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Moyce S, Crawford C. Community Health Workers as Mental Health Paraprofessionals: Protocol for a Mixed-Methods Pilot Feasibility Study. JMIR Res Protoc 2024; 13:e57343. [PMID: 39264699 PMCID: PMC11427855 DOI: 10.2196/57343] [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: 02/13/2024] [Revised: 07/24/2024] [Accepted: 07/31/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Community health workers (CHWs) are effective in delivering behavioral activation (BA), especially in low-resource settings. In an area with a lack of Spanish-speaking mental health counselors, such as southwest Montana, CHWs can provide needed care. OBJECTIVE The goal of this pilot study protocol is to test the feasibility, acceptability, and preliminary efficacy of a model of care that engages CHWs as providers of BA. METHODS We will train 2 CHWs in BA methodology. We will enroll 20 participants who screen positive for depression in a 12-week telephone intervention for BA. Preliminary efficacy will be tested in pre- and postscores of the Beck Depression Inventory and semistructured interviews. Feasibility and acceptability will be measured through participant retention and treatment adherence. The Therapeutic Alliance with Clinician Scale will be used to measure the strength of the therapeutic relationship. Descriptive statistics will measure alliances and repeated measures ANOVA will measure trends and changes in depression scores. RESULTS Enrollment began in October 2023. A total of 12 participants completed at least 10 BA sessions and all study measures by the time the study concluded in May 2024. In August 2024, data analysis occurred with an anticipated manuscript to be submitted for publication in October 2024. CONCLUSIONS Results from this study will inform future studies into the implementation of an evidence-based mental health intervention in a limited resource setting for Latino people with limited English proficiency. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/57343.
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Affiliation(s)
- Sally Moyce
- Mark and Robyn Jones College of Nursing, Montana State University, Bozeman, MT, United States
| | - Cassidy Crawford
- College of Health and Human Development, Montana State University, Bozeman, MT, United States
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2
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Resnik J, Miller CJ, Roth CE, Burns K, Bovin MJ. A Systematic Review of the Department of Veterans Affairs Mental Health-Care Access Interventions for Veterans With PTSD. Mil Med 2024; 189:1303-1311. [PMID: 37837200 DOI: 10.1093/milmed/usad376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 08/23/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Access to mental health care has been a priority area for the U.S. Department of Veterans Affairs (DVA) for decades. Access for veterans with PTSD is essential because untreated PTSD is associated with numerous adverse outcomes. Although interventions have been developed to improve access to DVA mental health care, the impact of these interventions on access for veterans with untreated PTSD has not been examined comprehensively, limiting guidance on appropriate implementation. MATERIALS AND METHODS We conducted a systematic review of PubMed and PTSDpubs between May 2019 and January 2022 to identify DVA access interventions for veterans with PTSD not engaged in DVA mental health care. We identified 17 interventions and 29 manuscripts reporting quantitative access outcomes. We categorized interventions into four major categories: Primary care mental health integration, other national initiatives, telemental health, and direct outreach. We evaluated five outcome domains: Binary attendance, number of sessions attended, wait time, number of patients seen, and care initiation. We assessed the risk of bias using the Cochrane Collaboration criteria. RESULTS Across articles, binary attendance generally improved, whereas the impact on the number of sessions attended was equivocal. Overall, the number of patients seen increased compared to control participants and retrospective data. The few articles that examined care initiation had mixed results. Only one article examined the impact on wait time. CONCLUSIONS Access interventions for veterans with PTSD demonstrated varied success across interventions and outcomes. The national initiatives-particularly primary care mental health integration -were successful across several outcomes; telemental health demonstrated promise in improving access; and the success of direct outreach varied across interventions. Confidence in these findings is tempered by potential bias among studies. Limited literature on how these interventions impact relevant preattendance barriers, along with incomplete data on how many perform nationally, suggests that additional work is needed to ensure that these interventions increase access for veterans with PTSD nationwide.
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Affiliation(s)
- Jack Resnik
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA 02130, USA
| | - Christopher J Miller
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Clara E Roth
- VA Boston Healthcare System, National Center for PTSD (116B-2), Boston, MA 02130, USA
- Boston VA Research Institute (BVARI), Boston, MA 02130, USA
| | - Katharine Burns
- VA Boston Healthcare System, National Center for PTSD (116B-2), Boston, MA 02130, USA
- Emmanuel College, Boston, MA 02115, USA
| | - Michelle J Bovin
- VA Boston Healthcare System, National Center for PTSD (116B-2), Boston, MA 02130, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
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3
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Tönnies J, Ayoub-Schreifeldt M, Schrader V, Hartmann M, Wild B, Friederich HC, Haun MW. From inpatient to outpatient mental health care: Protocol for a randomised feasibility trial of a care transition intervention for patients with depression and anxiety (the AMBITION-trial). PLoS One 2023; 18:e0291067. [PMID: 37922269 PMCID: PMC10624294 DOI: 10.1371/journal.pone.0291067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/17/2023] [Indexed: 11/05/2023] Open
Abstract
INTRODUCTION Despite guideline recommendations, inpatients with mental health disorders often do not receive appropriate treatment after discharge. This leads to high readmission rates, problems with medication adherence, increased risk of chronicity and suicide, and exclusion from the labour market accompanied by high individual and social costs. The causes are both system-related, such as limited treatment availability, and patient-related, such as ambivalent motivation to continue treatment and lack of information about available treatment options. The aim of this trial is to assess the feasibility of a Care Transition Intervention (CTI) which supports patients in the psychosocial follow-up treatment process after discharge from a psychotherapy ward. METHODS AND ANALYSIS Fifty patients with depression and/or anxiety who are treated as inpatients at a psychotherapy ward will be included and randomised into two groups with a 1:1 ratio. In the intervention group, patients will receive five CTI sessions with a Care Transition Navigator before and after discharge. The sessions will focus on individual patient support including a) identification and tackling of barriers to initiate follow-up treatment, b) reflection on the inpatient stay and individual progress, with focus on the helpful aspects and c) motivation of patients to organise and take up outpatient treatment. Patients in the control group will receive treatment-as-usual during discharge. We will evaluate the following outcomes: effectiveness of recruitment strategies, patient acceptance of randomisation, practicability of implemented workflows, feasibility of data collection, and clinical outcomes.
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Affiliation(s)
- Justus Tönnies
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Marayah Ayoub-Schreifeldt
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Viola Schrader
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Markus W. Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
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4
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Kuhn E, Sayers SL, Babusci C, Conroy C, Erbes CR. Internet-based family training with telephone coaching to promote mental health treatment initiation among veterans with posttraumatic stress disorder: A pilot study. J Trauma Stress 2022. [PMID: 36562921 DOI: 10.1002/jts.22900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/05/2022] [Accepted: 10/27/2022] [Indexed: 12/24/2022]
Abstract
Posttraumatic stress disorder (PTSD) is common among military veterans, yet many affected veterans do not seek treatment. Family members of these veterans often experience compromised well-being and a desire for the veteran to receive mental health care. The Veterans Affairs (VA)-Community Reinforcement and Family Training (VA-CRAFT) for PTSD is an internet-based intervention intended to teach veterans' family members skills to encourage veterans to initiate mental health care. This study assessed the feasibility, acceptability, and potential efficacy of VA-CRAFT with telephone coaching in a sample of 12 spouses and intimate partners of veterans with PTSD. Participants completed the intervention over 12 weeks and were assessed pre- and posttreatment. For feasibility, 75.0% (n = 9) of participants completed the intervention and reported few difficulties and ease of use. Supporting acceptability, all nine completers had mostly favorable impressions of the intervention and perceived it as helpful. Finally, six (50.0%) participants got the PTSD-affected veteran to engage in mental health care; however, aside from potentially increasing treatment talk frequency, outcome expectancy, and self-efficacy, ds = 0.60-1.08, no apparent improvements were observed for any well-being outcomes, ds = 0.01-0.40. Although the findings are promising, given the study limitations, future research is required to evaluate this approach in a full-scale randomized controlled trial.
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Affiliation(s)
- Eric Kuhn
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Steven L Sayers
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christina Babusci
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Catherine Conroy
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Christopher R Erbes
- Center for Chronic Disease Outcomes Research, Minneapolis VA HealthCare System, Minneapolis, Minnesota, USA.,Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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5
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Kaysen D, Walton TO, Rhew IC, Jaffe AE, Pierce AR, Walker DD. Development of StressCheck: A telehealth motivational enhancement therapy to improve voluntary engagement for PTSD treatment among active-duty service members. Contemp Clin Trials 2022; 119:106841. [PMID: 35777697 PMCID: PMC10030051 DOI: 10.1016/j.cct.2022.106841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/09/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Rates of PTSD in active-duty military are high relative to the general population. Although efficacious treatments exist, they are underutilized. Many service members with PTSD do not present for treatment and, of those who do, many do not receive sufficient doses of the interventions to receive full benefits. Motivational Enhancement Therapy (MET) "check-ups", are brief interventions designed to elicit treatment engagement for those who are not treatment-seeking. METHODS StressCheck is an MET for nontreatment seeking Army and Air Force personnel. StressCheck aims to improve PTSD and increase treatment engagement, especially around evidence-based interventions, as well as to decrease stigma about seeking mental health services and improve knowledge about treatment options. This paper describes the intervention components and process of treatment development. The paper also describes next steps in testing the effectiveness of the intervention. CONCLUSION PTSD is associated with deleterious health, occupational, and psychological effects. If effective, this innovative intervention will bridge the gap between those who are not treatment seeking and existing services, thereby enhancing reach and impact of existing services. CLINICALTRIALS GOV IDENTIFIER NCT03423394.
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Affiliation(s)
- Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, 401 Quarry Road, Palo Alto, CA 94305, USA; National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, NCPTSD - 334 795 Willow Rd, Menlo Park, CA 94025, USA.
| | - Thomas O Walton
- School of Social Work, University of Washington, 909 NE 43rd St. #304, Seattle, WA 98105, USA.
| | - Isaac C Rhew
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 1959 NE Pacific St., Box 357238, Seattle, WA 98195, USA.
| | - Anna E Jaffe
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588, USA.
| | - Adam R Pierce
- School of Social Work, University of Washington, 909 NE 43rd St. #304, Seattle, WA 98105, USA.
| | - Denise D Walker
- School of Social Work, University of Washington, 909 NE 43rd St. #304, Seattle, WA 98105, USA.
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6
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He L, Basar E, Wiers RW, Antheunis ML, Krahmer E. Can chatbots help to motivate smoking cessation? A study on the effectiveness of motivational interviewing on engagement and therapeutic alliance. BMC Public Health 2022; 22:726. [PMID: 35413887 PMCID: PMC9003955 DOI: 10.1186/s12889-022-13115-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/25/2022] [Indexed: 12/30/2022] Open
Abstract
Background Cigarette smoking poses a major threat to public health. While cessation support provided by healthcare professionals is effective, its use remains low. Chatbots have the potential to serve as a useful addition. The objective of this study is to explore the possibility of using a motivational interviewing style chatbot to enhance engagement, therapeutic alliance, and perceived empathy in the context of smoking cessation. Methods A preregistered web-based experiment was conducted in which smokers (n = 153) were randomly assigned to either the motivational interviewing (MI)-style chatbot condition (n = 78) or the neutral chatbot condition (n = 75) and interacted with the chatbot in two sessions. In the assessment session, typical intake questions in smoking cessation interventions were administered by the chatbot, such as smoking history, nicotine dependence level, and intention to quit. In the feedback session, the chatbot provided personalized normative feedback and discussed with participants potential reasons to quit. Engagement with the chatbot, therapeutic alliance, and perceived empathy were the primary outcomes and were assessed after both sessions. Secondary outcomes were motivation to quit and perceived communication competence and were assessed after the two sessions. Results No significant effects of the experimental manipulation (MI-style or neutral chatbot) were found on engagement, therapeutic alliance, or perceived empathy. A significant increase in therapeutic alliance over two sessions emerged in both conditions, with participants reporting significantly increased motivation to quit. The chatbot was perceived as highly competent, and communication competence was positively associated with engagement, therapeutic alliance, and perceived empathy. Conclusion The results of this preregistered study suggest that talking with a chatbot about smoking cessation can help to motivate smokers to quit and that the effect of conversation has the potential to build up over time. We did not find support for an extra motivating effect of the MI-style chatbot, for which we discuss possible reasons. These findings highlight the promise of using chatbots to motivate smoking cessation. Implications for future research are discussed.
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Affiliation(s)
- Linwei He
- Department of Communication and Cognition, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, the Netherlands.
| | - Erkan Basar
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT)-Lab, Department of Psychology, and Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
| | - Marjolijn L Antheunis
- Department of Communication and Cognition, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, the Netherlands
| | - Emiel Krahmer
- Department of Communication and Cognition, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, the Netherlands
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7
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Ellis AE, Martino S, Simiola V, Mackintosh MA, Bellamy C, Cook JM. Study design and interventions for a peer-delivered motivational interviewing group treatment for sexual and gender minority male sexual trauma survivors. Contemp Clin Trials 2021; 111:106597. [PMID: 34653650 DOI: 10.1016/j.cct.2021.106597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
Sexual abuse of boys and men is a public health problem that has received relatively little attention from clinical scholars and researchers. Given unique pathways for development of and recovery from trauma-related emotional distress, sexual abuse survivors who identify as men may require distinct psychosocial interventions to engage in formal mental health care and assist in symptom reduction. This paper describes the rationale for and methodology of a randomized controlled trial comparing the effectiveness of Motivational Interviewing (MI) versus MI with affirmative care (MI-AC) for sexual and gender minority men who have been sexually traumatized. This study is designed to randomly assign 356 participants to either condition of six online group sessions delivered by two trained peers with lived experience of sexual trauma. Assessments will be conducted at baseline, post-treatment, 60- and 120-day follow-up. The primary hypotheses are that participants assigned to MI-AC, compared to those in MI only, will report reduced symptoms of depression and increased levels of engagement in formal mental health treatment. Additional hypotheses relate to secondary outcome variables, including post-traumatic stress disorder, suicidality, and substance use.
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Affiliation(s)
- Amy E Ellis
- Nova Southeastern University, Fort Lauderdale, FL, United States of America.
| | - Steve Martino
- Yale School of Medicine, New Haven, CT, United States of America; VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Vanessa Simiola
- Kaiser Permanente, Center for Health Care Research, Honolulu, HI, United States of America
| | | | - Chyrell Bellamy
- Yale School of Medicine, New Haven, CT, United States of America
| | - Joan M Cook
- Yale School of Medicine, New Haven, CT, United States of America
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8
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Khazanov GK, Forbes CN, Dunn BD, Thase ME. Addressing anhedonia to increase depression treatment engagement. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61:255-280. [PMID: 34625993 DOI: 10.1111/bjc.12335] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/30/2021] [Indexed: 12/14/2022]
Abstract
Anhedonia, or reward system dysfunction, is associated with poorer treatment outcomes among depressed individuals. The role of anhedonia in treatment engagement, however, has not yet been explored. We review research on components of reward functioning impaired in depression, including effort valuation, reward anticipation, initial responsiveness, reward learning, reward probability, and reward delay, highlighting potential barriers to treatment engagement associated with these components. We then propose interventions to improve treatment initiation and continuation by addressing deficits in each component of reward functioning, focusing on modifications of existing evidence-based interventions to meet the needs of individuals with heightened anhedonia. We describe potential settings for these interventions and times at which they can be delivered during the process of referring individuals to mental health treatment, conducting intakes or assessments, and providing treatment. Additionally, we note the advantages of using screening processes already in place in primary care, workplace, school, and online settings to identify individuals with heightened anhedonia who may benefit from these interventions. We conclude with suggestions for future research on the impact of anhedonia on treatment engagement and the efficacy of interventions to address it. PRACTITIONER POINTS: Many depressed individuals who might benefit from treatment do not initiate it or discontinue early. One barrier to treatment engagement may be anhedonia, a core symptom of depression characterized by loss of interest or pleasure in usual activities. We describe brief interventions to improve treatment engagement in individuals with anhedonia that can be implemented during the referral process or early in treatment. We argue that interventions aiming to improve treatment engagement in depressed individuals that target anhedonia may be particularly effective.
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Affiliation(s)
- Gabriela K Khazanov
- Mental Illness Research, Education, and Clinical Center of the Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | | | | | - Michael E Thase
- Mental Illness Research, Education, and Clinical Center of the Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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Borsari B, Li Y, Tighe J, Manuel JK, Gökbayrak NS, Delucchi K, Morasco BJ, Abadjian L, Cohen BE, Baxley C, Seal KH. A pilot trial of collaborative care with motivational interviewing to reduce opioid risk and improve chronic pain management. Addiction 2021; 116:2387-2397. [PMID: 33405304 DOI: 10.1111/add.15401] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/20/2020] [Accepted: 12/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Opioid use and chronic pain are prevalent in the veteran population. Collaborative care enhances coordination between patients and their care teams, and motivational interviewing (MI) is a communication style designed to facilitate behavior change. This study evaluated the use of collaborative care with MI (CCMI) with patients with chronic pain and high-risk prescription opioid use. DESIGN Small pilot study of a randomized controlled trial. SETTING An urban Veterans Affairs (VA) Medical Center in the United States. PARTICIPANTS One hundred adult veterans with chronic pain currently enrolled into primary care and receiving long-term opioid therapy. INTERVENTION AND COMPARATOR During an initial 1-hour visit with a study primary-care physician (PCP), all veterans (n = 100) developed a personalized pain care plan, after which they were randomized to receive four sessions (at 4, 6, 8 and 12 weeks) of either CCMI (n = 51) or attention control psychoeducation (ACP; n = 49). Subsequently, participants had 30-minute follow-up visits with study PCPs and post-treatment assessment at 12 weeks. MEASUREMENTS Co-primary outcomes measures assessed opioid risk and pain interference; secondary measures assessed pain severity, PCP rating of opioid risk and pain management goals. FINDINGS At 12 weeks, intent-to-treat (ITT) analyses using multivariate mixed-effects linear regression were inconclusive regarding the between-group differences in primary and secondary outcomes at post-intervention (12 weeks). Bayes factors for opioid risk, pain interference, pain severity and PCP ratings were 1.96, 1.36, 0.45 and 0.82, respectively. Veterans in the CCMI group reported implementing more complementary integrative health (CIH) goals (e.g. yoga) than did those in the ACP group (d = 0.54). CONCLUSIONS US veterans with chronic pain who received collaborative care with motivational interviewing reduced their high-risk opioid use and showed improved pain interference and severity after an intake with a primary-care provider involving shared decision-making and the creation of a personalized pain care plan.
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Affiliation(s)
- Brian Borsari
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Yongmei Li
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Jennifer Tighe
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Jennifer K Manuel
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - N Simay Gökbayrak
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Kevin Delucchi
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.,Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Linda Abadjian
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Beth E Cohen
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Catherine Baxley
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Karen H Seal
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.,Department of Medicine, University of California, San Francisco, CA, USA
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10
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Kang AW, Walton M, Hoadley A, DelaCuesta C, Hurley L, Martin R. Patient Experiences with the Transition to Telephone Counseling during the COVID-19 Pandemic. Healthcare (Basel) 2021; 9:663. [PMID: 34199582 PMCID: PMC8226454 DOI: 10.3390/healthcare9060663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 11/17/2022] Open
Abstract
Background: To identify and document the treatment experiences among patients with opioid use disorder (OUD) in the context of the rapid move from in-person to telephone counseling due to the COVID-19 pandemic. Methods: Participants (n = 237) completed a survey with open-ended questions that included the following domains: (1) satisfaction with telephone counseling, (2) perceived convenience, (3) changes to the therapeutic relationship, (4) perceived impact on substance use recovery, and (5) general feedback. Responses were coded using thematic analysis. Codes were subsequently organized into themes and subthemes (covering 98% of responses). Interrater reliability for coding of participants' responses ranged from 0.89 to 0.95. Results: Overall, patients reported that telephone counseling improved the therapeutic experience. Specifically, 74% of respondents were coded as providing responses consistently indicating "positive valency". "Positive valency" responses include: (1) feeling supported, (2) greater comfort and privacy, (3) increased access to counselors, and (4) resolved transportation barriers. Conversely, "negative valency" responses include: (1) impersonal experience and (2) reduced privacy. Conclusions: Telephone counseling presents its own set of challenges that should be investigated further to improve the quality of care and long-term patient outcomes.
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Affiliation(s)
- Augustine W. Kang
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02912, USA; (C.D.); (R.M.)
| | - Mary Walton
- CODAC Behavioral Healthcare, Cranston, RI 02910, USA; (M.W.); (L.H.)
| | - Ariel Hoadley
- Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, PA 19122, USA;
| | - Courtney DelaCuesta
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02912, USA; (C.D.); (R.M.)
| | - Linda Hurley
- CODAC Behavioral Healthcare, Cranston, RI 02910, USA; (M.W.); (L.H.)
| | - Rosemarie Martin
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02912, USA; (C.D.); (R.M.)
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11
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Seal KH, Pyne JM, Manuel JK, Li Y, Koenig CJ, Zamora KA, Abraham TH, Mesidor MM, Hill C, Uddo M, Hamilton M, Borsari B, Bertenthal D, Casey JJ, Kelly PA. Telephone veteran peer coaching for mental health treatment engagement among rural veterans: The importance of secondary outcomes and qualitative data in a randomized controlled trial. J Rural Health 2021; 37:788-800. [PMID: 33978989 PMCID: PMC8519064 DOI: 10.1111/jrh.12582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Purpose To determine the effectiveness of telephone motivational coaching delivered by veteran peers to improve mental health (MH) treatment engagement among veterans. Methods Veterans receiving primary care from primarily rural VA community‐based outpatient clinics were enrolled. Veterans not engaged in MH treatment screening positive for ≥1 MH problem(s) were randomized to receive veteran peer‐delivered feedback on MH screen results and referrals plus 4 sessions of telephone motivational coaching (intervention) versus veteran peer‐delivered MH results and referrals without motivational coaching (control). Blinded telephone assessments were conducted at baseline, 8, 16, and 32 weeks. Cox proportional hazard models compared MH clinician‐directed treatment initiation between groups; descriptive analyses compared MH treatment retention, changes in MH symptoms, quality of life, and self‐care. Findings Among 272 veterans screening positive for ≥1 MH problem(s), 45% who received veteran peer telephone motivational coaching versus 46% of control participants initiated MH treatment (primary outcome) (hazard ratio: 1.09, 95% CI: 0.76‐1.57), representing no between‐group differences. In contrast, veterans receiving veteran peer motivational coaching achieved significantly greater improvements in depression, posttraumatic stress disorder and cannabis use scores, quality of life domains, and adoption of some self‐care strategies than controls (secondary outcomes). Qualitative data revealed that veterans who received veteran peer motivational coaching may no longer have perceived a need for MH treatment. Conclusions Among veterans with MH problems using predominantly rural VA community clinics, telephone peer motivational coaching did not enhance MH treatment engagement, but instead had positive effects on MH symptoms, quality of life indicators, and use of self‐care strategies.
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Affiliation(s)
- Karen H Seal
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA.,Departments of Medicine and Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Jeffrey M Pyne
- Department of Veterans Affairs, Center for Mental Healthcare & Outcomes Research, Health Services Research and Development, Little Rock, Arkansas, USA.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jennifer K Manuel
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA.,Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Yongmei Li
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Christopher J Koenig
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA.,Department of Communication Studies, San Francisco State University, San Francisco, California, USA
| | - Kara A Zamora
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Traci H Abraham
- Department of Veterans Affairs, Center for Mental Healthcare & Outcomes Research, Health Services Research and Development, Little Rock, Arkansas, USA.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Department of Veterans Affairs, South Central Mental Illness Research Education Clinical Center (MIRECC), Little Rock, Arkansas, USA
| | - Marie M Mesidor
- Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Coleen Hill
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Madeline Uddo
- Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana, USA.,Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Michelle Hamilton
- Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana, USA.,Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Brian Borsari
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA.,Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Daniel Bertenthal
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - James J Casey
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - P Adam Kelly
- Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana, USA.,Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
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12
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Turna J, MacKillop J. Cannabis use among military veterans: A great deal to gain or lose? Clin Psychol Rev 2021; 84:101958. [PMID: 33486280 DOI: 10.1016/j.cpr.2021.101958] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/11/2020] [Accepted: 01/06/2021] [Indexed: 12/16/2022]
Abstract
Policy changes have resulted in dramatic increases in access to cannabis for medical purposes. Veterans are disproportionately affected by conditions for which medical cannabis is often pursued, making an evidence-based perspective on risks versus benefits of high priority. The current review sought to examine the state of the evidence on the correlates and consequences of cannabis use among veterans. Using a comprehensive search strategy, 501 articles were identified and 86 studies met criteria for inclusion. The literature was predominated by cross-sectional studies (67%) of male veterans (71.4%-100% male) from the United States (93.0%). Three overarching themes emerged, comprising cannabis associations with other substance use, mental health, and physical health outcomes. The balance of the evidence associated cannabis use with negative health outcomes, with consistent positive associations with other substance use, psychiatric disorders, and self-harm/suicidality. Few studies examined the therapeutic effects of cannabis, thus limiting the potential to evaluate evidence of efficacy. Priority areas for future research are studies using designs that can examine the directionality of links between cannabis and health in veterans more conclusively, and studies directly examining therapeutic efficacy of cannabis-based therapies in veterans. Methodologically rigorous design will be essential to inform clinical recommendations and practices guidelines in an era of burgeoning access to cannabis.
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Affiliation(s)
- Jasmine Turna
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, 100 West 5(th) St, Hamilton, ON L9C 0E3, Canada; Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, 100 West 5(th) St, Hamilton, ON L9C 0E3, Canada
| | - James MacKillop
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, 100 West 5(th) St, Hamilton, ON L9C 0E3, Canada; Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, 100 West 5(th) St, Hamilton, ON L9C 0E3, Canada; Homewood Research Institute, 150 Delhi St. Riverslea Building, Guelph, ON N1E 6K9, Canada.
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13
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Johnson EM, Possemato K. Problem recognition and treatment beliefs relate to mental health utilization among veteran primary care patients. Psychol Serv 2021; 18:11-22. [PMID: 30869974 PMCID: PMC6745017 DOI: 10.1037/ser0000341] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mental health concerns are prevalent among primary care patients, but many do not utilize services for these conditions. This study aims to conduct a comprehensive assessment of barriers and facilitators to mental health care utilization among veteran primary care patients with common mental health concerns. We hypothesized that beliefs and knowledge about mental illness and mental health care would be more strongly associated with recent mental health care utilization than stigma, help-seeking behaviors, or logistical barriers. Veterans (n = 116) enrolled in primary care with current symptoms of depression (58%), posttraumatic stress disorder (37%), and/or hazardous alcohol use (50%) who either recently used mental health services (47%) or had no recent mental health treatment utilization (53%) completed a telephone-based screening, medical records review, and mail survey of 10 measures of barriers and facilitators to mental health treatment utilization. Recognition of problems as a cause for concern, odds ratio = 5.95, 95% confidence interval [2.36, 15.01], and beliefs about psychotherapy, odds ratio = 2.53, 95% confidence interval [1.39, 4.60], emerged as stronger correlates of recent mental health care utilization than stigma, self-efficacy, and external barriers to treatment. Results suggest the use of specific theories, measures, and interventions that focus on patient recognition of problems and beliefs about treatment over those that focus on other treatment barriers and facilitators. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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14
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Goodyear-Smith F, Darragh M, Warren J. VeCHAT: a proof-of-concept study on screening and managing veterans. J Prim Health Care 2021; 13:75-83. [PMID: 33785114 DOI: 10.1071/hc20070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 03/02/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION New Zealand veterans may have complex mental and physical complaints related to multiple exposures to war environments. They are entitled to, but often do not, access a range of physical, mental health and social services funded through Veterans' Affairs New Zealand. eCHAT (electronic Case-finding and Help Assessment Tool) is a self-completed electronic holistic screen for substance misuse, problem gambling, anger control, physical inactivity, depression, anxiety, exposure to abuse; and assesses whether help is wanted for identified issues. AIM A proof-of-concept study was conducted to develop a modified version of eCHAT (VeCHAT) with remote functionality for clinical assessment of mental health and lifestyle issues of contemporary veterans, and assesses acceptability by veterans and Veterans' Affairs staff, and feasibility of implementation. METHODS We used a co-design approach to develop VeCHAT. Veterans' Affairs and service organisations invited veterans to remotely complete VeCHAT and a subsequent short online acceptability survey. Veterans' Affairs medical and case manager staff underwent semi-structured interviews on feasibility and acceptability of VeCHAT use. RESULTS Thirty-four veterans completed VeCHAT. The tool proved acceptable to veterans and Veterans' Affairs staff. Key emergent themes related to tool functionality, design, ways and barriers to use, and suggested improvements. Veterans' Affairs staff considered VeCHAT use to be feasible with much potential. DISCUSSION Capacity of Veterans' Affairs to respond if their engagement with veterans increases and employment of VeCHAT is scaled up, is unknown. Work is needed to assess how introducing VeCHAT as a standard procedure might influence Veterans' Affairs case management processes.
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Affiliation(s)
- Felicity Goodyear-Smith
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand; and Corresponding author.
| | - Margot Darragh
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Jim Warren
- School of Computer Science, University of Auckland, Auckland, New Zealand
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15
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Seal KH, Becker WC, Murphy JL, Purcell N, Denneson LM, Morasco BJ, Martin AM, Reddy K, Iseghem TV, Krebs EE, Painter JM, Hagedorn H, Pyne JM, Hixon J, Maguen S, Neylan TC, Borsari B, DeRonne B, Gibson C, Matthias MS, Frank JW, Krishnaswamy A, Li Y, Bertenthal D, Chan A, Nunez A, McCamish N. Whole Health Options and Pain Education (wHOPE): A Pragmatic Trial Comparing Whole Health Team vs Primary Care Group Education to Promote Nonpharmacological Strategies to Improve Pain, Functioning, and Quality of Life in Veterans-Rationale, Methods, and Implementation. PAIN MEDICINE 2020; 21:S91-S99. [PMID: 33313734 DOI: 10.1093/pm/pnaa366] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Whole Health model of the U.S. Department of Veterans Affairs (VA) emphasizes holistic self-care and multimodal approaches to improve pain, functioning, and quality of life. wHOPE (Whole Health Options and Pain Education) seeks to be the first multisite pragmatic trial to establish evidence for the VA Whole Health model for chronic pain care. DESIGN wHOPE is a pragmatic randomized controlled trial comparing a Whole Health Team (WHT) approach to Primary Care Group Education (PC-GE); both will be compared to Usual VA Primary Care (UPC). The WHT consists of a medical provider, a complementary and integrative health (CIH) provider, and a Whole Health coach, who collaborate with VA patients to create a Personalized Health Plan emphasizing CIH approaches to chronic pain management. The active comparator, PC-GE, is adapted group cognitive behavioral therapy for chronic pain. The first aim is to test whether the WHT approach is superior to PC-GE and whether both are superior to UPC in decreasing pain interference in functioning in 750 veterans with moderate to severe chronic pain (primary outcome). Secondary outcomes include changes in pain severity, quality of life, mental health symptoms, and use of nonpharmacological and pharmacological therapies for pain. Outcomes will be collected from the VA electronic health record and patient-reported data over 12 months of follow-up. Aim 2 consists of an implementation-focused process evaluation and budget impact analysis. SUMMARY This trial is part of the Pain Management Collaboratory, which seeks to create national-level infrastructure to support evidence-based nonpharmacological pain management approaches for veterans and military service personnel.
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Affiliation(s)
- Karen H Seal
- San Francisco Veterans Affairs Health Care System.,University of California, San Francisco
| | | | - Jennifer L Murphy
- James A. Haley Veterans' Hospital.,University of South Florida Morsani College of Medicine
| | - Natalie Purcell
- San Francisco Veterans Affairs Health Care System.,University of California, San Francisco
| | | | | | | | - Kavitha Reddy
- VA St. Louis Health Care System.,Washington University School of Medicine
| | | | - Erin E Krebs
- Minneapolis VA Health Care System.,University of Minnesota School of Medicine
| | - Jacob M Painter
- University of Arkansas for Medical Sciences.,Central Arkansas VA Healthcare System
| | - Hildi Hagedorn
- Minneapolis VA Health Care System.,University of Minnesota School of Medicine
| | - Jeffrey M Pyne
- University of Arkansas for Medical Sciences.,Central Arkansas VA Healthcare System
| | - John Hixon
- San Francisco Veterans Affairs Health Care System.,University of California, San Francisco
| | - Shira Maguen
- San Francisco Veterans Affairs Health Care System.,University of California, San Francisco
| | - Thomas C Neylan
- San Francisco Veterans Affairs Health Care System.,University of California, San Francisco
| | - Brian Borsari
- San Francisco Veterans Affairs Health Care System.,University of California, San Francisco
| | | | - Carolyn Gibson
- San Francisco Veterans Affairs Health Care System.,University of California, San Francisco
| | | | - Joseph W Frank
- VA Eastern Colorado Health Care System.,University of Colorado School of Medicine
| | | | - Yongmei Li
- San Francisco Veterans Affairs Health Care System
| | | | - Allan Chan
- San Francisco Veterans Affairs Health Care System
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16
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Jones C, Miguel-Cruz A, Smith-MacDonald L, Cruikshank E, Baghoori D, Kaur Chohan A, Laidlaw A, White A, Cao B, Agyapong V, Burback L, Winkler O, Sevigny PR, Dennett L, Ferguson-Pell M, Greenshaw A, Brémault-Phillips S. Virtual Trauma-Focused Therapy for Military Members, Veterans, and Public Safety Personnel With Posttraumatic Stress Injury: Systematic Scoping Review. JMIR Mhealth Uhealth 2020; 8:e22079. [PMID: 32955456 PMCID: PMC7536597 DOI: 10.2196/22079] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/28/2020] [Accepted: 08/01/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND A necessary shift from in-person to remote delivery of psychotherapy (eg, teletherapy, eHealth, videoconferencing) has occurred because of the COVID-19 pandemic. A corollary benefit is a potential fit in terms of the need for equitable and timely access to mental health services in remote and rural locations. Owing to COVID-19, there may be an increase in the demand for timely, virtual delivery of services among trauma-affected populations, including public safety personnel (PSP; eg, paramedics, police, fire, correctional officers), military members, and veterans. There is a lack of evidence on the question of whether digital delivery of trauma-therapies for military members, veterans, and PSP leads to similar outcomes to in-person delivery. Information on barriers and facilitators and recommendations regarding digital-delivery is also scarce. OBJECTIVE This study aims to evaluate the scope and quality of peer-reviewed literature on psychotherapeutic digital health interventions delivered remotely to military members, veterans, and PSP and synthesize the knowledge of needs, gaps, barriers to, and facilitators for virtual assessment of and virtual interventions for posttraumatic stress injury. METHODS Relevant studies were identified using MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica dataBASE), APA (American Psychological Association) PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature) Plus with Full Text, and Military & Government Collection. For collation, analysis, summarizing, and reporting of results, we used the CASP (Critical Skills Appraisal Program) qualitative checklist, PEDro (Physiotherapy Evidence Database) scale, level of evidence hierarchy, PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews), and narrative synthesis. RESULTS A total of 38 studies were included in this review. Evidence for the effectiveness of digital delivery of prolonged exposure therapy, cognitive processing therapy, behavioral activation treatment with therapeutic exposure to military members, veterans, and PSP was rated level 1a, whereas evidence for cognitive behavioral therapy was conflicting. The narrative synthesis indicated that virtual delivery of these therapies can be as effective as in-person delivery but may reduce stigma and cost while increasing access to therapy. Issues of risk, safety, potential harm (ie, suicidality, enabling avoidance), privacy, security, and the match among the therapist, modality, and patient warrant further consideration. There is a lack of studies on the influences of gender, racial, and cultural factors that may result in differential outcomes, preferences, and/or needs. An investigation into other therapies that may be suitable for digital delivery is needed. CONCLUSIONS Digital delivery of trauma therapies for military members, veterans, and PSP is a critical area for further research. Although promising evidence exists regarding the effectiveness of digital health within these populations, many questions remain, and a cautious approach to more widespread implementation is warranted.
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Affiliation(s)
- Chelsea Jones
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- 1 Field Ambulance Physical Rehabilitation Department, Canadian Armed Forces Health Services, Department of National Defense, Edmonton, AB, Canada
| | - Antonio Miguel-Cruz
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Glenrose Rehabilitation Hospital Research Innovation and Technology (GRRIT), Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Lorraine Smith-MacDonald
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Emily Cruikshank
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Educational Psychology, Faculty of Education, University of Alberta, Edmonton, AB, Canada
| | - Delaram Baghoori
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Rehabilitation Science, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Avneet Kaur Chohan
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Alexa Laidlaw
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Allison White
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Bo Cao
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Vincent Agyapong
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lisa Burback
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Olga Winkler
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Phillip R Sevigny
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Educational Psychology, Faculty of Education, University of Alberta, Edmonton, AB, Canada
| | - Liz Dennett
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Martin Ferguson-Pell
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Rehabilitation Science, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Andrew Greenshaw
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Suzette Brémault-Phillips
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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17
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Erbes CR, Kuhn E, Polusny MA, Ruzek JI, Spoont M, Meis LA, Gifford E, Weingardt KR, Campbell EH, Oleson H, Taylor BC. A Pilot Trial of Online Training for Family Well-Being and Veteran Treatment Initiation for PTSD. Mil Med 2020; 185:401-408. [PMID: 31621884 DOI: 10.1093/milmed/usz326] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/27/2019] [Accepted: 08/13/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Family members are important supports for veterans with Posttrauamtic Stress Disroder (PTSD), but they often struggle with their own distress and challenges. The Veterans Affairs-Community Reinforcement and Family Training (VA-CRAFT) website was designed to teach family members of veterans with PTSD effective ways to interact with their veterans to encourage initiation of mental health services as well as to care for themselves and improve their relationships. This article presents a pilot investigation of VA-CRAFT. MATERIALS AND METHOD Spouse/partners of veterans who had screened positive for PTSD but were not in mental health treatment were randomized to either use the VA-CRAFT website (n = 22) or to a waitlist control condition (n = 19) for 3 months. Veteran mental health service initiation was assessed posttreatment. Spouse/partner distress, caregiver burden, quality of life, and relationship quality were assessed pre and posttreatment. The study was approved by the Minneapolis VA Health Care System Institutional Review Board (IRB). RESULTS Differences between groups on veteran treatment initiation were small (Phi = 0.17) and not statistically significant. VA-CRAFT participants reported large and statistically significantly greater decreases in overall caregiver burden (η2 = 0.10) and objective caregiver burden (η2 = 0.14) than control participants. Effects were larger for those with greater initial distress. Effects sizes for other partner outcomes were negligible (η2 = 0.01) to medium (η2 = 0.09) and not statistically significant. Postintervention interviews suggested that only 33% of the VA-CRAFT participants talked with their veterans about starting treatment for PTSD during the trial. CONCLUSION Results from this pilot trial suggest that VA-CRAFT holds initial promise in reducing caregiver burden and as such it could be a useful resource for family members of veterans with PTSD. However, VA-CRAFT does not enhance veteran treatment initiation. It may benefit from enhancements to increase effectiveness and caregiver engagement.
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Affiliation(s)
- Christopher R Erbes
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
- University of Minnesota Medical School, 420 Delaware St., Minneapolis, MN 55455
| | - Eric Kuhn
- Veterans Affairs Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305
- National Center for PTSD, 795 Willow Road Menlo Park, CA 94025
| | - Melissa A Polusny
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
- University of Minnesota Medical School, 420 Delaware St., Minneapolis, MN 55455
| | - Josef I Ruzek
- Veterans Affairs Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305
- National Center for PTSD, 795 Willow Road Menlo Park, CA 94025
| | - Michele Spoont
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
- University of Minnesota Medical School, 420 Delaware St., Minneapolis, MN 55455
- National Center for PTSD, 795 Willow Road Menlo Park, CA 94025
| | - Laura A Meis
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
- University of Minnesota Medical School, 420 Delaware St., Minneapolis, MN 55455
| | - Elizabeth Gifford
- Veterans Affairs Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025
| | | | - Emily Hagel Campbell
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
| | - Heather Oleson
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
| | - Brent C Taylor
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
- University of Minnesota Medical School, 420 Delaware St., Minneapolis, MN 55455
- University of Minnesota School of Public Health, 420 Delaware St., Minneapolis, MN 55455
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18
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Tong J, Simpson K, Alvarez-Jimenez M, Bendall S. Talking about trauma in therapy: Perspectives from young people with post-traumatic stress symptoms and first episode psychosis. Early Interv Psychiatry 2019; 13:1236-1244. [PMID: 30537145 DOI: 10.1111/eip.12761] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 10/19/2018] [Accepted: 11/04/2018] [Indexed: 11/29/2022]
Abstract
AIM Despite recommendations from national guidelines, individuals with first episode psychosis (FEP) are currently unlikely to have the effects of their traumatic experiences assessed and treated within psychosis treatment. This may be due to the mismatch between the objectives of trauma-specific treatments (directly targeting post-traumatic stress symptoms by talking about the trauma) and trauma-informed care (limiting practices that may retraumatise clients). We aimed to gain an understanding of what it was like for young people to talk about trauma in FEP treatment, and how their experiences related to the broad conceptualisations of trauma-informed and trauma-specific treatment approaches. METHODS Semi-structured interviews were conducted with eleven participants (18-27 years) with FEP and post-traumatic stress disorder (PTSD) symptoms after the completion of an intervention for the effects of trauma. Transcripts were analysed using an interpretative phenomenological approach. RESULTS Two superordinate themes were identified, each with subordinate themes. 1. Reluctance to approach the trauma memory: 1a. Not wanting to talk about trauma; 1b. Difficulty acknowledging that the trauma had occurred; 1c. Not wanting to re-experience emotions associated with trauma. 2. Factors aiding the process: 2a. Desire for change; 2b. Not being pushed to talk; 2c. Valuing the case manager; 2d. Time. CONCLUSIONS A majority of participants in the study experienced reluctance when recounting their trauma memories. Being in control of how trauma memories are shared and having time for the therapeutic relationship to develop enhanced participants' readiness for talking about trauma. Incorporating trauma-informed principles and motivational interviewing could aid in facilitating the processes around talking about trauma.
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Affiliation(s)
- Janet Tong
- School of Psychological Sciences, Monash University, Victoria, Australia
| | - Katrina Simpson
- School of Psychological Sciences, Monash University, Victoria, Australia
| | - Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia
| | - Sarah Bendall
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia
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19
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Messerschmitt-Coen S. Considerations for Counseling Student Veterans. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2019. [DOI: 10.1080/87568225.2019.1660292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Hwang TZ, Lin YH, Liu CY, Kao CC, Huang PC. The Effects of a Supportive Care Program on the Posttraumatic Stress Symptoms of Patients With Oral Cancer After Surgery. Clin Nurs Res 2019; 29:598-606. [PMID: 30808207 DOI: 10.1177/1054773819831444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to estimate the effects of a supportive care program on the posttraumatic stress symptoms (PTSSs) of patients with oral cancer after surgery. Participants were divided into two groups. Outcome measurements included the Chinese version of the Davidson trauma scale to examine PTSSs at a clinical follow-up 1 week (T0), 1 month (T1), and 3 months (T2) after hospital discharge. The results indicated that the frequency and severity mean scores of PTSSs for the two groups at T0 were significantly higher than those at T1 and T2. Both the groups and times were significantly different; moreover, the supported group's PTSS score decreased more than that of the nonsupported group. These findings supported the effects of the supportive care program. Health care staff should be aware of the PTSS status of patients with oral cancer who undergo surgery and consider these issues in combination with patients' discharge care plans.
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21
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Seal KH, Borsari B, Tighe J, Cohen BE, Delucchi K, Morasco BJ, Li Y, Sachs E, Abadjian L, Watson EC, Manuel JK, Vella L, Trafton J, Midboe A. Optimizing pain treatment interventions (OPTI): A pilot randomized controlled trial of collaborative care to improve chronic pain management and opioid safety-Rationale, methods, and lessons learned. Contemp Clin Trials 2019; 77:76-85. [PMID: 30572163 PMCID: PMC6392081 DOI: 10.1016/j.cct.2018.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/27/2018] [Accepted: 12/16/2018] [Indexed: 12/17/2022]
Abstract
Veterans seeking care in VA medical facilities have high rates of chronic pain, which often co-occur with mental health and substance use disorders, including prescription opioid misuse. The overall goal of the Optimizing Pain Treatment Interventions (OPTI) study was to pilot a 12-week Collaborative Care intervention to improve opioid safety, chronic pain disability, and use of non-pharmacological pain management strategies in veterans in VA primary care. Between November 2014 and January 2017, 100 veteran patients with chronic pain and high-risk prescription opioid use (e.g., high-dose therapy, early refills, etc.) were enrolled and completed an initial one-hour study visit with a primary care provider (PCP) within 4 weeks of enrollment. Study PCPs were guided by a web-based opioid management decision support program and templated notes in the VA electronic medical record. After assessment and education, study PCPs used Shared Decision-Making to formulate a Pain Care Plan aligned with a participant's personal values and goals. After the initial visit, patients randomized to Collaborative Care received one Motivational Interviewing (MI) session with a Care Manager followed by 3 Care Manager-delivered brief telephone MI sessions at 6, 8, and 12 weeks to reinforce Pain Care Plans; patients randomized to an Attention Control condition met with a Care Manager briefly, followed by 3 brief scripted telephone psychoeducation sessions at 6, 8, and 12 weeks. Masked evaluators assessed outcomes at baseline, end of intervention (12 weeks), and after eight weeks of no contact (20 weeks). We present study rationale, detailed methods, preliminary results and lessons learned.
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Affiliation(s)
- Karen H Seal
- San Francisco Veterans Affairs Health Care System, United States; University of California, San Francisco, San Francisco, CA, United States.
| | - Brian Borsari
- San Francisco Veterans Affairs Health Care System, United States; University of California, San Francisco, San Francisco, CA, United States
| | - Jennifer Tighe
- San Francisco Veterans Affairs Health Care System, United States
| | - Beth E Cohen
- San Francisco Veterans Affairs Health Care System, United States; University of California, San Francisco, San Francisco, CA, United States
| | - Kevin Delucchi
- University of California, San Francisco, San Francisco, CA, United States
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, United States; Department of Psychiatry, Oregon Health and Science University, United States
| | - Yongmei Li
- San Francisco Veterans Affairs Health Care System, United States
| | - Emily Sachs
- San Francisco Veterans Affairs Health Care System, United States
| | - Linda Abadjian
- San Francisco Veterans Affairs Health Care System, United States
| | - Erin C Watson
- San Francisco Veterans Affairs Health Care System, United States; University of California, San Francisco, San Francisco, CA, United States
| | - Jennifer K Manuel
- San Francisco Veterans Affairs Health Care System, United States; University of California, San Francisco, San Francisco, CA, United States
| | - Lea Vella
- San Francisco Veterans Affairs Health Care System, United States; University of California, San Francisco, San Francisco, CA, United States
| | - Jodie Trafton
- VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), United States; Program Evaluation and Resource Center (PERC), VA Office of Mental Health Operations, United States
| | - Amanda Midboe
- VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), United States
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Valenstein-Mah H, Kehle-Forbes S, Nelson D, Danan ER, Vogt D, Spoont M. Gender differences in rates and predictors of individual psychotherapy initiation and completion among Veterans Health Administration users recently diagnosed with PTSD. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2019; 11:811-819. [PMID: 30688508 DOI: 10.1037/tra0000428] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Most veterans with posttraumatic stress disorder (PTSD) who receive care from the Veterans Health Administration (VHA) do not receive individual psychotherapy. The purpose of this study was to explore gender differences in initiation and completion of a sufficient course (defined as attending 8 or more sessions) of individual psychotherapy among male and female VHA users recently diagnosed with PTSD. METHOD Participants (N = 7,218) were veterans in a prospective national cohort survey of VHA users diagnosed with PTSD; oversampling was used to increase representation of women and minority veterans. RESULTS Forty-two percent of the sample (40.1% of men, 52.3% of women) initiated individual psychotherapy within 6 months of their index PTSD diagnosis. Of those who initiated, 12.1% (10.8% of men, 17.7% of women) completed a sufficient course of individual psychotherapy. Women were generally more likely than men to initiate individual psychotherapy. However, we found an interaction between gender and age, such that younger men were more likely to initiate psychotherapy than older men; age was not significantly associated with initiation among women. Regarding completion of individual psychotherapy, an interaction between gender and beliefs about psychotherapy was found, such that men were less likely to complete individual psychotherapy when they held more negative beliefs about psychotherapy; these beliefs did not significantly impact female veterans' likelihood of completing psychotherapy. CONCLUSIONS Overall, while female veterans are more likely than male veterans with PTSD to initiate individual psychotherapy, rates of initiation and completion of individual psychotherapy for both genders remain relatively low. Interventions are needed to increase engagement in individual psychotherapy, particularly for male veterans with PTSD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | - David Nelson
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System
| | - Elisheva R Danan
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System
| | - Dawne Vogt
- National Center for PTSD Women's Health Sciences Division at VA Boston Health Care System
| | - Michele Spoont
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System
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Teo AR, Chan BK, Saha S, Nicolaidis C. Frequency of social contact in-person vs. on Facebook: An examination of associations with psychiatric symptoms in military veterans. J Affect Disord 2019; 243:375-380. [PMID: 30266029 DOI: 10.1016/j.jad.2018.09.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/22/2018] [Accepted: 09/15/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Social isolation is closely associated with negative mental health outcomes. Social media platforms may expand opportunities for social contact, but whether online interactions are as effective as face-to-face, or in-person, interactions at protecting against the negative effects of social isolation is unclear. METHODS Participants consisted of U.S. military veterans who served since September 2001 and used Facebook (n = 587). Our independent variables were frequency of social contact occurring in-person and on Facebook. Dependent variables were probable psychiatric disorders and suicidality, measured using several validated screening tools. The independent effect of each form of social contact was assessed using multivariate logistic regression, which included adjustment for several potential confounders. RESULTS We found that veterans who frequently interacted on Facebook engaged in more in-person social contact than infrequent Facebook users (p < .001). More frequent in-person social interaction was associated with significantly decreased risk of symptoms of major depression and PTSD, compared with contact every few weeks or less. In contrast, increased frequency of social interaction on Facebook had no associations with mental health outcomes. LIMITATIONS All associations are cross-sectional (direction of association is unclear) and based on self-report measures. CONCLUSIONS Although veterans who frequently use Facebook are also typically social in their offline life, it is their offline (in-person) social interaction, rather than their social contact on Facebook, that is associated with reduced psychiatric symptoms.
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Affiliation(s)
- Alan R Teo
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR 97239-2964, USA; Oregon Health & Science University, Department of Psychiatry, 3181 SW Sam Jackson Park Rd (Multnomah Pavilion, Room 2316), Portland, OR 97239-3098, USA; Oregon Health & Science University and Portland State University, School of Public Health, Biostatistics and Design Program, 3181 SW Sam Jackson Park Rd (CB669), Portland, OR 97239-3098, USA.
| | - Benjamin K Chan
- Oregon Health & Science University and Portland State University, School of Public Health, Biostatistics and Design Program, 3181 SW Sam Jackson Park Rd (CB669), Portland, OR 97239-3098, USA
| | - Somnath Saha
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR 97239-2964, USA; Oregon Health & Science University, Division of General Internal Medicine & Geriatrics, 3181 SW Sam Jackson Park Rd L475, Portland, OR 97239-3098, USA
| | - Christina Nicolaidis
- Oregon Health & Science University and Portland State University, School of Public Health, Biostatistics and Design Program, 3181 SW Sam Jackson Park Rd (CB669), Portland, OR 97239-3098, USA; Oregon Health & Science University, Division of General Internal Medicine & Geriatrics, 3181 SW Sam Jackson Park Rd L475, Portland, OR 97239-3098, USA; Portland State University, School of Social Work, 1600 SW 4th Ave, Portland, OR 97201-5522, USA
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Timko C, Below M, Vittorio L, Taylor E, Chang G, Lash S, Festin FED, Brief D. Randomized controlled trial of enhanced telephone monitoring with detoxification patients: 3- and 6-month outcomes. J Subst Abuse Treat 2019; 99:24-31. [PMID: 30797391 DOI: 10.1016/j.jsat.2018.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 11/24/2018] [Accepted: 12/20/2018] [Indexed: 12/15/2022]
Abstract
Telehealth interventions have the potential to deter repeated detoxification episodes and improve outcomes. Using a sample of 298 detoxification inpatients, this randomized controlled trial compared Enhanced Telephone Monitoring (ETM) to usual care (UC) on the primary outcome of reducing subsequent detoxification, and secondary outcomes of linking patients to addiction treatment and mutual-help, and patients' experience of improved substance use and mental health outcomes. At the 3-month follow-up (i.e., at the end of the ETM intervention), compared to UC patients, ETM patients were significantly less likely to have received additional inpatient detoxification, but no more likely to have participated in 12-step groups or received outpatient addiction treatment. Even so, ETM patients had better alcohol, drug, and mental health outcomes. In contrast, at the 6-month follow-up, patients in ETM and UC generally did not differ on primary or secondary outcomes. Findings suggest that ETM deters additional detoxification episodes while the intervention is ongoing, but not after the intervention ends. Because telephone monitoring is low-intensity and low-cost, its extension over time may help reduce repeated detoxifications.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Maureen Below
- VA Boston Health Care System, 150 South Huntington Ave. (116b), Boston, MA 02130, USA; Boston University School of Medicine, 72 East Concord St., Boston, MA 02118, USA.
| | - Lisa Vittorio
- VA Boston Health Care System, 150 South Huntington Ave. (116b), Boston, MA 02130, USA.
| | - Emmeline Taylor
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA 94304, USA.
| | - Grace Chang
- VA Boston Health Care System, 940 Belmont St., Brockton, MA 02301, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA.
| | - Steven Lash
- VA Medical Center, 1970 Roanoke Blvd, Salem, VA 24153, USA; Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA 22094, USA; Virgina Tech Carillon School of Medicine and Research Institute, 2 Riverside Circle, Roanoke, VA 24016, USA.
| | - Fe Erlita D Festin
- VA Boston Health Care System, 940 Belmont St., Brockton, MA 02301, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA.
| | - Deborah Brief
- VA Boston Health Care System, 150 South Huntington Ave. (116b), Boston, MA 02130, USA; Boston University School of Medicine, 72 East Concord St., Boston, MA 02118, USA.
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Randomized controlled trial of telephone monitoring with psychiatry inpatients with co-occurring substance use and mental health disorders. Drug Alcohol Depend 2019; 194:230-237. [PMID: 30466040 PMCID: PMC6448768 DOI: 10.1016/j.drugalcdep.2018.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 11/24/2022]
Abstract
Background Psychiatry inpatients frequently have co-occurring substance use and mental health disorders, which are related to poor post-discharge outcomes. Telephone monitoring is effective in specialty substance use disorder treatment settings in increasing continuing care and 12-step program utilization and improving substance use outcomes. This study examined the effectiveness of telephone monitoring among psychiatry inpatients with co-occurring substance use and mental health disorders. Methods This randomized controlled trial (n = 406) compared usual care to usual care plus telephone monitoring (one in-person session during the inpatient stay, followed by weekly telephone contact for three months post-discharge). Follow-ups were conducted at end-of-intervention (three months post-baseline) and nine and 15 months post-baseline (73% followed). Primary outcomes were number of days out of the past 30 of drinking alcohol, using drugs, and experiencing psychological problems. Secondary outcomes were outpatient substance use treatment, and 12-step group, utilization. Results Longitudinal modeling found that patients in both conditions improved over time on each primary outcome. Improvement was comparable between conditions on alcohol and drug use and psychological problems. Receipt of outpatient treatment decreased over the follow-up period and was not related to condition. Likelihood of attending 12-step group meetings did not change over follow-ups, and was not related to condition. Conclusions Improvement over time was evident regardless of condition assignment. Patients maintained attendance at 12-step groups from pre- to post-discharge. Short-term telephone monitoring in addition to usual care for patients with co-occurring substance use and mental health disorders may not be sufficiently intensive to achieve additional improvements on outcomes.
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Brookman-Frazee L, Stahmer AC. Effectiveness of a multi-level implementation strategy for ASD interventions: study protocol for two linked cluster randomized trials. Implement Sci 2018; 13:66. [PMID: 29743090 PMCID: PMC5944167 DOI: 10.1186/s13012-018-0757-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Centers for Disease Control (2018) estimates that 1 in 59 children has autism spectrum disorder, and the annual cost of ASD in the U.S. is estimated to be $236 billion. Evidence-based interventions have been developed and demonstrate effectiveness in improving child outcomes. However, research on generalizable methods to scale up these practices in the multiple service systems caring for these children has been limited and is critical to meet this growing public health need. This project includes two, coordinated studies testing the effectiveness of the Translating Evidence-based Interventions (EBI) for ASD: Multi-Level Implementation Strategy (TEAMS) model. TEAMS focuses on improving implementation leadership, organizational climate, and provider attitudes and motivation in order to improve two key implementation outcomes-provider training completion and intervention fidelity and subsequent child outcomes. The TEAMS Leadership Institute applies implementation leadership strategies and TEAMS Individualized Provider Strategies for training applies motivational interviewing strategies to facilitate provider and organizational behavior change. METHODS A cluster randomized implementation/effectiveness Hybrid, type 3, trial with a dismantling design will be used to understand the effectiveness of TEAMS and the mechanisms of change across settings and participants. Study #1 will test the TEAMS model with AIM HI (An Individualized Mental Health Intervention for ASD) in publicly funded mental health services. Study #2 will test TEAMS with CPRT (Classroom Pivotal Response Teaching) in education settings. Thirty-seven mental health programs and 37 school districts will be randomized, stratified by county and study, to one of four groups (Standard Provider Training Only, Standard Provider Training + Leader Training, Enhanced Provider Training, Enhanced Provider Training + Leader Training) to test the effectiveness of combining standard, EBI-specific training with the two TEAMS modules individually and together on multiple implementation outcomes. Implementation outcomes including provider training completion, fidelity (coded by observers blind to group assignment) and child behavior change will be examined for 295 mental health providers, 295 teachers, and 590 children. DISCUSSION This implementation intervention has the potential to increase quality of care for ASD in publicly funded settings by improving effectiveness of intervention implementation. The process and modules will be generalizable to multiple service systems, providers, and interventions, providing broad impact in community services. TRIAL REGISTRATION This study is registered with Clinicaltrials.gov ( NCT03380078 ). Registered 20 December 2017, retrospectively registered.
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Affiliation(s)
- Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0812 USA
- Child and Adolescent Services Research Center, 3020 Children’s Way MC 5033, San Diego, CA 92123 USA
| | - Aubyn C. Stahmer
- Child and Adolescent Services Research Center, 3020 Children’s Way MC 5033, San Diego, CA 92123 USA
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, UC Davis MIND Institute, 2825 50th Street, Sacramento, CA 95817 USA
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Bishop L, Hemingway A, Crabtree SA. Lifestyle coaching for mental health difficulties: scoping review. JOURNAL OF PUBLIC MENTAL HEALTH 2018. [DOI: 10.1108/jpmh-04-2017-0018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
UK mental health strategy calls for interventions that empower people to self-manage their condition. In lifestyle coaching, coach and client work collaboratively on positive behaviour change to improve client health. There is debate about the appropriateness of coaching for mental health, yet claims have not been supported with evidence. Therefore, the purpose of this paper is to explore the nature and scope of the existing research literature in this field.
Design/methodology/approach
Scoping review.
Findings
The growing evidence base shows positive outcomes of coaching; for instance, symptom reduction, enhanced self-management and achievement of personal goals.
Research limitations/implications
The evidence base is small and of variable quality, offering insights that warrant further exploration.
Practical implications
Coaching not only supports better self-management but also addresses further mental health strategy priorities (such as improved physical health and social functioning). Coaches need not be mental health experts; therefore coaching may be a cost-effective intervention.
Social implications
As mental ill-health prevalence continues to rise despite widespread use of Improving Access to Psychological Therapies and medication, there is a need to explore how novel approaches such as coaching might be integrated into mental healthcare.
Originality/value
This is the first study to collate the evidence on mental health coaching, highlighting its extensive potential, which should be further explored in research and practice.
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Lawrence P, Fulbrook P, Somerset S, Schulz P. Motivational interviewing to enhance treatment attendance in mental health settings: A systematic review and meta-analysis. J Psychiatr Ment Health Nurs 2017; 24:699-718. [PMID: 28816412 DOI: 10.1111/jpm.12420] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2017] [Indexed: 11/30/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Despite differences between samples, some literature reviews have suggested that MI is effective in enhancing treatment attendance for individuals with mental health issues. Little is known regarding the effects of MI as a pre-treatment on individuals who are not seeking treatment for mental health issues. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This systematic review of the literature and meta-analysis demonstrates that MI is most beneficial for individuals who are not seeking mental health treatment. MI represents an opportunity for health promotion when patients are unmotivated but may otherwise be amenable to an intervention. MI is effective as a pre-treatment intervention to motivate individuals to attend further post-MI treatment and counselling. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: MI is a process and a useful tool for clinicians in all therapeutic interactions, to motivate their patients to seek further assistance for mental heath issues. Health promotion and encouragement to attend further treatment sessions can be facilitated through telephone contact. ABSTRACT Introduction The stages of change model suggests that individuals seeking treatment are in the "preparation" or the "action" stage of change, which is the desired outcome of successful Motivational Interviewing (MI) interventions. MI is known to enhance treatment attendance among individuals with mental health problems. Aim This study examined the published research on MI as a pre-treatment to enhance attendance among individuals treatment-seeking and non-treatment-seeking for mental health issues. Methods Fourteen randomized controlled trials were identified, and MI efficacy was examined dichotomously: attendance or non-attendance for post-MI therapy. Subgroup analysis investigated treatment-seeking and non-treatment-seeking groups. Results Despite wide variations in sample sizes, blinding and monitoring, intervention fidelity was absent in the majority of published studies. Meta-analysis revealed that MI pre-treatment improved attendance relative to comparison groups. Conclusions Individuals not seeking treatment for mental health issues benefited the most from MI. Despite differences in MI treatment intensity, short interventions were as effective as longer interventions, whereas two MI sessions for as little as 15 min were effective in enhancing treatment attendance. Implications for Practice Motivational interviewing is a useful tool for clinicians in all therapeutic interactions to help motivate patients to seek assistance for mental health issues.
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Affiliation(s)
- P Lawrence
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia
| | - P Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia
| | - S Somerset
- School of Allied and Public Health, Australian Catholic University, Brisbane, Australia
| | - P Schulz
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia
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Johnson EM, Barrie KA, Possemato K, Wade M, Eaker A, Ouimette PC. Predictors of Mental Health Care Utilization in Veterans With Post-Traumatic Stress Disorder Symptoms and Hazardous Drinking. Mil Med 2017; 181:1200-1206. [PMID: 27753552 DOI: 10.7205/milmed-d-15-00495] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Describe outpatient mental health service use in a sample of recent combat Veterans with post-traumatic stress disorder (PTSD) symptoms and hazardous alcohol use and investigate predictors of mental health care utilization. METHODS In this prospective study, 126 Veterans with full or subthreshold PTSD and hazardous alcohol use completed a baseline assessment and reported mental health service use through a 12-month follow-up period. Logistic regressions were used to identify factors predicting mental health care utilization. RESULTS Veterans who were employed were 63% less likely to use outpatient mental health care in the 12 months following baseline. Additionally, for each 1-point increase in negative mental health care beliefs, participants were 70% less likely to use outpatient mental health care. For each 1-point worsening in social support and leisure functioning, participants were 2.2 times more likely to use outpatient mental health care. CONCLUSIONS The current study indicates that negative mental health beliefs are barriers to mental health care while unemployment and poor social support/leisure functioning are predictors of mental health care utilization for recent combat Veterans with PTSD symptoms and hazardous alcohol use. Patient and system level interventions for these factors are discussed to guide efforts to improve mental health care among this high-need population.
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Affiliation(s)
- Emily M Johnson
- Center for Integrated Healthcare (116C), Syracuse VA Medical Center, 800 Irving Avenue, Syracuse, NY 13210
| | - Kimberly A Barrie
- Center for Integrated Healthcare (116C), Syracuse VA Medical Center, 800 Irving Avenue, Syracuse, NY 13210
| | - Kyle Possemato
- Center for Integrated Healthcare (116C), Syracuse VA Medical Center, 800 Irving Avenue, Syracuse, NY 13210
| | - Michael Wade
- Center for Integrated Healthcare (116C), Syracuse VA Medical Center, 800 Irving Avenue, Syracuse, NY 13210
| | - April Eaker
- Center for Integrated Healthcare (116N), VA Western NY Healthcare System-Buffalo Campus, 3495 Bailey Avenue, Buffalo, NY 14215
| | - Paige C Ouimette
- Psychological Healthcare, P.L.L.C., Presidential Plaza, 600 East Genesee Street, Syracuse, NY 13202
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Abstract
Background: Post-traumatic stress disorder (PTSD) is a highly prevalent and impairing condition for which there are several evidence-based psychotherapies. However, a significant proportion of patients fail to complete a ‘sufficient dose’ of psychotherapy, potentially limiting treatment gains. Aims: The present study investigated predictors of premature treatment discontinuation during a trial of prolonged exposure (PE) therapy for PTSD. Method: Combat veterans with PTSD were recruited to participate in a randomized clinical trial of PE delivered in person or via telehealth technologies. Of the 150 initial participants, 61 participants discontinued the trial before the completion of eight sessions (of an 8‒12 session protocol). Treatment condition (telehealth or in person) and factors identified by prior research (age, combat theatre, social support, PTSD symptoms) were tested as predictors of treatment discontinuation. Results: A Cox proportional hazards model (a subtype of survival analysis) was used to evaluate predictors of treatment discontinuation. Disability status and treatment condition were identified as significant predictors of discontinuation, with a noted disability and use of telehealth demonstrating higher risk. Conclusions: The present findings highlight the influence of telehealth and disability status on treatment discontinuation, while minimizing the role of the previously identified variables from studies with less sensitive analyses.
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Borsari B, Yurasek A, Miller MB, Murphy JG, McDevitt-Murphy ME, Martens MP, Darcy MG, Carey KB. Student service members/veterans on campus: Challenges for reintegration. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2017; 87:166-175. [PMID: 28206804 PMCID: PMC5319708 DOI: 10.1037/ort0000199] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Many returning OIF/OEF/OND Veterans are seeking higher education in an effort to develop a meaningful career and financial stability. Evidence suggests that student service members/veterans (SSM/Vs) are experiencing less academic success than other students. The purpose of this review is to identify the unique challenges of SSM/Vs and evaluate current campus efforts to facilitate their retention and academic performance. With a focus on SSM/Vs attending colleges and universities, we obtained 57 peer-reviewed and 73 gray literature records published between 2001 and 2015. The current SSM/V literature contains an abundance of gray literature, and the empirical research tends to be limited by cross-sectional design and small sample sizes. SSM/Vs encounter significant personal and environmental challenges when transitioning from the military to college campuses. A variety of services have been developed to address the needs of the SSM/V population, but the efficacy of these services remains largely unknown. In conclusion, there is a clear need to provide education to faculty, students, and staff regarding the experiences of SSM/Vs. Efforts to enhance screening for, availability of, and SSM/V engagement in mental health services would also be beneficial, as would improved availability of and SSM/V access to academic support. All future programs designed to address the unique challenges of SSM/Vs in the academic environment should also be systematically implemented and evaluated. (PsycINFO Database Record
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Affiliation(s)
- Brian Borsari
- San Francisco Veteran Affairs Medical Center, Department of Psychiatry, University of California-San Francisco
| | - Ali Yurasek
- Center for Alcohol and Addiction Studies, Brown University
| | | | | | | | | | - Monica G Darcy
- Feinstein School of Education and Human Development, Rhode Island College
| | - Kate B Carey
- Center for Alcohol and Addiction Studies, Brown University
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Primack JM, Borsari B, Benz MB, Reddy MK, Shea MT. Mental health treatment utilization in OIF/OEF National Guard and Reserve troops with and without DSM diagnoses. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2017; 87:157-165. [PMID: 28206803 PMCID: PMC5605805 DOI: 10.1037/ort0000226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Military service members have an increased risk of developing mental health (MH) problems following deployment to Iraq or Afghanistan, yet only a small percentage seek mental health treatment. The aim of the present study was to explore patterns of MH service utilization within the first 12 months following return from combat deployment. Participants were 169 service members who had returned from war-zone deployment in either Iraq or Afghanistan and had assessments covering a 12-month period following their homecoming. The authors first examined the prevalence of mental health diagnoses and engagement with mental health treatment (e.g., visits to the emergency room, inpatient hospitalization, individual therapy, group therapy, family or couple therapy, medication appointments, and self-help). Regression analyses explored whether distress, functioning, diagnoses, or social support predicted treatment use. Findings indicated that 28 of 50 military service members (56%) who met diagnostic criteria for a mental health disorder accessed services in the year following their return from deployment. Individual treatment was the most common modality, and those with major depressive disorder (MDD) reported the most treatment contacts. Social support was not associated with use of mental health services. Baseline functioning and psychiatric distress predicted entry into treatment whereas only psychiatric distress predicted amount of mental health service use in the 12-month postdeployment period. Findings highlight the need for enhanced strategies to link those reporting psychiatric distress with MH treatment services and increase community connectedness regardless of whether they meet full criteria for a mental health diagnosis. (PsycINFO Database Record
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Hill RM, Pettit JW. Pilot Randomized Controlled Trial of LEAP: A Selective Preventive Intervention to Reduce Adolescents’ Perceived Burdensomeness. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 48:S45-S56. [DOI: 10.1080/15374416.2016.1188705] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ryan M. Hill
- Department of Psychology, Florida International University
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Koenig CJ, Abraham T, Zamora KA, Hill C, Kelly PA, Uddo M, Hamilton M, Pyne JM, Seal KH. Pre-Implementation Strategies to Adapt and Implement a Veteran Peer Coaching Intervention to Improve Mental Health Treatment Engagement Among Rural Veterans. J Rural Health 2016; 32:418-428. [DOI: 10.1111/jrh.12201] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 07/05/2016] [Accepted: 07/11/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Christopher J. Koenig
- San Francisco Veterans Affairs Health Care System; San Francisco California
- Department of Communication Studies; San Francisco State University; San Francisco California
| | - Traci Abraham
- Center for Mental Healthcare & Outcomes Research; Health Services Research and Development; Little Rock Arkansas
- Department of Psychiatry; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Kara A. Zamora
- San Francisco Veterans Affairs Health Care System; San Francisco California
| | - Coleen Hill
- San Francisco Veterans Affairs Health Care System; San Francisco California
| | - P. Adam Kelly
- Southeast Louisiana Veterans Health Care System; New Orleans Louisiana
- South Central Mental Illness Research Education Clinical Center (MIRECC); Little Rock Arkansas
- General Internal Medicine & Geriatrics; Tulane University School of Medicine; New Orleans Louisiana
| | - Madeline Uddo
- Southeast Louisiana Veterans Health Care System; New Orleans Louisiana
- South Central Mental Illness Research Education Clinical Center (MIRECC); Little Rock Arkansas
- Department of Psychiatry and Behavioral Sciences; Tulane University School of Medicine; New Orleans Louisiana
| | - Michelle Hamilton
- Southeast Louisiana Veterans Health Care System; New Orleans Louisiana
- Department of Psychiatry and Behavioral Sciences; Tulane University School of Medicine; New Orleans Louisiana
| | - Jeffrey M. Pyne
- Center for Mental Healthcare & Outcomes Research; Health Services Research and Development; Little Rock Arkansas
- Department of Psychiatry; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Karen H. Seal
- San Francisco Veterans Affairs Health Care System; San Francisco California
- Department of General Internal Medicine; University of California-San Francisco; San Francisco California
- Department of Psychiatry; University of California-San Francisco; San Francisco California
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Sirey JA, Banerjee S, Marino P, Halkett A, Raeifar E, Paggi M, Bruce ML. Improving Mental Health Treatment Initiation among Depressed Community Dwelling Older Adults. Am J Geriatr Psychiatry 2016; 24:310-9. [PMID: 26915900 PMCID: PMC8178741 DOI: 10.1016/j.jagp.2015.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/21/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Depression screening has been widely implemented in community settings to increase detection of late-life depression. Rates of treatment initiation are low without additional structured follow-up, however. The current study evaluates the effectiveness of a brief psychosocial intervention, Open Door, designed to improve initiation of mental health treatment among clients of aging service meals programs. DESIGN Older adult social service clients with depressive symptoms were randomized to either the Open Door intervention or a Service Referral control condition. In Open Door, the counselor collaborates with the client to identify and address both attitudinal and structural barriers to seeking mental health treatment. Independent research assessments were conducted 12 and 24 weeks after baseline to document treatment initiation (at least one session). RESULTS At follow up, 64.6% (104 out of 161) of participants had initiated a provider visit. Participants in Open Door were more likely to initiate treatment compared with those in the control condition (χ(2) = 5.83, df = 2, p = 0.016). Among participants with at least mild depressive symptoms, Open Door remained significantly more effective than the control condition (p < 0.05). In multivariate analyses controlling for gender differences, both participation in the Open Door group and depression severity predicted treatment initiation (χ(2) = 15.18, df = 3, p = 0.002). CONCLUSIONS High rates of depression have been documented among older adults receiving social services (case management or home meals). The Open Door program offers a useful strategy to overcome the barriers to treatment initiation while fitting within the responsibilities of aging service staff. The intervention can improve initiation of late-life depression care.
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Affiliation(s)
- Jo Anne Sirey
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY.
| | - Samprit Banerjee
- Department of Health Policy and Research, Weill Cornell Medical College, White Plains, NY
| | - Patricia Marino
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Ashley Halkett
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Elmira Raeifar
- Department of Clinical Psychology, Long Island University, 1 University Plaza, Brooklyn, NY
| | - Michelle Paggi
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Martha L Bruce
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY
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Mehta N, Clement S, Marcus E, Stona AC, Bezborodovs N, Evans-Lacko S, Palacios J, Docherty M, Barley E, Rose D, Koschorke M, Shidhaye R, Henderson C, Thornicroft G. Evidence for effective interventions to reduce mental health-related stigma and discrimination in the medium and long term: systematic review. Br J Psychiatry 2015; 207:377-84. [PMID: 26527664 PMCID: PMC4629070 DOI: 10.1192/bjp.bp.114.151944] [Citation(s) in RCA: 183] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 01/04/2015] [Accepted: 02/27/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Most research on interventions to counter stigma and discrimination has focused on short-term outcomes and has been conducted in high-income settings. AIMS To synthesise what is known globally about effective interventions to reduce mental illness-based stigma and discrimination, in relation first to effectiveness in the medium and long term (minimum 4 weeks), and second to interventions in low- and middle-income countries (LMICs). METHOD We searched six databases from 1980 to 2013 and conducted a multi-language Google search for quantitative studies addressing the research questions. Effect sizes were calculated from eligible studies where possible, and narrative syntheses conducted. Subgroup analysis compared interventions with and without social contact. RESULTS Eighty studies (n = 422 653) were included in the review. For studies with medium or long-term follow-up (72, of which 21 had calculable effect sizes) median standardised mean differences were 0.54 for knowledge and -0.26 for stigmatising attitudes. Those containing social contact (direct or indirect) were not more effective than those without. The 11 LMIC studies were all from middle-income countries. Effect sizes were rarely calculable for behavioural outcomes or in LMIC studies. CONCLUSIONS There is modest evidence for the effectiveness of anti-stigma interventions beyond 4 weeks follow-up in terms of increasing knowledge and reducing stigmatising attitudes. Evidence does not support the view that social contact is the more effective type of intervention for improving attitudes in the medium to long term. Methodologically strong research is needed on which to base decisions on investment in stigma-reducing interventions.
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Affiliation(s)
- N Mehta
- Nisha Mehta, MBBS, Sarah Clement, PhD, Elena Marcus, MSc, Anne-Claire Stona, BSc, Nikita Bezborodovs, MD, Sara Evans-Lacko, PhD, Jorge Palacios, PhD, Mary Docherty, MRCPsych, Elizabeth Barley, PhD, Diana Rose, PhD, Mirja Koschorke, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Rahul Shidhaye, PhD, Centre for Mental Health, Public Health Foundation of India, Delhi, India; Claire Henderson, PhD, Graham Thornicroft, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - S Clement
- Nisha Mehta, MBBS, Sarah Clement, PhD, Elena Marcus, MSc, Anne-Claire Stona, BSc, Nikita Bezborodovs, MD, Sara Evans-Lacko, PhD, Jorge Palacios, PhD, Mary Docherty, MRCPsych, Elizabeth Barley, PhD, Diana Rose, PhD, Mirja Koschorke, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Rahul Shidhaye, PhD, Centre for Mental Health, Public Health Foundation of India, Delhi, India; Claire Henderson, PhD, Graham Thornicroft, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - E Marcus
- Nisha Mehta, MBBS, Sarah Clement, PhD, Elena Marcus, MSc, Anne-Claire Stona, BSc, Nikita Bezborodovs, MD, Sara Evans-Lacko, PhD, Jorge Palacios, PhD, Mary Docherty, MRCPsych, Elizabeth Barley, PhD, Diana Rose, PhD, Mirja Koschorke, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Rahul Shidhaye, PhD, Centre for Mental Health, Public Health Foundation of India, Delhi, India; Claire Henderson, PhD, Graham Thornicroft, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - A-C Stona
- Nisha Mehta, MBBS, Sarah Clement, PhD, Elena Marcus, MSc, Anne-Claire Stona, BSc, Nikita Bezborodovs, MD, Sara Evans-Lacko, PhD, Jorge Palacios, PhD, Mary Docherty, MRCPsych, Elizabeth Barley, PhD, Diana Rose, PhD, Mirja Koschorke, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Rahul Shidhaye, PhD, Centre for Mental Health, Public Health Foundation of India, Delhi, India; Claire Henderson, PhD, Graham Thornicroft, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - N Bezborodovs
- Nisha Mehta, MBBS, Sarah Clement, PhD, Elena Marcus, MSc, Anne-Claire Stona, BSc, Nikita Bezborodovs, MD, Sara Evans-Lacko, PhD, Jorge Palacios, PhD, Mary Docherty, MRCPsych, Elizabeth Barley, PhD, Diana Rose, PhD, Mirja Koschorke, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Rahul Shidhaye, PhD, Centre for Mental Health, Public Health Foundation of India, Delhi, India; Claire Henderson, PhD, Graham Thornicroft, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - S Evans-Lacko
- Nisha Mehta, MBBS, Sarah Clement, PhD, Elena Marcus, MSc, Anne-Claire Stona, BSc, Nikita Bezborodovs, MD, Sara Evans-Lacko, PhD, Jorge Palacios, PhD, Mary Docherty, MRCPsych, Elizabeth Barley, PhD, Diana Rose, PhD, Mirja Koschorke, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Rahul Shidhaye, PhD, Centre for Mental Health, Public Health Foundation of India, Delhi, India; Claire Henderson, PhD, Graham Thornicroft, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - J Palacios
- Nisha Mehta, MBBS, Sarah Clement, PhD, Elena Marcus, MSc, Anne-Claire Stona, BSc, Nikita Bezborodovs, MD, Sara Evans-Lacko, PhD, Jorge Palacios, PhD, Mary Docherty, MRCPsych, Elizabeth Barley, PhD, Diana Rose, PhD, Mirja Koschorke, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Rahul Shidhaye, PhD, Centre for Mental Health, Public Health Foundation of India, Delhi, India; Claire Henderson, PhD, Graham Thornicroft, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - M Docherty
- Nisha Mehta, MBBS, Sarah Clement, PhD, Elena Marcus, MSc, Anne-Claire Stona, BSc, Nikita Bezborodovs, MD, Sara Evans-Lacko, PhD, Jorge Palacios, PhD, Mary Docherty, MRCPsych, Elizabeth Barley, PhD, Diana Rose, PhD, Mirja Koschorke, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Rahul Shidhaye, PhD, Centre for Mental Health, Public Health Foundation of India, Delhi, India; Claire Henderson, PhD, Graham Thornicroft, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - E Barley
- Nisha Mehta, MBBS, Sarah Clement, PhD, Elena Marcus, MSc, Anne-Claire Stona, BSc, Nikita Bezborodovs, MD, Sara Evans-Lacko, PhD, Jorge Palacios, PhD, Mary Docherty, MRCPsych, Elizabeth Barley, PhD, Diana Rose, PhD, Mirja Koschorke, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Rahul Shidhaye, PhD, Centre for Mental Health, Public Health Foundation of India, Delhi, India; Claire Henderson, PhD, Graham Thornicroft, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - D Rose
- Nisha Mehta, MBBS, Sarah Clement, PhD, Elena Marcus, MSc, Anne-Claire Stona, BSc, Nikita Bezborodovs, MD, Sara Evans-Lacko, PhD, Jorge Palacios, PhD, Mary Docherty, MRCPsych, Elizabeth Barley, PhD, Diana Rose, PhD, Mirja Koschorke, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Rahul Shidhaye, PhD, Centre for Mental Health, Public Health Foundation of India, Delhi, India; Claire Henderson, PhD, Graham Thornicroft, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - M Koschorke
- Nisha Mehta, MBBS, Sarah Clement, PhD, Elena Marcus, MSc, Anne-Claire Stona, BSc, Nikita Bezborodovs, MD, Sara Evans-Lacko, PhD, Jorge Palacios, PhD, Mary Docherty, MRCPsych, Elizabeth Barley, PhD, Diana Rose, PhD, Mirja Koschorke, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Rahul Shidhaye, PhD, Centre for Mental Health, Public Health Foundation of India, Delhi, India; Claire Henderson, PhD, Graham Thornicroft, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - R Shidhaye
- Nisha Mehta, MBBS, Sarah Clement, PhD, Elena Marcus, MSc, Anne-Claire Stona, BSc, Nikita Bezborodovs, MD, Sara Evans-Lacko, PhD, Jorge Palacios, PhD, Mary Docherty, MRCPsych, Elizabeth Barley, PhD, Diana Rose, PhD, Mirja Koschorke, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Rahul Shidhaye, PhD, Centre for Mental Health, Public Health Foundation of India, Delhi, India; Claire Henderson, PhD, Graham Thornicroft, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - C Henderson
- Nisha Mehta, MBBS, Sarah Clement, PhD, Elena Marcus, MSc, Anne-Claire Stona, BSc, Nikita Bezborodovs, MD, Sara Evans-Lacko, PhD, Jorge Palacios, PhD, Mary Docherty, MRCPsych, Elizabeth Barley, PhD, Diana Rose, PhD, Mirja Koschorke, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Rahul Shidhaye, PhD, Centre for Mental Health, Public Health Foundation of India, Delhi, India; Claire Henderson, PhD, Graham Thornicroft, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - G Thornicroft
- Nisha Mehta, MBBS, Sarah Clement, PhD, Elena Marcus, MSc, Anne-Claire Stona, BSc, Nikita Bezborodovs, MD, Sara Evans-Lacko, PhD, Jorge Palacios, PhD, Mary Docherty, MRCPsych, Elizabeth Barley, PhD, Diana Rose, PhD, Mirja Koschorke, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Rahul Shidhaye, PhD, Centre for Mental Health, Public Health Foundation of India, Delhi, India; Claire Henderson, PhD, Graham Thornicroft, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Lawrence P, Fulbrook P. Protocol for a pragmatic randomised controlled trial to evaluate effects of a brief intervention for emergency department attendees who present with moderate or high levels of non-specific psychological distress: a pilot study. Pilot Feasibility Stud 2015; 1:33. [PMID: 27965811 PMCID: PMC5154032 DOI: 10.1186/s40814-015-0028-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 09/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Screening and brief intervention in the emergency department (ED) has almost exclusively focused on individuals with alcohol-use problems. The early detection of mental health problems before problems become severe will enable early intervention and support which may improve health and prevent further deterioration. The main aim of this pilot study is to provide evidence of the acceptance of a telephone intervention aimed at ED attendees with moderate or high psychological distress. This will be determined by recruitment rates, retention rates and participant satisfaction with the intervention. Secondary outcomes include whether socio-demographic variables have an impact on retention rates, and whether the intervention had any impact on psychological distress. METHODS/DESIGN This study will be a single-site pragmatic randomised controlled pilot study. Consenting ED attendees will be screened with the Kessler Psychological Distress Scales (K10). There will be three arms to the study: a moderate/high psychological distress group with or without intervention, and a low psychological distress group. Those with severe psychological distress will be excluded. All included participants will be followed-up at 1, 3, 6 and 12 months post-recruitment. Retention rates will be determined by successful completion of surveys at the follow-up time-points. Psychological distress will be measured by the K10 at all follow-up time-points. DISCUSSION This study will provide information regarding the potential for screening and recruitment at an opportunistic hospital presentation. It will provide data for a future larger study with regard to participants accepting to be included in this study. Participant acceptability will be measured in terms of recruitment rates and retention rates measured by successful follow-ups over the following 12 months post-recruitment. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12614000031662. Registered 10/01/2014.
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Affiliation(s)
- Petra Lawrence
- Nursing Research and Practice Development Centre, The Prince Charles Hospital and Australian Catholic University, Brisbane, Australia
| | - Paul Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital and Australian Catholic University, Brisbane, Australia ; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia
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Gates P, Albertella L. The effectiveness of telephone counselling in the treatment of illicit drug and alcohol use concerns. J Telemed Telecare 2015; 22:67-85. [PMID: 26026185 DOI: 10.1177/1357633x15587406] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 03/20/2015] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Technology-assisted substance use interventions such as 'high-tech' internet-based treatments are thought to be effective; however, the relatively 'low-tech' use of telephone counselling does not yet have an established evidence base. This paper reviews the literature including articles with information on the use of telephone counselling for the treatment of illicit drug or alcohol use. METHODS A systematic literature search using a set of telephone counselling and substance-related terms was conducted across four electronic databases. English studies prior to June 2014 that involved the use of telephone counselling with the treatment of illicit drug or alcohol use as a primary or secondary outcome were included. Review papers, opinion pieces, letters or editorials, case studies, published abstracts, and posters were excluded. In all, 94 publications were included in the review. RESULTS AND DISCUSSION The literature was supportive of telephone counselling for the treatment of alcohol use in the short term; however, literature regarding illicit drug use was particularly scarce. The generalisability of findings was limited by evident methodological issues in the included studies.
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Affiliation(s)
- Peter Gates
- National Cannabis Prevention and Information Centre, Randwick NSW, Australia
| | - Lucy Albertella
- National Cannabis Prevention and Information Centre, Randwick NSW, Australia
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The effect of medical comorbidities on male and female Veterans' use of psychotherapy for PTSD. Med Care 2015; 53:S120-7. [PMID: 25767965 DOI: 10.1097/mlr.0000000000000284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with an increased risk for medical comorbidities that may prevent participation in psychotherapy. The present study investigated whether medical comorbidities were associated with lower initiation rates and fewer psychotherapy visits for PTSD. Because women are more likely to initiate psychotherapy after traumatic events, we also assessed whether relationships were weaker among women. METHODS Veterans (N=482, 47% women) recently diagnosed with PTSD completed a survey assessing demographics, mood, functional status, and interest in treatment. Data on medical comorbidities, psychotherapy visits, antidepressant prescriptions, and service connection were assessed longitudinally through administrative files. Logistic and negative binomial regressions assessed associations between number of medical comorbidities in the 2 years before the survey and the initiation and number of psychotherapy visits for PTSD in the year after the survey. All analyses were stratified by sex and controlled for survey and administrative variables. RESULTS The relationship between medical comorbidities and number of psychotherapy visits was stronger among women than among men. A greater number of medical comorbidities was associated with significantly fewer psychotherapy visits in the total sample [incidence rate ratio: 0.91; 95% confidence interval (CI): 0.83, 1.00] and among women (incidence rate ratio: 0.87; 95% CI: 0.77, 0.99), but not among men (95% CI: 0.75, 1.01). Medical comorbidities were not associated with the initiation of psychotherapy among men or women. CONCLUSIONS Addressing medical comorbidities may help individuals remain in psychotherapy for PTSD. Medical comorbidities may play a larger role in the number of psychotherapy visits among women than men.
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Schreiber M, McEnany GP. Stigma, American military personnel and mental health care: challenges from Iraq and Afghanistan. J Ment Health 2015; 24:54-9. [DOI: 10.3109/09638237.2014.971147] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Stecker T, McHugo G, Xie H, Whyman K, Jones M. RCT of a brief phone-based CBT intervention to improve PTSD treatment utilization by returning service members. Psychiatr Serv 2014; 65:1232-7. [PMID: 24933496 PMCID: PMC4182109 DOI: 10.1176/appi.ps.201300433] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Many service members do not seek care for mental health and addiction problems, often with serious consequences for them, their families, and their communities. This study tested the effectiveness of a brief, telephone-based, cognitive-behavioral intervention designed to improve treatment engagement among returning service members who screened positive for posttraumatic stress disorder (PTSD). METHODS Service members who had served in Operation Enduring Freedom or Operation Iraqi Freedom who screened positive for PTSD but had not engaged in PTSD treatment were recruited (N=300), randomly assigned to either control or intervention conditions, and administered a baseline interview. Intervention participants received a brief cognitive-behavioral therapy intervention; participants in the control condition had access to usual services. All participants received follow-up phone calls at months 1, 3, and 6 to assess symptoms and service utilization. RESULTS Participants in both conditions had comparable rates of treatment engagement and PTSD symptom reduction over the course of the six-month trial, but receiving the telephone-based intervention accelerated service utilization (treatment engagement and number of sessions) and PTSD symptom reduction. CONCLUSIONS A one-time brief telephone intervention can engage service members in PTSD treatment earlier than conventional methods and can lead to immediate symptom reduction. There were no differences at longer-term follow-up, suggesting the need for additional intervention to build upon initial gains.
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DeVylder JE, Oh HY, Corcoran CM, Lukens EP. Treatment seeking and unmet need for care among persons reporting psychosis-like experiences. Psychiatr Serv 2014; 65:774-80. [PMID: 24534875 PMCID: PMC6483726 DOI: 10.1176/appi.ps.201300254] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Psychosis-like experiences may be clinically significant given their demonstrated associations with concurrent psychological distress and the later development of diagnosable psychotic disorders. Prior studies of treatment for psychosis-like experiences have yielded conflicting results. The aims of this study were to investigate help seeking and need for care among individuals with psychosis-like experiences in a large general population sample. METHODS Data from the Collaborative Psychiatric Epidemiology Surveys (N=10,541) were used to examine help-seeking behaviors among survey respondents who reported psychosis-like symptoms over a 12-month period. Adjusted odds ratios were calculated for a variety of help-seeking variables, with control for demographic factors and co-occurring psychiatric conditions. RESULTS Among the 10,541 respondents, 3.4% reported a psychosis-like experience in the past 12 months. Respondents who reported psychosis-like experiences were more than twice as likely as those who did not to seek treatment. Those who reported such experiences but who did not seek treatment were more likely to have felt the need for or to have been encouraged by others to seek treatment and less likely to have felt that they had no psychiatric problem. Associations with unmet need for care were largely attributable to co-occurring psychiatric disorders. CONCLUSIONS Respondents with psychosis-like experiences had elevated rates of help seeking, as well as significant unmet clinical need among those not in treatment.
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Griffiths KM, Carron-Arthur B, Parsons A, Reid R. Effectiveness of programs for reducing the stigma associated with mental disorders. A meta-analysis of randomized controlled trials. World Psychiatry 2014; 13:161-75. [PMID: 24890069 PMCID: PMC4102289 DOI: 10.1002/wps.20129] [Citation(s) in RCA: 244] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The stigma associated with mental disorders is a global public health problem. Programs to combat it must be informed by the best available evidence. To this end, a meta-analysis was undertaken to investigate the effectiveness of existing programs. A systematic search of PubMed, PsycINFO and Cochrane databases yielded 34 relevant papers, comprising 33 randomized controlled trials. Twenty-seven papers (26 trials) contained data that could be incorporated into a quantitative analysis. Of these trials, 19 targeted personal stigma or social distance (6,318 participants), six addressed perceived stigma (3,042 participants) and three self-stigma (238 participants). Interventions targeting personal stigma or social distance yielded small but significant reductions in stigma across all mental disorders combined (d=0.28, 95% CI: 0.17-0.39, p<0.001) as well as for depression (d=0.36, 95% CI: 0.10-0.60, p<0.01), psychosis (d=0.20, 95% CI: 0.06-0.34, p<0.01) and generic mental illness (d=0.30, 95% CI: 0.10-0.50, p<0.01). Educational interventions were effective in reducing personal stigma (d=0.33, 95% CI: 0.19-0.42, p<0.001) as were interventions incorporating consumer contact (d=0.47, 95% CI: 0.17-0.78, p<0.001), although there were insufficient studies to demonstrate an effect for consumer contact alone. Internet programs were at least as effective in reducing personal stigma as face-to-face delivery. There was no evidence that stigma interventions were effective in reducing perceived or self-stigma. In conclusion, there is an evidence base to inform the roll out of programs for improving personal stigma among members of the community. However, there is a need to investigate methods for improving the effectiveness of these programs and to develop interventions that are effective in reducing perceived and internalized stigma.
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Affiliation(s)
- Kathleen M Griffiths
- Centre for Mental Health Research, Australian National University, Acton, Canberra, ACT 0200, Australia
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Blais RK, Hoerster KD, Malte C, Hunt S, Jakupcak M. Unique PTSD clusters predict intention to seek mental health care and subsequent utilization in US veterans with PTSD symptoms. J Trauma Stress 2014; 27:168-74. [PMID: 24634206 DOI: 10.1002/jts.21898] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Many veterans return from deployment with posttraumatic stress disorder (PTSD), but most attend only a limited number of mental health care visits. Although global PTSD relates to seeking mental health care, it is unclear whether specific features of PTSD inform the low rates of mental health care utilization. This study examined PTSD cluster severities of avoidance, reexperiencing, dysphoria, and hyperarousal as predictors of intention to seek mental health care and prospective treatment utilization. US veterans with at least subthreshold PTSD (N = 189) completed a PTSD symptom measure and indicated whether they intended to seek mental health care. Prospective Department of Veterans Affairs mental health care utilization was extracted from the medical record. At the bivariate level, each cluster was positively associated with a positive intention to seek mental health care and prospective treatment utilization. In multivariate models, however, dysphoria severity (OR = 1.16, 95% CI [1.06, 1.26]) was uniquely and positively correlated with intention to seek mental health care, whereas higher avoidance severity (IRR = 0.86, 95% CI [0.76, 0.98]) predicted lower treatment utilization, and higher reexperiencing severity (IRR = 1.07, 95% CI [1.01, 1.14]) predicted greater treatment utilization. It is critical to tailor interventions to target specific features of PTSD and to meet patients where they are.
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Affiliation(s)
- Rebecca K Blais
- Mental Health Service, VA Puget Sound-Seattle Division, Seattle, Washington, USA
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Finlay AK, Smelson D, Sawh L, McGuire J, Rosenthal J, Blue-Howells J, Timko C, Binswanger I, Frayne SM, Blodgett JC, Bowe T, Clark SC, Harris AHS. U.S. Department of Veterans Affairs Veterans Justice Outreach Program: Connecting Justice-Involved Veterans with Mental Health and Substance Use Disorder Treatment. ACTA ACUST UNITED AC 2013; 27. [PMID: 32180665 DOI: 10.1177/0887403414562601] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Veterans Justice Outreach (VJO) program of the U.S. Veterans Health Administration has a primary mission of linking military veterans in jails, courts, or in contact with law enforcement to mental health and substance use disorder treatment. National data of veterans with VJO contact were used to describe demographic characteristics, and mental health and substance use disorder diagnoses and treatment use and test correlates of treatment entry and engagement using multi-level logistic regression models. Of the 37,542 VJO veterans, treatment entry was associated with being homeless and having a mental health disorder or both a mental health and a substance use disorder versus a substance use disorder only. Being American Indian/Alaskan Native was associated with lower odds of treatment entry. Engagement was associated with female gender, older age, Asian race, urban residence, and homeless status. Increased utilization of substance use disorder treatment, especially pharmacotherapy, is an important quality improvement target.
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Affiliation(s)
- Andrea K Finlay
- Veteran Affairs Substance Use Disorder Quality Enhancement Research Initiative, Department of Veterans Affairs.,Center for Innovation to Implementation, VA Palo Alto Health Care System.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - David Smelson
- National Center on Homelessness Among Veterans, Edith Nourse Rogers Memorial Veterans Hospital.,Department of Psychiatry, University of Massachusetts Medical School
| | - Leon Sawh
- National Center on Homelessness Among Veterans, Edith Nourse Rogers Memorial Veterans Hospital.,Department of Psychiatry, University of Massachusetts Medical School.,School of Criminology and Justice Studies, University of Massachusetts Lowell
| | - Jim McGuire
- Veterans Justice Programs, Department of Veterans Affairs
| | - Joel Rosenthal
- Veterans Justice Programs, Department of Veterans Affairs
| | | | - Christine Timko
- Center for Innovation to Implementation, VA Palo Alto Health Care System.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | | | - Susan M Frayne
- Center for Innovation to Implementation, VA Palo Alto Health Care System.,Women's Health Service, Medical Service, VA Palo Alto Health Care System.,Division of General Medical Disciplines, Stanford University School of Medicine
| | - Janet C Blodgett
- Center for Innovation to Implementation, VA Palo Alto Health Care System
| | - Tom Bowe
- Veteran Affairs Substance Use Disorder Quality Enhancement Research Initiative, Department of Veterans Affairs
| | - Sean C Clark
- Veterans Justice Programs, Department of Veterans Affairs
| | - Alex H S Harris
- Veteran Affairs Substance Use Disorder Quality Enhancement Research Initiative, Department of Veterans Affairs.,Center for Innovation to Implementation, VA Palo Alto Health Care System
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Turchik JA, Rafie S, Rosen CS, Kimerling R. Preferences for Gender-Targeted Health Information. Am J Mens Health 2013; 8:240-8. [DOI: 10.1177/1557988313508304] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
No prior research has examined men’s opinions or preferences regarding receiving health education materials related to sexual violence. The objective of the current study was to investigate whether male veteran patients who have experienced military sexual trauma (MST) prefer gender-targeted versus gender-neutral printed health information and whether receipt of this information increased utilization of outpatient mental health services in the following 6-month period. In-person 45-minute interviews were conducted with 20 male veterans receiving health care services at a large Veterans Health Administration facility to evaluate opinions on a gender-targeted and a gender-neutral brochure about MST. An additional 153 veterans received psychoeducational materials through the mail and participated in the completion of a survey as part of a psychoeducational intervention. Our results demonstrate that male veterans prefer gender-targeted information about sexual trauma compared to gender-neutral information. Whereas veterans in the study had clear preferences for gender-targeted materials, receipt of information about MST (whether gender-targeted or gender-neutral) did not increase utilization of mental health care in the 6 months following receipt of these materials. These results demonstrated that materials about sexual trauma are acceptable to men and should be gender-targeted. Further research is needed to examine strategies to increase access to mental health care among male Veterans who have experienced MST.
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Affiliation(s)
- Jessica A. Turchik
- National Center for PTSD, VA Palo Health Care System, Palo Alto, CA, USA
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Samantha Rafie
- National Center for PTSD, VA Palo Health Care System, Palo Alto, CA, USA
- Palo Alto University, Palo Alto, CA, USA
| | - Craig S. Rosen
- National Center for PTSD, VA Palo Health Care System, Palo Alto, CA, USA
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Rachel Kimerling
- National Center for PTSD, VA Palo Health Care System, Palo Alto, CA, USA
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Gros DF, Price M, Yuen EK, Acierno R. Predictors of completion of exposure therapy in OEF/OIF veterans with posttraumatic stress disorder. Depress Anxiety 2013; 30:1107-13. [PMID: 24151141 DOI: 10.1002/da.22207] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 08/01/2013] [Accepted: 09/20/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Despite large-scale dissemination and implementation efforts of evidence-based psychotherapy to veterans from Operation Enduring/Iraqi Freedom (OEF/OIF), little is known regarding the factors that contribute to the successful completion of these treatments in this high-risk population. The present study investigated predictors of treatment completion during a standardized exposure-based psychotherapy for PTSD. METHODS Ninety-two OEF/OIF combat veterans enrolled in a randomized controlled trial for an eight session exposure-based psychotherapy for PTSD. All participants completed structured clinical interviews and several background and symptom questionnaires. Of the initial 92 participants, 28% of the sample (n = 26) discontinued treatment prior to completion of the trial. RESULTS Predictors of discontinuation of treatment were assessed with a hierarchical logistic regression. Disability status was positively associated with treatment discontinuation, and postdeployment social support was negatively associated with discontinuation. In contrast to previous findings, other factors, such as age and PTSD symptomatology, were not identified as significant predictors. CONCLUSIONS The present study suggested that disability status at the start of treatment increases the risk for treatment discontinuation whereas increased social support buffers against discontinuation. Together, these findings highlight the importance of increased assessment and early intervention when these factors are present to potentially reduce treatment discontinuation and improve treatment outcomes in OEF/OIF veterans with PTSD.
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Affiliation(s)
- Daniel F Gros
- Mental Health Service Line, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
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Maguen S, Madden E, Cohen B, Bertenthal D, Neylan T, Talbot L, Grunfeld C, Seal K. The relationship between body mass index and mental health among Iraq and Afghanistan veterans. J Gen Intern Med 2013; 28 Suppl 2:S563-70. [PMID: 23807066 PMCID: PMC3695271 DOI: 10.1007/s11606-013-2374-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Obesity is a growing public health concern and is becoming an epidemic among veterans in the post-deployment period. OBJECTIVE To explore the relationship between body mass index (BMI) and posttraumatic stress disorder (PTSD) in a large cohort of Iraq and Afghanistan veterans, and to evaluate trajectories of change in BMI over 3 years. DESIGN Retrospective, longitudinal cohort analysis of veterans' health records PARTICIPANTS A total of 496,722 veterans (59,790 female and 436,932 male veterans) whose height and weight were recorded at the Department of Veterans Affairs (VA) healthcare system at least once after the end of their last deployment and whose first post-deployment outpatient encounter at the VA was at least 1 year prior to the end of the study period (December 31, 2011). MAIN MEASURES BMI, mental health diagnoses. KEY RESULTS Seventy-five percent of Iraq and Afghanistan veterans were either overweight or obese at baseline. Four trajectories were observed: "stable overweight" represented the largest class; followed by "stable obese;" "overweight/obese gaining;" and "obese losing." During the 3-year ascertainment period, those with PTSD and depression in particular were at the greatest risk of being either obese without weight loss or overweight or obese and continuing to gain weight. Adjustment for demographics and antipsychotic medication attenuated the relationship between BMI and certain mental health diagnoses. Although BMI trajectories were similar in men and women, some gender differences were observed. For example, the risk of being in the persistently obese class in men was highest for those with PTSD, whereas for women, the risk was highest among those with depression. CONCLUSIONS The growing number of overweight or obese returning veterans is a concerning problem for clinicians who work with these patients. Successful intervention to reduce the prevalence of obesity will require integrated efforts from primary care and mental health to treat underlying mental health causes and assist with engagement in weight loss programs.
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Affiliation(s)
- Shira Maguen
- San Francisco VA Medical Center, 4150 Clement Street (116-P), San Francisco, CA 94121, USA.
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Jakupcak M, Hoerster KD, Blais RK, Malte CA, Hunt S, Seal K. Readiness for change predicts VA Mental Healthcare utilization among Iraq and Afghanistan war veterans. J Trauma Stress 2013; 26:165-8. [PMID: 23319359 DOI: 10.1002/jts.21768] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Many veterans present to Veteran Affairs (VA) care intending to seek mental health treatment for symptoms of posttraumatic stress disorder (PTSD), depression, and/or alcohol misuse, yet most subsequently underutilize mental health care. This study examined the association of readiness for change with outpatient VA mental health care utilization in 104 treatment-seeking Iraq and Afghanistan war veterans who screened positive for PTSD, depression, and/or alcohol misuse at intake. Multivariate analyses demonstrated that readiness for change assessed at intake was positively associated (Incident Rate Ratio [IRR] = 1.22) with prospective outpatient mental health care utilization with demographic factors, military characteristics, and mental health burden in the model. Results suggest that interventions that target readiness to change, such as motivational interviewing, may improve treatment utilization in veterans presenting for mental health care.
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Affiliation(s)
- Matthew Jakupcak
- VA Puget Sound Health Care System, Seattle Division, Seattle, WA 98108, USA.
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Rosen CS, Tiet QQ, Harris AHS, Julian TF, McKay JR, Moore WM, Owen RR, Rogers S, Rosito O, Smith DE, Smith MW, Schnurr PP. Telephone monitoring and support after discharge from residential PTSD treatment: a randomized controlled trial. Psychiatr Serv 2013; 64:13-20. [PMID: 23117443 PMCID: PMC6540753 DOI: 10.1176/appi.ps.201200142] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study assessed whether adding a telephone care management protocol to usual aftercare improved the outcomes of veterans in the year after they were discharged from residential treatment for posttraumatic stress disorder (PTSD). METHODS In a multisite randomized controlled trial, 837 veterans entering residential PTSD treatment were assigned to receive either standard outpatient aftercare (N=425) or standard aftercare plus biweekly telephone monitoring and support (N=412) for three months after discharge. Symptoms of PTSD and depression, violence, substance use, and quality of life were assessed by self-report questionnaires at intake, discharge, and four and 12 months postdischarge. Treatment utilization was determined from the Department of Veterans Affairs administrative data. RESULTS Telephone case monitors reached 355 participants (86%) by phone at least once and provided an average of 4.5 of the six calls planned. Participants in the telephone care and treatment-as-usual groups showed similar outcomes on all clinical measures. Time to rehospitalization did not differ by condition. In contrast with prior studies reporting poor treatment attendance among veterans, participants in both telephone monitoring and treatment as usual completed a mental health visit an average of once every ten days in the year after discharge. Many participants had continuing problems despite high utilization of outpatient care. CONCLUSIONS Telephone care management had little incremental value for patients who were already high utilizers of mental health services. Telephone care management could potentially be beneficial in settings where patients experience greater barriers to engaging with outpatient mental health care after discharge from inpatient treatment.
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Affiliation(s)
- Craig S Rosen
- National Center for Posttraumatic Stress Disorder Dissemination and Training Division, Veterans Affairs Palo Alto Health Care System, 795 Willow Rd., Menlo Park, CA 94025, USA.
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