Impact of discrimination and coping on Veterans' willingness to seek treatment for physical and mental health problems

Comparative feasibility and preliminary efficacy of CBT for insomnia among adults seeking and not seeking addiction treatment

Two out of three adults seeking treatment for alcohol or other substance use disorders report co-occurring symptoms of insomnia. This study compared the feasibility, acceptability, and preliminary efficacy of cognitive behavioural therapy for insomnia (CBT-I) among adults seeking and not seeking treatment for substance use. Adults with alcohol or other substance use disorders (n = 22, 32% female, 82% White; Mage  = 39.5) completed assessments at baseline, post-treatment, and at 6 week follow-up. Of those, 11 were and 11 were not enrolled in substance use treatment. All received CBT-I. Multiple imputation was used for missing data. Data were analysed using repeated measures analyses of variance. In the substance use treatment group, 6/11 completed post and 5/11 completed follow-up. In the non-treatment group, 9/11 completed post and 7/11 completed follow-up. Participants in both groups reported improvements in insomnia severity, sleep onset latency, and dysfunctional beliefs about sleep, with most effects evident at post and follow-up. There was a marginal group-by-time interaction in the change in frequency of substance use, with only participants not in substance use treatment reporting decreases at follow-up. Participants in substance use treatment reported significant reductions in substance-related problems and symptoms of post-traumatic stress disorder over time; however, they also reported more symptoms at baseline. CBT-I produces similar reductions in insomnia but is relatively less feasible among individuals in (versus not in) treatment for substance use disorder. This may be due to the more complex logistics of accessing CBT-I among those in treatment. We speculate that integrating CBT-I into treatment for addictions may improve feasibility in this population. clinicaltrials.gov NCT04198311.

Perpetuating and protective factors in insomnia across racial/ethnic groups of veterans

Few studies have examined racial/ethnic differences in rates and correlates of insomnia among veterans. This study compared rates of insomnia and interest in sleep treatment among veterans of diverse racial/ethnic backgrounds. Consistent with the 3P model, we tested racial discrimination as a predictor of insomnia, with post-traumatic stress disorder symptoms and romantic partners as perpetuating and protective moderators of this association, respectively. A total of 325 veterans (N = 236 veterans of colour; 12% Asian, 36% Black, 14% Hispanic/Latine) completed questionnaires online from remote locations. Descriptive statistics were used to compare patterns across racial/ethnic groups. Linear regression was used to test moderators of the association between racial discrimination and insomnia severity. Overall, 68% of participants screened positive for insomnia: 90% of Asian; 79% of Hispanic/Latine; 65% of Black; and 58% of White participants. Of those, 74% reported interest in sleep treatment, and 76% of those with partners reported interest in including their partner in treatment. Racial discrimination and post-traumatic stress disorder were correlated with more severe insomnia, while romantic partners were correlated with less severe insomnia. Only post-traumatic stress disorder moderated the association between racial discrimination and insomnia severity. Rates of insomnia were highest among Asian and Hispanic/Latine participants, yet these groups were among the least likely to express interest in sleep treatment. Racial discrimination may exacerbate insomnia symptoms among veterans, but only among those who do not already have disturbed sleep in the context of post-traumatic stress disorder. Romantic partners may serve as a protective factor in insomnia, but do not seem to mitigate the impact of racial discrimination.

Perceived discrimination enhances the association between distress and impact related to the murder of George Floyd and unhealthy alcohol use in a survey sample of U.S. Veterans who report drinking

Introduction

On May 25, 2020, George Floyd was murdered by a Minneapolis police officer leading to increased social justice and antiracism movements (SJARM) across the United States. Vicarious exposure to racism and perceived discrimination are salient sources of distress which may lead to increased alcohol use as means of coping. The primary aim of the current study was to examine how perceived discrimination and the subjective impact and personal distress related to the SJARM following the George Floyd murder interact and relate to unhealthy alcohol use among U.S. Veterans.

Methods

286 Veterans were assessed for unhealthy alcohol use (AUDIT-10), perceived discrimination (EDS), and subjective impact and personal distress related to the SJARM. Two moderation analyses were performed to examine whether subjective impact and personal distress moderated relations between perceived discrimination and alcohol use. In-depth follow-up analyses were conducted to examine differences and relationships among variables.

Results

In two different moderation models, perceived discrimination moderated the association between both subjective impact (p <.001) and personal distress (p <.001) felt by the SJARM and unhealthy alcohol use. In planned exploratory analyses, Veterans who reported perceived discrimination reported higher levels of unhealthy alcohol use (M = 14.71, SD = 9.39) than those who did not t(2 8 4) = 5.61, p <.001. In post-hoc analyses, racial/ethnic minorities were significantly more likely to report perceived racial discrimination (p <.001) while non-Hispanic Whites were more likely to report perceived discrimination based on education or income level (p <.01).

Conclusions

In the context of a socially unjust event amidst a global pandemic, perceived discrimination contributes to unhealthy alcohol use and subjective impact and personal distress associated with the SJARM following the murder of George Floyd. Results highlight the importance of addressing discrimination experiences in Veterans who seek alcohol treatment, particularly as rates of unhealthy alcohol use are on the rise.

FEATURES OF AFFECTIVE SYMPTOMS IN COMBATANTS WITH NON-PSYCHOTIC MENTAL DISORDERS THAT HAVE SUFFERED FROM COVID-19

OBJECTIVE

The aim: To establish the level of anxiety and depressive disorders and the impact of covid-19 on affective pathology in combatants with non-psychotic mental disorders who have suffered from COVID-19 in a comparative aspect.

PATIENTS AND METHODS

Materials and methods: 252 male combatants with non-psychotic mental disorders who suffered from COVID-19 were clinically examined using HRDS and HARS scales.

RESULTS

Results: A lower prevalence of anxiety or fear was found in combatants who did not have COVID-19: 70.5% vs. 80.8%; low mood - 55.3% vs. 66.7%; emotional lability - 44.7% vs. 58.3%; irritability - 40.9% vs. 55.0%; emotional sensitivity - 53.0% vs. 71.7%; dulling of emotions - 6.8% vs. 6.7%; anhedonia - 77.3% vs. 83.3% of patients, rapid fatigue - 51.5% vs. 65.8%, feelings of guilt, futility, anxiety or fear - 78.0% vs. 87.5%, dissomnia - 47.0% vs. 61.7%; inability to concentrate and make decisions - 25.8% vs. 43.3%; thoughts of death or suicide - 25.0% vs. 35.8% pessimism - 21.2% vs. 31.7%, low self-esteem - 21.2% vs. 31.7%, unstable appetite and weight loss-17.4% vs. 24.2%. The overall HDRS depression score in combatants with non-psychotic mental disorders who did not have COVID-19 was also significantly lower: 15.29±4.16 points vs. 18.05±4.29 points. Similar patterns were found for indicators of anxiety on the HARS scale: 20.52±7.14 points vs. 24.53±6.69 points.

CONCLUSION

Conclusions: Combatants with non-psychotic mental disorders are characterized by high levels of depressive and anxiety disorders. COVID-19 disease aggravates the course of affective pathology in combatants with non-psychotic mental disorders and increases the incidence of their depressive and anxiety symptoms.