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Fortier CB, Kenna A, Katz D, Kim S, Hursh C, Beck B, Sablone CA, Currao A, Lebas A, Jorge RE, Fonda JR. STEP-Home transdiagnostic group reintegration workshop to improve mental health outcomes for post-9/11 Veterans: Design, methods, and rationale for a randomized controlled behavioral trial. Contemp Clin Trials 2024; 141:107536. [PMID: 38614448 DOI: 10.1016/j.cct.2024.107536] [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: 11/10/2023] [Revised: 03/17/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Many post-9/11 U.S. combat Veterans experience difficulty readjusting to civilian life after military service, including relationship problems, reduced work productivity, substance misuse, and increased anger control problems. Mental health problems are frequently cited as causing these difficulties, driven by unparalleled rates of mild traumatic brain injury, posttraumatic stress, and other co-occurring emotional and physical conditions. Given the high prevalence of multimorbidity in this cohort, acceptable, non-stigmatizing, transdiagnostic interventions targeting reintegration are needed. The STEP-Home reintegration workshop has the potential to significantly improve skills to foster civilian reintegration, increase engagement in VA services, and improve mental health outcomes in Veterans with and without diagnosed clinical conditions. METHODS/DESIGN Ongoing from 2019, a prospective, two-site, randomized trial of 206 post-9/11 U.S. military Veterans randomized to receive either 12 sessions of the STEP-Home transdiagnostic reintegration workshop (SH; Active Intervention) or Present Centered Reintegration Group Therapy (PCRGT; Active Control Intervention). Primary outcomes are reintegration, anger, and emotional regulation post-intervention and at 3-months post-intervention. Secondary outcomes include measures of mental health, functional and vocational status, and cognition. CONCLUSION This study addresses an important gap in transdiagnostic interventions to improve civilian reintegration in post-9/11 Veterans. STEP-Home is designed to promote treatment engagement and retention, opening the door to critically needed VA care, and ultimately reducing long-term healthcare burden of untreated mental health illness in U.S. Veterans. TRIAL REGISTRATION Clinicaltrials.gov: D2907-R.
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Affiliation(s)
- Catherine B Fortier
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America; Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America.
| | - Alexandra Kenna
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Dylan Katz
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Sahra Kim
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Colleen Hursh
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Brigitta Beck
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Caroline A Sablone
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Alyssa Currao
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Adam Lebas
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Ricardo E Jorge
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America; Baylor College of Medicine, Houston, TX, United States of America
| | - Jennifer R Fonda
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Department of Psychiatry, Boston University Chobanian and Avedisian school of Medicine, Boston, MA, United States of America
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Vogt D, Rosellini AJ, Borowski S, Street AE, O'Brien RW, Tomoyasu N. How well can U.S. military veterans' suicidal ideation be predicted from static and change-based indicators of their psychosocial well-being as they adapt to civilian life? Soc Psychiatry Psychiatr Epidemiol 2024; 59:261-271. [PMID: 37291331 DOI: 10.1007/s00127-023-02511-2] [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: 07/15/2022] [Accepted: 05/25/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Identifying predictors of suicidal ideation (SI) is important to inform suicide prevention efforts, particularly among high-risk populations like military veterans. Although many studies have examined the contribution of psychopathology to veterans' SI, fewer studies have examined whether experiencing good psychosocial well-being with regard to multiple aspects of life can protect veterans from SI or evaluated whether SI risk prediction can be enhanced by considering change in life circumstances along with static factors. METHODS The study drew from a longitudinal population-based sample of 7141 U.S. veterans assessed throughout the first three years after leaving military service. Machine learning methods (cross-validated random forests) were applied to examine the predictive utility of static and change-based well-being indicators to veterans' SI, as compared to psychopathology predictors. RESULTS Although psychopathology models performed better, the full set of well-being predictors demonstrated acceptable discrimination in predicting new-onset SI and accounted for approximately two-thirds of cases of SI in the top strata (quintile) of predicted risk. Greater engagement in health promoting behavior and social well-being were most important in predicting reduced SI risk, with several change-based predictors of SI identified but stronger associations observed for static as compared to change-based indicator sets as a whole. CONCLUSIONS Findings support the value of considering veterans' broader well-being in identifying individuals at risk for suicidal ideation and suggest the possibility that well-being promotion efforts may be useful in reducing suicide risk. Findings also highlight the need for additional attention to change-based predictors to better understand their potential value in identifying individuals at risk for SI.
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Affiliation(s)
- Dawne Vogt
- Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder (PTSD), VA Boston Healthcare System, 150 S. Huntington Ave, Boston, MA, 02130, USA.
- Department of Psychiatry, Boston University Chobanian and Avedesian School of Medicine, Boston, MA, USA.
| | - Anthony J Rosellini
- Department of Psychological and Brain Sciences, Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Shelby Borowski
- Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder (PTSD), VA Boston Healthcare System, 150 S. Huntington Ave, Boston, MA, 02130, USA
- Department of Psychiatry, Boston University Chobanian and Avedesian School of Medicine, Boston, MA, USA
| | - Amy E Street
- Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder (PTSD), VA Boston Healthcare System, 150 S. Huntington Ave, Boston, MA, 02130, USA
- Department of Psychiatry, Boston University Chobanian and Avedesian School of Medicine, Boston, MA, USA
| | - Robert W O'Brien
- US Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development Service, Washington, D.C., USA
| | - Naomi Tomoyasu
- US Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development Service, Washington, D.C., USA
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Edwards ER, Coolidge B, Ruiz D, Epshteyn G, Krauss A, Gorman D, Connelly B, Redden C, El-Meouchy P, Geraci J. Situational stress and suicide attempt behavior in Army soldiers and veterans: Insights from the Army Study to Assess Risk and Resilience in Servicemembers-Longitudinal Study. Suicide Life Threat Behav 2023; 53:642-654. [PMID: 37306332 DOI: 10.1111/sltb.12970] [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: 01/24/2023] [Revised: 04/07/2023] [Accepted: 05/07/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Prevention of suicide-related behaviors is considered a top clinical priority within the Departments of Veterans Affairs and Defense. Despite previous literature attesting to the likely importance of situational stress as a key correlate of acute changes in suicide risk, longitudinal research into associations between situational stress and suicide-related outcomes among military personnel has been relatively limited. METHODS The current study examined associations between situational stress, recent suicide attempt, and future suicide attempt using data from 14,508 Army soldiers and recently discharged veterans enrolled in the Army Study to Assess Risk and Resilience in Servicemembers-Longitudinal Studies (STARRS-LS). RESULTS Recent situational stress was more common among recently discharged veterans (vs. soldiers), those with a recent suicide attempt (vs. those without), and those with a subsequent suicide attempt (vs. those without). Job loss was more closely associated with suicide attempts among soldiers, whereas financial crisis, police contact, and death, illness, or injury of close others were more closely associated with suicide attempts among recently discharged veterans. CONCLUSION Findings further highlight situational stress as a salient risk factor for suicide-related outcomes among military personnel, particularly among recently discharged veterans. Implications for screening and treatment of at-risk military personnel are discussed.
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Affiliation(s)
- Emily R Edwards
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Brettland Coolidge
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
- Department of Psychology, University of Central Florida, Orlando, Florida, USA
| | - Danny Ruiz
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
| | - Gabriella Epshteyn
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Alison Krauss
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Health Care System, Waco, Texas, USA
| | - Daniel Gorman
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
| | - Brigid Connelly
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, New York, USA
| | - Clare Redden
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, New York, USA
| | - Paul El-Meouchy
- Department of Psychology, Fielding Graduate University, Santa Barbara, California, USA
| | - Joseph Geraci
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, New York, USA
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Hoffmire CA, Borowski S, Vogt D. Contribution of veterans' initial post-separation vocational, financial, and social experiences to their suicidal ideation trajectories following military service. Suicide Life Threat Behav 2023; 53:443-456. [PMID: 36919380 PMCID: PMC10441614 DOI: 10.1111/sltb.12955] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Veterans' success with navigating the challenges of transition from military service may contribute to their risk for suicidal outcomes. The concept of well-being can help to conceptualize and assess successful navigation of reintegration challenges and may serve as an optimal target for public health-oriented suicide prevention. METHODS The relationship between US veterans' psychosocial well-being and experiences of suicidal ideation (SI) during the first 3 years following military separation was evaluated using multinomial logistic regression predicting SI trajectories over time in a population-based, longitudinal, post-9/11 veteran cohort. At 3-months post-separation, veterans reported on their socio-material conditions, functioning, and satisfaction with respect to vocational, financial, and social domains. SI frequency was assessed at 3-, 9-, 15-, 21-, and 27-months post-separation using the Patient Health Questionnaire-9. RESULTS Veterans' vocational, financial, and social well-being were associated with their SI trajectories, even after accounting for mental health. Socio-material conditions, functioning, and satisfaction all emerged as important predictors of SI trajectories, although results varied across domains. Effects were largest for social well-being. CONCLUSIONS Suicide prevention efforts may benefit from a holistic approach that considers veterans' needs for support across their vocational, financial, and social well-being, inclusive of their socio-material conditions, functioning, and satisfaction within each domain.
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Affiliation(s)
- Claire A. Hoffmire
- Rocky Mountain MIRECC for Suicide Prevention, Department of Veterans Affairs, Eastern Colorado Healthcare System, Aurora, Colorado, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Shelby Borowski
- Women’s Health Sciences Division, National Center for PTSD, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
| | - Dawne Vogt
- Women’s Health Sciences Division, National Center for PTSD, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
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Rugo-Cook KF, Kerig PK, Crowell SE, Bryan CJ. Fluid vulnerability theory as a framework for understanding the association between posttraumatic stress disorder and suicide: A narrative review. J Trauma Stress 2021; 34:1080-1098. [PMID: 34881461 DOI: 10.1002/jts.22782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022]
Abstract
Suicide is a persistent issue in the United States and across the globe. A large body of published research shows that posttraumatic stress disorder (PTSD) increases the risk of suicidal ideation, suicidal behaviors, and death by suicide. However, the existing literature examining why that association might pertain is widely dispersed across disciplines (e.g., psychology, nursing) and lacks an integrative theoretical framework, making it difficult to conceptualize the current state of science in this area. Therefore, the primary aims of this narrative review were to (a) provide a comprehensive and interdisciplinary critique of the current state of knowledge regarding mechanisms that underlie the association between PTSD and suicide and (b) organize that knowledge according to a specified theoretical framework. The framework guiding this review is "fluid vulnerability theory," a diathesis-stress model of suicide that emphasizes the dynamic nature of suicide risk across cognitive, emotional, behavioral, and physiological domains. A summary of the findings, including patterns that emerged, gaps that remain, and recommendations for the advancement of science and practice in this area are addressed in this narrative review.
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Affiliation(s)
- Kelsi F Rugo-Cook
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Patricia K Kerig
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Sheila E Crowell
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Craig J Bryan
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
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Troyanskaya M, Pastorek NJ, Walder A, Wilde EA, Kennedy JE, Levin HS, Scheibel RS. Role of deployment-related mTBI and resilience in perceived participation limitations among Veterans. MILITARY PSYCHOLOGY 2021. [DOI: 10.1080/08995605.2021.1962191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Maya Troyanskaya
- Michael E. DeBakey Veterans Affairs Medical Center Houston, Houston, Texas, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine Houston, Houston, Texas, USA
| | - Nicholas J. Pastorek
- Michael E. DeBakey Veterans Affairs Medical Center Houston, Houston, Texas, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine Houston, Houston, Texas, USA
| | - Annette Walder
- Michael E. DeBakey Veterans Affairs Medical Center Houston, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine Houston, Houston, Texas, USA
| | - Elisabeth A. Wilde
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine Houston, Houston, Texas, USA
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Jan E. Kennedy
- DefenseTX And Veterans Brain Injury Center, Brooke Army Medical Center Ft Sam Houston, San Antonio, Texas, USA
- General Dynamics Information Technology Falls Church, Falls Church, Virginia, USA
| | - Harvey S. Levin
- Michael E. DeBakey Veterans Affairs Medical Center Houston, Houston, Texas, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine Houston, Houston, Texas, USA
- Department of Neurology, Baylor College of Medicine Houston, Houston, Texas, USA
- Department of Neurosurgery, Baylor College of Medicine Houston, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine Houston, Houston, Texas, USA
| | - Randall S. Scheibel
- Michael E. DeBakey Veterans Affairs Medical Center Houston, Houston, Texas, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine Houston, Houston, Texas, USA
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Vitale A, Byma L, Sun S, Podolak E, Wang Z, Alter S, Galfalvy H, Geraci J, Langhoff E, Klingbeil H, Yehuda R, Haghighi F, Feder A. Effectiveness of Complementary and Integrative Approaches in Promoting Engagement and Overall Wellness Toward Suicide Prevention in Veterans. J Altern Complement Med 2021; 27:S14-S27. [PMID: 33788604 PMCID: PMC8035924 DOI: 10.1089/acm.2020.0245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective: Suicide is a major public health problem, specifically among U.S. veterans, who do not consistently engage in mental health services, often citing stigma as a barrier. Complementary and Integrative Health (CIH) interventions are promising alternatives in promoting patient engagement and further, they may play a critical role in transitioning people into mental health care. Toward this goal, the Resilience and Wellness Center (RWC) was developed to break through the stigma barrier by addressing risk factors of suicide through multimodal CIH interventions via cohort design, promoting social connectedness and accountability among participants. Design: This is a program evaluation study at a large urban VA medical center, where assessments were evaluated from pre- to post-program completion to determine the effectiveness of an intensive multimodal CIH 4-week group outpatient intervention for suicide prevention. Outcome measures: Primary outcomes measured included group connectedness, severity of depression and hopelessness symptoms, suicidal ideation, sleep quality, and diet. Secondary outcomes included measures of post-traumatic stress disorder (PTSD), generalized anxiety severity stress/coping skills, pain, and fatigue. Results: The RWC showed high participant engagement, with an 84%-95% attendance engagement rate depending on suicide risk history. Data from 15 cohorts (N = 126) demonstrate favorable outcomes associated with participation in this comprehensive program, as evidenced by a reduction in suicidal ideation, depression, and hopelessness, but not sleep quality and diet. In addition, in a subset of veterans with a history of suicidal ideation or attempt, significant improvements were noted in pain, PTSD/anxiety symptoms, and stress coping measures. Conclusions: The RWC shows that an intensive complement of CIH interventions is associated with a significant improvement with high veteran engagement. Findings from this program evaluation study can be used to aid health care systems and their providers in determining whether or not to utilize such multimodal CIH integrated interventions as an effective treatment for at-risk populations as a part of suicide prevention efforts.
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Affiliation(s)
| | - Lauren Byma
- James J. Peters VA Medical Center, Bronx, NY, USA
| | - Shengnan Sun
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evan Podolak
- James J. Peters VA Medical Center, Bronx, NY, USA
| | - Zhaoyu Wang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sharon Alter
- James J. Peters VA Medical Center, Bronx, NY, USA
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - Erik Langhoff
- James J. Peters VA Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Rachel Yehuda
- James J. Peters VA Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fatemeh Haghighi
- James J. Peters VA Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ann Feder
- James J. Peters VA Medical Center, Bronx, NY, USA
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Giesler M, Juarez A. “I Have Served to Tell”: A Qualitative Study of Veterans’ Reactions on Participating in a Living Library Project. JOURNAL OF VETERANS STUDIES 2019. [DOI: 10.21061/jvs.v5i1.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Cannady J, Adams J. Increasing nurse practitioner students' comfort levels in caring for veterans with post-traumatic stress disorder. J Am Assoc Nurse Pract 2019; 33:102-107. [PMID: 31868821 DOI: 10.1097/jxx.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 10/23/2019] [Indexed: 11/25/2022]
Abstract
ABSTRACT Few nurse practitioner programs integrate education on care of veterans into their curriculum. Because more veterans are seeking health care outside of the Veteran Affairs system, all advanced practice nurses need to be prepared to meet the unique needs of veterans with post-traumatic stress disorder (PTSD). The authors developed an education session on military-to-civilian transition and screening and treatment of veterans with PTSD. The session was provided to a convenience sample of students. Case studies were included to allow student participation and active learning. Students completed pre-education and post-education surveys to measure their comfort level in caring for this specific population and their understanding of PTSD. The participant scores on comfort level with identifying and managing PTSD after the education session were significantly increased. Placing veteran-specific education into nurse practitioner programs enhances the comfort level with identifying and managing PTSD. Adding this veteran-specific education could enhance the overall care for veterans in the civilian sector.
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Affiliation(s)
- Jolene Cannady
- Department of Nursing, University of North Carolina at Greensboro, Burlington, North Carolina
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10
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Straus E, Norman SB, Tripp JC, Pitts M, Pietrzak RH. Purpose in Life and Conscientiousness Protect Against the Development of Suicidal Ideation in U.S. Military Veterans With PTSD and MDD: Results From the National Health and Resilience in Veterans Study. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2019; 3:2470547019872172. [PMID: 31777766 PMCID: PMC6880965 DOI: 10.1177/2470547019872172] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/28/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Although several studies have examined risk factors for suicidal ideation among veterans, little is known about risk and protective factors for suicidal ideation in high-risk veteran samples. Thus, this study examined a broad range of risk and protective factors associated with the development of suicidal ideation in a high-risk sample of U.S. veterans who screened positive for current posttraumatic stress disorder (PTSD) and/or major depressive disorder (MDD). METHODS Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative, prospective cohort study of U.S. veterans. Veterans completed self-report measures to screen for PTSD and MDD and to assess for risk and protective factors. The sample included 222 veterans with PTSD and/or MDD who did not endorse suicidal ideation at baseline and completed at least one assessment over a seven-year follow-up period. A multivariable binary logistic regression analysis was conducted to examine baseline factors associated with incident suicidal ideation. RESULTS Nearly one in three (27.1%) of veterans with PTSD and/or MDD developed suicidal ideation over the seven-year follow-up period. Non-Caucasian race and lower scores on measures of purpose in life, conscientiousness, and frequency of religious service attendance were independently associated with incident suicidal ideation. Lower purpose in life (52.3%) and conscientiousness (33.2%) explained the vast majority of variance in incident suicidal ideation. CONCLUSION Nearly 30% of veterans with PTSD and/or MDD who did not endorse suicidal ideation at baseline developed suicidal ideation over a seven-year period. Prevention and treatment efforts designed to bolster purpose in life and conscientiousness may help mitigate risk for suicidal ideation in this high-risk population.
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Affiliation(s)
- Elizabeth Straus
- VA
San Diego Healthcare System, San Diego, CA,
USA
- Department of Psychiatry, University of
California, San Diego, CA, USA
| | - Sonya B. Norman
- VA
San Diego Healthcare System, San Diego, CA,
USA
- Department of Psychiatry, University of
California, San Diego, CA, USA
- VA Center of Excellence for Stress and
Mental Health, San Diego, CA, USA
- National Center for PTSD, White River
Junction, VT, USA
| | - Jessica C. Tripp
- VA
San Diego Healthcare System, San Diego, CA,
USA
- Department of Psychiatry, University of
California, San Diego, CA, USA
| | - Michelle Pitts
- VA
San Diego Healthcare System, San Diego, CA,
USA
- Department of Psychiatry, University of
California, San Diego, CA, USA
| | - Robert H. Pietrzak
- National Center for PTSD, West Haven,
CT, USA
- Department of Psychiatry, Yale School of
Medicine, Yale University, New Haven, CT, USA
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11
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McAndrew LM, Slotkin S, Kimber J, Maestro K, Phillips LA, Martin JL, Credé M, Eklund A. Cultural incongruity predicts adjustment to college for student veterans. J Couns Psychol 2019; 66:678-689. [PMID: 31204835 DOI: 10.1037/cou0000363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Little is known about what predicts student service members' and veterans' (SSM/V) adjustment to college. In qualitative research, SSM/V report feeling they do not belong and are misunderstood by college communities, a phenomenon that counseling psychologists call cultural incongruity. The goal of the current study was to quantitatively examine the relationship between cultural incongruity and adjustment to college. We surveyed 814 SSM/V about their adjustment to college using the Student Adaptation to College Questionnaire. Cultural incongruity was operationalized in two ways: feelings of not belonging were measured via direct report and the association with adjustment to college assessed with regression. Feelings of being misunderstood about academic barriers were assessed by comparing SSM/V's perceptions of academic barriers and SSM/V's perceptions of how others view the SSM/V's academic barriers and the association with adjustment was assessed using polynomial regression and response surface analysis. Cultural incongruity predicted adjustment to college. After controlling for other known predictors, feelings of not belonging accounted for 18% of the variance in adjustment to college. Polynomial regression showed that feeling understood about academic barriers protected against the negative impact of the barrier on adjustment to college. Cultural incongruity predicts adjustment to college for SSM/V. Helping SSM/V feel their unique barriers to college adjustment are understood may blunt the impact of these barriers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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12
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Mild Traumatic Brain Injury Burden Moderates the Relationship Between Cognitive Functioning and Suicidality in Iraq/Afghanistan-Era Veterans. J Int Neuropsychol Soc 2019; 25:79-89. [PMID: 30444208 PMCID: PMC6349513 DOI: 10.1017/s1355617718000851] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Suicidal ideation (SI) is highly prevalent in Iraq/Afghanistan-era veterans with a history of mild traumatic brain injury (mTBI), and multiple mTBIs impart even greater risk for poorer neuropsychological functioning and suicidality. However, little is known about the cognitive mechanisms that may confer increased risk of suicidality in this population. Thus, we examined relationships between neuropsychological functioning and suicidality and specifically whether lifetime mTBI burden would moderate relationships between cognitive functioning and suicidal ideation. METHODS Iraq/Afghanistan-era Veterans with a history of mTBI seeking outpatient services (N = 282) completed a clinical neuropsychological assessment and psychiatric and postconcussive symptom questionnaires. RESULTS Individuals who endorsed SI reported more severe post-traumatic stress disorder (PTSD), depression, and postconcussive symptoms and exhibited significantly worse memory performance compared to those who denied SI. Furthermore, mTBI burden interacted with both attention/processing speed and memory, such that poorer performance in these domains was associated with greater likelihood of SI in individuals with a history of three or more mTBIs. The pattern of results remained consistent when controlling for PTSD, depression, and postconcussive symptoms. CONCLUSIONS Slowed processing speed and/or memory difficulties may make it challenging to access and use past experiences to solve current problems and imagine future outcomes, leading to increases in hopelessness and SI in veterans with three or more mTBIs. Results have the potential to better inform treatment decisions for veterans with history of multiple mTBIs. (JINS, 2019, 25, 79-89).
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Currier JM, McDermott RC, McCormick WH, Churchwell MC, Milkeris L. Exploring cross-lagged associations between spiritual struggles and risk for suicidal behavior in a community sample of military veterans. J Affect Disord 2018; 230:93-100. [PMID: 29407545 DOI: 10.1016/j.jad.2018.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/13/2017] [Accepted: 01/22/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is consensus that struggles with religious faith and/or spirituality likely contribute to risk for suicidal behavior in military populations. However, a lack of longitudinal information has limited the ability to clarify the temporal associations between these variables. METHODS This study examined cross-lagged associations between key types of spiritual struggles (divine, morality, ultimate meaning, interpersonal relations, and doubting) and indices of risk for suicidal behavior (suicidal ideation and probability of future attempt) in a community sample of veterans who completed assessments spaced apart by six months. RESULTS Greater severity of all forms of spiritual struggles was generally concurrently associated with indices of suicidal behavior at both time points. Of the possible models for predicting suicide risk, structural equation modeling analyses revealed that a cross-lagged option with spiritual struggles predicting risk provided the best-fitting solution for veterans' responses on study measures. In addition to PTSD and MDD symptomatology, issues with ultimate meaning at Time 1 were uniquely predictive of veterans' perceived likelihood of making a suicide attempt beyond the second assessment, after accounting for autoregressive effects and other variables in this model. LIMITATIONS This sample was recruited from a single geographic region with disproportionate ties to Christian religious traditions. In addition, reliance on self-report instrumentation potentially limited the accuracy of gauging suicide risk in some cases. CONCLUSIONS Findings highlight the prognostic value of spiritually integrated models for assessing suicide risk in military veterans that account for mental health conditions along with possible expressions of suffering in the spiritual domain.
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Affiliation(s)
- Joseph M Currier
- University of South Alabama, Psychology Department, Mobile, AL, United States.
| | - Ryon C McDermott
- University of South Alabama, Department of Professional Studies, Mobile, AL, United States
| | - Wesley H McCormick
- University of South Alabama, Psychology Department, Mobile, AL, United States
| | - Marc C Churchwell
- University of West Florida, Military and Veterans Resource Center, Pensacola, FL, United States
| | - Lori Milkeris
- University of West Florida, Military and Veterans Resource Center, Pensacola, FL, United States
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De La Vega D, Giner L, Courtet P. Suicidality in Subjects With Anxiety or Obsessive-Compulsive and Related Disorders: Recent Advances. Curr Psychiatry Rep 2018; 20:26. [PMID: 29594718 DOI: 10.1007/s11920-018-0885-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Historically, anxiety disorders have not been considered as important determinants of suicide, but in the last years, many works have challenged this assumption. Here, we will review the available evidence on the relationship between suicide and anxiety disorders (e.g., obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, panic disorder, and body dysmorphic disorder), with special emphasis on findings published in the last years. RECENT FINDINGS Overall, anxiety disorders increase the risk of suicide. Specifically, 16% of patients with social anxiety disorder reported suicidal ideation in the previous month, and 18% of them had a history of suicide attempts. Similarly, in patients with panic disorder, suicidal ideation prevalence ranged between 17 and 32%, and 33% of them had a history of suicide attempts. Generalized anxiety disorder (GAD) was the most frequent anxiety disorder in completed suicides (present in 3% of people who committed suicide) and also subthreshold GAD was clearly linked to suicide ideation. Post-traumatic stress disorder was positively associated with suicidal ideation, and in patients with obsessive-compulsive disorder, suicide ideation rates ranged from 10 to 53% and suicide attempts from 1 to 46%. Body dysmorphic disorders presented a suicide ideation prevalence of about 80%. Suicide risk is increased in subjects with anxiety disorder. This risk is higher in the presence of comorbidities, but it is not clear whether it is independent from such comorbidities in some disorders.
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Affiliation(s)
- Diego De La Vega
- Unidad de Hospitalización de Salud Mental, Unidad de Gestión Clínica de Salud Mental del Hospital Virgen Macarena, Servicio Andaluz de Salud, Sevilla, Spain
| | - Lucas Giner
- Department of Psychiatry, School of Medicine, Universidad de Sevilla, Av. Sánchez-Pizjuán s/n, 41009, Seville, Spain.
| | - Philippe Courtet
- CHRU Montpellier, University of Montpellier, INSERM unit 1061, Montpellier, France.,Fondamental Foundation, Créteil, France
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Athey A, Overholser J. A Systematic Review of Suicide Risk in Veterans: Depression is a More Powerful Predictor than Comorbid Psychiatric Disorders. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/21635781.2018.1442757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Alison Athey
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio
| | - James Overholser
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio
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Mamon D, McDonald EC, Lambert JF, Cameron AY. Using Storytelling to Heal Trauma and Bridge the Cultural Divide Between Veterans and Civilians. JOURNAL OF LOSS & TRAUMA 2017. [DOI: 10.1080/15325024.2017.1382653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Daria Mamon
- Department of Veterans Affairs, Providence VA Medical Center, Providence, Rhode Island, USA
- Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Elise C. McDonald
- Department of Veterans Affairs, Providence VA Medical Center, Providence, Rhode Island, USA
| | - Jennifer F. Lambert
- Department of Veterans Affairs, Providence VA Medical Center, Providence, Rhode Island, USA
- Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Amy Y. Cameron
- Department of Veterans Affairs, Providence VA Medical Center, Providence, Rhode Island, USA
- Alpert Medical School, Brown University, Providence, Rhode Island, USA
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