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Moye J, O’Malley KA, Auguste EJ, Driver JA, Owsiany MT, Paik JM. Trauma re-engagement and PTSD in older medically ill veterans: implications for trauma-informed care. Aging Ment Health 2023; 27:957-964. [PMID: 35603825 PMCID: PMC10281592 DOI: 10.1080/13607863.2022.2068135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/12/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES We characterize rates and correlates of PTSD and of trauma re-engagement without PTSD in medically ill older Veterans, as well as supportive strategies, with the goal of advancing trauma-informed care. METHODS We interviewed medically ill older Veterans (N = 88, M age 75.13, SD = 6.14) with primary care screening measures for PTSD and trauma re-engagement, and open-ended questions to assess supportive strategies. RESULTS One-fifth (20.5%) presented with probable PTSD, associated with greater trauma exposures (r=.57, p<.001), whereas two-fifths (43.2%) reported re-engagement with military memories without PTSD, associated with having a spouse/partner (t = 2.27, p=.028). Of those who experienced trauma, half reported thinking more about the trauma recently and becoming more emotional on certain days. In response to the question 'What gives you strength as you think about the future with your illness' Veterans described support of family, healthcare, worldview, personal control, acceptance, and health behaviors. CONCLUSION Memories of trauma are common with medical illness. Age-friendly trauma-informed care could consider factors that patients describe as sources of strength with illness.
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Affiliation(s)
- Jennifer Moye
- VA New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kelly A. O’Malley
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Elizabeth J. Auguste
- VA New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Jane A. Driver
- VA New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Montgomery T. Owsiany
- VA New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Julie M. Paik
- VA New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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Karel MJ, Wray LO, Adler G, Hannum AOR, Luci K, Brady LA, McGuire MH. Mental Health Needs of Aging Veterans: Recent Evidence and Clinical Recommendations. Clin Gerontol 2022; 45:252-271. [PMID: 31971092 DOI: 10.1080/07317115.2020.1716910] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Large numbers of older Americans have a history of military service, which may be positively or negatively associated with mental health in late life. We reviewed literature with the aim of better understanding the mental health needs of older Veterans.Methods: Articles included those published in 2009-2018 and focused on prevalence/risk for mental illness and suicide among older Veterans; utilization of mental health services; effectiveness of evidence-based behavioral treatments; and pertinent care delivery models.Results: Older Veterans are generally resilient. A significant minority experience mental health concerns that are associated with poor outcomes including a substantial number of suicides. Most published research is based on the approximately one third of Veterans who use the Veterans Health Administration (VHA) for care. Older Veterans with mental health diagnoses are less likely to utilize mental health services compared to younger Veterans, but as likely to benefit once engaged. Integrated care models in primary and geriatric care settings are promising.Conclusions: Aging Veterans are a large subset of Americans whose mental health needs are complex and deserve attention.Clinical Implications: Clinicians should ask about history of military service (i.e., Veteran status) and utilize available resources when providing care for older Veterans.
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Affiliation(s)
- Michele J Karel
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs (VA) Central Office, Washington, DC, United States
| | - Laura O Wray
- VA Center for Integrated Healthcare, VA Western New York Health Care System, Buffalo, New York, United States.,Jacobs School of Medicine and Biomedical Sciences, SUNY University at Buffalo, Buffalo, New York, United States
| | - Geri Adler
- VA South Central Mental Illness Research, Education, and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, United States
| | - Alisa O' Riley Hannum
- Mental Health Service, VA Eastern Colorado Healthcare System, Colorado Springs, Colorado, United States
| | - Katherine Luci
- Center for Aging and Neurocognitive Services, Salem VA Medical Center, Salem, Virginia, United States.,Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Blacksburg, Virginia, United States
| | - Laura A Brady
- Jacobs School of Medicine and Biomedical Sciences, SUNY University at Buffalo, Buffalo, New York, United States
| | - Marsden H McGuire
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs (VA) Central Office, Washington, DC, United States
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Analysis of features of social anxiety and exploring the relationship between childhood major adverse experiences and social anxiety in early adulthood among Chinese college students. J Affect Disord 2021; 292:614-622. [PMID: 34153832 DOI: 10.1016/j.jad.2021.05.105] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 05/06/2021] [Accepted: 05/31/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Prior studies have explored the prevalence of social anxiety disorders and found that childhood major adverse experiences increased the risk of social anxiety. However, few studies analyzed features of social anxiety and explored the mediation mechanism of the relationship between childhood major adverse experiences and social anxiety in early adulthood. METHODS Two thousand seven hundred and fifty-nine college students from Hunan, China participated in the survey-based study. They completed questionnaires on major adverse childhood experiences, social anxiety symptoms, and a sense of security during a study conducted from 2017 to 2018. RESULTS 1) 33.38% of the students reported experiencing at least one social anxiety symptom; the highest detection rate (20.22%) was social anxiety symptoms related to participants' nervousness when in large groups. 2) Females and individuals who consumed alcohol in the past year and individuals with a poor physical condition had a significantly higher risk of having social anxiety symptoms (p<0.05). 3) Childhood major adverse events experience increased the risk of some social anxiety symptoms, especially experiencing 3 or more adverse events (p<0.05). 4) A sense of security mediated the relationship between childhood major adverse events experience and social anxiety symptoms. CONCLUSIONS Extensive detection rate of social anxiety symptoms existed among college students, early adversities increased the risk of social anxiety in early adulthood, and the relationship between childhood major adversity and social anxiety was affected by sense of security.
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Graham LA, Wagner TH, Richman JS, Morris MS, Copeland LA, Harris AH, Itani KM, Hawn MT. Exploring Trajectories of Health Care Utilization Before and After Surgery. J Am Coll Surg 2018; 228:116-128. [PMID: 30359825 DOI: 10.1016/j.jamcollsurg.2018.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 10/16/2018] [Accepted: 10/16/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Long-term trajectories of health care utilization in the context of surgery have not been well characterized. The objective of this study was to examine health care utilization trajectories among surgical patients and identify factors associated with high utilization that could possibly be mitigated after surgical admissions. STUDY DESIGN Hospital medical and surgical admissions within 2 years of an index inpatient surgery in the Veterans Health Administration (October 1, 2007 to September 30, 2014) were identified. Group-based trajectory analysis identified 5 distinct trajectories of inpatient admissions around surgery. Characteristics of trajectories of utilization were compared across groups using bivariate statistics and multivariate logistic regression. RESULTS Of 280,681 surgery inpatients, most underwent orthopaedic (29.2%), general (28.4%), or peripheral vascular procedures (12.2%). Five trajectories of health care utilization were identified, with 5.2% of patients among consistently high inpatient users accounting for 34.0% of inpatient days. Male (95.4% vs 93.5%, p < 0.01), African-American (21.6% vs 17.3%, p < 0.01), or unmarried patients (61.6% vs 52.5%, p < 0.01) were more likely to be high health care users as compared with other trajectories. High users also had a higher comorbidity burden and a strikingly higher burden of mental health diagnoses (depression: 30.3% vs 16.3%; bipolar disorder: 5.3% vs 2.1%, p < 0.01), social/behavioral risk factors (smoker: 41.1% vs 33.6%, p < 0.01; alcohol use disorder: 28.9% vs 12.9%, p < 0.01), and chronic pain (6.4% vs 2.8%, p < 0.01). CONCLUSIONS Mental health, social/behavioral, and pain-related factors are independently associated with high pre- and postoperative health care utilization in surgical patients. Connecting patients to social workers and mental health care coordinators around the time of surgery may mitigate the risk of postoperative readmissions related to these factors.
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Affiliation(s)
- Laura A Graham
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA; Birmingham Health Services Research & Development Unit, Birmingham VA Medical Center, Birmingham, AL
| | - Todd H Wagner
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA; Department of Surgery, Stanford University, Stanford, CA
| | - Joshua S Richman
- Birmingham Health Services Research & Development Unit, Birmingham VA Medical Center, Birmingham, AL; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Melanie S Morris
- Birmingham Health Services Research & Development Unit, Birmingham VA Medical Center, Birmingham, AL; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Laurel A Copeland
- VA Central Western Massachusetts Healthcare System, Leeds, MA; University of Massachusetts Medical School, Worcester, MA
| | - Alex Hs Harris
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA; Department of Surgery, Stanford University, Stanford, CA
| | - Kamal Mf Itani
- VA Boston Health Care System, Boston University and Harvard Medical School, Boston, MA
| | - Mary T Hawn
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA; Department of Surgery, Stanford University, Stanford, CA.
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Stock EM, Zeber JE, McNeal CJ, Banchs JE, Copeland LA. Psychotropic Pharmacotherapy Associated With QT Prolongation Among Veterans With Posttraumatic Stress Disorder. Ann Pharmacother 2018; 52:838-848. [DOI: 10.1177/1060028018769425] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: In 2012, the Food and Drug Administration issued Drug Safety Communications on several drugs associated with QT prolongation and fatal ventricular arrhythmias. Among these was citalopram, a selective serotonin reuptake inhibitor (SSRI) approved for depression and commonly used for posttraumatic stress disorder (PTSD). Evaluation of the risk for QT prolongation among other psychotropic drugs for individuals with PTSD remains limited. Objective: Explore psychotropic drugs associated with QT prolongation among veterans with PTSD. Methods: Patients in the Veterans Health Administration in 2006-2009 with PTSD and QT prolongation (176 cases) were matched 1:4 on age, gender, visit date and setting, and physical comorbidity. Classification trees assessed QT prolongation risk among prescribed medications (n=880). Results: Receipt of any drug with known risk of QT prolongation varied by group (23% QT cases vs 15% control, p<0.01). Psychotropic medications conferring significant risks included ziprasidone (3% vs 1%, p=0.02) and buspirone (6% vs 2%, p=0.01). Increased risk was not observed for the SSRIs, citalopram and fluoxetine. Classification trees found that sotalol and amitriptyline carried greater risk among cardiac patients and methadone, especially if prescribed with quetiapine, among noncardiac patients. Per adjusted survival model, patients with QT prolongation were at increased risk for death (hazard ratio=1.60; 95% CI=1.04-2.44). Conclusions: Decision models are particularly advantageous when exploring nonlinear relationships or nonadditive interactions. These findings may potentially affect clinical decision-making concerning treatment for PTSD. For patients at higher risk of QT prolongation, antidepressants other than amitriptyline should be considered. Medications for comorbid conditions should also be closely monitored for heightened QT prolongation risk.
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Affiliation(s)
- Eileen M. Stock
- Cooperative Studies Program Coordinating Center, VA Maryland Health Care System, Perry Point, MD, USA
| | - John E. Zeber
- Central Texas Veterans Health Care System, Temple, TX, USA
- Center for Applied Health Research, Baylor Scott & White Health, Temple, TX, USA
- Texas A&M Health Science Center, Bryan, TX, USA
| | - Catherine J. McNeal
- Texas A&M Health Science Center, Bryan, TX, USA
- Department of Cardiology, Baylor Scott & White Health, Temple, TX, USA
| | - Javier E. Banchs
- Department of Electrophysiology and Pacing, Baylor Scott & White Health, Temple, TX, USA
| | - Laurel A. Copeland
- Center for Applied Health Research, Baylor Scott & White Health, Temple, TX, USA
- Texas A&M Health Science Center, Bryan, TX, USA
- VA Central Western Massachusetts, Leeds, MA, USA
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