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Davis JP, Prindle J, Saba SK, Castro CA, Hummer J, Canning L, Pedersen ER. Longitudinal associations between insomnia, cannabis use and stress among US veterans. J Sleep Res 2024; 33:e13945. [PMID: 37243415 PMCID: PMC10676445 DOI: 10.1111/jsr.13945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
Insomnia is highly prevalent among military veterans, with rates nearly double that of civilian populations. Insomnia typically co-occurs with other psychological problems, including substance use (e.g. cannabis) and perceived stress. Much of the research focused on insomnia, stress and cannabis use explores cannabis as a sleep aid and a mechanism for stress relief. However, recent theoretical and empirical evidence suggests a dynamic interplay between insomnia, cannabis use and perceived stress, yet few longitudinal studies exist. Using a sample of 1105 post-9/11 veterans assessed over four time points across 12 months, we used latent difference score modelling to examine proportional change between insomnia, perceived stress and cannabis use. Results revealed a complex interplay between all three constructs. In particular, we show that higher prior levels of insomnia are associated with greater increases in perceived stress, and greater prior levels of stress are associated with greater increases in cannabis use. Perhaps more importantly, our results also point to cannabis use as a catalyst for greater increases in both stress and insomnia severity. Our results suggest there may be both benefits and costs of cannabis use among veterans. Specifically, for veterans who experience chronic sleep problems, perceived stress may become overwhelming, and the benefit of stress reduction from increased cannabis use may come at the cost of increasing insomnia symptomology.
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Affiliation(s)
- Jordan P. Davis
- University of Southern California, Suzanne Dworak-Peck School of Social Work
| | - John Prindle
- University of Southern California, Suzanne Dworak-Peck School of Social Work
| | - Shaddy K. Saba
- University of Southern California, Suzanne Dworak-Peck School of Social Work
| | - Carl A. Castro
- University of Southern California, Suzanne Dworak-Peck School of Social Work
| | | | - Liv Canning
- University of Southern California, Suzanne Dworak-Peck School of Social Work
| | - Eric R. Pedersen
- University of Southern California, Keck School of Medicine, Department of Psychiatry and Behavioral Sciences
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2
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Davis JP, Prindle J, Saba S, Lee DS, Leightley D, Tran DD, Sedano A, Fitzke R, Castro CA, Pedersen ER. Childhood adversity, combat experiences, and military sexual trauma: a test and extension of the stress sensitization hypothesis. Psychol Med 2023; 53:4055-4063. [PMID: 35440343 DOI: 10.1017/s0033291722000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND U.S. veterans report high rates of traumatic experiences and mental health symptomology [e.g. posttraumatic stress disorder (PTSD)]. The stress sensitization hypothesis posits experiences of adversity sensitize individuals to stress reactions which can lead to greater psychiatric problems. We extend this hypothesis by exploring how multiple adversities such as early childhood adversity, combat-related trauma, and military sexual trauma related to heterogeneity in stress over time and, subsequently, greater risk for PTSD. METHODS 1230 veterans were recruited for an observational, longitudinal study. Veterans responded to questionnaires on PTSD, stress, and traumatic experiences five times over an 18-month study period. We used latent transition analysis to understand how heterogeneity in adverse experiences is related to transition into stress trajectory classes. We also explored how transition patterns related to PTSD symptomology. RESULTS Across all models, we found support for stress sensitization. In general, combat trauma in combinations with other types of adverse experiences, namely early childhood adversity and military sexual trauma, imposed a greater probability of transitioning into higher risk stress profiles. We also showed differential effects of early childhood and military-specific adversity on PTSD symptomology. CONCLUSION The present study rigorously integrates both military-specific and early life adversity into analysis on stress sensitivity, and is the first to examine how sensitivity might affect trajectories of stress over time. Our study provides a nuanced, and specific, look at who is risk for sensitization to stress based on previous traumatic experiences as well as what transition patterns are associated with greater PTSD symptomology.
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Affiliation(s)
- Jordan P Davis
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - John Prindle
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Shaddy Saba
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Daniel S Lee
- Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | | | - Denise D Tran
- Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Angeles Sedano
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Reagan Fitzke
- Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Carl A Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Eric R Pedersen
- Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
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3
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Goldbach JT, Schrager SM, Mamey MR, Klemmer C, Holloway IW, Castro CA. Development and Validation of the Military Minority Stress Scale. Int J Environ Res Public Health 2023; 20:6184. [PMID: 37372770 DOI: 10.3390/ijerph20126184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/07/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023]
Abstract
Despite affecting nearly 3% of active-duty service members, little is known about how LGBT-related stress experiences may relate to health outcomes. Thus, the present study sought to create a Military Minority Stress Scale and assess its initial reliability and construct validity in a cross-sectional study of active-duty LGBT service members (N = 248). Associations between 47 candidate items and health outcomes of interest were analyzed to retain those with substantial betas. Item response theory analyzes, reliability testing, invariance testing, and exploratory factor analysis were performed. Construct validity of the final measure was assessed through associations between the sum score of the final measure and the health outcomes. The final 13-item measure demonstrated an excellent reliability (ω = 0.95). Bivariate linear regressions showed significant associations between the sum score of the measure and overall health (β = -0.26, p < 0.001), overall mental health (β = -0.34, p < 0.001), physical health (β = 0.45, p < 0.001), life satisfaction (β = -0.24, p < 0.001), anxiety (β = 0.34, p < 0.001), depressive symptoms (β = 0.37, p < 0.001), suicidality (β = 0.26, p < 0.001), and PTSD (β = 0.42, p < 0.001), respectively. This study provides the first evidence that minority stressors in the military setting can be operationalized and measured. They appear to have a role in the health of LGBT service members and may explain the continued health disparities experienced by this population. Little is known regarding the experiences of LGBT active-duty service members, including experiences of discrimination. Understanding these experiences and their associated health outcomes during military service may therefore help and guide further etiological studies and intervention development.
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Affiliation(s)
- Jeremy T Goldbach
- The Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Sheree M Schrager
- Department of Graduate Studies and Research, California State University, Dominguez Hills, Carson, CA 90747, USA
| | | | - Cary Klemmer
- Sexuality, Relationship, Gender Research Collective, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ian W Holloway
- Department of Social Welfare, Luskin School of Public Affairs, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Carl A Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA
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Davis JP, Prindle J, Saba SK, Tran DD, Lee DS, Sedano A, Castro CA, Pedersen ER. Changes in perceived stress during the COVID-19 pandemic among American veterans. Stress Health 2022; 38:1014-1028. [PMID: 35460535 PMCID: PMC9111081 DOI: 10.1002/smi.3153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/16/2022] [Accepted: 04/12/2022] [Indexed: 12/16/2022]
Abstract
American veterans are a population that suffer from both context specific stressors as well as many population-specific major-life events. The present exploratory study utilises a longitudinal cohort of 1230 U.S. veterans surveyed from February 2020 through February 2021. We sought to understand heterogeneity in perceived stress, using growth mixture modelling, over this time period, how COVID-specific factors such as negative reactions to the pandemic, loneliness, and employment disruptions influence perceived stress trajectories, and how veterans vary across distal outcomes including posttraumatic stress disorder (PTSD), pain, depression, sleep problems, physical health, and alcohol use disorder. Results revealed a 4-class solution: Stable High, Stable Low, Steady Increasing, and Steady Decreasing classes. In terms of COVID specific factors, negative reactions to COVID were consistently associated with perceived stress for those in the Stable High and Steady Increasing classes whereas loneliness was associated with stress trajectories for all emergent classes. Finally, in terms of our distal outcomes, results showed a relatively robust pattern with veterans in the Stable High or Steady Increasing classes reporting worse scores across all outcomes including PTSD, pain, sleep problems, physical health, depression, and alcohol use disorder. Understanding the interplay between existing vulnerabilities, ongoing stressors, and behavioural health outcomes among veterans is crucial for prevention and intervention efforts.
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Affiliation(s)
- Jordan P. Davis
- Suzanne Dworak‐Peck School of Social WorkUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - John Prindle
- Suzanne Dworak‐Peck School of Social WorkUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Shaddy K. Saba
- Suzanne Dworak‐Peck School of Social WorkUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Denise D. Tran
- Department of Psychiatry and Behavioral SciencesUniversity of Southern CaliforniaKeck School of MedicineLos AngelesCaliforniaUSA
| | - Daniel S. Lee
- Department of Psychiatry and Behavioral SciencesUniversity of Southern CaliforniaKeck School of MedicineLos AngelesCaliforniaUSA
| | - Angeles Sedano
- Department of Psychiatry and Behavioral SciencesUniversity of Southern CaliforniaKeck School of MedicineLos AngelesCaliforniaUSA
| | - Carl A. Castro
- Suzanne Dworak‐Peck School of Social WorkUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Eric R. Pedersen
- Department of Psychiatry and Behavioral SciencesUniversity of Southern CaliforniaKeck School of MedicineLos AngelesCaliforniaUSA
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5
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O'Loughlin JI, Cox DW, Ogrodniczuk JS, Castro CA. Traditional masculinity ideology and psychotherapy treatment outcome for military service veteran men. Psychology of Men & Masculinities 2022. [DOI: 10.1037/men0000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Sullivan KS, Dodge J, Park Y, Kale C, Merrill JC, Clarke-Walper K, Castro CA, Riviere LA. Predictors of reintegration adjustment among female U.S. Army spouses: A preliminary exploration. Journal of Military, Veteran and Family Health 2022. [DOI: 10.3138/jmvfh-2021-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
LAY SUMMARY Little is known about how military families navigate the challenges they experience during reintegration, the period after a deployment separation when a service member returns home and families must readjust to their presence. This study considers how family risk factors such as the mental health of both partners and protective factors such as social support and participation in military-sponsored training influence family adjustment during reintegration. Military spouses who reported having more social support were likely to report that their families adjusted more quickly during reintegration. However, spouses who expressed concern about a partner’s mental health were less likely to feel prepared for reintegration and, in turn, were more likely to report that their families adjusted more slowly. The results of this study suggest that supporting military spouses in feeling more prepared for reintegration may be an important means to shorten the adjustment period after a deployment.
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Affiliation(s)
- Kathrine S. Sullivan
- Silver School of Social Work, New York University, New York, New York, United States
| | - Jessica Dodge
- Center for Clinical Management Research, Ann Arbor Veterans Affairs Hospital, Ann Arbor, Michigan, United States
| | - Yangjin Park
- Silver School of Social Work, New York University, New York, New York, United States
| | - Caroline Kale
- Silver School of Social Work, New York University, New York, New York, United States
| | - Julie C. Merrill
- U.S. Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Washington, District of Columbia, United States
| | - Kristina Clarke-Walper
- Center for Military Psychiatry & Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States
| | - Carl A. Castro
- Center for Innovation and Research on Veterans and Military Families, University of Southern California, Los Angeles, California, United States
| | - Lyndon A. Riviere
- Center for Military Psychiatry & Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States
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Davis JP, Prindle J, Saba SK, DiGuiseppi GT, Hummer J, Lee DS, Fitzke R, Sedano A, Castro CA, Pedersen ER. What's sleep got to do with it? Longitudinal associations between insomnia, PTSD, and alcohol use among U.S. Veterans. Addict Behav 2022; 132:107358. [PMID: 35552069 DOI: 10.1016/j.addbeh.2022.107358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/20/2022] [Accepted: 05/03/2022] [Indexed: 12/30/2022]
Abstract
U.S. veterans are at risk for insomnia, which often co-occurs with symptoms of posttraumatic stress disorder (PTSD) and alcohol use. Much of the research on veterans and these three constructs is cross-sectional and focused on unidirectional pathways. Recent theoretical and empirical evidence suggests a dynamic interplay between insomnia, PTSD, and alcohol use, yet few longitudinal studies exist. A clearer understanding of these pathways is needed to help inform integrated treatments. Using a sample of 1,230 post-9/11 veterans assessed over four time points across 12 months, we used a latent difference score modeling approach to examine proportional and dynamic change between insomnia, PTSD, and alcohol. Results revealed a complex interplay between all three constructs. Higher prior levels of both PTSD and alcohol use were associated with greater subsequent changes in insomnia symptoms (i.e., worse sleep). Moreover, although veterans drank less frequently as their insomnia symptoms worsened over time, greater changes in insomnia symptoms (i.e., worse symptoms) was a mechanism linking PTSD and more frequent drinking. As the research on interventions addressing insomnia, PTSD, and alcohol is limited, there are opportunities for researchers and clinicians to develop programs that effectively target all three in integrated treatments.
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8
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Markowitz FE, Kintzle S, Castro CA. Military-to-civilian transition strains and risky behavior among post-9/11 veterans. Military Psychology 2022; 35:38-49. [PMID: 37130561 DOI: 10.1080/08995605.2022.2065177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Many military veterans face significant challenges in civilian reintegration that can lead to troublesome behavior. Drawing on military transition theory (MTT) and using data from a survey of post-9/11 veterans in two metropolitan areas (n = 783), we investigate previously unexamined relationships between post-discharge strains, resentment, depression, and risky behavior, taking into account a set of control variables, including combat exposure. Results indicated that unmet needs at time of discharge and perceived loss of military identity are associated with increased risky behavior. Much of the effects of unmet discharge needs and loss of military identity are mediated by depression and resentment toward civilians. The results of the study are consistent with insights from MTT, providing evidence of specific ways in which transitions can affect behavioral outcomes. Moreover, the findings highlight the importance of helping veterans meet their post-discharge needs and adapt to changing identity, in order to reduce the risk of emotional and behavioral problems.
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Affiliation(s)
- Fred E. Markowitz
- Department of Sociology, Northern Illinois University, DeKalb, Illinois, USA
| | - Sara Kintzle
- School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Carl A. Castro
- School of Social Work, University of Southern California, Los Angeles, California, USA
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9
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Porter B, Carey FR, Roenfeldt KA, Rull RP, Castro CA. A temporal analysis of mental health symptoms relative to separation from the military. Depress Anxiety 2022; 39:334-343. [PMID: 35343604 DOI: 10.1002/da.23246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 02/17/2022] [Accepted: 02/26/2022] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The transition from military to civilian life is a dramatic change that is often stressful for veterans. However, little is known regarding how mental health symptoms fluctuate in the period leading up to and following separation from the military. METHODS The current study examined posttraumatic stress disorder and depression symptoms reported on surveys completed within 1 year of military separation from 23,887 active duty Millennium Cohort Study participants. A series of general linear models and graphs stratified by demographic and military characteristics examined the association between time until/since separation and mental health symptoms. RESULTS Character of discharge had the most striking relationship between time until/since separation and mental health. Personnel with Honorable discharges did not differ in their level of mental health symptoms across the study period. In contrast, personnel with Other than Honorable/General discharges reported normal levels of mental health symptoms 1 year-prior to separation but reported progressively greater symptoms leading to separation which persisted through the remainder of study period. CONCLUSIONS This study suggests that additional outreach is needed for personnel with Other than Honorable/General discharges. However, for most other personnel, increased mental health symptomatology around military separation is not a normative phenomenon and any instance should be treated promptly.
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Affiliation(s)
- Ben Porter
- Leidos, Inc., Reston, Virginia, USA.,Military Population Health, Naval Health Research Center, San Diego, California, USA.,Department of Psychology, Mississippi State University, Starkville, Mississippi, USA
| | - Felicia R Carey
- Leidos, Inc., Reston, Virginia, USA.,Military Population Health, Naval Health Research Center, San Diego, California, USA
| | | | - Rudolph P Rull
- Military Population Health, Naval Health Research Center, San Diego, California, USA
| | - Carl A Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
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Abstract
Moral injury has emerged as a topic of significant research and clinical interest over the last decade. However, much work remains to be done to comprehensively define the moral injury construct, with implications for understanding the etiology and maintenance of moral injury, its symptoms, associations with and distinctions from traumatic illness, and treatment approaches. We provide a brief overview of the existing moral injury literature and introduce a novel dual process model (DPM) of moral injury and traumatic illness. The DPM posits an event exposure which may satisfy DSM-5 posttraumatic stress disorder (PTSD) criterion A, potential morally injurious event (PMIE) criteria, or both, followed by individual role appraisal as a perpetrator through action or inaction, a witness, a victim, or a combination of the these. Role appraisal influences symptoms and processes across biological, psychological, behavioral, social, spiritual/religious, as well as values, character, and identity domains to support a label of traumatic illness, moral injury, or both. The DPM provides a flexible analytical framework for evaluating symptoms associated with moral injury and traumatic stress and has important implications for treatment. The most thoroughly reviewed evidence-based interventions for traumatic stress hinge on exposure and habituation mechanisms to manage dysregulation of fear and memory systems, but these mechanisms often do not address core domains of moral injury identified in the DPM, including spiritual, religious, values, character, and identity domains as these exist largely outside of the putative fear network. We provide brief vignettes to illustrate the practical application of the DPM and argue that adjunct and stand-alone approaches which address values and character domains, leveraging principles of Stoicism, non-judgment of experience, acceptance, and values-oriented action, are more likely than traditional trauma treatment approaches to positively affect moral injury symptoms.
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Affiliation(s)
- Nicholas Barr
- School of Social Work, University of Nevada, Las Vegas, Las Vegas, NV, United States
| | - Hazel Atuel
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States.,Center for Innovation and Research on Veterans and Military Families, University of Southern California, Los Angeles, CA, United States
| | - Shaddy Saba
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Carl A Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States.,Center for Innovation and Research on Veterans and Military Families, University of Southern California, Los Angeles, CA, United States
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Kintzle S, Rivas WA, Castro CA. Satisfaction of the Use of Telehealth and Access to Care for Veterans During the COVID-19 Pandemic. Telemed J E Health 2021; 28:706-711. [PMID: 34551276 DOI: 10.1089/tmj.2021.0262] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: While many health care providers have shifted toward telehealth services in response to the COVID-19 pandemic, little is known about the perception and acceptance of such services, particularly among vulnerable populations. Veterans, who are at increased risk of physical and mental health needs, may benefit from the use and availability of telehealth services. Materials and Methods: Cross sectional survey data related to telehealth use, satisfaction, and access were collected through an online survey. Participants from previous research studies and veterans receiving care at a national veteran behavioral health organization were invited to participate. Results: A total of 404 veterans participated. Before the pandemic, many veterans had never used telehealth for physical (72%) or mental (76%) health care. Since the start of the pandemic, 62% of participants reported they received some care through telehealth services. Most participants found telehealth valuable and helpful (82%), indicated the technology was well explained (77%), and felt that issues were resolved quickly and easily (67%). Access to care was limited among participants who utilize massage therapy (64%), dental care (53%), routine checkups (50%), acupuncture (50%), and physical therapy (48%). Discussion: These findings showed an increase in the use of telehealth services and overwhelming satisfaction among veterans. Despite this, some veterans indicated barriers to receiving physical and mental health care. Conclusions: This provides an opportunity to expand the use of telehealth services to meet the health care needs of veterans. Barriers to care should be addressed to minimize the impact on the well-being of veterans.
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Affiliation(s)
- Sara Kintzle
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Wilmer A Rivas
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Carl A Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
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12
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Sullivan KS, Dodge J, McNamara KA, Gribble R, Keeling M, Taylor-Beirne S, Kale C, Goldbach JT, Fear NT, Castro CA. Perceptions of family acceptance into the military community among U.S. LGBT service members: A mixed-methods study. Journal of Military, Veteran and Family Health 2021. [DOI: 10.3138/jmvfh-2021-0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
LAY SUMMARY There are approximately 16,000 families of lesbian, gay, bisexual, or transgender (LGBT) service members in the U.S. military, but very little is known about how accepted they feel in the communities in which they live. This study begins to address this question by considering the perspectives of LGBT service members, which they shared both in response to an online survey and in interviews. Findings suggest that many service members believe their spouses and families are accepted by their chain of command. However, a smaller but important group continued to express concerns about their family being accepted in their military community. Many service members appear concerned that family services available to them through the military are not appropriate for LGBT families. Altogether, this article highlights the need for more research to understand the well-being and needs of this group.
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Affiliation(s)
- Kathrine S. Sullivan
- Silver School of Social Work, New York University, New York, New York, United States
| | - Jessica Dodge
- Center for Innovation and Research on Veterans and Military Families, University of Southern California, Los Angeles, California, United States
| | | | - Rachael Gribble
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
| | - Mary Keeling
- Department of Social Sciences, University of the West of England, Bristol, United Kingdom
| | - Sean Taylor-Beirne
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
| | - Caroline Kale
- Silver School of Social Work, New York University, New York, New York, United States
| | - Jeremy T. Goldbach
- Center for Innovation and Research on Veterans and Military Families, University of Southern California, Los Angeles, California, United States
| | - Nicola T. Fear
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
| | - Carl A. Castro
- Center for Innovation and Research on Veterans and Military Families, University of Southern California, Los Angeles, California, United States
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Beltran RM, Schuyler AC, Blair CS, Goldbach JT, Castro CA, Holloway IW. "That's kind of like the big struggle right now is can we get PrEP?": Facilitators and Barriers to PrEP Uptake Among Active Duty Gay and Bisexual Men. Sex Res Social Policy 2021; 20:413-425. [PMID: 37250806 PMCID: PMC10212805 DOI: 10.1007/s13178-021-00622-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 05/27/2023]
Abstract
Introduction The US Military is experiencing a rise in HIV infections among gay and bisexual men (GBM) serving on active duty, yet little is known about this population's uptake of pre-exposure prophylaxis (PrEP), an evidence-based intervention for HIV prevention. This mixed methods study examines the facilitators and barriers to PrEP access and uptake among active duty GBM. Methods Active duty GBM were recruited using respondent-driven sampling (2017 and 2018). Participants (n = 93) answered quantitative survey questions on PrEP interest and accessibility. Another set of participants (n = 10) discussed their PrEP experiences in qualitative interviews. We conducted descriptive and bivariate analyses of quantitative data, while qualitative data were analyzed using structural and descriptive coding techniques. Results Approximately 71% of active duty GBM indicated interest in accessing PrEP. A greater proportion of those who disclosed (vs. did not disclose) their sexual orientation to their military doctor discussed (p < 0.001) or accessed (p = 0.017) PrEP. The following qualitative themes emerged: (1) providers' negative views and knowledge gaps related to PrEP; (2) lack of a systems approach to PrEP access; (3) confidentiality concerns; and (4) reliance on peer networks for PrEP guidance and support. Conclusions Study results indicate that active duty GBM are interested in and want to discuss PrEP with their military doctors, but gaps in providers' PrEP-related knowledge and skills, as well as mistrust in the military health care system, remain. Policy Implications A system-wide approach that addresses confidentiality concerns and removes procedural barriers to PrEP access is recommended to improve PrEP uptake in this population.
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Affiliation(s)
- Raiza M. Beltran
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA USA
| | - Ashley C. Schuyler
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR USA
| | - Cherie S. Blair
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA USA
| | - Jeremy T. Goldbach
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA USA
| | - Carl A. Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA USA
| | - Ian W. Holloway
- Department of Social Welfare, School of Public Affairs, UCLA Luskin, University of California, Los Angeles, Los Angeles, CA USA
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Sullivan KS, Hawkins SA, Gilreath TD, Castro CA. Mental Health Outcomes Associated with Risk and Resilience among Military-Connected Youth. Fam Process 2021; 60:507-522. [PMID: 32981035 PMCID: PMC7997811 DOI: 10.1111/famp.12596] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The present study aimed to describe patterns of risk and protective factors affecting U.S. Army families and their association with mental health diagnoses among military-connected children. Wartime military service is associated with increased adverse outcomes for military-connected youth, but few studies have explored the impact of concurrent risk and access to protective factors. Using big data methods to link existing datasets, protective factors (e.g., marital and family functioning) were drawn from a voluntary survey completed by 1,630 US Army spouses. Risk factors (e.g., parent mental health, family moves, deployment) were drawn from Department of Defense (DoD) archival data. Rates of mental health diagnoses among youth were derived from DoD healthcare records. Using the three-step method of latent profile analysis, five profiles emerged with variability across risk and protective factors. The largest group (40% of the sample) had considerable protective factors and limited risk exposure. Statistically significant differences in the prevalence of mental health diagnoses among military-connected youth were observed across profiles (χ2 = 30.067, df = 4, p < .001), with the highest rates (31.1% and 30.5%) observed in the two profiles with the lowest protective factors. Findings suggest most military families are faring well and highlight the importance of a thorough assessment that evaluates both the stressors military families face and the strengths they possess.
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Affiliation(s)
| | - Stacy Ann Hawkins
- Research Facilitation Laboratory, Army Analytics Group, Monterey, CA, USA
| | - Tamika D Gilreath
- Department of Health and Kinesiology, Transdisciplinary Center for Health Equity Research, Texas A&M University, College Station, TX, USA
| | - Carl A Castro
- Center for Innovation and Research on Veterans and Military Families, University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, CA, USA
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15
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O’Loughlin JI, Cox DW, Castro CA, Ogrodniczuk JS. Disentangling the Individual and Group Effects of Masculinity Ideology on PTSD Treatment. Counselling Psychology Quarterly 2021. [DOI: 10.1080/09515070.2021.1922359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Julia I. O’Loughlin
- Department of Educational & Counselling Psychology, and Special Education, University of British Columbia, Counselling Psychology Program, Vancouver, BC, Canada
| | - Daniel W. Cox
- Department of Educational & Counselling Psychology, and Special Education, University of British Columbia, Counselling Psychology Program, Vancouver, BC, Canada
| | - Carl A. Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, School of Social Work, Los Angeles, California, USA
| | - John S. Ogrodniczuk
- University of British Columbia, Department of Psychiatry, Vancouver, BC Canada
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16
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Sullivan KS, Hawkins SA, Gilreath TD, Castro CA. Mental health outcomes associated with profiles of risk and resilience among U.S. Army spouses. J Fam Psychol 2021; 35:33-43. [PMID: 32437203 PMCID: PMC7679271 DOI: 10.1037/fam0000702] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The current study examined patterns of risk and protective factors among military families and associations with mental health diagnoses among U.S. Army spouses. Spouses (N = 3,036) completed a survey of family psychosocial fitness, which informed protective factors including coping, family cohesion, and social support. Survey results were linked with Department of Defense archival data, which provided information on military-specific risks, including relocation, deployments, and reunification, as well as mental health care diagnoses. The three-step method of latent profile analysis identified six profiles, suggesting significant heterogeneity in military families with respect to their access to resources and exposure to risk. The largest profile of families (40.48% of the sample) had limited risk exposure and considerable strengths. Variability in risk and protection across profiles was associated with statistically significant differences in the prevalence of mental health diagnoses among spouses (χ² = 108.968, df = 5, p < .001). The highest prevalence of mental health diagnoses among Army spouses (41.2%) was observed in the profile with the lowest levels of protective factors. Findings point to the importance of evaluating both concurrent risk and protective factors. Increasing access to resources may be a fruitful avenue for prevention among military families that are struggling. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Carl A Castro
- Center for Innovation and Research on Veterans and Military Families
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17
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Holloway IW, Green D, Pickering C, Wu E, Tzen M, Goldbach JT, Castro CA. Mental Health and Health Risk Behaviors of Active Duty Sexual Minority and Transgender Service Members in the United States Military. LGBT Health 2021; 8:152-161. [PMID: 33538639 PMCID: PMC8336224 DOI: 10.1089/lgbt.2020.0031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: The aim of this study was to examine health risk behaviors and mental health outcomes among sexual minority and transgender active duty military service members and their heterosexual and cisgender counterparts. Methods: Participants (N = 544) were recruited by using respondent-driven sampling between August 2017 and March 2018 and completed an online survey by using validated measures of cigarette smoking, alcohol use, anxiety, depression, post-traumatic stress disorder (PTSD), and suicidality. Bayesian random intercept multiple logistic regressions were used to understand differences between sexual minority participants and heterosexual participants as well as between transgender participants and both their cisgender sexual minority and cisgender heterosexual peers. Results: Cisgender sexual minority women service members were more likely to meet criteria for problematic alcohol use (adjusted odds ratio [aOR] = 10.11) and cigarette smoking (aOR = 7.12) than cisgender heterosexual women. Cisgender sexual minority men had greater odds of suicidality (aOR = 4.73) than their cisgender heterosexual counterparts. Transgender service members had greater odds of anxiety, PTSD, depression, and suicidality than their cisgender peers. Conclusion: Military researchers and policymakers who seek to improve the overall health and well-being of sexual minority and transgender service members should consider programs and policies that are tailored to specific health outcomes and unique sexual minority and transgender subgroups.
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Affiliation(s)
- Ian W. Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California, USA
| | - Daniel Green
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Chad Pickering
- Department of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
- California Center for Population Research, University of California, Los Angeles, Los Angeles, California, USA
| | - Elizabeth Wu
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California, USA
| | - Michael Tzen
- California Center for Population Research, University of California, Los Angeles, Los Angeles, California, USA
| | - Jeremy T. Goldbach
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Carl A. Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
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18
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Blair CS, Dunlap S, Tzen M, Castro CA, Goldbach JT, Holloway IW. Mental Health, Sexual Orientation, and Perceived Social Network Support in Relation to Hazardous Alcohol Consumption Among Active Duty Military Men. Am J Mens Health 2020; 14:1557988320976306. [PMID: 33267728 PMCID: PMC7720330 DOI: 10.1177/1557988320976306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 12/02/2022] Open
Abstract
Knowledge surrounding perceived network support and alcohol consumption among active duty U.S. military personnel is limited, particularly among sexual minorities.We sought to determine the correlates of hazardous alcohol consumption and whether perceived network support moderated the relationship between sexual orientation and Alcohol Use Identification Test (AUDIT-C) score.The sample comprised cisgender men currently serving in the U.S. military (N = 292). Participants were recruited through respondent-driven sampling and completed an online survey. Logistic regression analysis evaluated associations between positive AUDIT-C with sociodemographic characteristics (including sexual orientation), military service, mental health, and perceived social network support. Interaction analysis assessed the moderating effect of perceived network support on sexual orientation and AUDIT-C.Among study participants, 52.7% (154/292) had positive AUDIT-C, while 65.4% (191/292) self-identified as heterosexual/straight and 34.6% (101/292) identified as gay or bisexual. In adjusted analysis, positive AUDIT-C was associated with increased post-traumatic stress disorder symptomatology (adjusted odds ratio [adjOR] 1.03; 95% CI [1.00, 1.06]; p = .019) and high perceived network support (adjOR 1.85; 95% CI [1.04, 3.29]; p = .036), while mental health service utilization had reduced odds of positive AUDIT-C (adjOR 0.40; 95% CI [0.20, 0.78]; p = .007). In interaction analysis, high perceived network support was associated with increased odds of positive AUDIT-C among sexual minority men (adjOR 3.09; 95% CI [1.21, 7.93]; p = .019) but not heterosexual men (adjOR 1.38; 95% CI [0.68, 2.81]; p = .37).Hazardous alcohol use was prevalent among all men in our sample. Perceived social network support may influence hazardous alcohol consumption, particularly among sexual minority servicemen. These findings suggest the potential role of tailored social network-based interventions to decrease hazardous alcohol use among military personnel.
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Affiliation(s)
- Cheríe S. Blair
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Shannon Dunlap
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA, USA
| | - Michael Tzen
- California Center for Population Research, University of California, Los Angeles, CA, USA
| | - Carl A. Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Jeremy T. Goldbach
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Ian W. Holloway
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA, USA
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Shelton CJ, Kim A, Hassan AM, Bhat A, Barnello J, Castro CA. System-wide implementation of telehealth to support military Veterans and their families in response to COVID-19: A paradigm shift. Journal of Military, Veteran and Family Health 2020. [DOI: 10.3138/jmvfh-co19-0003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The need for the expansion of telehealth services in behavioural health care existed long before the COVID-19 pandemic. Yet, for a variety of reasons – including technological costs, reluctance of behavioural care providers to adapt telehealth to their practices, privacy concerns, and client aversion to receiving care remotely, among many others– telehealth has not been widely implemented. However, the COVID-19 crisis, and the accompanying social isolation that ensued, necessitated either a swift transition to telehealth delivery of behavioural health care, the termination of behavioural health care, or the clinician continuing to meet face-to-face with clients, placing both the clinician and the client at increased risk of infection. Shifting behavioural health care to a telehealth platform seemed the most sensible and, quite candidly, the only option, although many clinics still operate employing the face-to-face modality. In this article, we describe how an emerging national behavioural health care network, Cohen Veterans Network (CVN) in the United States, rapidly and relatively seamlessly transitioned to a full-service, virtual network of outpatient behavioural health clinics when faced with a national crisis.
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Affiliation(s)
| | - Alice Kim
- Cohen Veterans Network, Silver Spring, Maryland, United States
| | | | - Aaditya Bhat
- Cohen Veterans Network, Silver Spring, Maryland, United States
| | - Jeff Barnello
- Cohen Veterans Network, Silver Spring, Maryland, United States
| | - Carl A. Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, United States
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20
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Shelton CJ, Kim A, Hassan AM, Bhat A, Barnello J, Castro CA. System-wide implementation of telehealth to support military Veterans and their families in response to COVID-19: A paradigm shift. Journal of Military, Veteran and Family Health 2020. [DOI: 10.3138/jmvfh-6.s2-co19-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | - Alice Kim
- Cohen Veterans Network, Silver Spring, Maryland, United States
| | | | - Aaditya Bhat
- Cohen Veterans Network, Silver Spring, Maryland, United States
| | - Jeff Barnello
- Cohen Veterans Network, Silver Spring, Maryland, United States
| | - Carl A. Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, United States
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21
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Keeling M, Barr N, Atuel H, Castro CA. Symptom Severity, Self-efficacy and Treatment-Seeking for Mental Health Among US Iraq/Afghanistan Military Veterans. Community Ment Health J 2020; 56:1239-1247. [PMID: 32064566 PMCID: PMC7434717 DOI: 10.1007/s10597-020-00578-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 02/11/2020] [Indexed: 12/04/2022]
Abstract
Military veterans have high rates of mental health problems, yet the majority do not seek treatment. Understanding treatment-seeking in this population is important. This study investigated if symptom severity and self-efficacy are associated with treatment-seeking among US Iraq/Afghanistan veterans. Survey data from 525 veterans meeting clinical criteria for PTSD and depression were included of which, 54.4% had sought treatment in the past 12 months. Multivariate logistic regression analysis indicated that high symptom severity was associated with treatment seeking, whereas high self-efficacy was associated with a decreased likelihood to seek treatment. Self-efficacy could be an underlying mechanism of treatment seeking decisions.
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Affiliation(s)
- Mary Keeling
- Department of Health and Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Frenchey Campus, Coldharbour Road, Bristol, BS16 1QY, UK.
| | - Nicholas Barr
- Center for Innovation and Research on Veterans & Military Families, USC Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 South Olive Street, Suite 1400, Los Angeles, CA, 90015, USA
| | - Hazel Atuel
- Center for Innovation and Research on Veterans & Military Families, USC Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 South Olive Street, Suite 1400, Los Angeles, CA, 90015, USA
| | - Carl A Castro
- Center for Innovation and Research on Veterans & Military Families, USC Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 South Olive Street, Suite 1400, Los Angeles, CA, 90015, USA
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22
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Sullivan KS, Hawkins SA, Gilreath TD, Castro CA. Preliminary Psychometrics and Potential Big Data Uses of the U.S. Army Family Global Assessment Tool. ACTA ACUST UNITED AC 2020; 8:74-85. [PMID: 32884854 DOI: 10.1080/21635781.2019.1676334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of the present study is to explore the psychometric properties of the U.S. Army's Family Global Assessment Tool (GAT), which assesses the psychosocial fitness of Army families. With data from 1,692 Army spouses, we examined the structure, reliability and validity of the GAT, using confirmatory factor analysis (CFA) and two validity studies. Fifty-three items and 9 factors were retained following CFA. This model provided a good fit, and scales demonstrated strong internal consistency. Bivariate correlations and results from a theoretically driven model provide preliminary evidence of validity. Findings support the usefulness of the GAT for measuring psychosocial fitness of Army spouses.
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Affiliation(s)
- Kathrine S Sullivan
- New York University, Silver School of Social Work, 1 Washington Square North, New York, NY 10003
| | - Stacy A Hawkins
- Research Facilitation Laboratory, Army Analytics Group, 20 Ryan Ranch Road, Suite 170, Monterey, CA 93940
| | - Tamika D Gilreath
- Transdisciplinary Center for Health Equity Research, Texas A&M University Department of Health and Kinesiology, College Station, TX 77843
| | - Carl A Castro
- Center for Innovation and Research on Veterans and Military Families, University of Southern California School of Social Work, 1150 S. Olive Street, Suite 1400, Los Angeles, CA 90015
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23
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Gribble R, Mahar AL, Keeling M, Sullivan K, McKeown S, Burchill S, Fear NT, Castro CA. Are we family? A scoping review of how military families are defined in mental health and substance use research. Journal of Military, Veteran and Family Health 2020. [DOI: 10.3138/jmvfh-2019-0054] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: While some families may experience poor mental health, substance use, and poor school performance due to service life, the usefulness and applicability of these research findings may be affected by how representative study participants are of the broader population. This article aims to examine how research on mental health and substance use defines a “military family” to understand if the current body of evidence reflects the increasing diversity of this population. Methods: A systematic search of academic articles was conducted in Ovid MEDLINE, Ovid Embase, Ovid PsycINFO, Ebsco CINAHL and ProQuest PILOTS using database-specific subject headings and keyword searches for ‘military’, ‘family’, ‘mental health’ and ‘substance use’. Sociodemographic and military characteristics of study participants were extracted to identify who was and was not included. Results: The most commonly represented family structure was the traditional, heteronormative family comprised of a male service member married to a female civilian with whom they have children. Military couples without children, dual-serving couples, families of LGBTQ personnel, unmarried and new relationships, single parents, male spouses/partners, Veterans not seeking Veterans Affairs (VA) services, and families with additional challenges were regularly not reflected in the research due to implicit or explicit exclusion from studies. Discussion: Research on mental health and substance use among the family members of service personnel continues to reflect the traditional, heteronormative family. Future studies should consider more inclusive definitions of family and creative approaches to recruitment to ensure research in this area reflects the experiences, needs, and strengths of an increasingly diverse military community.
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Affiliation(s)
- Rachael Gribble
- King’s Centre for Military Health Research (KCMHR), Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Alyson L. Mahar
- Manitoba Centre for Health Policy, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mary Keeling
- Center for Innovation and Research on Veterans and Military Families, University of Southern California, Los Angeles, California, USA
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Bristol, United Kingdom
| | - Kate Sullivan
- Center for Innovation and Research on Veterans and Military Families, University of Southern California, Los Angeles, California, USA
- Silver School of Social Work, New York University, New York, New York, USA
| | - Sandra McKeown
- Bracken Health Sciences Library, Queen’s University, Kingston, Ontario, Canada
| | - Susan Burchill
- Manitoba Centre for Health Policy, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicola T. Fear
- King’s Centre for Military Health Research (KCMHR), Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Academic Department of Military Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Carl A. Castro
- Center for Innovation and Research on Veterans and Military Families, University of Southern California, Los Angeles, California, USA
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24
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Kintzle S, Schuyler AC, Alday-Mejia E, Castro CA. The continuum of sexual trauma: An examination of stalking and sexual assault in former US service members. Military Psychology 2019. [DOI: 10.1080/08995605.2019.1664367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Sara Kintzle
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Ashley C. Schuyler
- College of Public Health and Human Services, Oregon State University, Corvallis, Oregon
| | - Eva Alday-Mejia
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Carl A. Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
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25
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Milan-Mattos JC, Anibal FF, Perseguini NM, Minatel V, Rehder-Santos P, Castro CA, Vasilceac FA, Mattiello SM, Faccioli LH, Catai AM. Effects of natural aging and gender on pro-inflammatory markers. ACTA ACUST UNITED AC 2019; 52:e8392. [PMID: 31411315 PMCID: PMC6694726 DOI: 10.1590/1414-431x20198392] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 06/25/2019] [Indexed: 12/21/2022]
Abstract
The term inflammaging is now widely used to designate the inflammatory process of natural aging. During this process, cytokine balance is altered, presumably due to the loss of homeostasis, thus contributing to a greater predisposition to disease and exacerbation of chronic diseases. The aim of the study was to analyze the relationship between pro-inflammatory markers and age in the natural aging process of healthy individuals. One hundred and ten subjects were divided into 5 groups according to age (22 subjects/group). Interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) were quantified using the ELISA method. High-sensitivity C-reactive protein (hsCRP) was analyzed by turbidimetry according to laboratory procedures. The main findings of this study were: a positive correlation between hsCRP and IL-6 as a function of age (110 subjects); women showed stronger correlations; the 51–60 age group had the highest values for hsCRP and IL-6; women presented higher values for hsCRP in the 51–60 age group and higher values for IL-6 in the 61–70 age group; and men showed higher values in the 51–60 age group for hsCRP and IL-6. In conclusion, the natural aging process increased IL-6 and hsCRP levels, which is consistent with the inflammaging theory; however, women presented stronger correlations compared to men (IL-6 and hsCRP) and the 51–60 age range seems to be a key point for these increases. These findings are important because they indicate that early preventive measures may minimize the increase in these inflammatory markers in natural human aging.
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Affiliation(s)
- J C Milan-Mattos
- Laboratório de Fisioterapia Cardiovascular, Núcleo de Pesquisas em Exercício Físico, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil.,Departamento de Morfologia e Patologia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - F F Anibal
- Departamento de Morfologia e Patologia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - N M Perseguini
- Laboratório de Fisioterapia Cardiovascular, Núcleo de Pesquisas em Exercício Físico, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - V Minatel
- Laboratório de Fisioterapia Cardiovascular, Núcleo de Pesquisas em Exercício Físico, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - P Rehder-Santos
- Laboratório de Fisioterapia Cardiovascular, Núcleo de Pesquisas em Exercício Físico, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - C A Castro
- Departamento de Morfologia e Patologia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - F A Vasilceac
- Laboratório de Função Articular, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - S M Mattiello
- Laboratório de Função Articular, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - L H Faccioli
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A M Catai
- Laboratório de Fisioterapia Cardiovascular, Núcleo de Pesquisas em Exercício Físico, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
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26
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Affiliation(s)
- Kathleen A. McNamara
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | | | - Jeremy T. Goldbach
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Sara Kintzle
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Carl A. Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
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27
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Sullivan K, Kintzle S, Barr N, Gilreath TD, Castro CA. Veterans’ social–emotional and physical functioning informs perceptions of family and child functioning. Journal of Military, Veteran and Family Health 2018. [DOI: 10.3138/jmvfh.2017-0008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | - Sara Kintzle
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Nicholas Barr
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Tamika D. Gilreath
- Department of Health and Kinesiology, Transdisciplinary Center for Health Equity Research, Texas A&M University, College Station, Texas, USA
| | - Carl A. Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
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28
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Huffman AH, Dunbar N, Broom TW, Castro CA. Soldiers’ perspectives of the Married Army Couples Program: A review of perceived problems and proposed solutions. Military Psychology 2018. [DOI: 10.1080/08995605.2018.1478537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ann Hergatt Huffman
- Department of Psychological Sciences and W. A. Franke College of Business, Northern Arizona University, Flagstaff, Arizona
| | - Nora Dunbar
- Department of Psychological Sciences, Northern Arizona University, Flagstaff, Arizona
| | - Timothy W. Broom
- Department of Psychological Sciences, Northern Arizona University, Flagstaff, Arizona
| | - Carl A. Castro
- Center for Innovation and Research on Veterans, Military Families (CIR), USC School of Social Work University of Southern California, Los Angeles, California
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Abstract
Emerging evidence highlights employment as a key factor influencing the success of transition from military to civilian life. Historically, employment programs have focused on improving skills such as resume writing and interview skills. However, it is likely that employment challenges are more than these practical barriers. Four focus groups with employed and unemployed Gulf War Era II veterans were conducted aimed at moving past a practical perspective by gaining experiential understandings of veterans’ employment. Thematic analysis indicated that the veterans’ employment experiences were best understood temporally in two master themes: pretransition and the divergent experiences of veterans who did and did not plan ahead and living the transition and the veterans’ experiences of employment barriers and facilitators. Further to the two master themes, an underlying thread of the need for self-determination was evident. Interpretation of the results led to the development of recommendations for policy, service provision, and future research.
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Affiliation(s)
- Mary Elizabeth Keeling
- Center for Innovation and Research in Veterans and Military Families, University of Southern California, Los Angeles, CA, USA
| | - Sara M. Ozuna
- Center for Innovation and Research in Veterans and Military Families, University of Southern California, Los Angeles, CA, USA
| | - Sara Kintzle
- Center for Innovation and Research in Veterans and Military Families, University of Southern California, Los Angeles, CA, USA
| | - Carl A. Castro
- Center for Innovation and Research in Veterans and Military Families, University of Southern California, Los Angeles, CA, USA
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Porter B, Hoge CW, Tobin LE, Donoho CJ, Castro CA, Luxton DD, Faix D. Measuring Aggregated and Specific Combat Exposures: Associations Between Combat Exposure Measures and Posttraumatic Stress Disorder, Depression, and Alcohol-Related Problems. J Trauma Stress 2018; 31:296-306. [PMID: 29603393 DOI: 10.1002/jts.22273] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 12/27/2017] [Accepted: 01/05/2018] [Indexed: 11/09/2022]
Abstract
Research has shown combat exposure to be associated with negative mental health outcomes. Different combat exposure measures are not composed of the same combat experiences, and few combat exposure measures have been directly compared to another measure. Furthermore, research about the unique associations between specific combat experiences and mental health is lacking. We investigated associations between new-onset posttraumatic stress disorder (PTSD), new-onset depression, and alcohol-related problems and two commonly used measures of combat among a sample of 20,719 recently deployed U.S. military personnel. A 13-item measure assessed both direct and indirect combat exposures, and a 5-item measure assessed only indirect exposures. Both combat measures were associated with all outcomes in the same direction (e.g., PTSD, odds ratio [OR] = 2.97 vs. 4.01; depression, OR = 2.03 vs. 2.42; alcohol-related problems, OR = 1.41 vs. 1.62, respectively, for the 5- and 13-item measures). The 13-item measure had a stronger association with some outcomes, particularly PTSD. Each specific item had significant bivariate associations with all outcomes, ORs = 1.43-4.92. After adjusting for other combat exposures, items assessing witnessing abuse, feeling in danger, and knowing someone injured or killed remained associated with all outcomes, ORs = 1.18-2.72. After this adjustment, several items had unexpected protective associations with some mental health outcomes. Results indicated these two combat exposure measures were approximately equally effective for determining risk for negative mental health outcomes in a deployed population, despite having different content. Additional research is needed to replicate and understand how specific combat exposures affect health.
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Affiliation(s)
- Ben Porter
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Charles W Hoge
- Center for Military Psychiatry and Neuroscience Research, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Laura E Tobin
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Carrie J Donoho
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Carl A Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - David D Luxton
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Dennis Faix
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
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Affiliation(s)
- Mary Keeling
- Center for Innovation and Research in Veterans and Military Families, University of Southern California, Los Angeles, California
| | - Sara Kintzle
- Center for Innovation and Research in Veterans and Military Families, University of Southern California, Los Angeles, California
| | - Carl A. Castro
- Center for Innovation and Research in Veterans and Military Families, University of Southern California, Los Angeles, California
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Affiliation(s)
| | - Sara Kintzle
- USC Center for Innovation and Research on Veterans & Military Families, University of Southern California, Los Angeles, California, USA
| | - Carl A. Castro
- USC Center for Innovation and Research on Veterans & Military Families, University of Southern California, Los Angeles, California, USA
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Wood MD, Adler AB, Bliese PD, McGurk D, Castro CA, Hoge CW, Koffman R. Psychological Adjustment after Combat Deployment: Decompression at Home Versus at Sea. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/21635781.2017.1412842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Amy B. Adler
- Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Paul D. Bliese
- Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Dennis McGurk
- Medical Research and Materiel Command, Fort Detrick, Maryland
| | - Carl A. Castro
- Medical Research and Materiel Command, Fort Detrick, Maryland
| | - Charles W. Hoge
- Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Robert Koffman
- National Intrepid Center of Excellence, Bethesda, Maryland
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Schuyler AC, Kintzle S, Lucas CL, Moore H, Castro CA. Military sexual assault (MSA) among veterans in Southern California: Associations with physical health, psychological health, and risk behaviors. ACTA ACUST UNITED AC 2017. [DOI: 10.1037/trm0000098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hoge CW, Lee DJ, Castro CA. Refining Trauma-Focused Treatments for Servicemembers and Veterans With Posttraumatic Stress Disorder: Progress and Ongoing Challenges. JAMA Psychiatry 2017; 74:13-14. [PMID: 27893037 DOI: 10.1001/jamapsychiatry.2016.2740] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Charles W Hoge
- Center for Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Daniel J Lee
- Center for Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Carl A Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
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Hoge CW, Yehuda R, Castro CA, McFarlane AC, Vermetten E, Jetly R, Koenen KC, Greenberg N, Shalev AY, Rauch SAM, Marmar CR, Rothbaum BO. Unintended Consequences of Changing the Definition of Posttraumatic Stress Disorder in DSM-5: Critique and Call for Action. JAMA Psychiatry 2016; 73:750-2. [PMID: 27224895 DOI: 10.1001/jamapsychiatry.2016.0647] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Charles W Hoge
- Walter Reed Army Institute of Research, US Army Medical Research and Material Command, Silver Spring, Maryland
| | - Rachel Yehuda
- James J. Peters Veterans Affairs Medical Center, Bronx, New York3Icahn School of Medicine at Mount Sinai, New York, New York
| | - Carl A Castro
- School of Social Work, University of Southern California, Los Angeles
| | - Alexander C McFarlane
- Centre for Traumatic Stress Studies, University of Adelaide, Adelaide, South Australia, Australia
| | - Eric Vermetten
- Military Mental Health Research Center, Ministry of Defense, Utrecht, the Netherlands7Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands8Arq Psychotrauma Expert Group, Diemen, the Netherlands
| | - Rakesh Jetly
- Canadian Forces Health Services Group Headquarters, Directorate of Mental Health, Ottawa, Ontario, Canada
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts11Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Neil Greenberg
- The King's Centre for Military Health Research, King's College London, London, England
| | - Arieh Y Shalev
- Department of Psychiatry, NYU Langone Medical Center, New York, New York14Hadassah and Hebrew University School of Medicine, Jerusalem, Israel
| | - Sheila A M Rauch
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia16Mental Health Services, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU Langone Medical Center, New York, New York
| | - Barbara O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
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Timenetsky KT, Castro CA, Eid RC, Carnieli-Cazati D. Prevalence of burnout syndrome among physiotherapist working in intensive care units and step down unit. Intensive Care Med Exp 2015. [PMCID: PMC4797737 DOI: 10.1186/2197-425x-3-s1-a722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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McGurk D, Sinclair RR, Thomas JL, Merrill JC, Bliese PD, Castro CA. Destructive and Supportive Leadership in Extremis: Relationships With Post-Traumatic Stress During Combat Deployments. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/21635781.2014.963765] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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39
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Affiliation(s)
- Charles W Hoge
- Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Carl A Castro
- School of Social Work, University of Southern California, Los Angeles
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Vermetten E, Greenberg N, Boeschoten MA, Delahaije R, Jetly R, Castro CA, McFarlane AC. Deployment-related mental health support: comparative analysis of NATO and allied ISAF partners. Eur J Psychotraumatol 2014; 5:23732. [PMID: 25206953 PMCID: PMC4138710 DOI: 10.3402/ejpt.v5.23732] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 05/26/2014] [Accepted: 06/26/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND For years there has been a tremendous gap in our understanding of the mental health effects of deployment and the efforts by military forces at trying to minimize or mitigate these. Many military forces have recently systematized the mental support that is provided to support operational deployments. However, the rationale for doing so and the consequential allocation of resources are felt to vary considerably across North Atlantic Treaty Organisation (NATO) International Security Assistance (ISAF) partners. This review aims to compare the organization and practice of mental support by five partnering countries in the recent deployment in Afghanistan in order to identify and compare the key methods and structures for delivering mental health support, describe bottlenecks and illustrate new developments. METHOD Information was collected through document analysis and semi-structured interviews with key military mental healthcare stakeholders. The review resulted from close collaboration between key military mental healthcare professionals within the Australian Defense Forces (ADF), Canadian Armed Forces (CAF), United Kingdom Armed Forces (UK), Netherlands Armed Forces (NLD), and the United States Army (US). Key stakeholders were interviewed about the mental health support provided during a serviceperson's military career. The main items discussed were training, prevention, early identification, intervention, and aftercare in the field of mental health. RESULTS All forces reported that much attention was paid to mental health during the individual's military career, including deployment. In doing so there was much overlap between the rationale and applied methods. The main method of providing support was through training and education. The educative focus was to strengthen the mental resilience of individual soldiers while providing a range of mental healthcare services. All forces had abandoned standard psychological debriefing after critical incidents. Instead, by default, mental healthcare professionals acted to support the leader and peer led "after action" reviews. All countries provided professional mental support close to the front line, aimed at early detection and early return to normal activities within the unit. All countries deployed a mental health support team that consisted of a range of mental health staff including psychiatrists, psychologists, social workers, mental health nurses, and chaplains. There was no overall consensus in the allocation of mental health disciplines in theatre. All countries (except the US) provided troops with a third location decompression (TLD) stop after deployment, which aimed to recognize what the deployed units had been through and to prepare them for transition home. The US conducted in-garrison 'decompression', or 'reintegration training' in the US, with a similiar focus to TLD. All had a reasonably comparable infrastructure in the field of mental healthcare. Shared bottlenecks across countries included perceived stigma and barriers to care around mental health problems as well as the need for improving the awareness and recognition of mental health problems among service members. CONCLUSION This analysis demonstrated that in all five partners state-of-the-art preventative mental healthcare was included in the last deployment in Afghanistan, including a positive approach towards strengthening the mental resilience, a focus on self-regulatory skills and self-empowerment, and several initiatives that were well-integrated in a military context. These initiatives were partly/completely implemented by the military/colleagues/supervisors and applicable during several phases of the deployment cycle. Important new developments in operational mental health support are recognition of the role of social leadership and enhancement of operational peer support. This requires awareness of mental problems that will contribute to reduction of the barriers to care in case of problems. Finally, comparing mental health support services across countries can contribute to optimal preparation for the challenges of military deployment.
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Affiliation(s)
- Eric Vermetten
- Military Mental Health Research, Department of Defence, Utrecht, The Netherlands
- Department Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Arq Psychotrauma Research Group, Diemen, The Netherlands
| | - Neil Greenberg
- Academic Centre for Defence Mental Health, Weston Education Centre, Kings College London, London, UK
| | | | - Roos Delahaije
- Netherlands Organization for Applied Scientific Research (TNO), Defense Safety and Security, Soesterberg, The Netherlands
| | - Rakesh Jetly
- Directorate of Mental Health, Health Services Group, National Defence, Ottawa, Canada
| | - Carl A. Castro
- School of Social Work, University Southern California, Los Angeles CA, USA
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41
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Affiliation(s)
- Charles W Hoge
- Center for Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Christopher H Warner
- Psychiatry Consultant to the Army Surgeon General and Division Surgeon (Rear), 101st Airborne Division, Ft Campbell, Kentucky
| | - Carl A Castro
- School of Social Work, University of Southern California, Los Angeles
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Odle-Dusseau HN, Herleman HA, Britt TW, Moore DD, Castro CA, McGurk D. Family-supportive work environments and psychological strain: A longitudinal test of two theories. J Occup Health Psychol 2013; 18:27-36. [DOI: 10.1037/a0030803] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Affiliation(s)
- Charles W Hoge
- Walter Reed Army Institute of Research, 501 Robert Grant Ave, Silver Spring, MD 20910, USA.
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Peterson C, Park N, Castro CA. Assessment for the U.S. Army Comprehensive Soldier Fitness program: the Global Assessment Tool. ACTA ACUST UNITED AC 2011; 66:10-8. [PMID: 21219043 DOI: 10.1037/a0021658] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Psychology and the U.S. military have a long history of collaboration. The U.S. Army Comprehensive Soldier Fitness (CSF) program aims to measure the psychosocial strengths and assets of soldiers as well as their problems, to identify those in need of basic training in a given domain as well as those who would benefit from advanced training, and then to provide that training. The goals of the CSF program include the promotion of well-being as well as the prevention of problems. Assessment is the linchpin of the CSF program, and the Global Assessment Tool (GAT) is a self-report survey that measures psychosocial fitness in emotional, social, family, and spiritual domains. We review the history of psychological assessment in the military and the lessons taught by this history. Then we describe the process by which the GAT was developed and evaluated. We conclude with a discussion of pending next steps in the development and use of the GAT.
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Abstract
Mental health advisory teams (MHATs) conduct comprehensive mental health surveillance of US service members in combat environments. Since 2003, six teams have deployed to Iraq and four have deployed to Afghanistan, and results have played a key role influencing behavioural health policy. The repeated deployments of the teams have provided opportunities for processes to be refined, and this refinement has led to a scientifically rigorous and replicable approach. In this article we focus on two themes. The first theme is how changes in sampling have influenced the nature of the inferences drawn from the survey-based surveillance data. The second theme is how the ability to utilize different forms of data has served to strengthen the programme. Focusing on these two themes provides a way to discuss key findings, recommendations and limitations while also interspersing practical observations intended to help inform the design of broad-scale, in-theatre mental health surveillance efforts. We believe that future surveillance efforts should build on the lessons of the MHATs and attempt to replicate the more rigorous sampling methods; nonetheless, we also strive to convey that large surveillance efforts are valuable even if they cannot be executed with random sampling.
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Affiliation(s)
- Paul D Bliese
- Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA.
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Riviere LA, Kendall-Robbins A, McGurk D, Castro CA, Hoge CW. Coming home may hurt: risk factors for mental ill health in US reservists after deployment in Iraq. Br J Psychiatry 2011; 198:136-42. [PMID: 21282784 DOI: 10.1192/bjp.bp.110.084863] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Little research has been conducted on the factors that may explain the higher rates of mental health problems in United States National Guard soldiers who have deployed to the Iraq War. AIMS To examine whether financial hardship, job loss, employer support and the effect of deployment absence on co-workers were associated with depression and post-traumatic stress disorder (PTSD). METHOD Cross-sectional data were obtained from 4034 National Guard soldiers at two time points. All measures were assessed by self-report. RESULTS The four factors were associated with depression and PTSD, with variability based on outcome and time point. For example, job loss increased the odds of meeting criteria for depression at 3 and 12 months and for PTSD at 12 months; the negative effect of deployment absence on co-workers increased the likelihood of meeting criteria for PTSD, but not depression, at both time points. CONCLUSIONS The findings demonstrate that National Guard soldiers have unique post-deployment social and material concerns that impair their mental health.
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Affiliation(s)
- Lyndon A Riviere
- Center for Military Psychiatry & Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, Maryland, MD 20910, USA.
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Killgore WDS, Castro CA, Hoge CW. Preliminary normative data for the Evaluation of Risks Scale-Bubble Sheet Version (EVAR-B) for large-scale surveys of returning combat veterans. Mil Med 2010; 175:725-31. [PMID: 20968261 DOI: 10.7205/milmed-d-09-00143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The Evaluation of Risks (EVAR) scale has been used to assess risk-taking propensity in military samples. This report provides preliminary reliability, validity, and normative data on a modified version of the instrument designed to facilitate data entry with optical scanners, the Evaluation of Risks-Bubble Sheet version (EVAR-B). METHODS 2,015 U.S. Army soldiers completed the EVAR-B and a survey assessing risk-related behaviors 3 months after returning home from combat deployment in Iraq. RESULTS EVAR-B demonstrated acceptable internal consistency and reliability and correlated significantly with independent measures of self-reported risk-taking behavior, including alcohol use and aggressive behavior, in the weeks preceding the survey. Tentative cut-offs significantly differentiated heavy drinkers, dangerous drivers, and soldiers reporting recent aggressive outbursts. Normative data are provided for comparison with future studies. CONCLUSIONS The EVAR-B is a reliable and valid measure of risk-taking propensity, which provides enhanced flexibility for administration and scoring in large surveys and field environments.
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Affiliation(s)
- William D S Killgore
- Division of Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
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Carneiro-Júnior MA, Pelúzio MCG, Silva CHO, Amorim PRS, Silva KA, Souza MO, Castro CA, Roman-Campos D, Prímola-Gomes TN, Natali AJ. Exercise training and detraining modify the morphological and mechanical properties of single cardiac myocytes obtained from spontaneously hypertensive rats. Braz J Med Biol Res 2010; 43:1042-6. [PMID: 21049244 DOI: 10.1590/s0100-879x2010007500117] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 10/14/2010] [Indexed: 11/22/2022] Open
Abstract
We determined the effects of exercise training and detraining on the morphological and mechanical properties of left ventricular myocytes in 4-month-old spontaneously hypertensive rats (SHR) randomly divided into the following groups: sedentary for 8 weeks (SED-8), sedentary for 12 weeks (SED-12), treadmill-running trained for 8 weeks (TRA, 16 m/min, 60 min/day, 5 days/week), and treadmill-running trained for 8 weeks followed by 4 weeks of detraining (DET). At sacrifice, left ventricular myocytes were isolated enzymatically, and resting cell length, width, and cell shortening after stimulation at a frequency of 1 Hz (~25°C) were measured. Cell length was greater in TRA than in SED-8 (161.30 ± 1.01 vs 156.10 ± 1.02 μm, P < 0.05, 667 vs 618 cells, respectively) and remained larger after detraining. Cell width and volume were unaffected by either exercise training or detraining. Cell length to width ratio was higher in TRA than in SED-8 (8.50 ± 0.08 vs 8.22 ± 0.10, P < 0.05) and was maintained after detraining. Exercise training did not affect cell shortening, which was unchanged with detraining. TRA cells exhibited higher maximum velocity of shortening than SED-8 (102.01 ± 4.50 vs 82.01 ± 5.30 μm/s, P < 0.05, 70 cells per group), with almost complete regression after detraining. The maximum velocity of relengthening was higher in TRA cells than in SED-8 (88.20 ± 4.01 vs70.01 ± 4.80 μm/s, P < 0.05), returning to sedentary values with detraining. Therefore, exercise training affected left ventricle remodeling in SHR towards eccentric hypertrophy, which remained after detraining. It also improved single left ventricular myocyte contractile function, which was reversed by detraining.
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Picchioni D, Cabrera OA, McGurk D, Thomas JL, Castro CA, Balkin TJ, Bliese PD, Hoge CW. Sleep Symptoms as a Partial Mediator Between Combat Stressors and Other Mental Health Symptoms in Iraq War Veterans. Military Psychology 2010. [DOI: 10.1080/08995605.2010.491844] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Dante Picchioni
- a Walter Reed Army Institute of Research , Silver Spring , Maryland
| | - Oscar A. Cabrera
- a Walter Reed Army Institute of Research , Silver Spring , Maryland
| | - Dennis McGurk
- a Walter Reed Army Institute of Research , Silver Spring , Maryland
| | | | - Carl A. Castro
- a Walter Reed Army Institute of Research , Silver Spring , Maryland
| | - Thomas J. Balkin
- a Walter Reed Army Institute of Research , Silver Spring , Maryland
| | - Paul D. Bliese
- a Walter Reed Army Institute of Research , Silver Spring , Maryland
| | - Charles W. Hoge
- a Walter Reed Army Institute of Research , Silver Spring , Maryland
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