK. Remote Access Therapy for Veterans With Psychological Problems: Current State of the Art. Mil Med 2020; 185:e1046-e1050. [PMID: 32060551 DOI: 10.1093/milmed/usaa020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The past decade has seen both an increase in use and research into ways in which psychological therapy might be delivered remotely. Remote access therapy uses technology to deliver talking therapies. It is important to understand how remote technologies are being used as part of the therapeutic process and consider what effect this has on the success of therapeutic interventions. This review discusses what is currently known about the use of remote access therapy with a veteran population. Moreover, the review summarizes potential benefits and barriers to conducting therapy remotely. MATERIALS AND METHODS This review was conducted to explore the use of remote access therapies with veterans. All available literature identified for this review focused on veteran cohorts from the US and UK. To meet search criteria, studies had to include veteran participants engaging with any form of talking therapy delivered remotely. A total of 15 studies met the inclusion criteria: two from the UK and 13 from the US. Searches were carried out during June and July 2019. RESULTS A number of potential benefits to remote therapy delivery were observed in the research reviewed, including improved accessibility to therapy for people living in remote locations (providing infrastructure existed to facilitate the remote access technologies), increased flexibility of timing, and being able to undergo therapy alongside other life commitments. The studies also suggested that those involved in remote therapy found the technology accessible and easy to operate. Digital technologies could generally be relied upon and although there were some technical difficulties reported that these were generally not seen as a barrier to the use of remote technologies as a whole. Some limitations to using remote therapies were observed, such as the acceptability of remote therapy, particularly in the UK, and the willingness of practitioners to engage with digital technologies to facilitate remote therapy. There was also caution raised that the apparent cost effectiveness of delivering therapy remotely needs to be further investigated, particularly in relation to costs involved in enabling remote access technologies in locations where poor infrastructure exists. CONCLUSIONS Overall, studies reported largely positive outcomes for veterans undergoing remote access therapy and in general participants did not find the therapeutic process compromised by remote delivery. Studies showed that remote access therapy is being conducted successfully in both the US and UK. There is, however, a need for more research into the use of remote access therapies to treat a wider range of psychological difficulties in veterans.
Collapse
Affiliation(s)
- Kristina Fleuty
- Forces in Mind Trust Research Centre, Anglia Ruskin University, Michael Salmon Building, Bishops Hall Lane, Chelmsford CM1 1SQ, UK
| | - Michael K Almond
- Forces in Mind Trust Research Centre, Anglia Ruskin University, Michael Salmon Building, Bishops Hall Lane, Chelmsford CM1 1SQ, UK
| |
Collapse
|
15
|
Women Veterans' Perspectives on How to Make Veterans Affairs Healthcare Settings More Welcoming to Women. Womens Health Issues 2020; 30:299-305. [DOI: 10.1016/j.whi.2020.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/04/2020] [Accepted: 03/17/2020] [Indexed: 02/06/2023]
|
16
|
Gerber MR, Elisseou S, Sager ZS, Keith JA. Trauma-Informed Telehealth in the COVID-19 Era and Beyond. Fed Pract 2020; 37:302-308. [PMID: 32908333 PMCID: PMC7473719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The Veterans Health Administration (VHA) entered the COVID-19 pandemic crisis with an existing and robust telehealth program, but it still faces a fundamental paradigm shift as most routine outpatient in-person care was converted to telehealth visits. Veterans are a highly trauma-exposed population, and VHA has long offered effective telemental health services. Natural disasters and pandemics like COVID-19 are known to be traumatic. Those with preexisting trauma exposure and mental health conditions are often at greater risk than the general population for long-term adverse health sequelae. Application of trauma-informed principles to telehealth care is critical and timely. OBSERVATIONS Trauma-focused care (including telemental health) refers to evidence-based treatment models that directly facilitate recovery from trauma-related conditions like posttraumatic stress disorder. Despite the widespread availability of trauma-focused treatment in VHA, not all veterans chose to engage in it. In contrast, trauma-informed care (TIC) is a global, "universal precautions" approach to providing strengths-based, collaborative quality medical care in any discipline or location. In this article the authors, all primary care and mental health clinicians at VHA, advocate for the application of the 6 Substance Abuse and Mental Health Services Administration principles of trauma-informed care to telehealth. Using examples from telehealth research conducted in trauma-exposed patient populations, we illustrate the characteristics of telehealth that are well suited to delivery of trauma-informed care and suggest readily applicable strategies that can be used across disciplines including primary care and medical/surgical specialties. A primary care patient case scenario is included to illustrate how telehealth visits can be trauma-informed. CONCLUSIONS Telehealth expansion has occurred nationally out of necessity during the COVID-19 pandemic. Trauma-informed virtual care has the potential to ensure and even expand continuity of medical care by fostering safe and collaborative interactions between patients and the health care team.
Collapse
Affiliation(s)
- Megan R Gerber
- and are Primary Care Physicians; and is a Hospice and Palliative Care Physician at the New England Geriatric Research Education and Clinical Center; all at the Veterans Affairs Boston Healthcare System in Massachusetts. is a Clinical Psychologist at Bay Pines Veterans Affairs Healthcare System and an Associate Professor of Psychology at the University of Central Florida College of Medicine in Orlando. Megan Gerber is an Associate Professor of Medicine at Boston University School of Medicine. Sadie Elisseou is an Instructor in Medicine and Zachary Sager is an Instructor in Psychiatry, both at Harvard Medical School in Boston
| | - Sadie Elisseou
- and are Primary Care Physicians; and is a Hospice and Palliative Care Physician at the New England Geriatric Research Education and Clinical Center; all at the Veterans Affairs Boston Healthcare System in Massachusetts. is a Clinical Psychologist at Bay Pines Veterans Affairs Healthcare System and an Associate Professor of Psychology at the University of Central Florida College of Medicine in Orlando. Megan Gerber is an Associate Professor of Medicine at Boston University School of Medicine. Sadie Elisseou is an Instructor in Medicine and Zachary Sager is an Instructor in Psychiatry, both at Harvard Medical School in Boston
| | - Zachary S Sager
- and are Primary Care Physicians; and is a Hospice and Palliative Care Physician at the New England Geriatric Research Education and Clinical Center; all at the Veterans Affairs Boston Healthcare System in Massachusetts. is a Clinical Psychologist at Bay Pines Veterans Affairs Healthcare System and an Associate Professor of Psychology at the University of Central Florida College of Medicine in Orlando. Megan Gerber is an Associate Professor of Medicine at Boston University School of Medicine. Sadie Elisseou is an Instructor in Medicine and Zachary Sager is an Instructor in Psychiatry, both at Harvard Medical School in Boston
| | - Jessica A Keith
- and are Primary Care Physicians; and is a Hospice and Palliative Care Physician at the New England Geriatric Research Education and Clinical Center; all at the Veterans Affairs Boston Healthcare System in Massachusetts. is a Clinical Psychologist at Bay Pines Veterans Affairs Healthcare System and an Associate Professor of Psychology at the University of Central Florida College of Medicine in Orlando. Megan Gerber is an Associate Professor of Medicine at Boston University School of Medicine. Sadie Elisseou is an Instructor in Medicine and Zachary Sager is an Instructor in Psychiatry, both at Harvard Medical School in Boston
| |
Collapse
|
17
|
Dyer KE, Moreau JL, Finley E, Bean-Mayberry B, Farmer MM, Bernet D, Kress A, Lewis JL, Batuman FK, Haskell SG, Hamilton AB, Moin T. Tailoring an evidence-based lifestyle intervention to meet the needs of women Veterans with prediabetes. Women Health 2020; 60:748-762. [PMID: 31959089 DOI: 10.1080/03630242.2019.1710892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Prediabetes affects one-third of U.S. adults. Lifestyle change interventions, such as the Diabetes Prevention Program (DPP), can significantly lower type 2 diabetes risk, but little is known about how the DPP could be best adapted for women. This mixed-methods study assessed the impact of gender-tailoring and modality choice on DPP engagement among women Veterans with prediabetes. Participants were offered women-only groups and either in-person/peer-led or online modalities. Implementation outcomes were assessed using attendance logs, recruitment calls, and semi-structured interviews about patient preferences. Between June 2016 and March 2017, 119 women Veterans enrolled in the DPP (n = 51 in-person, n = 68 online). We conducted 22 interviews between August and September 2016 (n = 10 early-implementation) and March and July 2017 (n = 12 follow-up). Most interviewees preferred women-only groups, citing increased comfort, camaraderie, and mutual understanding of gender-specific barriers to lifestyle change. More women preferred online DPP, and those using this modality participated at higher rates. Most endorsed the importance of modality choice and were satisfied with their selection; however, selection was frequently based on participants' personal circumstances and access barriers and not on a "preferred choice" of two equally accessible options. Patient engagement and program reach can be expanded by tailoring the DPP for population-specific needs.
Collapse
Affiliation(s)
- Karen E Dyer
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Jessica L Moreau
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Erin Finley
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA.,Veterans Evidence-based Research, Dissemination, and Implementation Center (VERDICT), South Texas Veterans Healthcare System , San Antonio, Texas, USA.,Departments of Medicine and Psychiatry, University of Texas Health Science Center , San Antonio, Texas, USA
| | - Bevanne Bean-Mayberry
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA.,UCLA David Geffen School of Medicine , Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Melissa M Farmer
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Dorothy Bernet
- VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Arthur Kress
- VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Jackie L Lewis
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Fatma K Batuman
- UCLA David Geffen School of Medicine , Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Sally G Haskell
- Women's Health Services, Veterans Health Administration , Washington, District of Columbia, USA.,VA Connecticut Healthcare System , West Haven, Connecticut, USA.,Yale University School of Medicine , New Haven, Connecticut, USA
| | - Alison B Hamilton
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA.,UCLA David Geffen School of Medicine , Los Angeles, California, USA
| | - Tannaz Moin
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA.,UCLA David Geffen School of Medicine , Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| |
Collapse
|
18
|
Liu L, Thorp SR, Moreno L, Wells SY, Glassman LH, Busch AC, Zamora T, Rodgers CS, Allard CB, Morland LA, Agha Z. Videoconferencing psychotherapy for veterans with PTSD: Results from a randomized controlled non-inferiority trial. J Telemed Telecare 2019; 26:507-519. [PMID: 31216210 DOI: 10.1177/1357633x19853947] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Veterans with post-traumatic stress disorder (PTSD) face significant barriers that make it less likely for them to pursue treatment. A randomized controlled non-inferiority trial was used to determine if providing psychotherapy for PTSD via videoconference (VC) is as effective as in-person (IP) psychotherapy. METHODS All eligible veterans (n = 207) received cognitive processing therapy (CPT) to treat PTSD symptoms in one of the two treatment modalities. Participant symptoms were collected at baseline, post-treatment, and six months after treatment completion. The primary outcome measure, the Clinician-Administered PTSD Scale (CAPS), was used to assess PTSD diagnosis and symptom severity. Secondary outcomes included two self-report measures of symptom severity, the Post-traumatic Stress Disorder Checklist - Specific (PCL-S) for PTSD and the Patient Health Questionnaire - 9 (PHQ-9) for depressive symptoms. A linear mixed-effects model was used to assess non-inferiority for participants who completed treatment (completers) and those who were randomized to treatment (intention-to-treat (ITT)). RESULTS Both completer and ITT analyses showed that improvement in CAPS scores in the VC condition was non-inferior to that in the IP condition at six-month follow-up, but VC was inferior to IP for improvement in CAPS at post-treatment. Non-inferiority was supported by completer analyses for PCL-S and PHQ-9 in both post-treatment change and six-month follow-up change, and the ITT analysis supported the significant non-inferiority for PCL at post-treatment change. DISCUSSION These findings generally suggest that CPT delivered via VC can be as effective as IP for reducing the severity of PTSD symptoms.
Collapse
Affiliation(s)
- Lin Liu
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Steven R Thorp
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.,Veterans Medical Research Foundation, San Diego, CA, USA.,California School of Professional Psychology, Alliant International University, San Diego, CA, USA
| | - Lucy Moreno
- VA San Diego Healthcare System, San Diego, CA, USA.,California Primary Care Association, Sacramento, CA, USA
| | - Stephanie Y Wells
- VA San Diego Healthcare System, San Diego, CA, USA.,Veterans Medical Research Foundation, San Diego, CA, USA.,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Lisa H Glassman
- VA San Diego Healthcare System, San Diego, CA, USA.,Veterans Medical Research Foundation, San Diego, CA, USA
| | - Angela C Busch
- Veterans Medical Research Foundation, San Diego, CA, USA
| | - Tania Zamora
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Carie S Rodgers
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA.,PsychArmor Institute, San Diego, CA, USA
| | - Carolyn B Allard
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Leslie A Morland
- VA San Diego Healthcare System, San Diego, CA, USA.,Veterans Medical Research Foundation, San Diego, CA, USA
| | - Zia Agha
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Medicine, University of California, San Diego, La Jolla, CA, USA.,West Health Institute, San Diego, CA, USA
| |
Collapse
|
19
|
Dyer KE, Potter SJ, Hamilton AB, Luger TM, Bergman AA, Yano EM, Klap R. Gender Differences in Veterans’ Perceptions of Harassment on Veterans Health Administration Grounds. Womens Health Issues 2019; 29 Suppl 1:S83-S93. [DOI: 10.1016/j.whi.2019.04.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 04/27/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
|
20
|
Holliday R, Monteith LL. Seeking help for the health sequelae of military sexual trauma: a theory-driven model of the role of institutional betrayal. J Trauma Dissociation 2019; 20:340-356. [PMID: 30714879 DOI: 10.1080/15299732.2019.1571888] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although rates vary, approximately 38.4% of women and 3.9% of men report experiencing military sexual trauma (MST). MST is associated with numerous psychosocial consequences, increased propensity for physical and mental health diagnoses, suicide, and an elevated likelihood of revictimization. Consequently, medical and mental health care for MST-related health sequelae is often warranted for individuals who have experienced MST; however, many MST survivors forgo or delay MST-related care, despite the fact that the Veterans Health Administration (VHA) provides free healthcare for MST-related health conditions. One potential explanation for this phenomenon is that survivors of MST feel betrayed by the military institution that they served when the MST occurred due to the institutional response to MST or perceptions that the institution failed to prevent MST from occurring. Perceptions of institutional betrayal may, in turn, decrease survivors' likelihood of disclosing MST and utilizing necessary treatment through VHA or affiliated institutions. A theoretical model of the role of institutional betrayal on help-seeking is proposed in which institutional betrayal serves as a potential barrier to utilizing MST-related healthcare. Potential mediators of this association (e.g., distrust, beliefs about safety) are also posited. This model offers utility in conceptualizing institutional factors that may influence helping-seeking following MST. By testing and refining such models, institutions and providers may be better-equipped to support MST survivors in obtaining necessary healthcare.
Collapse
Affiliation(s)
- Ryan Holliday
- a Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, USA.,b Department of Psychiatry, University of Colorado Anschutz Medical Campus, USA
| | - Lindsey L Monteith
- a Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, USA.,b Department of Psychiatry, University of Colorado Anschutz Medical Campus, USA
| |
Collapse
|
21
|
Azarang A, Pakyurek M, Giroux C, Nordahl TE, Yellowlees P. Information Technologies: An Augmentation to Post-Traumatic Stress Disorder Treatment Among Trauma Survivors. Telemed J E Health 2019; 25:263-271. [DOI: 10.1089/tmj.2018.0068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Atoosa Azarang
- MIND Institute, University of California-Davis Medical Center, Sacramento, California
| | - Murat Pakyurek
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, School of Medicine, Sacramento, California
| | - Caroline Giroux
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, School of Medicine, Sacramento, California
| | - Thomas E. Nordahl
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, School of Medicine, Sacramento, California
| | - Peter Yellowlees
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, School of Medicine, Sacramento, California
| |
Collapse
|
22
|
Morland LA, Wells SY, Glassman LH, Grubbs KM, Mackintosh MA, Golshan S, Sohn MJ, Thorp SR, Savage UC, Acierno RE. What Do Veterans Want? Understanding Veterans’ Preferences for PTSD Treatment Delivery. Mil Med 2019; 184:686-692. [DOI: 10.1093/milmed/usz035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/26/2018] [Accepted: 02/13/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Home-based delivery of psychotherapy may offer a viable alternative to traditional office-based treatment for post-traumatic stress disorder (PTSD) by overcoming several barriers to care. Little is known about patient perceptions of home-based mental health treatment modalities. This study assessed veterans’ preferences for treatment delivery modalities and how demographic variables and trauma type impact these preferences.
Materials and Methods
Veterans with PTSD (N = 180) participating in a randomized clinical trial completed a clinician-administered PTSD assessment and were asked to identify their modality preference for receiving prolonged exposure: home-based telehealth (HBT), office-based telehealth (OBT), or in-home-in-person (IHIP). Ultimately, modality assignment was randomized, and veterans were not guaranteed their preferred modality. Descriptive statistics were used to examine first choice preference. Chi-square tests determined whether there were significant differences among first choice preferences; additional tests examined if age, sex, and military sexual trauma (MST) history were associated with preferences.
Results
The study includes 135 male veterans and 45 female veterans from all military branches; respondents were 46.30 years old, on average. Veterans were Caucasian (46%), African-American (28%), Asian-American (9%), American Indian or Alaskan Native (3%), Native Hawaiian or Pacific Islander (3%), and 11% identified as another race. Veterans experienced numerous trauma types (e.g., combat, sexual assault), and 29% had experienced MST. Overall, there was no clear preference for one modality: 42% of veterans preferred HBT, 32% preferred IHIP, and 26% preferred OBT. One-sample binomial tests assuming equal proportions were conducted to compare each pair of treatment options. HBT was significantly preferred over OBT (p = 0.01); there were no significant differences between the other pairs. A multinomial regression found that age group significantly predicted veterans’ preferences for HBT compared to OBT (odds ratio [OR] = 10.02, 95% confidence interval [CI]: 1.63, 61.76). Older veterans were significantly more likely to request HBT compared to OBT. Veteran characteristics did not differentiate those who preferred IHIP to OBT. Because there were fewer women (n = 45), additional multinomial regressions were conducted on each sex separately. There was no age group effect among the male veterans. However, compared to female Veterans in the younger age group, older female Veterans were significantly more likely to request HBT over OBT (OR = 10.66, 95% CI: 1.68, 67.58, p = 0.012). MST history did not predict treatment preferences in any analysis.
Conclusions
Fewer than 50% of the sample preferred one method, and each modality was preferred by at least a quarter of all participants, suggesting that one treatment modality does not fit all. Both home-based care options were desirable, highlighting the value of offering a range of options. The use of home-based care can expand access to care, particularly for rural veterans. The current study includes a diverse group of veterans and increases our understanding of how they would like to receive PTSD treatment. The study used a forced choice preference measure and did not examine the strength of preference, which limits conclusions. Future studies should examine the impact of modality preferences on treatment outcomes and engagement.
Collapse
Affiliation(s)
- Leslie A Morland
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA
- Department of Psychiatry, University of California San Diego, Department of Psychiatry, 9500 Gilman Drive Mc 0603, La Jolla, CA
- National Center for PTSD-Pacific Island Division; 3375 Koapaka Street, Suite I-560, Honolulu, HI
- Veterans Medical Research Foundation, 3350 La Jolla Village Dr # 151a Bldg 13, San Diego, CA
| | - Stephanie Y Wells
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA
- Veterans Medical Research Foundation, 3350 La Jolla Village Dr # 151a Bldg 13, San Diego, CA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA
| | - Lisa H Glassman
- Department of Psychiatry, University of California San Diego, Department of Psychiatry, 9500 Gilman Drive Mc 0603, La Jolla, CA
- Center of Excellence for Stress and Mental Health, San Diego VA Healthcare System, 3350 La Jolla Village Drive. San Diego, CA (MC 116A)
| | - Kathleen M Grubbs
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA
- Department of Psychiatry, University of California San Diego, Department of Psychiatry, 9500 Gilman Drive Mc 0603, La Jolla, CA
| | - Margaret-Anne Mackintosh
- National Center for PTSD – Dissemination and Training Division; NCPTSD – 334, 795 Willow Road Menlo Park, CA
| | - Shahrokh Golshan
- Department of Psychiatry, University of California San Diego, Department of Psychiatry, 9500 Gilman Drive Mc 0603, La Jolla, CA
| | - Min Ji Sohn
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA
| | | | - Ulysses C Savage
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA
| | - Ronald E Acierno
- College of Nursing, Medical University of South Carolina, 179 Ashley Ave, Charleston, SC
- Ralph H. Johnson Medical Center, 109 Bee St, Charleston, SC
| |
Collapse
|
23
|
Cichowski S, Ashley M, Ortiz O, Dunivan G. Female Veterans' Experiences With VHA Treatment for Military Sexual Trauma. Fed Pract 2019; 36:41-47. [PMID: 30766417 PMCID: PMC6366579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Provider validation and support for females' experiences as well as a range of therapies are essential treatments for female veterans with military sexual trauma.
Collapse
Affiliation(s)
- Sara Cichowski
- is a Female Pelvic Medicine and Reconstructive Surgeon at New Mexico VA Health Care System and University of New Mexico. is a Medical Student, is a Resident Physician in psychiatry, and is a Female Pelvic Medicine and Reconstructive Surgeon, all at the University of New Mexico in Albuquerque
| | - Malia Ashley
- is a Female Pelvic Medicine and Reconstructive Surgeon at New Mexico VA Health Care System and University of New Mexico. is a Medical Student, is a Resident Physician in psychiatry, and is a Female Pelvic Medicine and Reconstructive Surgeon, all at the University of New Mexico in Albuquerque
| | - Orlando Ortiz
- is a Female Pelvic Medicine and Reconstructive Surgeon at New Mexico VA Health Care System and University of New Mexico. is a Medical Student, is a Resident Physician in psychiatry, and is a Female Pelvic Medicine and Reconstructive Surgeon, all at the University of New Mexico in Albuquerque
| | - Gena Dunivan
- is a Female Pelvic Medicine and Reconstructive Surgeon at New Mexico VA Health Care System and University of New Mexico. is a Medical Student, is a Resident Physician in psychiatry, and is a Female Pelvic Medicine and Reconstructive Surgeon, all at the University of New Mexico in Albuquerque
| |
Collapse
|
24
|
Evans EA, Glover DL, Washington DL, Hamilton AB. Psychosocial Factors that Shape Substance Abuse and Related Mental Health of Women Military Veterans who Use Community-Based Services. Subst Use Misuse 2018; 53:1878-1892. [PMID: 29485302 DOI: 10.1080/10826084.2018.1441309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Women Veterans who use the Veterans Health Administration (VA) have high rates of substance abuse and poorer health than non-Veteran women. Less is known about the psychosocial needs of women Veterans who seek care in non-VA settings. OBJECTIVES We provide a grounded description of factors that impact substance abuse, mental health, and related quality of life of women Veterans who use non-VA community-based health and social services. METHODS Utilizing a mixed methods design, we conducted semi-structured in-person interviews with 22 women Veterans in Los Angeles in 2013-2015. RESULTS The current health of these women Veterans was shaped by substance abuse and several other factors, including: histories of trauma (in childhood, during military service) and discrimination, and associated mental health conditions; post-military socio-economic stressors; shifting social roles and adverse social support; and lost personal identity after military service. Psychosocial factors collectively underscore areas in which delivery of health and social services to women Veterans being treated in non-VA settings could be improved: (1) diffuse, implement, and sustain evidence-based gender-sensitive substance abuse treatment; (2) address traumas contributing to poor health; (3) recognize stress proliferation processes erode women's capacity to access healthcare or cope with stressors in healthy ways; (4) champion women Veterans who embody resilience and thereby can help others to form empowered personal identities of health and wellness. CONCLUSION Findings can inform interventions and services that ameliorate vulnerability to substance abuse and other health risks among women Veterans.
Collapse
Affiliation(s)
- Elizabeth A Evans
- a Department of Health Promotion and Policy , School of Public Health and Health Sciences, University of Massachusetts , Amherst , Massachusetts , USA.,b Department of Veterans Affairs (VA) Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation , Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles , California , USA
| | - Dawn L Glover
- b Department of Veterans Affairs (VA) Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation , Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles , California , USA
| | - Donna L Washington
- b Department of Veterans Affairs (VA) Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation , Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,c Department of Medicine , Geffen School of Medicine, University of California , Los Angeles , California , USA
| | - Alison B Hamilton
- b Department of Veterans Affairs (VA) Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation , Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,d Department of Psychiatry and Biobehavioral Sciences , David Geffen School of Medicine, University of California , Los Angeles , California , USA
| |
Collapse
|
25
|
Moreau JL, Cordasco KM, Young AS, Oishi SM, Rose DE, Canelo I, Yano EM, Haskell SG, Hamilton AB. The Use of Telemental Health to Meet the Mental Health Needs of Women Using Department of Veterans Affairs Services. Womens Health Issues 2018; 28:181-187. [DOI: 10.1016/j.whi.2017.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 11/27/2017] [Accepted: 12/11/2017] [Indexed: 01/01/2023]
|
26
|
Implementing Video to Home to Increase Access to Evidence-Based Psychotherapy for Rural Veterans. ACTA ACUST UNITED AC 2017; 2:140-148. [PMID: 32346604 DOI: 10.1007/s41347-017-0032-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This clinical demonstration project used facilitation to implement VA Video to Home (VTH) to deliver evidence-based psychotherapies to underserved rural Veterans, to increase access to mental health care. Participants were Veterans seeking mental health treatment at "Sonny" Montgomery Veterans Affairs Medical Center in Jackson, MS, and/or its six community-based outpatient clinics. Measures included patient encounter and demographic data, patient and provider interviews, reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) factors, measures of fidelity to manualized evidence-based psychotherapies (EBPs), and qualitative interviews. The project was deemed feasible; 93 (67 men, 26 women, including 77 rural, 16 urban) patients received weekly EBPs via VTH. Nearly half were Black (n = 46), 36 of whom (78.3%) were also rural. Fifty-three (48.4%) were Operation Enduring Freedom/Operation Iraqi Freedom Veterans. Ages varied widely, from 20 to 79 years. Primary diagnoses included posttraumatic stress disorder (41), depressive disorders (22), anxiety disorders (nine), insomnia (eight), chronic pain (eight), and substance use disorder (five). Fifteen clinicians were trained to deliver eight EBPs via VTH. Growth in number of Veterans treated by telehealth was 10.12 times and mental health visits were 7.34 times greater than the national annual average of growth for telehealth at VHA facilities. Illustrative examples and qualitative data from both patients and providers suggested overall satisfaction with VTH. This demonstrates the benefits of VTH for increasing access to mental health treatment for rural patients and advantages of an implementation facilitation strategy using an external facilitator. Continuing research should clarify whether certain patients are more likely to participate than others and whether certain EBPs are more easily delivered with VTH than others.
Collapse
|
27
|
Study adaptation, design, and methods of a web-based PTSD intervention for women Veterans. Contemp Clin Trials 2017; 53:68-79. [DOI: 10.1016/j.cct.2016.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/24/2016] [Accepted: 12/03/2016] [Indexed: 01/18/2023]
|
28
|
Gilmore AK, Brignone E, Painter JM, Lehavot K, Fargo J, Suo Y, Simpson T, Carter ME, Blais RK, Gundlapalli AV. Military Sexual Trauma and Co-occurring Posttraumatic Stress Disorder, Depressive Disorders, and Substance Use Disorders among Returning Afghanistan and Iraq Veterans. Womens Health Issues 2016; 26:546-54. [PMID: 27528358 DOI: 10.1016/j.whi.2016.07.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 06/23/2016] [Accepted: 06/29/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE Posttraumatic stress disorder (PTSD), depressive disorders (DD), and substance use disorders (SUD) are prevalent among veterans. A positive military sexual trauma (MST) screen is associated with higher likelihood of each of these disorders. The current study examined the associations between MST, gender, and co-occurring PTSD, DD, and SUD among veterans receiving services at the Department of Veterans Affairs to inform assessment and treatment. We were specifically interested in the interactions between MST and gender on co-occurring disorders. METHODS The sample included 494,822 Department of Veterans Affairs service-seeking veterans (12.5% women) deployed to Iraq and Afghanistan who recently separated from the military and were screened for MST between 2004 and 2013. MAIN FINDINGS Veterans with positive MST screens had higher odds than those with negative screens of individual and co-occurring PTSD, DD, and SUD. The association between positive MST screens and diagnostic outcomes, including PTSD, was stronger for women than for men, and the association between positive MST screens and some diagnostic outcomes, including DD, was stronger for men than for women. CONCLUSIONS These results highlight the importance of assessing for and recognizing the potential MST and gender interactions in the clinical context among veterans with co-occurring PTSD, DD, and/or SUD.
Collapse
Affiliation(s)
- Amanda K Gilmore
- Department of Psychiatry, National Crime Victims Research & Treatment Center, Medical University of South Carolina, Charleston, South Carolina; VA Puget Sound Health Care System, Seattle Division, Seattle, Washington.
| | - Emily Brignone
- Department of Psychology, Utah State University, Logan, Utah; VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Janelle M Painter
- VA Puget Sound Health Care System, Seattle Division, Seattle, Washington
| | - Keren Lehavot
- VA Puget Sound Health Care System, Seattle Division, Seattle, Washington
| | - Jamison Fargo
- Department of Psychology, Utah State University, Logan, Utah; VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Ying Suo
- VA Salt Lake City Health Care System, Salt Lake City, Utah; Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Tracy Simpson
- VA Puget Sound Health Care System, Seattle Division, Seattle, Washington
| | | | - Rebecca K Blais
- Department of Psychology, Utah State University, Logan, Utah
| | - Adi V Gundlapalli
- VA Salt Lake City Health Care System, Salt Lake City, Utah; Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| |
Collapse
|