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Smigelsky MA, Maynard JL, Ford CG, Parker R, Wortmann JH, Meador KG, Fink A, Nieuwsma JA. Increasing chaplain support for veterans at high risk for suicide through targeted outreach: A quality improvement initiative. J Health Care Chaplain 2024; 30:33-45. [PMID: 36288092 DOI: 10.1080/08854726.2022.2136466] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The Department of Veterans Affairs (VA) has prioritized improving the identification of veterans at risk for suicide and ensuring adequate staffing of personnel to assist veterans in need. It is imperative that suicide prevention efforts make use of the full range of available resources, including diverse professionals with distinctive skillsets. Chaplains are engaged in suicide prevention efforts in VA, but the literature lacks examples of chaplain-involved suicide prevention efforts that clearly describe how chaplains are engaged, the training and/or qualifications chaplains possess in the area of suicide prevention, and the reach and impact of such efforts. The purpose of this report is to describe the development and implementation of a novel, innovative, and ongoing chaplain-led suicide prevention outreach initiative for veterans at high risk for suicide. Results indicated the program was feasible and supported at the systems level, and chaplains were able to collaboratively sustain outreach efforts over the course of a year. Chaplain suicide prevention outreach was found to be acceptable to veterans, who overwhelmingly indicated openness to and appreciation for outreach. Chaplains can address the spiritual crisis underlying suicidality, bolster spiritual protective factors, and are a part of holistic care. Considerations for implementation and future investigation are discussed.
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Affiliation(s)
- Melissa A Smigelsky
- Integrative Mental Health, Department of Veterans Affairs, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA
| | - Justin L Maynard
- North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - C Graham Ford
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Healthcare System, Durham, NC, USA
| | - Ryan Parker
- Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Jennifer H Wortmann
- Integrative Mental Health, Department of Veterans Affairs, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA
| | - Keith G Meador
- Integrative Mental Health, Department of Veterans Affairs, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA
- Departments of Psychiatry and Health Policy, Center for Biomedical Ethics and Society, and Graduate Department of Religion, Vanderbilt University, Nashville, TN, USA
| | - Anna Fink
- Integrative Mental Health, Department of Veterans Affairs, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA
| | - Jason A Nieuwsma
- Integrative Mental Health, Department of Veterans Affairs, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Ford CG, Smigelsky MA, Yi JY, Trimm VM, Wortmann JH, Meador KG, Nieuwsma JA. Measuring morality: Analyzing the factor structure of the moral foundations questionnaire in veterans. J Clin Psychol 2023; 79:954-968. [PMID: 36269895 DOI: 10.1002/jclp.23448] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 07/29/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Moral reasoning is an underexamined and potentially useful area of research relative to the care of moral injury in veterans. However, the most widely used measure of moral reasoning, the moral foundations questionnaire (MFQ), has not been validated in this population. METHODS Post-9/11 veterans (N = 311) completed questionnaires which included the MFQ. Veterans' scores were compared to the general US population. Confirmatory factor analysis was used to test existing models of the MFQ in the sample. Exploratory factor analysis (EFA) was also used to examine potentially improved model fits. RESULTS The two leading, preexisting MFQ models were both poor fits for the data. EFA results produced a four-factor model for the veteran sample using 25 of the original 30 items of the MFQ. CONCLUSIONS Measuring moral reasoning among veterans may be important in understanding the experience of moral injury. However, the most widely used scale (MFQ) performs poorly among a sample of post-9/11 veterans, indicating that veterans may respond differently to the measure than the general US population. Military culture may uniquely influence veterans' moral reasoning, suggesting the need for military specific measures for this construct.
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Affiliation(s)
- Christopher Graham Ford
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Melissa A Smigelsky
- Department of Veterans Affairs, Integrative Mental Health, Durham, North Carolina, USA.,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, North Carolina, USA
| | - Jennifer Y Yi
- Durham VA Medical Center, Durham, North Carolina, USA
| | - Victoria M Trimm
- Department of Veterans Affairs, Integrative Mental Health, Durham, North Carolina, USA.,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, North Carolina, USA
| | - Jennifer H Wortmann
- Department of Veterans Affairs, Integrative Mental Health, Durham, North Carolina, USA.,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, North Carolina, USA
| | - Keith G Meador
- Department of Veterans Affairs, Integrative Mental Health, Durham, North Carolina, USA.,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, North Carolina, USA.,Departments of Psychiatry and Health Policy, Center for Biomedical Ethics and Society, Nashville, Tennessee, USA.,Graduate Department of Religion, Vanderbilt University, Nashville, Tennessee, USA
| | - Jason A Nieuwsma
- Department of Veterans Affairs, Integrative Mental Health, Durham, North Carolina, USA.,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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Wortmann JH, Nieuwsma JA, Cantrell W, Fernandez P, Smigelsky M, Meador K. Chaplain Training in Evidence-Based Practices to Promote Mental Health and Improve Care for Suicidality in Veterans and Service Members. Arch Suicide Res 2023; 27:122-134. [PMID: 34520687 DOI: 10.1080/13811118.2021.1972884] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Chaplains are key care providers in a comprehensive approach to suicide prevention, which is a priority area for the U.S. Department of Veterans Affairs (VA) and the Department of Defense (DoD). In a cohort of 87 VA and military chaplains who completed the Mental Health Integration for Chaplain Services (MHICS) training-an intensive, specialty education in evidence-based psychosocial and collaborative approaches to mental health care-we assessed chaplains' self-perceptions, intervention behaviors, and use of evidence-based practices, including Acceptance and Commitment Therapy (ACT), Problem-Solving Therapy (PST), and Motivational Interviewing (MI), in providing care for suicidality. METHOD Chaplains responded to a battery of items Pre- and Post-training and provided deidentified case examples describing their use of evidence-based practices in spiritual care for service members and veterans (SM/V) on various levels of a suicide prevention continuum. RESULTS Post-training, chaplains reported increased abilities to provide care and mobilize collaborative resources. Over the course of MHICS, 87% of chaplains used one or more evidence-based practices with a SM/V at risk for suicide or acutely suicidal. Fifty-six percent of chaplains reported intervening with an acutely suicidal SM/V by using principles from ACT, 36% PST, and 48% MI. With persons at risk for suicide, 81% used principles from ACT, 66% PST, and 71% MI. Cases exemplified diverse evidence-based practice applications. CONCLUSIONS Findings indicate chaplains trained in evidence-based practices report effective application in caring for SM/V who are suicidal, thus offering a valuable resource to meet needs in a priority area for VA and DoD.HIGHLIGHTSChaplains provide essential care for SM/V who are at risk for suicide or acutely suicidalTraining helps chaplains mobilize interdisciplinary and community resources in suicide careEvidence-based practices can effectively integrate within the scope of chaplaincy practice for suicide care.
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Smigelsky MA, Trimm V, Meador KG, Jackson GL, Wortmann JH, Nieuwsma JA. Core components of moral injury groups co-facilitated by mental health providers and chaplains. Spirituality in Clinical Practice 2022. [DOI: 10.1037/scp0000297] [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: 11/08/2022]
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Nieuwsma JA, O'Brien EC, Xu H, Smigelsky MA, Meador KG. Patterns of Potential Moral Injury in Post-9/11 Combat Veterans and COVID-19 Healthcare Workers. J Gen Intern Med 2022; 37:2033-2040. [PMID: 35381899 PMCID: PMC8982664 DOI: 10.1007/s11606-022-07487-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [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: 01/25/2022] [Accepted: 03/09/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Moral injury has primarily been studied in combat veterans but might also affect healthcare workers (HCWs) due to the COVID-19 pandemic. OBJECTIVE To compare patterns of potential moral injury (PMI) between post-9/11 military combat veterans and healthcare workers (HCWs) surveyed during the COVID-19 pandemic. DESIGN Cross-sectional surveys of veterans (2015-2019) and HCWs (2020-2021) in the USA. PARTICIPANTS 618 military veterans who were deployed to a combat zone after September 11, 2001, and 2099 HCWs working in healthcare during the COVID-19 pandemic. MAIN MEASURES Other-induced PMI (disturbed by others' immoral acts) and self-induced PMI (disturbed by having violated own morals) were the primary outcomes. Sociodemographic variables, combat/COVID-19 experience, depression, quality of life, and burnout were measured as correlates. KEY RESULTS 46.1% of post-9/11 veterans and 50.7% of HCWs endorsed other-induced PMI, whereas 24.1% of post-9/11 veterans and 18.2% of HCWs endorsed self-induced PMI. Different types of PMI were significantly associated with gender, race, enlisted vs. officer status, and post-battle traumatic experiences among veterans and with age, race, working in a high COVID-19-risk setting, and reported COVID-19 exposure among HCWs. Endorsing either type of PMI was associated with significantly higher depressive symptoms and worse quality of life in both samples and higher burnout among HCWs. CONCLUSIONS The potential for moral injury is relatively high among combat veterans and COVID-19 HCWs, with deleterious consequences for mental health and burnout. Demographic characteristics suggestive of less social empowerment may increase risk for moral injury. Longitudinal research among COVID-19 HCWs is needed. Moral injury prevention and intervention efforts for HCWs may benefit from consulting models used with veterans.
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Affiliation(s)
- Jason A Nieuwsma
- Integrative Mental Health, Department of Veterans Affairs, Durham, NC, USA. .,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA. .,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA.
| | | | - Haolin Xu
- Duke Clinical Research Institute, Durham, NC, USA
| | - Melissa A Smigelsky
- Integrative Mental Health, Department of Veterans Affairs, Durham, NC, USA.,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
| | | | | | - Keith G Meador
- Integrative Mental Health, Department of Veterans Affairs, Durham, NC, USA.,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA.,Department of Psychiatry and Preventative Medicine, Center for Biomedical Ethics and Society, & Graduate Department of Religion, Vanderbilt University, Nashville, TN, USA
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Nieuwsma JA, Smigelsky MA, Grossoehme DH. Introduction to the special issue "Moral injury care: Practices and collaboration". J Health Care Chaplain 2022; 28:S3-S8. [PMID: 35254952 DOI: 10.1080/08854726.2022.2047564] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Since moral injury was introduced in the psychological literature little more than a decade ago, it has received substantial attention from mental health professionals as well as chaplains. This special issue features ways that chaplains are and can be engaged in addressing moral injury within health care contexts, especially the Department of Veterans Affairs. The efforts highlighted in this special issue provide building blocks for advancing moral injury care practices, research agendas, and interdisciplinary collaborations into the future.
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Affiliation(s)
- Jason A Nieuwsma
- Integrative Mental Health, Department of Veterans Affairs, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, USA.,Vanderbilt Divinity School, USA
| | | | - Daniel H Grossoehme
- Haslinger Family Pediatric Palliative Care Center, Rebecca D. Considine Research Institute, Akron Children's Hospital, USA
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Wortmann JH, Nieuwsma JA, King HA, Fernandez P, Jackson GL, Smigelsky MA, Cantrell W, Meador KG. Collaborative spiritual care for moral injury in the veterans Affairs Healthcare System (VA): Results from a national survey of VA chaplains. J Health Care Chaplain 2021; 28:S9-S24. [PMID: 34825859 DOI: 10.1080/08854726.2021.2004847] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The psychospiritual nature of moral injury invites consideration regarding how chaplains understand the construct and provide care. To identify how chaplains in the VA Healthcare System conceptualize moral injury, we conducted an anonymous online survey (N = 361; 45% response rate). Chaplains responded to a battery of items and provided free-text definitions of moral injury that generally aligned with key elements in the existing literature, though with different emphases. Over 90% of chaplain respondents indicated that they encounter moral injury in their chaplaincy care, and a similar proportion agreed that chaplains and mental health professionals should collaborate in providing care for moral injury. Over one-third of chaplain respondents reported offering or planning to offer a moral injury group. Separately, nearly one-quarter indicated present or planned collaboration with mental health to provide groups that in some manner address moral injury. Previous training in evidence-based and collaborative care approaches appears to contribute to the likelihood of providing integrated psychosocial-spiritual care. Results and future directions are discussed, including a description of moral injury that may be helpful to understand present areas of emphasis in VA chaplains' care for moral injury.
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Affiliation(s)
- Jennifer H Wortmann
- Integrative Mental Health, Veterans Affairs Healthcare System, Durham, NC, USA.,VA Mid-Atlantic MIRECC, Durham Veterans Affairs Healthcare System, Durham, NC, USA
| | - Jason A Nieuwsma
- Integrative Mental Health, Veterans Affairs Healthcare System, Durham, NC, USA.,VA Mid-Atlantic MIRECC, Durham Veterans Affairs Healthcare System, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Healthcare System, Durham, NC, USA
| | - Heather A King
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Healthcare System, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA.,Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Paola Fernandez
- Integrative Mental Health, Veterans Affairs Healthcare System, Durham, NC, USA.,VA Mid-Atlantic MIRECC, Durham Veterans Affairs Healthcare System, Durham, NC, USA.,Department of Psychology, University of South Alabama, Mobile, AL, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Healthcare System, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA.,Division of General Internal Medicine, Duke University, Durham, NC, USA.,Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
| | - Melissa A Smigelsky
- Integrative Mental Health, Veterans Affairs Healthcare System, Durham, NC, USA.,VA Mid-Atlantic MIRECC, Durham Veterans Affairs Healthcare System, Durham, NC, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Healthcare System, Durham, NC, USA
| | - William Cantrell
- Integrative Mental Health, Veterans Affairs Healthcare System, Durham, NC, USA.,VA Mid-Atlantic MIRECC, Durham Veterans Affairs Healthcare System, Durham, NC, USA
| | - Keith G Meador
- Integrative Mental Health, Veterans Affairs Healthcare System, Durham, NC, USA.,VA Mid-Atlantic MIRECC, Durham Veterans Affairs Healthcare System, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University, Nashville, TN, USA.,Center for Biomedical Ethics and Society, Vanderbilt University, Nashville, TN, USA.,Department of Health Policy, Vanderbilt University, Nashville, TN, USA.,Graduate Department of Religion, Vanderbilt University, Nashville, TN, USA
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Nieuwsma JA, Brancu M, Wortmann J, Smigelsky MA, King HA, Meador KG. Screening for moral injury and comparatively evaluating moral injury measures in relation to mental illness symptomatology and diagnosis. Clin Psychol Psychother 2020; 28:239-250. [PMID: 32830386 DOI: 10.1002/cpp.2503] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 11/09/2022]
Abstract
Moral injury merits further study to clarify its identification, prevalence, assessment and intersection with psychosocial and psychiatric problems. The present study investigated the screening potential of the Brief Moral Injury Screen (BMIS) in a sample of post-9/11 veterans (N = 315) and comparatively evaluated how this tool, the Moral Injury Events Scale (MIES), and the Moral Injury Questionnaire-Military Version (MIQ-M) relate to psychiatric diagnoses and mental illness symptom severity. Those who endorsed failing to prevent or doing something morally wrong had the highest symptomatology scores on measures of posttraumatic stress disorder, depression, suicidality, alcohol abuse and drug abuse, followed by those who reported solely witnessing a moral injury event. Posttraumatic stress disorder and depressive symptoms correlated most strongly with scores on the MIQ-M; suicidality, alcohol abuse and drug abuse scores correlated most strongly with scores on the BMIS and MIQ-M. Moral injury, as measured by three scales, was robustly correlated with worse outcomes on various symptom measures. The three scales appear to differentially predict mental illness symptomatology and diagnoses, with the BMIS predicting suicidality and alcohol and drug abuse as well as better than other measures.
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Affiliation(s)
- Jason A Nieuwsma
- Department of Veterans Affairs, Mental Health and Chaplaincy, Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Mira Brancu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA.,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina, USA
| | - Jennifer Wortmann
- Department of Veterans Affairs, Mental Health and Chaplaincy, Durham, North Carolina, USA
| | - Melissa A Smigelsky
- Department of Veterans Affairs, Mental Health and Chaplaincy, Durham, North Carolina, USA
| | - Heather A King
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.,Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina, USA
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- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina, USA
| | - Keith G Meador
- Department of Veterans Affairs, Mental Health and Chaplaincy, Durham, North Carolina, USA.,Department of Psychiatry and Preventative Medicine, Center for Biomedical Ethics and Society, & Graduate Department of Religion, Vanderbilt University, Nashville, Tennessee, USA
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Smigelsky MA, Nieuwsma JA, Meador K, Vega RJ, Henderson B, Jackson GL. Dynamic Diffusion Network: Advancing moral injury care and suicide prevention using an innovative model. Healthc (Amst) 2020; 8:100440. [PMID: 32919579 PMCID: PMC7405892 DOI: 10.1016/j.hjdsi.2020.100440] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/24/2020] [Accepted: 05/23/2020] [Indexed: 11/19/2022]
Abstract
Healthcare providers across a wide variety of settings face a common challenge: the need to provide real time care for complex problems that are not adequately addressed by existing protocols. In response to these intervention gaps, frontline providers may utilize existing evidence to develop new approaches that are tailored to specific problems. It is imperative that such approaches undergo some form of evaluation, ensuring quality control while permitting ongoing adaptation and refinement. “Dynamic diffusion” is an innovative approach to intervention improvement and dissemination whereby care practices are delivered and continuously evaluated under real-world conditions as part of a structured network experience. This “dynamic diffusion network” (DDN) promotes cross-pollination of ideas and shared learning to generate relatively rapid improvements in care. The pilot Mental Health and Chaplaincy DDN was developed to advance suicide prevention efforts and moral injury care practices being conducted by 13 chaplain-mental health professional teams across the Veterans Health Administration. Lessons learned from the pilot DDN include the importance of the following: geographic and cultural diversity among innovation collaborators to ensure the broadest possible relevance of solutions; leadership support to facilitate engagement of frontline providers in quality improvement efforts; and participation in a community of practice to motivate providers and offer opportunities for direct collaboration and cross-pollination of ideas.
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Affiliation(s)
- Melissa A Smigelsky
- Mental Health and Chaplaincy, Department of Veterans Affairs, Durham, NC, USA; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA.
| | - Jason A Nieuwsma
- Mental Health and Chaplaincy, Department of Veterans Affairs, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Keith Meador
- Mental Health and Chaplaincy, Department of Veterans Affairs, Durham, NC, USA; Departments of Psychiatry and Health Policy, Center for Biomedical Ethics and Society, Vanderbilt Divinity School, Vanderbilt University, Nashville, TN, USA
| | - Ryan J Vega
- VHA Innovation Ecosystem/Diffusion of Excellence, Department of Veterans Affairs, Washington, DC, USA
| | - Blake Henderson
- VHA Innovation Ecosystem/Diffusion of Excellence, Department of Veterans Affairs, Washington, DC, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA; Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
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Smigelsky MA, Jardin C, Nieuwsma JA, Brancu M, Meador KG, Molloy KG, Elbogen EB. Religion, spirituality, and suicide risk in Iraq and Afghanistan era veterans. Depress Anxiety 2020; 37:728-737. [PMID: 32248664 DOI: 10.1002/da.23013] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/21/2020] [Accepted: 03/10/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND United States military veterans experience disproportionate rates of suicide relative to the general population. Evidence suggests religion and spirituality may impact suicide risk, but less is known about which religious/spiritual factors are most salient. The present study sought to identify the religious/spiritual factors most associated with the likelihood of having experienced suicidal ideation and attempting suicide in a sample of recent veterans. METHODS Data were collected from 1002 Iraq/Afghanistan-era veterans (Mage = 37.68; 79.6% male; 54.1% non-Hispanic White) enrolled in the ongoing Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center multi-site Study of Post-Deployment Mental Health. RESULTS In multiple regression models with stepwise deletion (p < .05), after controlling for depression and posttraumatic stress disorder (PTSD) diagnoses, independent variables that demonstrated a significant effect on suicidal ideation were perceived lack of control and problems with self-forgiveness. After controlling for age, PTSD diagnosis, and substance use problems, independent variables that demonstrated a significant effect on suicide attempt history were perceived as punishment by God and lack of meaning/purpose. CONCLUSIONS Clinical screening for spiritual difficulties may improve detection of suicidality risk factors and refine treatment planning. Collaboration with spiritual care providers, such as chaplains, may enhance suicide prevention efforts.
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Affiliation(s)
- Melissa A Smigelsky
- Mental Health and Chaplaincy, Department of Veterans Affairs, Durham, North Carolina.,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham Veterans Affairs Healthcare System, Durham, North Carolina
| | - Charles Jardin
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham Veterans Affairs Healthcare System, Durham, North Carolina
| | - Jason A Nieuwsma
- Mental Health and Chaplaincy, Department of Veterans Affairs, Durham, North Carolina.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Mira Brancu
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham Veterans Affairs Healthcare System, Durham, North Carolina.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Keith G Meador
- Mental Health and Chaplaincy, Department of Veterans Affairs, Durham, North Carolina.,Departments of Psychiatry and Preventative Medicine, Graduate Department of Religion, Center for Biomedical Ethics and Society, Vanderbilt University, Nashville, Tennessee
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- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham Veterans Affairs Healthcare System, Durham, North Carolina
| | - Eric B Elbogen
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham Veterans Affairs Healthcare System, Durham, North Carolina.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
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Kopacz MS, Nieuwsma JA, Wortmann JH, Hanson JL, Meador KG, Thiel MM. The role of chaplaincy in LGBT veteran healthcare. Spirituality in Clinical Practice 2019. [DOI: 10.1037/scp0000196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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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Farnsworth JK, Borges LM, Nieuwsma JA. What Ought We to Do With "Thick Terms"? A Response to Frankfurt & Coady's "Bringing Philosophy to Bear on Moral Injury and Posttraumatic Stress Disorder Construct Validation". J Trauma Stress 2019; 32:642-644. [PMID: 31276234 DOI: 10.1002/jts.22424] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 11/12/2022]
Abstract
We respond to the commentary by Frankfurt and Coady (this issue) regarding the descriptive-prescriptive framework for partially distinguishing between posttraumatic stress disorder (PTSD) and moral injury (Farnsworth, 2019). In their commentary, Frankfurt & Coady raise concerns about the application of R. M. Hare's (2014) philosophical approach of prescriptivism to military-related moral injury (MI) and the potential philosophical and ethical implications that may follow. In this response, we clarify that Farnsworth's descriptive-prescriptive framework is not tied to or aligned with Hare's prescriptivism and, as a result, many of Frankfurt and Coady's critiques become tangential to Farnsworth's original argument. We go on to clarify that Farnsworth's descriptive-prescriptive framework does not deny the utility of all cognitive therapies for moral injury, nor does it attempt to fully separate descriptive and prescriptive cognitions from one another, as was asserted by Frankfurt and Coady. We also provide a counterargument to Frankfurt and Coady's ethical concerns regarding the potential of Farnsworth's framework to enable militarism and instead assert its value for increasing peace and understanding. Finally, we address the relevance of "thick terms" for MI, highlighting their potential strengths and clinical weaknesses. We conclude by joining with Frankfurt and Coady in expressing our hopes for future research on the association between PTSD and MI. We argue that future research must go beyond defining content-level boundaries between the two constructs and instead grapple with the processes that give rise to them and the philosophical, empirical, and professional questions that they imply.
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Affiliation(s)
- Jacob K Farnsworth
- Veteran Affairs Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Lauren M Borges
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, Colorado, USA.,Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jason A Nieuwsma
- Duke University Medical Center, Durham, North Carolina, USA.,Mental Health and Chaplaincy, Department of Veterans Affairs, VISN 6 MIRECC, Durham, North Carolina, USA
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Kopacz MS, Nieuwsma JA, Wortmann JH, Reyes ILB, Meador KG. Examining faith-based collaboration in U.S. States' suicide prevention guidelines. J Prev Interv Community 2019; 48:81-93. [PMID: 31140954 DOI: 10.1080/10852352.2019.1617524] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Faith-based communities (FBCs) are recognized by most states as key players within systematic suicide prevention efforts. The aim of the present study was to conduct a thematic analysis of documents that detail the suicide prevention efforts of individual states with respect to the role(s) delegated to FBCs. Thematic analysis is recognized as a useful methodology for identifying implications for policy and practice. Documents were procured from all states, with the exception of New Mexico (n = 49). The findings suggest six areas relevant to collaboration with FBCs: suicide prevention training for the FBC, suicide prevention training for individual faith leaders, community engagement, faith leaders as gatekeepers, culturally sensitive suicide prevention, and postvention support. These state guideline documents consistently affirm the importance of engaging FBCs in suicide prevention efforts and cover a range of recommendations, though generally lack specifics with respect to how FBCs can optimally engage.
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Affiliation(s)
- Marek S Kopacz
- US Department of Veterans Affairs, VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA.,US Department of Veterans Affairs, Mid-Atlantic Mental Illness Research, Education and Clinical Center, Mental Health and Chaplaincy, Durham, North Carolina, USA
| | - Jason A Nieuwsma
- US Department of Veterans Affairs, Mid-Atlantic Mental Illness Research, Education and Clinical Center, Mental Health and Chaplaincy, Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Jennifer H Wortmann
- US Department of Veterans Affairs, Mid-Atlantic Mental Illness Research, Education and Clinical Center, Mental Health and Chaplaincy, Durham, North Carolina, USA
| | - Iza L B Reyes
- US Department of Veterans Affairs, Mid-Atlantic Mental Illness Research, Education and Clinical Center, Mental Health and Chaplaincy, Durham, North Carolina, USA
| | - Keith G Meador
- US Department of Veterans Affairs, Mid-Atlantic Mental Illness Research, Education and Clinical Center, Mental Health and Chaplaincy, Durham, North Carolina, USA.,Departments of Psychiatry and Health Policy, Center for Biomedical Ethics and Society, Vanderbilt University, Nashville, Tennessee, USA.,Graduate Department of Religion, Vanderbilt University, Nashville, Tennessee, USA
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14
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Sun D, Phillips RD, Mulready HL, Zablonski ST, Turner JA, Turner MD, McClymond K, Nieuwsma JA, Morey RA. Resting-state brain fluctuation and functional connectivity dissociate moral injury from posttraumatic stress disorder. Depress Anxiety 2019; 36:442-452. [PMID: 30690812 PMCID: PMC6488394 DOI: 10.1002/da.22883] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 07/02/2018] [Revised: 01/07/2019] [Accepted: 01/12/2019] [Indexed: 02/04/2023] Open
Abstract
Moral injury is closely associated with posttraumatic stress disorder (PTSD) and characterized by disturbances in social and moral cognition. Little is known about the neural underpinnings of moral injury, and whether the neural correlates are different between moral injury and PTSD. A sample of 26 U.S. military veterans (two females: 28-55 years old) were investigated to determine how subjective appraisals of morally injurious events measured by Moral Injury Event Scale (MIES) and PTSD symptoms are differentially related to spontaneous fluctuations indexed by amplitude of low frequency fluctuation (ALFF) as well as functional connectivity during resting-state functional magnetic resonance imaging scanning. ALFF in the left inferior parietal lobule (L-IPL) was positively associated with MIES subscores of transgressions, negatively associated with subscores of betrayals, and not related with PTSD symptoms. Moreover, functional connectivity between the L-IPL and bilateral precuneus was positively related with PTSD symptoms and negatively related with MIES total scores. Our results provide the first evidence that morally injurious events and PTSD symptoms have dissociable neural underpinnings, and behaviorally distinct subcomponents of morally injurious events are different in neural responses. The findings increase our knowledge of the neural distinctions between moral injury and PTSD and may contribute to developing nosology and interventions for military veterans afflicted by moral injury.
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Affiliation(s)
- Delin Sun
- Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, North Carolina,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina
| | - Rachel D. Phillips
- Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, North Carolina,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina
| | - Hannah L. Mulready
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina
| | - Stephen T. Zablonski
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina
| | - Jessica A. Turner
- Department of Psychology, Georgia State University, Atlanta, Georgia
| | - Matthew D. Turner
- Department of Psychology, Georgia State University, Atlanta, Georgia
| | - Kathryn McClymond
- Department of Religious Studies, Georgia State University, Atlanta, Georgia
| | - Jason A. Nieuwsma
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina,Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina
| | - Rajendra A. Morey
- Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, North Carolina,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina,Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina
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15
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Drescher KD, Currier JM, Nieuwsma JA, McCormick W, Carroll TD, Sims BM, Cauterucio C. A Qualitative Examination of VA Chaplains' Understandings and Interventions Related to Moral Injury in Military Veterans. J Relig Health 2018; 57:2444-2460. [PMID: 30094678 DOI: 10.1007/s10943-018-0682-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study examines VA chaplains' understandings of moral injury (MI) and preferred intervention strategies. Drawing qualitative responses with a nationally-representative sample, content analyses indicated that chaplains' definitions of MI comprised three higher order clusters: (1) MI events, (2) mechanisms in development of MI, and (3) warning signs of MI. Similarly, chaplains' intervention foci could be grouped into three categories: (1) pastoral/therapeutic presence, (2) implementing specific interventions, and (3) therapeutic processes to promote moral repair. Findings are discussed related to emerging conceptualizations of MI, efforts to adapt existing evidence-based interventions to better address MI, and the potential benefits of better integrating chaplains into VA mental health service delivery.
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Affiliation(s)
- Kent D Drescher
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System (MAILSTOP - NCPTSD-334), 795 Willow Rd., Menlo Park, CA, 94025, USA.
| | - Joseph M Currier
- Psychology Department, University of South Alabama, Mobile, AL, USA
| | - Jason A Nieuwsma
- Mental Health and Chaplaincy Program, Department of Veterans Affairs, Education and Clinical Center, Mid-Atlantic Mental Illness Research, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical School, Durham, NC, USA
| | - Wesley McCormick
- Psychology Department, University of South Alabama, Mobile, AL, USA
| | | | - Brook M Sims
- Psychology Department, University of South Alabama, Mobile, AL, USA
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16
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Stolldorf DP, Fortune-Britt AG, Nieuwsma JA, Gierisch JM, Datta SK, Angel C, Millspaugh DD, Jackson GL. Measuring sustainability of a grassroots program in a large integrated health care delivery system: the Warrior to Soul Mate Program. J Mil Veteran Fam Health 2018; 4:81-90. [PMID: 31448320 DOI: 10.3138/jmvfh.2017-0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction Veterans experience many physical and psychosocial adjustment problems that challenge personal relationships and social functioning and successful social reintegration. The Warrior to Soul Mate (W2SM) program uses a structured curriculum [i.e., the Practical Application of Intimate Relationships Skills (PAIRS)] to address veterans' interpersonal needs by teaching participants effective interpersonal skills. Veterans who attended the W2SM program reported lower anxiety levels, improvements in marital alterations and satisfaction, and increased intimacy, cohesion, and affection. Therefore, sustaining the W2SM program can have long-term positive effects for veterans, families, and the greater society. The purpose of this paper is to describe the sustainability of the W2SM program. Methods The Model of Community-based Program Sustainability conceptually guided the evaluation. Twenty-three VA hospitals in the U.S. that offer W2SM programs completed a self-report survey to measure sustainability. Results The highest scoring sustainability elements were "Demonstrating program results" (M=5.82, SD=1.23), "Staff involvement and integration" (M= 5.79, SD= 1.34), and "Program responsivity" (M=4.39, SD= 1.16); the lowest scoring element was "Strategic funding" (M=2.78, SD=1.75). Statistically significant associations were found between the global middle-range program results and three sustainability elements: leadership competence (r = .472, p = .023), effective collaboration (r = .470, p = .024), and strategic funding (r = .507, p = .014). Discussion Efforts to sustain programs should focus on leaders planning for sustainability at the onset of program implementation, collaborators must be involved in program design, implementation and evaluation, and long-term funding sources must be secured to support program operations and continuation.
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Affiliation(s)
| | - Alice G Fortune-Britt
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Jason A Nieuwsma
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC USA
| | - Jennifer M Gierisch
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA.,Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Santanu K Datta
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Clyde Angel
- Chaplain Service, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA
| | - Dick D Millspaugh
- Chaplain Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - George L Jackson
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA.,Division of General Internal Medicine, Duke University, Durham, NC, USA
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17
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Abstract
Amidst the return of military personnel from post-9/11 conflicts, a construct describing the readjustment challenges of some has received increasing attention: moral injury. This term has been variably defined with mental health professionals more recently conceiving of it as a transgression of moral beliefs and expectations that are witnessed, perpetrated, or allowed by the individual. To the extent that morality is a system of conceptualizing right and wrong, individuals' moral systems are in large measure developmentally and socially derived and interpreted. Thus, in seeking to provide care and aid in reintegration for combat veterans, it is necessary to consider communities that have contributed to an individual's formation and that might have participated in the interpretation of his/her suffering. This can take many forms, but given that morality is often complexly intertwined with issues of religion, faith, and spirituality for many individuals, and recognizing that much of the current focus on moral injury is emanating out of healthcare contexts, we devote particular attention to how chaplains might be more intentionally engaged in healthcare systems such as the Veterans Health Administration to provide non-judgmental, person-centered, culturally-relevant care rooted in communities of practice to veterans with moral injury.
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Affiliation(s)
- Keith G Meador
- Center for Biomedical Ethics and Society, Vanderbilt University, 2525 West End Avenue, Suite 400, Nashville, TN, 37203, USA.
- Mental Health and Chaplaincy, VHA, Durham, NC, 27705, USA.
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18
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Bulling D, DeKraai M, Abdel-Monem T, Nieuwsma JA, Cantrell WC, Ethridge K, Meador K. Confidentiality and Mental Health/Chaplaincy Collaboration. Military Psychology 2017. [DOI: 10.1037/mil0000019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | - Jason A. Nieuwsma
- Durham Veterans Affairs Medical Center, Mental Health and Chaplaincy, Mid-Atlantic Mental Health Research Education Clinical Centers of Excellence, Durham, North Carolina, and Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - William C. Cantrell
- Durham Veterans Affairs Medical Center, Mental Health and Chaplaincy, Mid-Atlantic Mental Health Research Education Clinical Centers of Excellence
| | - Keith Ethridge
- Department of Veterans Affairs, National Chaplain Center, Hampton, Virginia
| | - Keith Meador
- Durham Veterans Affairs Medical Center, Mental Health and Chaplaincy, Mid-Atlantic Mental Health Research Education Clinical Centers of Excellence, and Departments of Psychiatry and Preventative Medicine, Center for Biomedical Ethics and Society, and Graduate Department of Religion, Vanderbilt University
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19
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Nieuwsma JA, King HA, Jackson GL, Bidassie B, Wright LW, Cantrell WC, Bates MJ, Rhodes JE, White BS, Gatewood SJL, Meador KG. Implementing Integrated Mental Health and Chaplain Care in a National Quality Improvement Initiative. Psychiatr Serv 2017; 68:1213-1215. [PMID: 29191144 PMCID: PMC5726535 DOI: 10.1176/appi.ps.201700397] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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] [Indexed: 11/30/2022]
Abstract
This column describes the development, implementation, and outcomes of a quality improvement learning collaborative that aimed to better integrate chaplaincy with mental health care services at 14 participating health care facilities evenly distributed across the U.S. Department of Veterans Affairs and Department of Defense. Teams of health care chaplains and mental health professionals from participating sites sought to improve cross-disciplinary service integration in six key domains: screening, referrals, assessment, communication and documentation, cross-disciplinary training, and role clarification. Chaplains and mental health providers across all facilities at participating sites were significantly more likely post-collaboration to report having a clear understanding of how to collaborate and to report using a routine process for screening patients who could benefit from seeing a professional from the other discipline. Foundational efforts to enhance cross-disciplinary awareness and screening practices between chaplains and mental health professionals appear particularly promising.
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Affiliation(s)
- Jason A Nieuwsma
- Dr. Nieuwsma, Dr. King, Dr. Jackson, Dr. Bidassie, Ms. Wright, Rev. Cantrell, Ms. White, and Dr. Meador are with the U.S. Department of Veterans Affairs (VA). Dr. Nieuwsma, Dr. King, and Dr. Jackson are also with Duke University Medical Center, Durham, North Carolina, and Dr. Meador is also with Vanderbilt University, Nashville, Tennessee. Dr. Bates, Dr. Rhodes, and Ms. Gatewood are with the Department of Defense (DoD), Arlington, Virginia
| | - Heather A King
- Dr. Nieuwsma, Dr. King, Dr. Jackson, Dr. Bidassie, Ms. Wright, Rev. Cantrell, Ms. White, and Dr. Meador are with the U.S. Department of Veterans Affairs (VA). Dr. Nieuwsma, Dr. King, and Dr. Jackson are also with Duke University Medical Center, Durham, North Carolina, and Dr. Meador is also with Vanderbilt University, Nashville, Tennessee. Dr. Bates, Dr. Rhodes, and Ms. Gatewood are with the Department of Defense (DoD), Arlington, Virginia
| | - George L Jackson
- Dr. Nieuwsma, Dr. King, Dr. Jackson, Dr. Bidassie, Ms. Wright, Rev. Cantrell, Ms. White, and Dr. Meador are with the U.S. Department of Veterans Affairs (VA). Dr. Nieuwsma, Dr. King, and Dr. Jackson are also with Duke University Medical Center, Durham, North Carolina, and Dr. Meador is also with Vanderbilt University, Nashville, Tennessee. Dr. Bates, Dr. Rhodes, and Ms. Gatewood are with the Department of Defense (DoD), Arlington, Virginia
| | - Balmatee Bidassie
- Dr. Nieuwsma, Dr. King, Dr. Jackson, Dr. Bidassie, Ms. Wright, Rev. Cantrell, Ms. White, and Dr. Meador are with the U.S. Department of Veterans Affairs (VA). Dr. Nieuwsma, Dr. King, and Dr. Jackson are also with Duke University Medical Center, Durham, North Carolina, and Dr. Meador is also with Vanderbilt University, Nashville, Tennessee. Dr. Bates, Dr. Rhodes, and Ms. Gatewood are with the Department of Defense (DoD), Arlington, Virginia
| | - Laura W Wright
- Dr. Nieuwsma, Dr. King, Dr. Jackson, Dr. Bidassie, Ms. Wright, Rev. Cantrell, Ms. White, and Dr. Meador are with the U.S. Department of Veterans Affairs (VA). Dr. Nieuwsma, Dr. King, and Dr. Jackson are also with Duke University Medical Center, Durham, North Carolina, and Dr. Meador is also with Vanderbilt University, Nashville, Tennessee. Dr. Bates, Dr. Rhodes, and Ms. Gatewood are with the Department of Defense (DoD), Arlington, Virginia
| | - William C Cantrell
- Dr. Nieuwsma, Dr. King, Dr. Jackson, Dr. Bidassie, Ms. Wright, Rev. Cantrell, Ms. White, and Dr. Meador are with the U.S. Department of Veterans Affairs (VA). Dr. Nieuwsma, Dr. King, and Dr. Jackson are also with Duke University Medical Center, Durham, North Carolina, and Dr. Meador is also with Vanderbilt University, Nashville, Tennessee. Dr. Bates, Dr. Rhodes, and Ms. Gatewood are with the Department of Defense (DoD), Arlington, Virginia
| | - Mark J Bates
- Dr. Nieuwsma, Dr. King, Dr. Jackson, Dr. Bidassie, Ms. Wright, Rev. Cantrell, Ms. White, and Dr. Meador are with the U.S. Department of Veterans Affairs (VA). Dr. Nieuwsma, Dr. King, and Dr. Jackson are also with Duke University Medical Center, Durham, North Carolina, and Dr. Meador is also with Vanderbilt University, Nashville, Tennessee. Dr. Bates, Dr. Rhodes, and Ms. Gatewood are with the Department of Defense (DoD), Arlington, Virginia
| | - Jeffrey E Rhodes
- Dr. Nieuwsma, Dr. King, Dr. Jackson, Dr. Bidassie, Ms. Wright, Rev. Cantrell, Ms. White, and Dr. Meador are with the U.S. Department of Veterans Affairs (VA). Dr. Nieuwsma, Dr. King, and Dr. Jackson are also with Duke University Medical Center, Durham, North Carolina, and Dr. Meador is also with Vanderbilt University, Nashville, Tennessee. Dr. Bates, Dr. Rhodes, and Ms. Gatewood are with the Department of Defense (DoD), Arlington, Virginia
| | - Brandolyn S White
- Dr. Nieuwsma, Dr. King, Dr. Jackson, Dr. Bidassie, Ms. Wright, Rev. Cantrell, Ms. White, and Dr. Meador are with the U.S. Department of Veterans Affairs (VA). Dr. Nieuwsma, Dr. King, and Dr. Jackson are also with Duke University Medical Center, Durham, North Carolina, and Dr. Meador is also with Vanderbilt University, Nashville, Tennessee. Dr. Bates, Dr. Rhodes, and Ms. Gatewood are with the Department of Defense (DoD), Arlington, Virginia
| | - Shannon J L Gatewood
- Dr. Nieuwsma, Dr. King, Dr. Jackson, Dr. Bidassie, Ms. Wright, Rev. Cantrell, Ms. White, and Dr. Meador are with the U.S. Department of Veterans Affairs (VA). Dr. Nieuwsma, Dr. King, and Dr. Jackson are also with Duke University Medical Center, Durham, North Carolina, and Dr. Meador is also with Vanderbilt University, Nashville, Tennessee. Dr. Bates, Dr. Rhodes, and Ms. Gatewood are with the Department of Defense (DoD), Arlington, Virginia
| | - Keith G Meador
- Dr. Nieuwsma, Dr. King, Dr. Jackson, Dr. Bidassie, Ms. Wright, Rev. Cantrell, Ms. White, and Dr. Meador are with the U.S. Department of Veterans Affairs (VA). Dr. Nieuwsma, Dr. King, and Dr. Jackson are also with Duke University Medical Center, Durham, North Carolina, and Dr. Meador is also with Vanderbilt University, Nashville, Tennessee. Dr. Bates, Dr. Rhodes, and Ms. Gatewood are with the Department of Defense (DoD), Arlington, Virginia
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20
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Nieuwsma JA, Williams JW, Namdari N, Washam JB, Raitz G, Blumenthal JA, Jiang W, Yapa R, McBroom AJ, Lallinger K, Schmidt R, Kosinski AS, Sanders GD. Diagnostic Accuracy of Screening Tests and Treatment for Post-Acute Coronary Syndrome Depression: A Systematic Review. Ann Intern Med 2017; 167:725-735. [PMID: 29132152 DOI: 10.7326/m17-1811] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 11/22/2022] Open
Abstract
BACKGROUND Patients who have had an acute coronary syndrome (ACS) event have an increased risk for depression. PURPOSE To evaluate the diagnostic accuracy of depression screening instruments and to compare safety and effectiveness of depression treatments in adults within 3 months of an ACS event. DATA SOURCES MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane Database of Systematic Reviews from January 2003 to August 2017, and a manual search of citations from key primary and review articles. STUDY SELECTION English-language studies of post-ACS patients that evaluated the diagnostic accuracy of depression screening tools or compared the safety and effectiveness of a broad range of pharmacologic and nonpharmacologic depression treatments. DATA EXTRACTION 2 investigators independently screened each article for inclusion; abstracted the data; and rated the quality, applicability, and strength of evidence. DATA SYNTHESIS Evidence from 6 of the 10 included studies showed that a range of depression screening instruments produces acceptable levels of diagnostic sensitivity, specificity, and negative predictive values (70% to 100%) but low positive predictive values (below 50%). The Beck Depression Inventory-II was the most studied tool. A large study found that a combination of cognitive behavioral therapy (CBT) and antidepressant medication improved depression symptoms, mental health-related function, and overall life satisfaction more than usual care. LIMITATION Few studies, no evaluation of the influence of screening on clinical outcomes, and no studies addressing several clinical interventions of interest. CONCLUSION Depression screening instruments produce diagnostic accuracy metrics that are similar in post-ACS patients and other clinical populations. Depression interventions have an uncertain effect on cardiovascular outcomes, but CBT combined with antidepressant medication produces modest improvement in psychosocial outcomes. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality (PROSPERO: CRD42016047032).
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Affiliation(s)
- Jason A Nieuwsma
- From Duke University School of Medicine, Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham Veterans Affairs Evidence Synthesis Center, Durham, North Carolina, and Southern California Permanente Medical Group, Anaheim, California; and University of Washington, Boise, Idaho
| | - John W Williams
- From Duke University School of Medicine, Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham Veterans Affairs Evidence Synthesis Center, Durham, North Carolina, and Southern California Permanente Medical Group, Anaheim, California; and University of Washington, Boise, Idaho
| | - Natasha Namdari
- From Duke University School of Medicine, Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham Veterans Affairs Evidence Synthesis Center, Durham, North Carolina, and Southern California Permanente Medical Group, Anaheim, California; and University of Washington, Boise, Idaho
| | - Jeffrey B Washam
- From Duke University School of Medicine, Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham Veterans Affairs Evidence Synthesis Center, Durham, North Carolina, and Southern California Permanente Medical Group, Anaheim, California; and University of Washington, Boise, Idaho
| | - Giselle Raitz
- From Duke University School of Medicine, Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham Veterans Affairs Evidence Synthesis Center, Durham, North Carolina, and Southern California Permanente Medical Group, Anaheim, California; and University of Washington, Boise, Idaho
| | - James A Blumenthal
- From Duke University School of Medicine, Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham Veterans Affairs Evidence Synthesis Center, Durham, North Carolina, and Southern California Permanente Medical Group, Anaheim, California; and University of Washington, Boise, Idaho
| | - Wei Jiang
- From Duke University School of Medicine, Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham Veterans Affairs Evidence Synthesis Center, Durham, North Carolina, and Southern California Permanente Medical Group, Anaheim, California; and University of Washington, Boise, Idaho
| | - Roshini Yapa
- From Duke University School of Medicine, Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham Veterans Affairs Evidence Synthesis Center, Durham, North Carolina, and Southern California Permanente Medical Group, Anaheim, California; and University of Washington, Boise, Idaho
| | - Amanda J McBroom
- From Duke University School of Medicine, Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham Veterans Affairs Evidence Synthesis Center, Durham, North Carolina, and Southern California Permanente Medical Group, Anaheim, California; and University of Washington, Boise, Idaho
| | - Kathryn Lallinger
- From Duke University School of Medicine, Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham Veterans Affairs Evidence Synthesis Center, Durham, North Carolina, and Southern California Permanente Medical Group, Anaheim, California; and University of Washington, Boise, Idaho
| | - Robyn Schmidt
- From Duke University School of Medicine, Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham Veterans Affairs Evidence Synthesis Center, Durham, North Carolina, and Southern California Permanente Medical Group, Anaheim, California; and University of Washington, Boise, Idaho
| | - Andrzej S Kosinski
- From Duke University School of Medicine, Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham Veterans Affairs Evidence Synthesis Center, Durham, North Carolina, and Southern California Permanente Medical Group, Anaheim, California; and University of Washington, Boise, Idaho
| | - Gillian D Sanders
- From Duke University School of Medicine, Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham Veterans Affairs Evidence Synthesis Center, Durham, North Carolina, and Southern California Permanente Medical Group, Anaheim, California; and University of Washington, Boise, Idaho
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21
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Currier JM, Drescher KD, Nieuwsma JA, McCormick WH. Theodicies and professional quality of life in a nationally representative sample of chaplains in the veterans' health administration. J Prev Interv Community 2017; 45:286-296. [PMID: 28880810 DOI: 10.1080/10852352.2016.1197748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 10/18/2022]
Abstract
This study examined the role of theodicies or theological/philosophic attempts to resolve existential dilemmas related to evil and human suffering in chaplains' professional quality of life (ProQOL). A nationally representative sample of 298 VHA chaplains completed the recently developed Views of Suffering Scale (Hale-Smith, Park, & Edmondson, 2012 ) and ProQOL-5 (Stamm, 2010 ). Descriptive results revealed that 20-50% endorsed strong theistic beliefs in a compassionate deity who reciprocally suffers with hurting people, God ultimately being responsible for suffering, and that suffering can provide opportunities for intimate encounters with God and personal growth. Other results indicated that chaplains' beliefs about human suffering were differentially linked with their sense of enjoyment/purpose in working with veterans. These results suggest that theodicies might serve as a pathway to resilience for individuals in spiritual communities and traditions in USA, particularly for clinicians and ministry professionals who are committed to serving the needs of traumatized persons.
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Affiliation(s)
- Joseph M Currier
- a Psychology Department , University of South Alabama , Mobile , Alabama , USA
| | - Kent D Drescher
- b National Center for PTSD , Palo Alto VA Healthcare System, Dissemination and Training Division , Menlo Park , California , USA
| | - Jason A Nieuwsma
- c Mental Health and Chaplaincy Program, Department of Veterans Affairs , Durham , North Carolina , USA.,d Department of Psychiatry and Behavioral Sciences , Duke University Medical School , Durham , North Carolina , USA
| | - Wesley H McCormick
- a Psychology Department , University of South Alabama , Mobile , Alabama , USA
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22
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Nieuwsma JA, Wray LO, Voils CI, Gierisch JM, Dundon M, Coffman CJ, Jackson GL, Merwin R, Vair C, Juntilla K, White-Clark C, Jeffreys AS, Harris A, Owings M, Marr J, Edelman D. A problem-solving intervention for cardiovascular disease risk reduction in veterans: Protocol for a randomized controlled trial. Contemp Clin Trials 2017; 60:42-50. [PMID: 28600161 PMCID: PMC5579718 DOI: 10.1016/j.cct.2017.06.001] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 05/30/2017] [Accepted: 06/05/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Health behaviors related to diet, tobacco usage, physical activity, medication adherence, and alcohol use are highly determinative of risk for developing cardiovascular disease. This paper describes a study protocol to evaluate a problem-solving intervention that aims to help patients at risk for developing cardiovascular disease address barriers to adopting positive health behaviors in order to reduce cardiovascular risk. METHODS Eligible patients are adults enrolled in Veterans Affairs (VA) health care who have not experienced a cardiovascular event but are at elevated risk based on their Framingham Risk Score (FRS). Participants in this two-site study are randomized to either the intervention or care as usual, with a target of 400 participants. The study intervention, Healthy Living Problem-Solving (HELPS), consists of six group sessions conducted approximately monthly interspersed with individualized coaching calls to help participants apply problem-solving principles. The primary outcome is FRS, analyzed at the beginning and end of the study intervention (6months). Participants also complete measures of physical activity, caloric intake, self-efficacy, group cohesion, problem-solving capacities, and demographic characteristics. CONCLUSION Results of this trial will inform behavioral interventions to change health behaviors in those at risk for cardiovascular disease and other health conditions. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT01838226.
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Affiliation(s)
- Jason A Nieuwsma
- Mid-Atlantic MIRECC, Department of Veterans Affairs, Durham, NC, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States.
| | - Laura O Wray
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, NY, United States; Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Corrine I Voils
- Center for Health Services Research in Primary Care, Department of Veterans Affairs, Durham, NC, United States; Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Jennifer M Gierisch
- Center for Health Services Research in Primary Care, Department of Veterans Affairs, Durham, NC, United States; Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Margaret Dundon
- National Center for Health Promotion and Disease Prevention, Department of Veterans Affairs, Durham, NC, United States
| | - Cynthia J Coffman
- Center for Health Services Research in Primary Care, Department of Veterans Affairs, Durham, NC, United States; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, United States
| | - George L Jackson
- Center for Health Services Research in Primary Care, Department of Veterans Affairs, Durham, NC, United States; Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Rhonda Merwin
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States; Center for Health Services Research in Primary Care, Department of Veterans Affairs, Durham, NC, United States
| | - Christina Vair
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, NY, United States
| | - Karen Juntilla
- Center for Health Services Research in Primary Care, Department of Veterans Affairs, Durham, NC, United States
| | - Courtney White-Clark
- Center for Health Services Research in Primary Care, Department of Veterans Affairs, Durham, NC, United States
| | - Amy S Jeffreys
- Center for Health Services Research in Primary Care, Department of Veterans Affairs, Durham, NC, United States
| | - Amy Harris
- Center for Health Services Research in Primary Care, Department of Veterans Affairs, Durham, NC, United States
| | - Michael Owings
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Johnpatrick Marr
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - David Edelman
- Center for Health Services Research in Primary Care, Department of Veterans Affairs, Durham, NC, United States; Department of Medicine, Duke University Medical Center, Durham, NC, United States
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Abstract
This descriptive study examines the provision of chaplaincy services to veterans who sought health care at a Department of Veterans Affairs (VA) Medical Center following a suicide attempt. A system-wide VA database of suicidal behavior was used to identify a cohort of n = 22,701 veterans who survived a suicide attempt. Next, an electronic review of VA clinical records found that n = 7,447 (32.8%) received chaplaincy services in the 30 days following their attempt. Of this group, the overwhelming majority of first chaplaincy encounters took place in in-patient settings: n = 6890 (92.5%). First chaplaincy encounters most often occurred 1-7 days following the attempt: n = 5,033 (67.6%). Most chaplaincy service users had only one chaplaincy encounter: n = 3,514 (47.2%). The findings suggest that, at VA Medical Centers, a relatively sizeable percentage of suicide attempt survivors have contact with chaplaincy services. Additional research is needed to ascertain if chaplaincy services yield any therapeutic benefit for this group.
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Affiliation(s)
- Marek S Kopacz
- a VISN 2 Center of Excellence for Suicide Prevention , Canandaigua , New York , USA
| | - Cathleen P Kane
- a VISN 2 Center of Excellence for Suicide Prevention , Canandaigua , New York , USA
| | - Wilfred R Pigeon
- a VISN 2 Center of Excellence for Suicide Prevention , Canandaigua , New York , USA.,b University of Rochester Medical Center , Rochester , New York , USA
| | - Jason A Nieuwsma
- c Mid-Atlantic Mental Illness Research, Education and Clinical Center, Mental Health and Chaplaincy , Durham , North Carolina , USA.,d Duke University Medical Center , Durham , North Carolina , USA
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McCormick WH, Carroll TD, Slagel BA, Drescher KD, Nieuwsma JA, Currier JM. Professional Quality of Life and Changes in Spirituality Among VHA Chaplains: A Mixed Methods Investigation. J Health Care Chaplain 2017; 23:113-129. [DOI: 10.1080/08854726.2017.1295675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Fortune-Britt AG, Nieuwsma JA, Gierisch JM, Datta SK, Stolldorf DP, Cantrell WC, Ethridge AK, Angel C, Millspaugh D, Bauch SL, Jackson GL. Evaluating the implementation and sustainability of a program for enhancing veterans' intimate relationships. Mil Med 2016; 180:676-83. [PMID: 26032383 DOI: 10.7205/milmed-d-14-00336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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
The Warrior to Soul Mate (W2SM) program is a grassroots initiative on the part of Veterans Affairs chaplain services to provide relationship enhancement skills to veterans and significant others based on the Practical Application of Intimate Relationship Skills model. To examine the implementation and sustainability of the W2SM program, two online surveys were sent to each participating facility's W2SM leader. The first examined how individual W2SM events were conducted (100% response rate, 67 surveys) and the second assessed facility-level issues impacting program sustainability (100% response rate, 23 surveys). Four sites were selected for qualitative interviews based on levels of sustainability. In 2013, W2SM served 1,664 people including 847 veterans, incurring reasonable program costs when compared to other intensive Veterans Affairs services. However, there have been important systematic (e.g., contracting processes) and resource (e.g., time, concern over funding) challenges that are reflected in the wide range of predicted program sustainability.
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Affiliation(s)
- Alice G Fortune-Britt
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street (152), Durham, NC 27705
| | - Jason A Nieuwsma
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham Veterans Affairs Medical Center, 411 W. Chapel Hill Street, Durham, NC 27701
| | - Jennifer M Gierisch
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street (152), Durham, NC 27705
| | - Santanu K Datta
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street (152), Durham, NC 27705
| | - Deonni P Stolldorf
- Geriatric Research Education Clinical Center (GRECC), Veterans Affairs Tennessee Valley Healthcare System, G-410, 1310 24th Avenue South, Nashville, TN 37212
| | - William C Cantrell
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham Veterans Affairs Medical Center, 411 W. Chapel Hill Street, Durham, NC 27701
| | - A Keith Ethridge
- National Chaplain Center, Veterans Health Administration, 100 Emancipation Drive, Hampton, VA 23667
| | - Clyde Angel
- Chaplain Service, Richard L. Roudebush Veterans Affairs Medical Center, 1481 West 10th Street (125), Indianapolis, IN 46202
| | - Dick Millspaugh
- Chaplain Service, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161
| | - Sherri L Bauch
- Office of Patient Centered Care and Cultural Transformation (10NE), Veterans Health Administration, 810 Vermont Avenue, NW Washington, DC 20420
| | - George L Jackson
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street (152), Durham, NC 27705
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Kopacz MS, Nieuwsma JA, Jackson GL, Rhodes JE, Cantrell WC, Bates MJ, Meador KG. Chaplains' Engagement with Suicidality among Their Service Users: Findings from the VA/DoD Integrated Mental Health Strategy. Suicide Life Threat Behav 2016; 46:206-12. [PMID: 26255592 DOI: 10.1111/sltb.12184] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 04/08/2015] [Accepted: 06/02/2015] [Indexed: 11/26/2022]
Abstract
Chaplains play an important role in supporting the mental health of current and former military personnel; in this study, the engagement of Department of Veterans Affairs (VA), Army, Navy, and Air Force chaplains with suicidality among their service users were examined. An online survey was used to collect data from 440 VA and 1,723 Department of Defense (DoD) chaplains as part of the VA/DoD Integrated Mental Health Strategy. Differences were noted for demographics, work setting characteristics, encountering suicidality, and self-perceived preparation for dealing with suicidality. Compared to DoD chaplains, VA chaplains encounter more at-risk service users, yet feel less prepared for dealing with suicidality.
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Affiliation(s)
- Marek S Kopacz
- US Department of Veterans Affairs, VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY, USA
| | - Jason A Nieuwsma
- Mental Health and Chaplaincy, Department of Veterans Affairs, Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - George L Jackson
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA
| | - Jeffrey E Rhodes
- Psychological Health Promotion, Deployment Health Clinical Center, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, Silver Spring, MD, USA
| | - William C Cantrell
- Mental Health and Chaplaincy, Department of Veterans Affairs, Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
| | - Mark J Bates
- Psychological Health Promotion, Deployment Health Clinical Center, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, Silver Spring, MD, USA
| | - Keith G Meador
- Mental Health and Chaplaincy, Department of Veterans Affairs, Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA.,Departments of Psychiatry and Health Policy, Center for Biomedical Ethics and Society & Graduate Department of Religion, Vanderbilt University, Nashville, TN, USA
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Spoont MR, Williams JW, Kehle-Forbes S, Nieuwsma JA, Mann-Wrobel MC, Gross R. Does This Patient Have Posttraumatic Stress Disorder?: Rational Clinical Examination Systematic Review. JAMA 2015; 314:501-10. [PMID: 26241601 DOI: 10.1001/jama.2015.7877] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Posttraumatic stress disorder (PTSD) is a relatively common mental health condition frequently seen, though often unrecognized, in primary care settings. Identifying and treating PTSD can greatly improve patient health and well-being. OBJECTIVE To systematically review the utility of self-report screening instruments for PTSD among primary care and high-risk populations. EVIDENCE REVIEW We searched MEDLINE and the National Center for PTSD's Published International Literature on Traumatic Stress (PILOTS) databases for articles published on screening instruments for PTSD published from January 1981 through March 2015. Study quality was rated using Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria. STUDY SELECTION Studies of screening instruments for PTSD evaluated using gold standard structured clinical diagnostic interviews that had interview samples of at least 50 individuals. FINDINGS We identified 2522 citations, retrieved 318 for further review, and retained 23 cohort studies that evaluated 15 screening instruments for PTSD. Of the 23 studies, 15 were conducted in primary care settings in the United States (n = 14,707 were screened, n = 5374 given diagnostic interview, n = 814 had PTSD) and 8 were conducted in community settings following probable trauma exposure (ie, natural disaster, terrorism, and military deployment; n = 5302 were screened, n = 4263 given diagnostic interview, n = 393 were known to have PTSD with an additional 50 inferred by rates reported by authors). Two screens, the Primary Care PTSD Screen (PC-PTSD) and the PTSD Checklist were the best performing instruments. The 4-item PC-PTSD has a positive likelihood ratio of 6.9 (95% CI, 5.5-8.8) and a negative likelihood ratio of 0.30 (95% CI, 0.21-0.44) using the same score indicating a positive screen as used by the Department of Veterans Affairs in all of its primary care clinics. The 17-item PTSD Checklist has a positive likelihood ratio of 5.2 (95% CI, 3.6-7.5) and a negative likelihood ratio of 0.33 (95% CI, 0.29-0.37) using scores of around 40 as indicating a positive screen. Using the same score employed by primary care clinics in the Department of Veterans Affairs to indicate a positive screen, the 4-item PC-PTSD has a sensitivity of 0.69 (95% CI, 0.55-0.81), a specificity of 0.92 (95% CI, 0.86-0.95), a positive likelihood ratio of 8.49 (95% CI, 5.56-12.96) and a negative likelihood ratio of 0.34 (95% CI, 0.22-0.48). For the 17-item PTSD Checklist, scores around 40 as indicating a positive screen, have a sensitivity of 0.70 (95% CI, 0.64-0.77), a specificity of 0.90 (95% CI, 0.84-0.93), a positive likelihood ratio of 6.8 (95% CI, 4.7-9.9) and a negative likelihood ratio of 0.33 (95% CI, 0.27-0.40). CONCLUSIONS AND RELEVANCE Two screening instruments, the PC-PTSD and the PTSD Checklist, show reasonable performance characteristics for use in primary care clinics or in community settings with high-risk populations. Both are easy to administer and interpret and can readily be incorporated into a busy practice setting.
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Affiliation(s)
- Michele R Spoont
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota2Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Healthcare System, Minne
| | - John W Williams
- US Department of Veterans Affairs Evidence-based Synthesis Center, Durham Veterans Affairs Medical Center, Durham, North Carolina 5Division of General Internal Medicine, Duke University Medical School, Durham, North Carolina
| | - Shannon Kehle-Forbes
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota3University of Minnesota Medical School, Minneapolis
| | - Jason A Nieuwsma
- Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina 7Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Monica C Mann-Wrobel
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina8Department of Mental Health,Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Raz Gross
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel 10Gertner Institute for Health Policy and Epidemiology,Sheba Medical Center, Tel Hashomer, Israel
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Farnsworth JK, Drescher KD, Nieuwsma JA, Walser RB, Currier JM. The Role of Moral Emotions in Military Trauma: Implications for the Study and Treatment of Moral Injury. Review of General Psychology 2014. [DOI: 10.1037/gpr0000018] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [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
Moral injury, a term coined to represent the potential negative outcomes following transgression of deeply held moral values and beliefs, has recently gained increased recognition as a major concern among military service members exposed to trauma. However, working definitions of moral injury have not yet fully clarified the mechanisms whereby violations of conscience result in these outcomes or their co-occurrence with posttraumatic stress disorder (PTSD). In this paper, advances from the field of moral psychology are used to integrate cognitive, affective, and social dimensions of the emerging moral injury construct, while also pointing to new possibilities for clinical intervention. After reviewing the salience of moral injury for military and veteran populations, the presence of negative moral emotions (e.g., guilt, anger, disgust) are examined within the context of trauma and military-related PTSD. Next, social functionalist accounts of moral emotions are used to explain the development of moral injury and are linked to potential etiologies of PTSD that emphasize both fear and nonfear emotions. Finally, the clinical importance of positive moral emotions for existing and emerging trauma-focused interventions is discussed. Future directions for research and clinical interventions are identified highlighting the importance of utilizing community support.
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Affiliation(s)
| | - Kent D. Drescher
- National Center for PTSD, Menlo Park, California; and The Pathway Home, Yountville, California
| | - Jason A. Nieuwsma
- Mental Health and Chaplaincy, Department of Veterans Affairs, Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina; and Duke University Medical Center, Durham, North Carolina
| | - Robyn B. Walser
- National Center for PTSD; and Department of Psychology, University of California, Berkeley
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Nieuwsma JA, Jackson GL, DeKraai MB, Bulling DJ, Cantrell WC, Rhodes JE, Bates MJ, Ethridge K, Lane ME, Tenhula WN, Batten SV, Meador KG. Collaborating across the Departments of Veterans Affairs and Defense to integrate mental health and chaplaincy services. J Gen Intern Med 2014; 29 Suppl 4:885-94. [PMID: 25355089 PMCID: PMC4239284 DOI: 10.1007/s11606-014-3032-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recognizing that clergy and spiritual care providers are a key part of mental health care systems, the Department of Veterans Affairs (VA) and Department of Defense (DoD) jointly examined chaplains' current and potential roles in caring for veterans and service members with mental health needs. OBJECTIVE Our aim was to evaluate the intersection of chaplain and mental health care practices in VA and DoD in order to determine if improvement is needed, and if so, to develop actionable recommendations as indicated by evaluation findings. DESIGN A 38-member multidisciplinary task group partnered with researchers in designing, implementing, and interpreting a mixed methods study that included: 1) a quantitative survey of VA and DoD chaplains; and 2) qualitative interviews with mental health providers and chaplains. PARTICIPANTS Quantitative: the survey included all full-time VA chaplains and all active duty military chaplains (n = 2,163 completed of 3,464 invited; 62 % response rate). Qualitative: a total of 291 interviews were conducted with mental health providers and chaplains during site visits to 33 VA and DoD facilities. MAIN MEASURES Quantitative: the online survey assessed intersections between chaplaincy and mental health care and took an average of 37 min to complete. Qualitative: the interviews assessed current integration of mental health and chaplain services and took an average of 1 h to complete. KEY RESULTS When included on interdisciplinary mental health care teams, chaplains feel understood and valued (82.8-100 % of chaplains indicated this, depending on the team). However, findings from the survey and site visits suggest that integration of services is often lacking and can be improved. CONCLUSIONS Closely coordinating with a multidisciplinary task group in conducting a mixed method evaluation of chaplain-mental health integration in VA and DoD helped to ensure that researchers assessed relevant domains and that findings could be rapidly translated into actionable recommendations.
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Affiliation(s)
- Jason A Nieuwsma
- Mental Health and Chaplaincy, Department of Veterans Affairs, Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA,
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Fitchett G, Nieuwsma JA, Bates MJ, Rhodes JE, Meador KG. Evidence-Based Chaplaincy Care: Attitudes and Practices in Diverse Healthcare Chaplain Samples. J Health Care Chaplain 2014; 20:144-60. [DOI: 10.1080/08854726.2014.949163] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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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Nieuwsma JA, Fortune-Greeley AK, Jackson GL, Meador KG, Beckham JC, Elbogen EB. Pastoral care use among post-9/11 veterans who screen positive for mental health problems. Psychol Serv 2014; 11:300-8. [PMID: 24933105 DOI: 10.1037/a0037065] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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
As a result of their military experience, veterans with mental health problems may have unique motivations for seeking help from clergy. Patterns and correlates of seeking pastoral care were examined using a nationwide representative survey that was conducted among veterans of post-9/11 conflicts (adjusted N = 1,068; 56% response rate). Separate multivariate logistic regression models were used to examine veteran characteristics associated with seeking pastoral care and seeking mental health services. Among post-9/11 veterans with a probable mental disorder (n = 461)-defined as a positive screen for posttraumatic stress disorder, major depressive disorder, or alcohol misuse-20.2% reported talking to a "pastoral counselor" in the preceding year, 44.7% reported talking to a mental health professional, and 46.6% reported talking to neither. In a multivariate analysis for veterans with a probable mental disorder, seeing a pastoral counselor was associated with an increased likelihood of seeing a mental health professional in the past year (OR: 2.16; 95% CI: [1.28, 3.65]). In a separate bivariate analysis, pastoral counselors were more likely to be seen by veterans who indicated concerns about stigma or distrust of mental health care. These results suggest that pastoral and mental health care services may complement one another and underscore the importance of enhancing understanding and collaboration between these disciplines so as to meet the needs of the veterans they serve.
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Affiliation(s)
- Jason A Nieuwsma
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham Veterans Affairs Medical Center
| | | | - George L Jackson
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center
| | - Keith G Meador
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center
| | - Jean C Beckham
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham Veterans Affairs Medical Center
| | - Eric B Elbogen
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham Veterans Affairs Medical Center
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Van Voorhees EE, Hamlett-Berry K, Christofferson DE, Beckham JC, Nieuwsma JA. No wrong door to smoking cessation care: a Veterans Affairs Chaplain survey. Mil Med 2014; 179:472-6. [PMID: 24806490 DOI: 10.7205/milmed-d-13-00380] [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: 11/11/2022] Open
Abstract
Cigarette smoking disproportionately affects veterans, particularly those with psychiatric diagnoses. Chaplains working within the Department of Veterans Affairs (VA) play key roles in emotional, physical, and spiritual health care of veterans, and veterans often turn to chaplains with mental health concerns. The VA/Department of Defense Integrated Mental Health Care Strategy is working to understand how collaboration between chaplains and mental health professionals may improve services to veterans, and one interest area is the role chaplains might play in facilitating the dissemination of smoking cessation programs. We report the survey results of 321 VA chaplains regarding their interest and willingness to be involved in smoking cessation efforts. Results indicated that over 80% of responding chaplains would feel "somewhat" or "very comfortable" providing information to veterans about VA smoking cessation programs, and that a smaller majority (between 55% and 85%) would feel this level of comfort engaging in smoking cessation-related activities. Findings suggest the potential for collaboration among chaplains and mental health providers in smoking cessation efforts, and also point to the need for further discussion and deeper mutual understanding between these professionals in how they view their roles in contributing to the overall health and well-being of veterans.
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Affiliation(s)
| | - Kim Hamlett-Berry
- Veterans Affairs National Public Health Tobacco & Health: Policy and Programs, 810 Vermont Avenue NW Washington, DC 20420
| | - Dana E Christofferson
- Veterans Affairs National Public Health Tobacco & Health: Policy and Programs, 810 Vermont Avenue NW Washington, DC 20420
| | - Jean C Beckham
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC 27705
| | - Jason A Nieuwsma
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC 27705
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Gierisch JM, Nieuwsma JA, Bradford DW, Wilder CM, Mann-Wrobel MC, McBroom AJ, Hasselblad V, Williams JW. Pharmacologic and behavioral interventions to improve cardiovascular risk factors in adults with serious mental illness: a systematic review and meta-analysis. J Clin Psychiatry 2014; 75:e424-40. [PMID: 24922495 DOI: 10.4088/jcp.13r08558] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [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: 04/30/2013] [Accepted: 10/07/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Individuals with serious mental illness have high rates of cardiovascular disease (CVD) risk factors and mortality. This systematic review was conducted to evaluate pharmacologic and behavioral interventions to reduce CVD risk in adults with serious mental illness. DATA SOURCES MEDLINE, EMBASE, PsycINFO, ClinicalTrials.gov, and Cochrane Database of Systematic Reviews were searched from January 1980 to July 2012 for English language studies. Examples of search terms used include schizophrenia, bipolar disorder, antipsychotics, weight, glucose, lipid, and cardiovascular disease. STUDY SELECTION Two reviewers independently screened citations and identified 33 randomized controlled trials of at least 2 months' duration that enrolled adults with serious mental illness and evaluated pharmacologic or behavioral interventions targeting weight, glucose, or lipid control. DATA EXTRACTION Reviewers extracted data, assessed applicability, and evaluated study quality; the team jointly graded overall strength of evidence. RESULTS We included 33 studies. Most studies targeted weight control (28 studies). Compared with control groups, weight control was improved with behavioral interventions (mean difference = -3.13 kg; 95% CI, -4.21 to -2.05), metformin (mean difference = -4.13 kg; 95% CI, -6.58 to -1.68), anticonvulsive medications topiramate and zonisamide (mean difference = -5.11 kg; 95% CI, -9.48 to -0.74), and adjunctive or antipsychotic switching to aripiprazole (meta-analysis not possible). Evidence was insufficient for all other interventions and for effects on glucose and lipid control. The small number of studies precluded analyses of variability in treatment effects by patient characteristics. CONCLUSIONS Few studies have evaluated interventions addressing 1 or more CVD risk factors in people with serious mental illness. Glucose- and lipid-related results were mainly reported as secondary outcome assessments in studies of weight-management interventions. Comparative effectiveness studies are needed to test multimodal strategies, agents known to be effective in nonserious mental illness populations, and antipsychotic-management strategies.
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Affiliation(s)
- Jennifer M Gierisch
- Center for Health Services Research in Primary Care, Durham Veteran Affairs Medical Center (152), 508 Fulton St, Durham, NC 27705
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Zullig LL, Jackson GL, Provenzale D, Griffin JM, Phelan S, Nieuwsma JA, van Ryn M. Utilization of hospital-based chaplain services among newly diagnosed male Veterans Affairs colorectal cancer patients. J Relig Health 2014; 53:498-510. [PMID: 23054482 PMCID: PMC3578120 DOI: 10.1007/s10943-012-9653-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 05/16/2023]
Abstract
The aim of the study was to examine utilization of chaplain services among Veterans Affairs patients with colorectal cancer (CRC). In 2009, the Cancer Care Assessment and Responsive Evaluation Studies questionnaire was mailed to VA CRC patients diagnosed in 2008 (67 % response rate). Multivariable logistic regression examined factors associated with chaplain utilization. Of 918 male respondents, 36 % reported utilizing chaplains. Chaplain services were more likely to be utilized by patients with higher pain levels (OR = 1.017; 95 % CI = 0.999-1.035), younger age (age OR = 0.979; 95 % CI = 0.964-0.996), and later cancer stage (early stage OR = 0.743; 95 % CI = 0.559-0.985). Chaplain services are most utilized by younger, sicker patients.
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Affiliation(s)
- Leah L Zullig
- Health Services Research and Development (152), Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC, 27705, USA,
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Nieuwsma JA, Rhodes JE, Jackson GL, Cantrell WC, Lane ME, Bates MJ, Dekraai MB, Bulling DJ, Ethridge K, Drescher KD, Fitchett G, Tenhula WN, Milstein G, Bray RM, Meador KG. Chaplaincy and Mental Health in the Department of Veterans Affairs and Department of Defense. J Health Care Chaplain 2013; 19:3-21. [DOI: 10.1080/08854726.2013.775820] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
OBJECTIVE Because evidence-based psychotherapies of 12 to 20 sessions can be perceived as too lengthy and time intensive for the treatment of depression in primary care, a number of studies have examined abbreviated psychotherapy protocols. The purpose of this study was to conduct a systematic review and meta-analysis to determine the efficacy of brief psychotherapy (i.e., < or =8 sessions) for depression. METHODS We used combined literature searches in PubMed, EMBASE, PsycINFO, and an Internet-accessible database of clinical trials of psychotherapy to conduct two systematic searches: one for existing systematic reviews and another for randomized controlled trials (RCTs). Included studies examined evidence-based psychotherapy(s) of eight or fewer sessions, focused on adults with depression, contained an acceptable control condition, were published in English, and used validated measures of depressive symptoms. RESULTS We retained 2 systematic reviews and 15 RCTs evaluating cognitive behavioral therapy, problem-solving therapy, and mindfulness-based cognitive therapy. The systematic reviews found brief psychotherapies to be more efficacious than control, with effect sizes ranging from -0.33 to -0.25. Our meta-analysis found six to eight sessions of cognitive behavioral therapy to be more efficacious than control (ES -0.42, 95% CI -0.74 to -0.10, 12 = 56%). A sensitivity analysis controlled for statistical heterogeneity but showed smaller treatment effects (ES -0.24, 95% CI -0.42 to -0.06, 12 = 0%). CONCLUSIONS Depression can be efficaciously treated with six to eight sessions of psychotherapy, particularly cognitive behavioral therapy and problem-solving therapy. Access to non-pharmacologic treatments for depression could be improved by training healthcare providers to deliver brief psychotherapies.
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Abstract
Depression is a major health concern in India, yet indigenous Indian perspectives on depression have often been disregarded in favor of Western conceptualizations. The present study used quantitative and qualitative measures modeled on the Explanatory Model Interview Catalogue (EMIC) to elicit beliefs about the symptoms, causes, treatments, and stigma associated with depression. Data were collected from 92 students at a university in the Himalayan region of Northern India and from 97 students at a university in the Rocky Mountain region of the United States. U.S. participants in this study were included primarily to approximate a "Western baseline" (in which professional conceptions of depression are predominantly rooted) from which to elucidate Indian perspectives. Compared to U.S. participants, Indian participants were more likely to view restive symptoms (e.g., irritation, anxiety, difficulty thinking) as common features of depression, to view depression as the result of personally controllable causes (e.g., failure), to endorse social support and spiritual reflection or relaxation (e.g., yoga, meditation) as useful means for dealing with depression, and to associate stigma with depression. Efforts aimed at reducing depression among Indians should focus more on implementing effective and culturally acceptable interventions, such as yoga, meditation, and increasing social support.
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Affiliation(s)
- Jason A Nieuwsma
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Department of Veterans Affairs-VA- Mid-Atlantic Mental Illness Research, Education and Clinical Center-MIRECC, 508 Fulton Street, Durham, NC 27705, USA.
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Trivedi RB, Nieuwsma JA, Williams JW. Examination of the utility of psychotherapy for patients with treatment resistant depression: a systematic review. J Gen Intern Med 2011; 26:643-50. [PMID: 21184287 PMCID: PMC3101965 DOI: 10.1007/s11606-010-1608-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [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: 03/09/2010] [Revised: 08/05/2010] [Accepted: 12/03/2010] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To examine the utility of psychotherapy in managing treatment resistant depression. DATA SOURCES PubMed, PsycInfo, Embase, Cochrane Registry of Controlled Clinical Trials, article bibliographies. REVIEW METHODS Eligible articles had to be in English and include English-speaking adult outpatients from general medical or mental health clinics. Studies had to be randomized clinical trials (RCT) involving at least one of the following psychotherapy modalities: cognitive therapy, interpersonal therapy, or behavior therapy. Patients were considered treatment resistant if they reported partial or no remission following treatment with an adequate antidepressant dose for ≥ 6 weeks. Exclusion criteria included receiving psychotherapy at the time of recruitment, and/or comorbid psychiatric conditions unlikely to be treated outside of specialized mental health care (e.g., severe substance abuse). Due to heterogeneity in study designs, a summary estimate of effect was not calculated. Studies were critically analyzed and a qualitative synthesis was conducted. RESULTS Of 941 original titles, 13 articles evaluating 7 unique treatment comparisons were included. Psychotherapy was examined as an augmentation to antidepressants in five studies and as substitution treatment in two studies. A total of 592 patients were evaluated (Mean age ~40 y; Females = 50-85%; Caucasians ≥ 75%). The STAR*D trial used an equipoise stratified randomization design; the remaining studies were RCTs. Compared to active management, two good quality trials showed similar benefit from augmenting antidepressants with psychotherapy; one fair quality and one poor quality trial showed benefit from psychotherapy augmentation; and one good and one poor trial found similar benefit from substituting psychotherapy for antidepressants. One fair quality trial showed lithium augmentation to be more beneficial than psychotherapy. CONCLUSIONS Review demonstrates the utility of psychotherapy in managing treatment resistant depression. However, evidence is sparse and results are mixed. Given that quality trials are lacking, rigorous clinical trials are recommended to guide practice. In the interim, primary care providers should consider psychotherapy when treating patients with treatment resistant depression.
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Affiliation(s)
- Ranak B Trivedi
- VA Puget Sound Health Care System, University of Washington School of Public Health, 1100 Olive Way, Suite 1400, Seattle, WA 98101, USA.
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Nieuwsma JA, Pepper CM. How etiological explanations for depression impact perceptions of stigma, treatment effectiveness, and controllability of depression. J Ment Health 2010; 19:52-61. [PMID: 20380498 DOI: 10.3109/09638230903469095] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND AIMS There is controversy regarding how etiological explanations for depression, particularly biological explanations, influence perceptions of stigma, perceived controllability of depression, and perceived effectiveness of depression treatments. This study evaluated how biological and psychosocial explanations for depression relate to these variables. METHOD Undergraduate students who reported ever suffering from clinical depression (n = 36) and who reported no personal history of depression (n = 33) completed a diagnostic interview and questionnaires assessing etiology beliefs, stigma perceptions, perceived controllability of depression, and perceived effectiveness of different depression treatments. RESULTS Although "ever depressed" participants perceived more stigma than "never depressed" participants, endorsing either etiological model had little relation to perceived stigma. Endorsing psychosocial explanations was associated with perceiving self-initiated treatments as effective, and self-initiated treatments were viewed as more effective than either psychotherapy or medical interventions. CONCLUSIONS Stigmatizing attitudes about depression appear more meaningfully related to individuals' personal experiences with depression than to etiological explanations for depression; yet etiological models appear to have important implications for treatment preference and perceived controllability of mood.
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