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Evans MK, Grove JL, Patel TA, Gromatsky M, Calhoun PS, Beckham JC, Kimbrel NA. Attention-deficit/hyperactivity disorder and nonsuicidal self-injury among veterans with complex psychiatric presentations. Psychiatry Res 2022; 314:114618. [PMID: 35660965 PMCID: PMC9499821 DOI: 10.1016/j.psychres.2022.114618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/27/2022] [Accepted: 05/08/2022] [Indexed: 10/18/2022]
Abstract
Prior research suggests a possible association between attention-deficit/hyperactivity disorder (ADHD) symptoms and nonsuicidal self-injury (NSSI) in veterans. However, this association has not yet been replicated. The present study sought to replicate and expand upon this association in a gender-balanced sample of veterans (N = 124), more than half of whom had a lifetime history of NSSI. Contrary to hypotheses, adult ADHD symptoms were not associated with NSSI history or disorder. Instead, our findings suggest that disorders characterized by negative affect may have greater utility for predicting NSSI versus those characterized by impulsivity. Further research in epidemiological samples is needed.
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Affiliation(s)
- Mariah K. Evans
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jeremy L. Grove
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Tapan A. Patel
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Molly Gromatsky
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Patrick S. Calhoun
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA,VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Jean C. Beckham
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
| | - Nathan A. Kimbrel
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA,VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
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Spreyermann R. Case Report: Infra-Low-Frequency Neurofeedback for PTSD: A Therapist's Perspective. Front Hum Neurosci 2022; 16:893830. [PMID: 35685333 PMCID: PMC9170915 DOI: 10.3389/fnhum.2022.893830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/15/2022] [Indexed: 11/30/2022] Open
Abstract
The practical use of a combination of trauma psychotherapy and neurofeedback [infra-low-frequency (ILF) neurofeedback and alpha-theta training] is described for the treatment of patients diagnosed with complex post-traumatic stress disorder (C-PTSD). The indication for this combined treatment is the persistence of symptoms of a hyper-aroused state, anxiety, and sleep disorders even with adequate trauma-focused psychotherapy and supportive medication, according to the Guidelines of the German Society of Psycho-Traumatology (DeGPT). Another indication for a supplementary treatment with neurofeedback is the persistence of dissociative symptoms. Last but not least, the neurofeedback treatment after a trauma-focused psychotherapy session helps to calm the trauma-related reactions and to process the memories. The process of the combined therapy is described and illustrated using two representative case reports. Overall, a rather satisfying result of this outpatient treatment program can be seen in the qualitative appraisal of 7 years of practical application.
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Shura RD, Richard KW, Martindale SL, Brearly TW, Taber KH, Canu WH. Internalizing and externalizing comorbidity and symptom burden in a VA ADHD specialty evaluation clinic. Psychiatry Res 2022; 309:114395. [PMID: 35051878 DOI: 10.1016/j.psychres.2022.114395] [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: 05/04/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to evaluate psychiatric diagnosis and symptom comorbidity in veterans diagnosed with attention-deficit/hyperactivity disorder (ADHD). Study design was retrospective chart review from an ADHD evaluation clinic at a Veterans Affairs hospital. Participants were 227 military veterans who completed a standardized ADHD assessment and produced valid Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) profiles. There were no differences in rates of internalizing or externalizing psychiatric conditions diagnosed in inattentive compared to combined ADHD presentations. However, compared to a subsample with no psychiatric diagnoses, individuals diagnosed with ADHD endorsed significantly more internalizing symptom burden, with combined ADHD veterans also endorsing significantly greater levels of negative emotions and neuroticism. Base rates of comorbid classes of psychiatric diagnoses were not increased in individuals with ADHD, though higher rates of trauma disorders were seen in the combined group compared to the inattentive group. Multivariate base rates of MMPI-2-RF Restructured Clinical scales across various subgroups are presented. There was evidence for differential phenotypes of psychiatric symptoms across ADHD presentations in clinically referred veterans, predominantly related to higher rates of internalizing symptoms.
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Affiliation(s)
- Robert D Shura
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, USA; W. G. (Bill) Hefner Veterans Affairs Healthcare System, Salisbury, NC, USA; Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Kevin W Richard
- W. G. (Bill) Hefner Veterans Affairs Healthcare System, Salisbury, NC, USA
| | - Sarah L Martindale
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, USA; W. G. (Bill) Hefner Veterans Affairs Healthcare System, Salisbury, NC, USA; Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Katherine H Taber
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, USA; W. G. (Bill) Hefner Veterans Affairs Healthcare System, Salisbury, NC, USA; Via College of Osteopathic Medicine, Blacksburg, VA, USA; Baylor College of Medicine, Houston, TX, USA
| | - Will H Canu
- Appalachian State University, Boone, NC, USA
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Tofthagen R, Gabrielsson S, Fagerström L, Haugerud LM, Lindgren BM. Men who self-harm-A scoping review of a complex phenomenon. J Adv Nurs 2021; 78:1187-1211. [PMID: 34931712 DOI: 10.1111/jan.15132] [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: 07/23/2021] [Revised: 10/24/2021] [Accepted: 12/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND To understand and care for men who self-harm, it is important that healthcare professionals have understanding of how and why men self-harm, men's experiences of self-harm and what can be done to hinder or prevent self-harm. AIMS The aim of this study was to synthesize the existing knowledge on men who self-harm, with a special emphasis on background, self-harming methods, experiences and reported therapeutic interventions and/or care approaches. DESIGN Scoping review of internationally published and grey literature, based on a methodological framework by Arksey and O'Malley. DATA SOURCES Systematic electronic database searches were conducted in CINAHL, MEDLINE (Ovid) and PsycINFO. From a total of 684 studies found, 24 studies met the inclusion criteria: full-text, published in English, peer-reviewed studies and grey literature including a focus on men who self-harm, men aged between 18 and 65 years, and published between 2010 and 2019. RESULTS Men's self-harm was understood as being related to mental disorders, a means of affect regulation, a loss of self-control, and a means of interpersonal communication. Self-harm can be a positive or negative experience, and there is a wide variety in the methods that men use to self-harm: sharp objects, injection, ingestion, without aids or riskful behaviour. Few studies reported on therapeutic interventions and/or care approaches for men who self-harm. CONCLUSION Men's self-harm should be understood as a complex, socially and culturally conditioned phenomenon and studied from a multitude of perspectives. IMPACT This scoping review concludes that self-harm among men should be understood as a complex, socially and culturally conditioned phenomenon. To empower men and support their recovery from self-harm, a person-centred approach should be incorporated into research on the subject and practice.
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Affiliation(s)
- Randi Tofthagen
- Faculty of Health Science, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Sebastian Gabrielsson
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Lisbeth Fagerström
- Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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Stevens AK, Gunn RL, Jackson KM, Borsari B, Metrik J. Examining motivational pathways from adult attention-deficit/hyperactivity disorder symptoms to cannabis use: Results from a prospective study of veterans. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 35:16-28. [PMID: 32881541 DOI: 10.1037/adb0000682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: Attention-deficit/hyperactivity disorder (ADHD) is linked prospectively to cannabis; however, no study has examined mechanisms underlying this comorbidity. We examined 5 cannabis motives (i.e., coping with negative affect, sleep, social anxiety, perceived low risk of cannabis, and altered perception) as mediators of the prospective ADHD-cannabis relation. Method: Veterans reporting lifetime cannabis use (N = 361; 93% male; 80% White) completed three semiannual assessments. Prospective mediation models using structural equation modeling analyzed the indirect effects of baseline ADHD symptoms on 12-month cannabis use and problems via each motive at 6 months. Zero-inflated negative binomial models were employed for both manifest outcomes and ADHD symptoms and motives were each modeled as 1-factor latent variables. Results: Sleep motives was a robust mediator for cannabis use frequency in single mediator models and was marginally significant when examined simultaneously with other motives after accounting for baseline cannabis use, demographics, other substance use, and other psychopathology. Coping with negative affect was the only significant mediator of ADHD symptoms and subsequent cannabis problem severity. Conclusion: Among veterans with ADHD symptoms, sleep disturbance is a salient motive for cannabis use, whereas coping with negative affect is a proximal predictor of cannabis problems. Findings support addressing sleep disturbance in adults with ADHD symptoms and converge with extant literature demonstrating robust associations between coping motives and substance use problems. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Lear MK, Penzenik ME, Forster JE, Starosta A, Brenner LA, Nazem S. Characteristics of nonsuicidal self-injury among veterans. J Clin Psychol 2020; 77:286-297. [PMID: 32662073 DOI: 10.1002/jclp.23027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/23/2020] [Accepted: 06/11/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The current study aimed to (a) assess basic nonsuicidal self-injury (NSSI) characteristics using a validated clinical interview among a sample of veterans not recruited for specific diagnostic or environmental criteria and (b) examine the relation between NSSI and medical severity of prior suicide attempts (SAs) among veterans. DESIGN We conducted secondary data analyses among a combined sample of veterans (N = 165) from two parent studies conducted at a large VA Medical Center that implemented identical recruitment protocols. No psychiatric criteria were utilized for inclusion or exclusion purposes. RESULTS Approximately 16% of participants reported NSSI history and almost 21% reported SA history. NSSI history was associated with probability of prior SA but not the medical severity of prior SA. CONCLUSIONS NSSI is a prevalent concern among veterans and is associated with probability of SA. It remains unclear whether prior NSSI is associated with more medically serious SA in this population.
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Affiliation(s)
- Mary K Lear
- Portland Psychotherapy Clinic, Research, and Training Center, Portland, Oregon, USA
| | - Molly E Penzenik
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amy Starosta
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lisa A Brenner
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sarra Nazem
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
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Turner BJ, Kleiman EM, Nock MK. Non-suicidal self-injury prevalence, course, and association with suicidal thoughts and behaviors in two large, representative samples of US Army soldiers. Psychol Med 2019; 49:1470-1480. [PMID: 30131080 DOI: 10.1017/s0033291718002015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) prospectively predicts suicidal thoughts and behaviors in civilian populations. Despite high rates of suicide among US military members, little is known about the prevalence and course of NSSI, or how NSSI relates to suicidal thoughts and behaviors, in military personnel. METHODS We conducted secondary analyses of two representative surveys of active-duty soldiers (N = 21 449) and newly enlisted soldiers (N = 38 507) from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). RESULTS The lifetime prevalence of NSSI is 6.3% (1.2% 12-month prevalence) in active-duty soldiers and 7.9% (1.3% 12-month prevalence) in new soldiers. Demographic risk factors for lifetime NSSI include female sex, younger age, non-Hispanic white ethnicity, never having married, and lower educational attainment. The association of NSSI with temporally primary internalizing and externalizing disorders varies by service history (new v. active-duty soldiers) and gender (men v. women). In both active-duty and new soldiers, NSSI is associated with increased odds of subsequent onset of suicidal ideation [adjusted odds ratio (OR) = 1.66-1.81] and suicide attempts (adjusted OR = 2.02-2.43), although not with the transition from ideation to attempt (adjusted OR = 0.92-1.36). Soldiers with a history of NSSI are more likely to have made multiple suicide attempts, compared with soldiers without NSSI. CONCLUSIONS NSSI is prevalent among US Army soldiers and is associated with significantly increased odds of later suicidal thoughts and behaviors, even after NSSI has resolved. Suicide risk assessments in military populations should screen for history of NSSI.
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Affiliation(s)
- Brianna J Turner
- Department of Psychology,University of Victoria,Victoria, BC,Canada
| | - Evan M Kleiman
- Department of Psychology,Harvard University,Cambridge, MA,USA
| | - Matthew K Nock
- Department of Psychology,Harvard University,Cambridge, MA,USA
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Holliday R, Smith NB, Monteith LL. An initial investigation of nonsuicidal self-injury among male and female survivors of military sexual trauma. Psychiatry Res 2018; 268:335-339. [PMID: 30096662 DOI: 10.1016/j.psychres.2018.07.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022]
Abstract
Nonsuicidal self-injury (NSSI) has been understudied among survivors of military sexual trauma (MST). The aims of the current study were to: (1) describe characteristics of NSSI among survivors of MST and (2) determine if MST survivors who have engaged in NSSI differ from those who have never engaged in NSSI in terms of the severity of posttraumatic stress disorder (PTSD) and depressive symptoms, trauma-related cognitions, and recent suicidal ideation. Participants were 107 veterans (65 females, 42 males) with a history of MST who completed measures of NSSI, PTSD and depressive symptoms, recent suicidal ideation, and trauma-related cognitions. Approximately one-fourth of participants (n = 27; 25.23%) endorsed a history of NSSI. The majority of participants who engaged in NSSI reported that they first engaged in NSSI following MST (n = 18; 66.67%). MST survivors with a history of NSSI reported more severe PTSD symptoms, recent suicidal ideation, and trauma-related cognitions. NSSI was relatively common in the sample and was associated with a more severe clinical presentation. Longitudinal research is needed to understand the development, maintenance, and function of NSSI in MST survivors, especially as it pertains to risk for suicidal self-directed violence.
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Affiliation(s)
- Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Denver, CO, USA; University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Noelle B Smith
- VA Northeast Program Evaluation Center, West Haven, CT, USA
| | - Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Denver, CO, USA; University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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