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Albaqawi HM, Alshammari MH. Resilience, compassion fatigue, moral distress and moral injury of nurses. Nurs Ethics 2024:9697330241287862. [PMID: 39378980 DOI: 10.1177/09697330241287862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2024]
Abstract
Background: Compassion fatigue, moral distress, and moral injury are interconnected phenomena that have a detrimental impact on the delivery of nursing care. Nurses possess the inherent resilience necessary to effectively handle these three adverse occurrences. Aim: To determine the mediating impact of resilience on compassion fatigue, moral distress, and moral injury among nurses in Saudi Arabia. Design: The final product was a structural equation model (SEM) generated using a quantitative correlation cross-sectional design, and we followed the STROBE guidelines for this study. Methods: The study involved a sample of 511 staff nurses, who were selected using consecutive sampling. The study was conducted in three government hospitals in Saudi Arabia. Ethical considerations: This study received approval from Ethics Committee under approval number H-2021-151 on March 5, 2021. The survey's description and consent statements were clearly presented on Google survey forms in both English and Arabic. Results: Results showed that resilience negatively influenced moral distress, while compassion fatigue and moral injury had a positive influence. Likewise, compassion fatigue had a direct, positive effect on moral distress and moral injury, and moral distress had a direct, positive effect on moral injury. Analyses also showed that resilience had positive, indirect effects on moral injury through the mediation of both compassion fatigue and moral distress. Similarly, compassion fatigue had a positive, indirect effect on moral injury through the mediation of moral distress. Conclusion: Because resilience enables nurses to adapt, it helps them overcome obstacles in their career and professional lives. Resilience is frequently cited by nurses as a protective quality. Moral injury, compassion fatigue, and moral distress can negatively impact the health of nurses. Implications for the profession and/or patient care: Nurse leaders should develop programs and initiate efforts to improve nurses' resilience as an important protective trait against compassion fatigue, moral distress, and moral injury. Patient or Public Contribution: There was no public or patient participation in this study.
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Anastasi G, Gravante F, Barbato P, Bambi S, Stievano A, Latina R. Moral injury and mental health outcomes in nurses: A systematic review. Nurs Ethics 2024:9697330241281376. [PMID: 39323219 DOI: 10.1177/09697330241281376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
Introduction: Moral injury involves the adverse psychological, biological, spiritual, behavioural, and social consequences of actions that violate moral values. It can lead to anxiety, depression, burnout, and post-traumatic stress disorder. Nurses, who often face ethical dilemmas, are particularly vulnerable. Despite its significance, the relationship between moral injury and mental health outcomes in nurses remains underexplored. Aim: This systematic review aimed to describe the associations among moral injury, anxiety, depression, and quality of life in nurses. Methods: The review was registered in PROSPERO (CRD42023438731) and was conducted following the PRISMA guidelines. A literature search was performed in December 2023 across PubMed, CINAHL, Scopus, and Web of Science. Peer-reviewed primary research involving nurses, published in English or Italian, without time restrictions, was considered eligible. The risk of bias and the quality of evidence were assessed using the Joanna Briggs Institute checklist and the GRADE approach. Results: Out of 4730 articles identified, eight met the inclusion criteria. The analysis revealed significant positive associations between moral injury, anxiety, and depression, along with a significant negative association with quality of life. Conclusion: These findings highlight the need for healthcare systems to implement strategies that mitigate moral injury among nurses. Future research should prioritize longitudinal studies to explore causal relationships and develop targeted interventions. Additionally, standardizing the concept and measurements of moral injury is crucial for enhancing the comparability and understanding of this phenomenon.
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Levinstein Y, Zerach G, Levi-Belz Y, Dekel R. The contribution of exposure to potentially morally injurious events to trajectories of posttraumatic stress symptoms among discharged veterans - a five-year study. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02766-3. [PMID: 39302426 DOI: 10.1007/s00127-024-02766-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 09/07/2024] [Indexed: 09/22/2024]
Abstract
PURPOSE Combatants and veterans are at risk of developing post traumatic stress symptoms (PTSS). The long-term responses to traumatic events are variable and can be classified into distinct PTSS trajectories. In this prospective study, we evaluated PTSS trajectories among combat veterans during the initial year after discharge from military service. Subsequently, we analyzed how combat exposure and PMIEs contributed to these trajectories. METHODS Our study encompassed 374 combat veterans who participated in a five-year prospective study, with four waves of measurements, T1 - one year before enlistment, T2 - one month prior to discharge from military service (July 2021), and then again at six months (T3 - February 2022) and twelve months after discharge (T4, July-August 2022) . RESULTS The utilization of Latent Profile Analysis (LPA) revealed a diverse array of PTSS trajectories. Predominantly, a resilient trajectory emerged as the most frequently observed (69.3%), with 'delayed onset'(13.6%), 'improving'(9.9%) and 'chronic'(6.1%) trajectories following in order. Importantly, multinominal regression analysis indicated that combat exposure and PMIE-betrayal contributed to alignment with symptomatic trajectories. CONCLUSIONS This study represents the first of its kind to establish longitudinal, time-dependent associations between PMIEs and PTSS trajectories. These results emphasize the critical importance of ongoing screening and the development of tailored interventions for combat veterans.
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Affiliation(s)
- Yoav Levinstein
- Department of Health and Well-Being Medical Corps, IDF, Tel HaShomer, Israel.
- School of Social Work, Bar-Ilan University, Ramat-Gan, Israel.
| | - Gadi Zerach
- Department of Psychology, Ariel University, Ariel, Israel
| | - Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Rachel Dekel
- School of Social Work, Bar-Ilan University, Ramat-Gan, Israel
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Maguen S, Griffin BJ, Pietrzak RH, McLean CP, Hamblen JL, Norman SB. Using the Moral Injury and Distress Scale to identify clinically meaningful moral injury. J Trauma Stress 2024; 37:685-696. [PMID: 38655683 DOI: 10.1002/jts.23050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/26/2024]
Abstract
Despite the proliferation of moral injury studies, a remaining gap is distinguishing moral injury from normative distress following exposure to potentially morally injurious events (PMIEs). Our goal was to leverage mental health and functional measures to identify clinically meaningful and functionally impairing moral injury using the Moral Injury and Distress Scale (MIDS). Participants who endorsed PMIE exposure (N = 645) were drawn from a population-based sample of military veterans, health care workers, and first responders. Using signal detection methods, we identified the optimally efficient MIDS score for detecting clinically significant posttraumatic stress and depressive symptom severity, trauma-related guilt, and functional impairment. The most efficient cut scores across outcomes converged between 24 and 27. We recommend a cut score of 27 given that roughly 70% of participants who screened positive on the MIDS at this threshold reported clinically significant mental health symptoms, and approximately 50% reported severe trauma-related guilt and/or functional impairment. Overall, 10.2% of respondents exposed to a PMIE screened positive for moral injury at this threshold, particularly those who identified as a member of a minoritized racial or ethnic group (17.9%) relative to those who identified as White, non-Hispanic (8.0%), aOR = 2.52, 95% CI [1.45, 4.42]. This is the first known study to establish a cut score indicative of clinically meaningful and impairing moral injury. Such scores may enhance clinicians' abilities to conduct measurement-based moral injury care by enabling them to identify individuals at risk of negative outcomes and better understand risk and protective factors for moral injury.
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Affiliation(s)
- Shira Maguen
- Mental Health Services, San Francisco VA Health Care System, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Brandon J Griffin
- Center for Mental Health Care and Outcomes Research, Central Arkansas VA, Little Rock, Arkansas, USA
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Robert H Pietrzak
- Clinical Neurosciences Division, National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, West Haven, Connecticut, USA
| | - Carmen P McLean
- Dissemination and Training Division, National Center for PTSD, Menlo Park, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Jessica L Hamblen
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Executive Division, National Center for PTSD, White River Junction, Vermont, USA
| | - Sonya B Norman
- Executive Division, National Center for PTSD, White River Junction, Vermont, USA
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, California, USA
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Pasinetti GM, Ashford JW, Durham A, Shah D, Saxena V, Palmieri J. Editorial: Neuropsychiatric disorders in the veterans volume II: emerging evidence of precision medicine and complementary and integrative health (CIH) approaches. Front Psychiatry 2024; 15:1456022. [PMID: 39091458 PMCID: PMC11291439 DOI: 10.3389/fpsyt.2024.1456022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 07/05/2024] [Indexed: 08/04/2024] Open
Affiliation(s)
- Giulio M. Pasinetti
- Department of Neurology, Mount Sinai School of Medicine, New York, NY, United States
- Geriatric Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, United States
| | - J. Wesson Ashford
- War Related Illness and Injury Study Center, Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Psychiatry & Behavioral Sciences, Stanford University, Palo Alto, CA, United States
| | - Andrea Durham
- Department of Neurology, Mount Sinai School of Medicine, New York, NY, United States
| | - Divyash Shah
- Department of Neurology, Mount Sinai School of Medicine, New York, NY, United States
| | - Vrinda Saxena
- Department of Neurology, Mount Sinai School of Medicine, New York, NY, United States
| | - Joshua Palmieri
- Department of Neurology, Mount Sinai School of Medicine, New York, NY, United States
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Kline AC, Harlé KM, Panza KE, Nichter B, Lyons R, Pitts M, Haller M, Allard CB, Capone C, Norman SB. Changes in guilt cognitions mediate the effect of trauma-informed guilt reduction therapy on PTSD and depression outcomes. J Clin Psychol 2024; 80:1147-1160. [PMID: 38340354 DOI: 10.1002/jclp.23659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/08/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Trauma-informed guilt reduction therapy (TrIGR), a six-session cognitive behavioral therapy targeting trauma-related guilt and distress, reduces guilt and symptoms of posttraumatic stress disorder (PTSD) and depression, yet little is known regarding how and why TrIGR may be effective. METHOD This study examined treatment-related changes in avoidant coping and trauma-related guilt cognitions as possible mediators of treatment effects on PTSD and depression outcomes at 3- and 6-month follow-up. Data were from a randomized controlled trial for treatment of trauma-related guilt comparing TrIGR and supportive care therapy among 145 post-9/11 US veterans (Mage = 39.2 [8.1], 93.8% male). RESULTS At pretreatment, most (86%) met PTSD criteria. Intent to treat analyses using parallel mediation models indicated changes in guilt cognitions, but not avoidant coping, mediated the effect of TrIGR on reducing PTSD severity at 3-month (a × b = -0.15, p < 0.01, 95% CI: [-0.24 to -0.06], p = 0.001) and 6-month (a × b = -0.17, 95% CI: [-0.26 to -0.07], p = 0.001) follow-up. Similarly, changes in guilt cognitions, but not avoidant coping, mediated the effect of TrIGR on reducing depression severity at 3-month (a × b = -0.10, 95% CI: [-0.18 to -0.02], p = 0.02) and 6-month (a × b = -0.11, 95% CI: [-0.20 to -0.03], p = 0.01) follow-up. CONCLUSIONS Compared to guilt cognitions, changes in avoidant coping were less integral to downstream PTSD and depression symptom reduction. Guilt cognition change may be a salient active ingredient of PTSD and depression treatment for those with trauma-related guilt and a key therapy element to which providers should be attuned.
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Affiliation(s)
- Alexander C Kline
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Katia M Harlé
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Kaitlyn E Panza
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | | | - Robert Lyons
- VA San Diego Healthcare System, San Diego, California, USA
| | - Michelle Pitts
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Moira Haller
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Carolyn B Allard
- VA San Diego Healthcare System, San Diego, California, USA
- California School of Professional Psychology, Alliant International University, San Diego, California, USA
| | - Christy Capone
- Providence VA Medical Center, Providence, Rhode Island, USA
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Sonya B Norman
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, California, USA
- National Center for Posttraumatic Stress Disorder, White River Junction, Vermont, USA
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Acevedo León NF, Jaramillo PL, Gabela CD, Boren-Alpízar A, Andrukonis A, Schmidt M, McGlone J, Garcia A. Hispanic worker attitudes toward pig euthanasia on U.S. farms. Front Vet Sci 2024; 11:1281102. [PMID: 38628943 PMCID: PMC11019433 DOI: 10.3389/fvets.2024.1281102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/08/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction On-farm pig euthanasia considers aspects of animal welfare and industry economics. Guidelines are available about the euthanasia process, but the agricultural workforce is highly diverse and guidelines do not consider cultural barriers. Euthanasia requires the ability to identify compromised pigs, technical skills, and willingness to euthanize pigs. In addition, timely euthanasia is part of the Common Swine Industry Audit (CSIA) and, thus, can lead to failed audits if not performed as required by the audit standards. The United States (US) swine industry employs a high percentage of Latin American workers, some US residents/citizens, and others through non-immigrant North American Free Trade Agreement (NAFTA) visas. These workers vary in their level of education and swine industry experience. Proper training of this workforce and identification of the barriers associated with performing timely euthanasia are critical to promote improved welfare practices. The objectives of this study were to: (1) develop a survey instrument to identify Hispanic caretaker attitudes toward pig euthanasia, (2) assess and describe swine caretakers' attitudes toward pig euthanasia using the developed survey instrument, and (3) determine the demographic and psychological barriers associated with performing pig euthanasia. Methods Participants (n = 163) were surveyed from 16 farms across the State of Iowa. The on-farm survey was administered for two days in a period of 60 min per day. Results The results for demographics and the swine management survey data indicated that employees with less time working on the farm showed less knowledge of the CSIA, lower perceived ability to identify compromised pigs that needed to be euthanized, lower willingness to pecrform euthanasia on their own, and preferred not to have the responsibility of telling others when to euthanize pigs (p < 0.001). Secondary traumatic stress and transgressions were significantly correlated scales, associated with burnout, betrayals, and worker satisfaction (p = 0.022). Furthermore, individuals identifying as female had higher secondary traumatic stress scores (p = 0.026) and lower compassion satisfaction scores (p = 0.015). Discussion This data suggest that there are demographic, psychometric, and training-related factors correlated with Hispanic caretakers' feelings about pig euthanasia. The results of this study could be used to further improve and develop targeted training programs for Hispanic caretakers for early identification of compromised pigs and timely euthanasia, which could benefit human well-being, animal welfare, and the swine industry audit performance.
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Affiliation(s)
- Nancy F. Acevedo León
- School of Veterinary Medicine, Texas Tech University, Amarillo, TX, United States
- Animal and Food Sciences Department, Texas Tech University, Lubbock, TX, United States
| | - Pablo Lamino Jaramillo
- Department of Agricultural Education and Communication, University of Florida, Gainesville, TX, United States
| | - Carlos Durán Gabela
- Agricultural Education and Communications Department, Texas Tech University, Lubbock, TX, United States
| | - Amy Boren-Alpízar
- Agricultural Education and Communications Department, Texas Tech University, Lubbock, TX, United States
| | | | - Marcelo Schmidt
- School of Veterinary Medicine, Texas Tech University, Amarillo, TX, United States
| | - John McGlone
- Animal and Food Sciences Department, Texas Tech University, Lubbock, TX, United States
| | - Arlene Garcia
- School of Veterinary Medicine, Texas Tech University, Amarillo, TX, United States
- Animal and Food Sciences Department, Texas Tech University, Lubbock, TX, United States
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Nichter B, Hill ML, Maguen S, Norman SB, Fischer IC, Pietrzak RH. Health and psychiatric impairment associated with moral injury, military sexual trauma, and their co-occurrence in U.S. combat veterans. J Psychosom Res 2024; 179:111617. [PMID: 38394711 DOI: 10.1016/j.jpsychores.2024.111617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/16/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Military sexual trauma (MST) and moral injury (MI) are associated with adverse psychiatric and health outcomes among military veterans. However, no known population-based studies have examined the incremental burden associated with the co-occurrence of these experiences relative to either alone. METHOD Cross-sectional data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative sample of 1330 U.S. combat veterans. Veterans reported on history of exposure to MST and potentially morally injurious events (PMIEs). Analyses estimated the lifetime prevalence of MST only, PMIEs only, and co-occurring MST and PMIEs; and examined associations between MST/PMIEs status and psychiatric and physical health comorbidities, functioning, and suicidality. RESULTS The lifetime weighted prevalence of exposure to MST only, PMIEs only, and co-occurring MST and PMIEs were 2.7%, 32.3%, and 4.5%, respectively. Compared with all other groups, the co-occurring MST + PMIEs group reported greater severity of posttraumatic stress, depression, generalized anxiety, and insomnia symptoms. They also scored lower on measures of physical, mental, and psychosocial functioning, and reported a greater number of chronic medical conditions and somatic complaints. Veterans with co-occurring MST + PMIEs were more than twice as likely as those with MST only to report past-year suicidal ideation. CONCLUSIONS The co-occurrence of MST and MI is associated with a greater psychiatric and health burden among combat veterans than either experience alone. Results underscore the importance of assessing and treating MST and MI in this population. Findings underscore the importance for future work to parse overlap between morally salient aspects of MST and the concept of moral injury.
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Affiliation(s)
- Brandon Nichter
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America.
| | - Melanie L Hill
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States of America
| | - Shira Maguen
- San Francisco VA Health Care System, San Francisco, CA, United States of America; University of California - San Francisco, San Francisco, United States of America
| | - Sonya B Norman
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States of America; VA San Diego Healthcare System, San Diego, CA, USA; National Center for PTSD, White River Junction, VT, United States of America
| | - Ian C Fischer
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America; National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America; National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States of America
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Kennedy E, Ozmen M, Bouldin ED, Panahi S, Mobasher H, Troyanskaya M, Martindale SL, Merritt VC, O'Neil M, Sponheim SR, Remigio-Baker RA, Presson A, Swan AA, Werner JK, Greene TH, Wilde EA, Tate DF, Walker WC, Pugh MJ. Phenotyping Depression After Mild Traumatic Brain Injury: Evaluating the Impact of Multiple Injury, Gender, and Injury Context. J Neurotrauma 2024; 41:924-933. [PMID: 38117134 DOI: 10.1089/neu.2023.0381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
The chronic mental health consequences of mild traumatic brain injury (TBI) are a leading cause of disability. This is surprising given the expectation of significant recovery after mild TBI, which suggests that other injury-related factors may contribute to long-term adverse outcomes. The objective of this study was to determine how number of prior injuries, gender, and environment/context of injury may contribute to depressive symptoms after mild TBI among deployed United States service members and veterans (SMVs). Data from the Long-term Impact of Military-Relevant Brain Injury Consortium Prospective Longitudinal Study was used to assess TBI injury characteristics and depression scores previously measured on the Patient Health Questionnaire-9 (PHQ-9) among a sample of 1456 deployed SMVs. Clinical diagnosis of mild TBI was defined via a multi-step process centered on a structured face-to-face interview. Logistical and linear regressions stratified by gender and environment of injury were used to model depressive symptoms controlling for sociodemographic and combat deployment covariates. Relative to controls with no history of mild TBI (n = 280), the odds ratios (OR) for moderate/severe depression (PHQ-9 ≥ 10) were higher for SMVs with one mild TBI (n = 358) OR: 1.62 (95% confidence interval [CI] 1.09-2.40, p = 0.016) and two or more mild TBIs (n = 818) OR: 1.84 (95% CI 1.31-2.59, p < 0.001). Risk differences across groups were assessed in stratified linear models, which found that depression symptoms were elevated in those with a history of multiple mild TBIs compared with those who had a single mild TBI (p < 0.001). Combat deployment-related injuries were also associated with higher depression scores than injuries occurring in non-combat or civilian settings (p < 0.001). Increased rates of depression after mild TBI persisted in the absence of post-traumatic stress disorder. Both men and women SMVs separately exhibited significantly increased depressive symptom scores if they had had combat-related mild TBI. These results suggest that contextual information, gender, and prior injury history may influence long-term mental health outcomes among SMVs with mild TBI exposure.
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Affiliation(s)
- Eamonn Kennedy
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Mustafa Ozmen
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Department of Electrical and Electronics Engineering, Antalya Bilim University, Döşemealtı/Antalya, Türkiye
| | - Erin D Bouldin
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Samin Panahi
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Helal Mobasher
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Maya Troyanskaya
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Holcombe Boulevard Houston, Texas, USA
| | - Sarah L Martindale
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Research and Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, North Carolina, USA
- Department of Physiology & Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Victoria C Merritt
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA
| | - Maya O'Neil
- VA Portland Health Care System, Portland, Oregon, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Scott R Sponheim
- Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rosemay A Remigio-Baker
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, Maryland, USA
- Compass Government Solutions, Annapolis, Maryland, USA
| | - Angela Presson
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Alicia A Swan
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - J Kent Werner
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Tom H Greene
- Division of Biostatistics, Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Elisabeth A Wilde
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David F Tate
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - William C Walker
- Physical Medicine and Rehabilitation Service, Richmond Veterans Affairs Medical Center, Richmond, Virginia, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mary Jo Pugh
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
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10
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Marcewicz LJ, O'Neill LB, Sigler LE. Caring for Veterans with Serious Illness. Clin Geriatr Med 2023; 39:417-422. [PMID: 37385693 DOI: 10.1016/j.cger.2023.05.001] [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] [Indexed: 07/01/2023]
Abstract
US Veterans comprise approximately 7% of the population. About half of these Veterans seek care within the Department of Veterans Affairs; the other half receive their health-care services in the wider community. Community providers should be familiar with the unique needs of Veterans and the resources that exist to provide care for them. This article discusses the unique culture of Veterans, conditions that are more common among Veterans and the challenges these conditions may pose, and the resources available to Veterans through the Veterans Health Administration.
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Affiliation(s)
- Lawson J Marcewicz
- Department of Veterans Affairs, Atlanta Veterans Affairs Health Care System, 1670 Clairmont Road, Decatur, GA 30033, USA; Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, 1821 Clifton Road Northeast, Atlanta, GA 30329, USA.
| | - Lynn B O'Neill
- Department of Veterans Affairs, Atlanta Veterans Affairs Health Care System, 1670 Clairmont Road, Decatur, GA 30033, USA; Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, 1821 Clifton Road Northeast, Atlanta, GA 30329, USA
| | - Lauren E Sigler
- Department of Veterans Affairs, Atlanta Veterans Affairs Health Care System, 1670 Clairmont Road, Decatur, GA 30033, USA; Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, 1821 Clifton Road Northeast, Atlanta, GA 30329, USA
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McDaniel JT. Moral injury and quality of life among military veterans. BMJ Mil Health 2023:e002457. [PMID: 37344006 DOI: 10.1136/military-2023-002457] [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: 05/04/2023] [Accepted: 06/10/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Moral injury concerns transgressive harms and the outcomes that such experiences may cause. A gap in the literature surrounding moral injury, and an outcome that may be important to include in the mounting evidence toward the need for the formal clinical acknowledgement of moral injury, has to do with the relationship between moral injury and quality of life. No studies have examined this relationship in US military veterans-a population that is disproportionately exposed to potentially morally injurious events. METHODS A nationwide cross-sectional survey was conducted yielding 1495 military veterans. Participants were asked questions about moral injury and quality of life, among other things. Multivariable linear regression was used to characterise the adjusted relationship between moral injury and quality of life. RESULTS Moral injury (mean=40.1 out of 98) and quality-of-life (mean=69.5 out of 100) scores were calculated for the sample. Moral injury was inversely associated with quality of life in an adjusted model, indicating that worsening moral injury was associated with decreased quality of life (adjusted unstandardised beta coefficient (b)=-0.3, p<0.001). Results showed that age moderated said relationship, such that ageing veterans experienced an increasingly worse quality of life with increasingly severe moral injury (b=-0.1, p=0.003). CONCLUSIONS Results of the study showed that moral injury was inversely associated with quality of life and that this relationship rapidly worsens with age. More work is needed to more precisely understand this relationship and to determine the best strategies for intervention.
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Affiliation(s)
- Justin Tyler McDaniel
- School of Human Sciences, Southern Illinois University Carbondale, Carbondale, Illinois, USA
- Dale and Deborah Smith Center for Alzheimer's Research and trEatment (CARE), Southern Illinois University School of Medicine, Springfield, Illinois, USA
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