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Sampson L, Cohen GH, Fink DS, Conroy C, Calabrese JR, Wryobeck JM, Elhai JD, King AP, Liberzon I, Galea S. Cohort profile: the Ohio Army National Guard Mental Health Initiative (OHARNG-MHI). Soc Psychiatry Psychiatr Epidemiol 2021; 56:2107-2116. [PMID: 34480595 PMCID: PMC8577754 DOI: 10.1007/s00127-021-02166-x] [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: 03/01/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Rates of mental disorders in the United States military have increased in recent years. National Guard members may be particularly at risk for mental disorders, given their dual role as citizen-soldiers and their increased involvement in combat deployments during recent conflicts. The Ohio Army National Guard Mental Health Initiative (OHARNG-MHI) was launched to assess the prevalence, incidence, and potential causes and consequences of mental disorders in this unique population. METHODS OHARNG-MHI is a decade-long dynamic cohort study that followed over 3,000 National Guard members yearly through structured telephone interviews. RESULTS Findings thus far have applied a pre-, peri-, post-deployment framework, identifying factors throughout the life course associated with mental disorders, including childhood events and more recent events, both during and outside of deployment. An estimated 61% of participants had at least one mental disorder in their lifetime, the majority of which initiated prior to military service. Psychiatric comorbidity was common, as were alcohol use and stressful events. Latent class growth analyses revealed four distinct trajectory paths of both posttraumatic stress and depression symptoms across four years. Only 37% of soldiers with probable past-year mental disorders accessed mental health services in the subsequent year, with substance use disorders least likely to be treated. CONCLUSION Strengths of this study include a large number of follow-up interviews, detailed data on both military and non-military experiences, and a clinical assessment subsample that assessed the validity of the telephone screening instruments. Findings, methods, and procedures of the study are discussed, and collaborations are welcome.
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Affiliation(s)
- Laura Sampson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Gregory H. Cohen
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, U.S.A
| | - David S. Fink
- New York State Psychiatric Institute, New York, NY, U.S.A
| | - Carla Conroy
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH, U.S.A
| | - Joseph R. Calabrese
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH, U.S.A
| | - John M. Wryobeck
- Department of Psychiatry, University of Toledo, Toledo, OH, U.S.A
| | - Jon D. Elhai
- Department of Psychology, University of Toledo, Toledo, OH, U.S.A
| | - Anthony P. King
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, U.S.A
| | - Israel Liberzon
- Department of Psychiatry, College of Medicine, Texas A&M, College Station, TX, U.S.A
| | - Sandro Galea
- Office of the Dean, Boston University School of Public Health, Boston, MA, U.S.A
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Thériault FL, Gardner W, Momoli F, Garber BG, Kingsbury M, Clayborne Z, Cousineau-Short DY, Sampasa-Kanyinga H, Landry H, Colman I. Mental Health Service Use in Depressed Military Personnel: A Systematic Review. Mil Med 2020; 185:e1255-e1262. [PMID: 32073617 DOI: 10.1093/milmed/usaa015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/23/2019] [Accepted: 05/22/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Major depression is a leading cause of morbidity in military personnel and an important impediment to operational readiness in military organizations. Although treatment options are available, a large proportion of individuals with depression do not access mental health services. Quantifying and closing this treatment gap is a public health priority. However, the scientific literature on the major depression treatment gap in military organizations has never been systematically reviewed. METHODS We systematically searched the EMBASE, MEDLINE, and PsychINFO databases for studies measuring recent mental health service use in personnel serving in the armed forces of a Five-Eye country (Australia, Canada, New Zealand, the United Kingdom, or the United States). We excluded studies conducted with retired veterans. Because of the substantial heterogeneity in included studies, we did not pool their results. Instead, we computed median period prevalence of mental health service use. RESULTS Twenty-eight studies were included in the systematic review; 12 had estimated mental health service use in personnel with depression, and another 16 had estimated mental health service use in personnel with depression or another mental health disorder. The period prevalence of mental health service use in depressed military personnel ranged from 20 to 75% in 12 included studies, with a median of 48%, over 2-12 months. The other 16 studies yielded similar conclusions; they reported period prevalence of mental health service use in personnel with any mental health disorder ranging from 14 to 75%, with a median of 36%, over 1-12 months. The median was higher in studies relying on diagnostic interviews to identify depressed personnel, compared to studies relying on screening tools (60% vs. 44%). CONCLUSIONS There is a large treatment gap for major depression in particular, and for mental health disorders in general, among military personnel. However, our results highlight the association between the use of measurement tools and treatment gaps: estimated treatment gaps were larger when depressed patients were identified by screening tools instead of diagnostic interviews. Researchers should be wary of overestimating the mental health treatment gap when using screening tools in future studies.
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Affiliation(s)
- François L Thériault
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada.,Canadian Forces Health Services Group, Department of National Defence, National Defence HQ (Carling), 60 Moodie Drive, Ottawa, ON K1A 0K2, Canada
| | - William Gardner
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada.,CHEO Research Institute, Children Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | - Franco Momoli
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada.,CHEO Research Institute, Children Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada.,Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Bryan G Garber
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada.,Canadian Forces Health Services Group, Department of National Defence, National Defence HQ (Carling), 60 Moodie Drive, Ottawa, ON K1A 0K2, Canada
| | - Mila Kingsbury
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada
| | - Zahra Clayborne
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada
| | - Daniel Y Cousineau-Short
- Canadian Forces Health Services Group, Department of National Defence, National Defence HQ (Carling), 60 Moodie Drive, Ottawa, ON K1A 0K2, Canada.,Department of Health Sciences, Carleton University, 2305 Health Sciences Building, 1125 Colonel By Drive, Ottawa, ON K1S 5B6, Canada
| | - Hugues Sampasa-Kanyinga
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada
| | - Hannah Landry
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada
| | - Ian Colman
- Centre for Fertility and Health, Norwegian Institute of Public Health, Postbox 222 Skøyen, N-0213 Oslo, Norway
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Boulos D, Fikretoglu D. Differences between the Canadian military's Regular and Reserve Forces in perceived need for care, mental health services use and perceived sufficiency of care: a cross-sectional survey. BMJ Open 2019; 9:e028849. [PMID: 31537560 PMCID: PMC6756430 DOI: 10.1136/bmjopen-2018-028849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The primary objective was to explore differences in perceived need for care (PNC), mental health services use (MHSU) and perceived sufficiency of care (PSC) between Canadian Armed Forces Regular Force (RegF) and Reserve Force (ResF) personnel with an objective need for mental health services. DESIGN Data came from the 2013 Canadian Armed Forces Mental Health Survey, a cross-sectional survey of serving personnel (n=72 629). Analyses were among those with an Afghanistan deployment and an identified mental disorder (population n=6160; sampled n=868). Logistic regression compared PNC, MHSU and PSC between RegF and ResF. Covariate-adjusted marginal prevalence difference estimates were computed. PRIMARY OUTCOME MEASURE The primary outcomes were PNC, MHSU and PSC. Each had three service categories, including an aggregate 'any' of the three: (1) information about problems, treatments or services; (2) medication and (3) counselling. RESULTS ResF had an 10.5% (95% CI -16.7% to -4.4%) lower perceived need for medication services but PNC differences were not significant for other service categories. MHSU tended to be lower for ResF; 9.1% (95%CI -15.5% to -2.6%) lower for medication, 5.4% (95% CI -11.5% to 0.7%) lower, with marginal significance, for counselling and 11.3% (95% CI -17.3% to -5.2%) lower for the 'any' service category. Additionally, ResF tended to have a lower fully met need for care; 13.4% (95% CI -22.1% to -4.6%) lower for information, 15.3% (95% CI -22.9% to -7.6%) lower for counselling and 14.6% (95% CI -22.4% to -6.8%) lower for the 'any' service category. CONCLUSIONS Our findings suggest MHSU and PSC differences between Canadian RegF and ResF personnel that are not fully accounted for by PNC differences. Deficits in ResF members' perceptions of the sufficiency of information services and counselling services suggest perceived, or experienced, barriers to care beyond any PNC barriers. Additional research assessing barriers to mental healthcare is warranted.
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Affiliation(s)
- David Boulos
- Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario, Canada
| | - Deniz Fikretoglu
- Defence Research and Development Canada, Toronto, Ontario, Canada
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Reengagement in PTSD psychotherapy: A case-control study. Gen Hosp Psychiatry 2017; 48:20-24. [PMID: 28917390 DOI: 10.1016/j.genhosppsych.2017.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/18/2017] [Accepted: 06/20/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study sought to identify patient characteristics and care processes related to reengagement in VA psychotherapy. METHODS Using national VA data, a retrospective cohort was constructed (N=24,492) of veterans who received a new PTSD diagnosis in FY08/FY09 and attended only one to five PTSD psychotherapy sessions. A nested case-control study was conducted comparing veterans who reengaged in psychotherapy (n=9649) in a 1:5 ratio with those who did not reengage by the end of FY12. Conditional logistic regression models were run to examine differences in sociodemographic, mental health, and service utilization factors between cases and controls. RESULTS Among veterans in the study cohort, 39.4% reengaged in psychotherapy. In adjusted analyses, all measured types of health system encounters (primary care [OR=1.61], primary care mental health [OR=1.61], non-PTSD psychotherapy [OR=1.76], other non-PTSD mental health care [OR=1.43], other non-psychotherapy PTSD care [OR=3.31], emergency room [OR=1.14], and psychiatric hospitalization [OR=1.56]) were related to greater odds of reengagement in PTSD psychotherapy. CONCLUSIONS Veterans' receipt of a broad range of care services may play an important role in reengagement in PCT psychotherapy, suggesting providers across care settings should be knowledgeable in how to support a Veteran's return to psychotherapy for PTSD.
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Gorman LA, Sripada RK, Ganoczy D, Walters HM, Bohnert KM, Dalack GW, Valenstein M. Determinants of National Guard Mental Health Service Utilization in VA versus Non-VA Settings. Health Serv Res 2016; 51:1814-37. [PMID: 26840993 PMCID: PMC5034208 DOI: 10.1111/1475-6773.12446] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine associations between need, enabling, and predisposing factors with mental health service use among National Guard soldiers in the first year following a combat deployment to Iraq or Afghanistan. DATA SOURCES/STUDY SETTING Primary data were collected between 2011 and 2013 from 1,426 Guard soldiers representing 36 units. STUDY DESIGN Associations between Guard soldier factors and any mental health service use were assessed using multivariable logistic regression models in a cross-sectional study. Further analysis among service users (N = 405) assessed VA treatment versus treatment in other settings. PRINCIPAL FINDINGS Fifty-six percent of Guard soldiers meeting cutoffs on symptom scales received mental health services with 81 percent of those reporting care from the VA. Mental health service use was associated with need (mental health screens and physical health) and residing in micropolitan communities. Among service users, predisposing factors (middle age range and female gender) and enabling factors (employment, income above $50,000, and private insurance) were associated with greater non-VA services use. CONCLUSION Overall service use was strongly associated with need, whereas sector of use (non-VA vs. VA) was insignificantly associated with need but strongly associated with enabling factors. These findings have implications for the recent extension of veteran health coverage to non-VA providers.
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Affiliation(s)
| | - Rebecca K Sripada
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
- VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI
| | - Dara Ganoczy
- VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI
| | - Heather M Walters
- VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI
| | - Kipling M Bohnert
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
- VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI
| | - Gregory W Dalack
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
- VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI
| | - Marcia Valenstein
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
- VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI
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Cook WA, Doorenbos AZ, Bridges EJ. Trends in Research with U.S. Military Service Member Participants: A Population-Specific ClinicalTrials.gov Review. Contemp Clin Trials Commun 2016; 3:122-130. [PMID: 27822569 PMCID: PMC5096463 DOI: 10.1016/j.conctc.2016.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/30/2016] [Accepted: 04/15/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND ClinicalTrials.gov reviews have evaluated research trends for specific conditions and age groups but not for specific populations of research participants. No ClinicalTrials.gov reviews have evaluated research with military service member participants. PURPOSE Study objectives were (a) to use ClinicalTrials.gov to identify trends in biomedical research from 2005 to 2014 in which U.S. military service members actively participated as research participants and (b) to describe a search strategy for adaptation in future ClinicalTrials.gov reviews of specific participant populations. METHODS A systematic review of ClinicalTrials.gov was performed to identify studies that included U.S. service members as participants, either exclusively or with other groups of participants. RESULTS U.S. service members were identified as participants in 512 studies. Service members participated together with other groups in 392 studies, while 120 studies included only service members. The top five conditions of interest were post-traumatic stress disorder, traumatic brain injury, amputations, burns, and ocular injuries/disorders. The number of studies started each year peaked in 2011 and declined from 2012 to 2014. Twenty-five percent of studies exclusive to service members aimed to enroll 500 or more participants. Research exclusive to Guard and Reserve service members during this period was limited. CONCLUSIONS U.S. military service members participate in biomedical research. To address the health needs of U.S. service members, it is important to ensure there is not a prolonged decline in research among this population. The search strategy may be adapted to ClinicalTrials.gov reviews of specific participant populations for which straightforward searches are not possible.
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Affiliation(s)
- Wendy A Cook
- Biobehavioral Nursing and Health Systems, Box 357266, University of Washington, Seattle, WA, USA 98195,
| | - Ardith Z Doorenbos
- Biobehavioral Nursing and Health Systems, Box 357266, University of Washington, Seattle, WA, USA 98195,
| | - Elizabeth J Bridges
- Biobehavioral Nursing and Health Systems, Box 357266, University of Washington, Seattle, WA, USA 98195,
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