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Tomko RL, Wolf BJ, McClure EA, Carpenter MJ, Magruder KM, Squeglia LM, Gray KM. Who responds to a multi-component treatment for cannabis use disorder? Using multivariable and machine learning models to classify treatment responders and non-responders. Addiction 2023; 118:1965-1974. [PMID: 37132085 PMCID: PMC10524796 DOI: 10.1111/add.16226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/13/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND AND AIMS Treatments for cannabis use disorder (CUD) have limited efficacy and little is known about who responds to existing treatments. Accurately predicting who will respond to treatment can improve clinical decision-making by allowing clinicians to offer the most appropriate level and type of care. This study aimed to determine whether multivariable/machine learning models can be used to classify CUD treatment responders versus non-responders. METHODS This secondary analysis used data from a National Drug Abuse Treatment Clinical Trials Network multi-site outpatient clinical trial in the United States. Adults with CUD (n = 302) received 12 weeks of contingency management, brief cessation counseling and were randomized to receive additionally either (1) N-Acetylcysteine or (2) placebo. Multivariable/machine learning models were used to classify treatment responders (i.e. two consecutive negative urine cannabinoid tests or a 50% reduction in days of use) versus non-responders using baseline demographic, medical, psychiatric and substance use information. RESULTS Prediction performance for various machine learning and regression prediction models yielded area under the curves (AUCs) >0.70 for four models (0.72-0.77), with support vector machine models having the highest overall accuracy (73%; 95% CI = 68-78%) and AUC (0.77; 95% CI = 0.72, 0.83). Fourteen variables were retained in at least three of four top models, including demographic (ethnicity, education), medical (diastolic/systolic blood pressure, overall health, neurological diagnosis), psychiatric (depressive symptoms, generalized anxiety disorder, antisocial personality disorder) and substance use (tobacco smoker, baseline cannabinoid level, amphetamine use, age of experimentation with other substances, cannabis withdrawal intensity) characteristics. CONCLUSIONS Multivariable/machine learning models can improve on chance prediction of treatment response to outpatient cannabis use disorder treatment, although further improvements in prediction performance are likely necessary for decisions about clinical care.
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Affiliation(s)
- Rachel L. Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Bethany J. Wolf
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Erin A. McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Matthew J. Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Kathryn M. Magruder
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Lindsay M. Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Richerson JT, Wagner TH, Abrams T, Skelton K, Biswas K, Illarmo S, McSherry F, Fallon MT, Frakt A, Pizer S, Magruder KM, Groer S, Dorn PA, Huang GD, Stock EM. Therapeutic and Economic Benefits of Service Dogs Versus Emotional Support Dogs for Veterans With PTSD. Psychiatr Serv 2023; 74:790-800. [PMID: 36718602 DOI: 10.1176/appi.ps.20220138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/01/2023]
Abstract
OBJECTIVE This work aimed to assess the therapeutic and economic benefits of service dogs versus emotional support dogs for veterans with posttraumatic stress disorder (PTSD). METHODS Veterans with PTSD (N=227) participating in a multicenter trial were randomly assigned to receive a service or emotional support dog; 181 veterans received a dog and were followed up for 18 months. Primary outcomes included overall functioning (assessed with World Health Organization Disability Assessment Scale II [WHODAS 2.0]) and quality of life (Veterans RAND 12-Item Health Survey [VR-12]). Secondary outcomes included PTSD symptoms (PTSD Checklist for DSM-5), suicidal ideation, depression, sleep quality, health care costs and utilization, medication adherence, employment, and productivity. RESULTS Participants paired with a dog had a mean±SD age of 50.6±13.6 years (range 22-79), and most were male (80%), White (66%), and non-Hispanic (91%). Adjusted linear mixed repeated-measures models indicated no difference between the two groups on WHODAS 2.0 or VR-12 scores. Participants with service dogs had a 3.7-point greater reduction in PTSD symptoms versus participants with emotional support dogs (p=0.036). No reduced health care utilization or cost was associated with receiving a service dog. Veterans with service dogs had an increase of 10 percentage points in antidepressant adherence compared with those with emotional support dogs (p<0.01). CONCLUSIONS Both groups appeared to benefit from having a service or emotional support dog. No significant differences in improved functioning or quality of life were observed between the groups. Those in the service dog group had a greater reduction in PTSD symptoms and better antidepressant adherence, improvements that should be explored further.
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Affiliation(s)
- Joan T Richerson
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Todd H Wagner
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Thad Abrams
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Kelly Skelton
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Kousick Biswas
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Samantha Illarmo
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Frances McSherry
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Michael T Fallon
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Austin Frakt
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Steven Pizer
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Kathryn M Magruder
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Shirley Groer
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Patricia A Dorn
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Grant D Huang
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Eileen M Stock
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
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Forsberg CW, Estrada SA, Baraff A, Magruder KM, Vaccarino V, Litz BT, Friedman MJ, Goldberg J, Smith NL. Risk factors for suicide in the Vietnam-era twin registry. Suicide Life Threat Behav 2022; 52:631-641. [PMID: 35499385 DOI: 10.1111/sltb.12848] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The risk of suicide among Veterans is of major concern, particularly among those who experienced a combat deployment and/or have a history of PTSD. DESIGN AND METHODS This was a retrospective cohort study of post-discharge suicide among Vietnam-era Veterans who are members of the Vietnam Era Twin (VET) Registry. The VET Registry is a national sample of male twins from all branches of the military, both of whom served on active duty between 1964 and 1975. Military service and demographic factors were available from the military records. Service in-theater was based on military records; combat exposure and PTSD symptoms were assessed in 1987 by questionnaire. Mortality follow-up, from discharge to 2016, is identified from Department of Veterans Affairs, Social Security Administration, and National Death Index records; suicide as a cause of death is based on the International Classification of Death diagnostic codes from the death certificate. Statistical analysis used Cox proportional hazards regression to estimate the association of Vietnam-theater service, combat exposure, and PTSD symptoms with suicide while adjusting for military service and demographic confounding factors. RESULTS From the 14,401 twins in the VET Registry, there were 147 suicide deaths during follow-up. In adjusted analyses, twins who served in the Vietnam theater were at similar risk of post-discharge suicide compared with non-theater Veterans; there was no association between combat and suicide. An increase in severity of PTSD symptoms was significantly associated with an increased risk of suicide in adjusted analyses (hazard ratio = 1.13 per five-point increase in symptom score; 95% CI: 1.02-1.27). CONCLUSIONS Service in the Vietnam theater is not associated with greater risk of suicide; however, PTSD symptom severity poses a degree of risk of suicide in Vietnam-era Veterans. Adequate screening for PTSD in Veterans may be promising to identify Veterans who are at increased risk of suicide.
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Affiliation(s)
- Christopher W Forsberg
- Seattle Epidemiologic Research and Information Center Department of Veterans Affairs, Seattle, Washington, USA
| | - Santiago A Estrada
- Seattle Epidemiologic Research and Information Center Department of Veterans Affairs, Seattle, Washington, USA
| | - Aaron Baraff
- Seattle Epidemiologic Research and Information Center Department of Veterans Affairs, Seattle, Washington, USA
| | - Kathryn M Magruder
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Brett T Litz
- Massachusetts Veterans Epidemiological Research and Information Center, US Department of Veteran Affairs, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University, Boston, Massachusetts, USA
| | - Matthew J Friedman
- Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA.,National Center for PTSD, U.S. Department of Veterans Affairs, Washington, District of Columbia, USA
| | - Jack Goldberg
- Seattle Epidemiologic Research and Information Center Department of Veterans Affairs, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Nicholas L Smith
- Seattle Epidemiologic Research and Information Center Department of Veterans Affairs, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA
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Ingram LA, Tinago CB, Cai B, Sanders LW, Bevington T, Wilson S, Magruder KM, Svendsen E. Examining Long-Term Mental Health in a Rural Community Post-Disaster: A Mixed Methods Approach. J Health Care Poor Underserved 2019; 29:284-302. [PMID: 29503301 DOI: 10.1353/hpu.2018.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Psychological stressors have been observed immediately following disasters, yet less is known about the long-term effects on the mental health of vulnerable communities. In 2005, Graniteville, S.C. was ravaged by a train derailment that leaked approximately 60 tons of chlorine gas and left several people dead in the small community. The purpose of this study was to examine the mental health of Graniteville-area residents in the nine years following the train disaster using a mixed methods approach. Using the photovoice method, participants reported compromised mental health with symptoms consistent with depression, post-traumatic stress disorder, fear, and anxiety. Medical records analysis indicated that mental health-related hospital encounters generally increased post-disaster. Mental health concerns should be anticipated in the long-term aftermath of disasters. Addressing these concerns is particularly vital in resource-poor communities. Our findings can be useful in developing mental health disaster management protocols and policies for communities in the long-term post-disaster period.
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Smith BN, Spiro A, Magruder KM. THE IMPACT OF MILITARY STRESS EXPOSURES ON HEALTH AND FUNCTIONING IN VIETNAM-ERA WOMEN VETERANS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B N Smith
- National Center for PTSD at VA Boston Healthcare System & Boston University School of Medicine, Boston, Massachusetts, United States
| | - A Spiro
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA; Departments of Epidemiology and Psychiatry, Boston University Schools of Public Health and Medicine, Boston, MA, USA
| | - K M Magruder
- Departments of Psychiatry and Behavioral Sciences and Public Health, Medical University of South Carolina, Charleston, SC, USA
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Affiliation(s)
- K S Mitchell
- National Center for PTSD, VA Boston Healthcare System,Boston, MA,USA
| | - E J Wolf
- National Center for PTSD, VA Boston Healthcare System,Boston, MA,USA
| | - M J Lyons
- Department of Psychological and Brain Sciences,Boston University,Boston, MA,USA
| | - J Goldberg
- Seattle VA Epidemiology Research and Information Center,VA Puget Sound Health Care System,Seattle, WA,USA
| | - K M Magruder
- Department of Psychiatry and Behavioral Sciences,Medical University of South Carolina,Charleston, SC,USA
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Wolf EJ, Miller MW, Sullivan DR, Amstadter AB, Mitchell KS, Goldberg J, Magruder KM. A classical twin study of PTSD symptoms and resilience: Evidence for a single spectrum of vulnerability to traumatic stress. Depress Anxiety 2018; 35:132-139. [PMID: 29283198 PMCID: PMC5794534 DOI: 10.1002/da.22712] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [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: 07/17/2017] [Revised: 11/01/2017] [Accepted: 11/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To examine shared genetic and environmental risk factors across PTSD symptoms and resilience. METHODS Classical twin study of 2010-2012 survey data conducted among 3,318 male twin pairs in the Vietnam Era Twin Registry. Analyses included: (a) estimates of genetic and environmental influences on PTSD symptom severity (as measured by the PTSD Checklist) and resilience (assessed with the Connor-Davidson Resilience Scale-10); (b) development of a latent model of traumatic stress, spanning both PTSD and resilience; and (c) estimates of genetic and environmental influences on this spectrum. RESULTS The heritability of PTSD was 49% and of resilience was 25%. PTSD and resilience were correlated at r = -.59, and 59% of this correlation was attributable to a single genetic factor, whereas the remainder was due to a single non-shared environment factor. Resilience was also influenced by common and unique environmental factors not shared with PTSD, but there was no genetic factor specific to resilience. Confirmatory factor analysis supported the Development of a revised phenotype reflecting the broader dimension of traumatic stress, with biometric models suggesting increased heritability (66%) of this spectrum compared to PTSD or resilience individually. CONCLUSIONS Genetic factors contribute to a single spectrum of traumatic stress reflecting resilience at one end and high symptom severity at the other. This carries implications for phenotype refinement in the search for molecular genetic markers of trauma-related psychopathology. Rather than focusing only on genetic risk for PTSD, molecular genetics research may benefit from evaluation of the broader spectrum of traumatic stress.
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Affiliation(s)
- Erika J. Wolf
- National Center for PTSD at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine
| | - Mark W. Miller
- National Center for PTSD at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine
| | - Danielle R. Sullivan
- National Center for PTSD at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine
| | - Ananda B. Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University
| | - Karen S. Mitchell
- National Center for PTSD at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine
| | - Jack Goldberg
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System,Department of Epidemiology, University of Washington
| | - Kathryn M. Magruder
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
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Kilbourne AM, Schumacher K, Frayne SM, Cypel Y, Barbaresso MM, Nord KM, Perzhinsky J, Lai Z, Prenovost K, Spiro A, Gleason TC, Kimerling R, Huang GD, Serpi TB, Magruder KM. Physical Health Conditions Among a Population-Based Cohort of Vietnam-Era Women Veterans: Agreement Between Self-Report and Medical Records. J Womens Health (Larchmt) 2017; 26:1244-1251. [DOI: 10.1089/jwh.2016.6069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Amy M. Kilbourne
- VA Ann Arbor Healthcare System and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Karen Schumacher
- VA Ann Arbor Healthcare System and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Susan M. Frayne
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System and Stanford University School of Medicine, Menlo Park, California
| | - Yasmin Cypel
- Post Deployment Health Services (10P4Q), Epidemiology Program, Office of Patient Care Services, Department of Veterans Affairs, Washington, District of Columbia
| | - Michelle M. Barbaresso
- VA Ann Arbor Healthcare System and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kristina M. Nord
- Office of Research and Development, Veterans Health Administration, U.S. Department of Veterans Affairs, Washington, District of Columbia
| | - Juliette Perzhinsky
- Aleda E. Lutz VAMC and Central Michigan University College of Medicine, Saginaw, Michigan
| | - Zongshan Lai
- Department of Pathology, Beaumont Health System, Troy, Michigan
| | - Katherine Prenovost
- VA Ann Arbor Healthcare System and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Avron Spiro
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System and Departments of Epidemiology and Psychiatry, Boston University Schools of Public Health and Medicine, Boston, Massachusetts
| | - Theresa C. Gleason
- Patient-Centered Outcomes Research Institute, Clinical Effectiveness & Decision Science, Washington DC
| | - Rachel Kimerling
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System and Stanford University School of Medicine, Menlo Park, California
| | - Grant D. Huang
- Cooperative Studies Program Central Office, VHA Office of Research and Development, Washington, DC
| | - Tracey B. Serpi
- VA Cooperative Studies Program, Veterans Health Administration, Perry Point, Maryland
| | - Kathryn M. Magruder
- Medical University of South Carolina, Charleston, South Carolina, Charleston, South Carolina
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9
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Abstract
Exposure to trauma is pervasive in societies worldwide and is associated with substantial costs to the individual and society, making it a significant global public health concern. We present evidence for trauma as a public health issue by highlighting the role of characteristics operating at multiple levels of influence - individual, relationship, community, and society - as explanatory factors in both the occurrence of trauma and its sequelae. Within the context of this multi-level framework, we highlight targets for prevention of trauma and its downstream consequences and provide examples of where public health approaches to prevention have met with success. Finally, we describe the essential role of public health policies in addressing trauma as a global public health issue, including key challenges for global mental health and next steps for developing and implementing a trauma-informed public health policy agenda. A public health framework is critical for understanding risk and protective factors for trauma and its aftermath operating at multiple levels of influence and generating opportunities for prevention.
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Affiliation(s)
- Kathryn M. Magruder
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, S.C, U.S.A
| | | | - Diane L. Elmore Borbon
- Department of Psychiatry and Behavioral Sciences, UCLA-Duke University National Center for Child Traumatic Stress, Washington, D.C, U.S.A
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10
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Saunders GH, Biswas K, Serpi T, McGovern S, Groer S, Stock EM, Magruder KM, Storzbach D, Skelton K, Abrams T, McCranie M, Richerson J, Dorn PA, Huang GD, Fallon MT. Design and challenges for a randomized, multi-site clinical trial comparing the use of service dogs and emotional support dogs in Veterans with post-traumatic stress disorder (PTSD). Contemp Clin Trials 2017; 62:105-113. [PMID: 28844986 DOI: 10.1016/j.cct.2017.08.017] [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] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/13/2017] [Accepted: 08/23/2017] [Indexed: 01/01/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a leading cause of impairments in quality of life and functioning among Veterans. Service dogs have been promoted as an effective adjunctive intervention for PTSD, however published research is limited and design and implementation flaws in published studies limit validated conclusions. This paper describes the rationale for the study design, a detailed methodological description, and implementation challenges of a multisite randomized clinical trial examining the impact of service dogs on the on the functioning and quality of life of Veterans with PTSD. Trial design considerations prioritized participant and intervention (dog) safety, selection of an intervention comparison group that would optimize enrollment in all treatment arms, pragmatic methods to ensure healthy well-trained dogs, and the selection of outcomes for achieving scientific and clinical validity in a Veteran PTSD population. Since there is no blueprint for conducting a randomized clinical trial examining the impact of dogs on PTSD of this size and scope, it is our primary intent that the successful completion of this trial will set a benchmark for future trial design and scientific rigor, as well as guiding researchers aiming to better understand the role that dogs can have in the management of Veterans experiencing mental health conditions such as PTSD.
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Affiliation(s)
- Gabrielle H Saunders
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR 97239, United States.
| | - Kousick Biswas
- Cooperative Studies Program Coordinating Center, VA Maryland Health Care System, Perry Point, MD 21902, United States
| | - Tracey Serpi
- Cooperative Studies Program Coordinating Center, VA Maryland Health Care System, Perry Point, MD 21902, United States
| | | | - Shirley Groer
- VA Office of Research and Development, Washington, DC 20420, United States
| | - Eileen M Stock
- Cooperative Studies Program Coordinating Center, VA Maryland Health Care System, Perry Point, MD 21902, United States
| | - Kathryn M Magruder
- Medical University of South Carolina, Charleston, SC 29425, United States
| | - Daniel Storzbach
- VA Portland Health Care System, Portland, OR 97239, Unites States
| | - Kelly Skelton
- Atlanta VA Medical Center, Atlanta, GA, United States
| | - Thad Abrams
- Iowa City Veterans Affairs Health Care System, Iowa City, IA 52246, United States; University of Iowa, Iowa City, IA 52246, United States
| | - Mark McCranie
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR 97239, United States
| | - Joan Richerson
- VA Tennessee Valley Health Care System, Nashville, TN 37212, United States
| | - Patricia A Dorn
- VA Office of Research and Development, Washington, DC 20420, United States
| | - Grant D Huang
- Cooperative Studies Program Central Office, VA Office of Research and Development, Washington, DC 20420, United States
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11
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Bastian LA, Gray KE, DeRycke E, Mirza S, Gierisch JM, Haskell SG, Magruder KM, Wakelee HA, Wang A, Ho GYF, LaCroix AZ. Differences in Active and Passive Smoking Exposures and Lung Cancer Incidence Between Veterans and Non-Veterans in the Women's Health Initiative. Gerontologist 2017; 56 Suppl 1:S102-11. [PMID: 26768384 DOI: 10.1093/geront/gnv664] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Women Veterans may have higher rates of both active and passive tobacco exposure than their civilian counterparts, thereby increasing their risk for lung cancer. PURPOSE OF THE STUDY To compare differences in active and passive smoking exposure and lung cancer incidence among women Veterans and non-Veterans using prospective data from the Women's Health Initiative (WHI). DESIGN AND METHODS We used data from the WHI, which collected longitudinal demographic, clinical, and laboratory data on 161,808 postmenopausal women. We employed linear and multinomial regression and generalized linear models to compare active and passive smoking exposure between Veterans and non-Veterans and Cox proportional hazards models to estimate differences in lung cancer incidence rates. RESULTS After adjustment, Veterans had 2.54 additional pack years of smoking compared with non-Veterans (95% confidence interval [CI] 1.68, 3.40). Veterans also had a 1% increase in risk of any passive smoking exposure (95% CI 1.00, 1.02) and a 9% increase in risk of any workplace exposure (95% CI 1.07, 1.11) compared with non-Veterans. After adjustment for age and smoking exposures, Veterans did not have a higher risk of lung cancer compared with non-Veterans (relative risk = 1.06 95% CI 0.86, 1.30). IMPLICATIONS Women Veterans had higher rates of tobacco use and exposure to passive smoking, which were associated with a higher risk for lung cancer compared with non-Veterans. Clinicians who care for Veterans need to be aware that older women Veterans have more exposures to risk factors for lung cancer.
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Affiliation(s)
- Lori A Bastian
- VA Connecticut, Newington. Division of General Internal Medicine, University of Connecticut, Farmington.
| | - Kristen E Gray
- Health Services Research and Development (HSR&D), VA Puget Sound Health Care System, Seattle, Washington. Department of Health Services, University of Washington School of Public Health, Seattle
| | | | - Shireen Mirza
- VA Connecticut, Newington. Department of Medicine, University of Connecticut, Newington
| | - Jennifer M Gierisch
- Durham VA Medical Center, North Carolina. Department of Medicine, Duke University, Durham, North Carolina
| | - Sally G Haskell
- VA Office of Patient Care, Women's Health Services, Washington, District of Columbia. VA Connecticut Health Care System, West Haven, Connecticut. Department of Medicine, Yale University, New Haven, Connecticut
| | - Kathryn M Magruder
- Department of Psychiatry and Behavioral Sciences, Medical University South Carolina, Charleston. VA Medical Center, Charleston, South Carolina
| | | | - Ange Wang
- Department of Medicine, Stanford University, California
| | - Gloria Y F Ho
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Andrea Z LaCroix
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego
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12
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Libin AV, Schladen MM, Danford E, Cichon S, Bruner D, Scholten J, Llorente M, Zapata S, Dromerick AW, Blackman MR, Magruder KM. Perspectives of veterans with mild traumatic brain injury on community reintegration: Making sense of unplanned separation from service. Am J Orthopsychiatry 2017; 87:129-138. [PMID: 28206800 DOI: 10.1037/ort0000253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
For veterans separated from the military as a result of acquired mild traumatic brain injury (mTBI), the transition from a military identity to a civilian one is complicated by health, cognitive, and psychosocial factors. We conducted in-depth interviews with 8 veterans with mTBI to understand how they perceived the experience of departure from the military, rehabilitation services provided at a Department of Veterans Affairs (VA) Polytrauma Network Site, and reentry into civilian life. Two distinct patterns of thinking about community reintegration emerged. The first pattern was characterized by the perception of a need to fade one's military identity. The second pattern, conversely, advanced the perception of a need to maintain the integrity of one's military identity though living in a civilian world. These perceptions may be linked to individuals' roles while in the military and whether violent acts were committed in carrying out the mission of service, acts not consonant with positive self-appraisal in the civilian world. The crisis of unplanned, involuntary separation from the military was universally perceived as a crisis equal to that of the precipitating injury itself. The perception that civilians lacked understanding of veterans' military past and their current transition set up expectations for interactions with health care providers, as well as greatly impacting relationships with friend and family. Our veterans' shared perceptions support existing mandates for greater dissemination of military culture training to health care providers serving veterans both at VA and military facilities as well as in the civilian community at large. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | - Dwan Bruner
- Washington DC Veterans Affairs Medical Center
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13
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Abstract
Substance abuse treatment organizations are universally faced with the problem of co-occurring psychiatric disorders among the clients they serve. A first step is assessment of such comorbid conditions; however, the time constraints in front-line substance abuse treatment organizations make extensive clinical assessments almost impossible. The development and validation of a brief screening tool for psychiatric disorders in individuals with substance use disorders (SUDs) could have enormous implications for clinical practice. We assessed the performance characteristics of the Psychiatric Diagnostic Screening Questionnaire (PDSQ) and the Conners' Adult ADHD Rating Scale (CAARS) against the Structured Clinical Interview for DSM-IV (SCID-IV) in 120 patients admitted to SUD treatment. Patients were randomly assigned to receive either the SCID or PDSQ. In general, the PDSQ and CAARS performed well. There were no statistically significant performance differences by order of administration, gender, or drug use in past month. For the GAD subscale, Caucasian patients had higher levels of agreement than non-Caucasian patients.
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Affiliation(s)
- Kathryn M. Magruder
- Acting Associate Chief of Staff for Education at the V.A. Medical Center in Charleston, S.C. and a tenured associate professor at the Medical University of South Carolina in the Departments of Psychiatry and Behavioral Sciences and Biometry and Epidemiology
| | - Susan C. Sonne
- A research associate professor in the Department of Psychiatry and Behavioral Sciences, Clinical Neuroscience Division, Medical University of South Carolina
| | - Kathleen T. Brady
- A board-certified psychiatrist specializing in addiction psychiatry and a professor of psychiatry at the Medical University of South Carolina
| | - Susan Quello
- Currently project coordinator of the Pearson Center for Alcoholism and Addiction Research in the Department of Neuropharmacology at The Scripps Research Institute
| | - Renée Hebert Martin
- Received a doctorate in Biostatistics from the Medical University of South Carolina in 2001
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14
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Marriott BP, Hibbeln JR, Killeen TK, Magruder KM, Holes-Lewis K, Tolliver BK, Turner TH. Design and methods for the Better Resiliency Among Veterans and non-Veterans with Omega-3's (BRAVO) study: A double blind, placebo-controlled trial of omega-3 fatty acid supplementation among adult individuals at risk of suicide. Contemp Clin Trials 2016; 47:325-33. [PMID: 26855120 DOI: 10.1016/j.cct.2016.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 02/01/2016] [Accepted: 02/04/2016] [Indexed: 01/19/2023]
Abstract
Suicide remains the 10th leading cause of death among adults in the United States (U.S.). Annually, approximately 30 per 100,000 U.S. military Veterans commit suicide, compared to 14 per 100,000 U.S. civilians. Symptoms associated with suicidality can be treatment resistant and proven-effective pharmaceuticals may have adverse side-effects. Thus, a critical need remains to identify effective approaches for building psychological resiliency in at-risk individuals. Omega-3 highly unsaturated fatty acids (n-3 HUFAs) are essential nutrients, which must be consumed in the diet. N-3 HUFAs have been demonstrated to reduce symptoms of depression, anxiety, and impulsivity - which are associated with suicide risk. Here we present the design and methods for the Better Resiliency Among Veterans and non-Veterans with Omega-3's (BRAVO) study, which is a double blind, randomized, controlled trial among individuals at risk of suicide of an n-3 HUFA versus placebo supplementation in the form of all natural fruit juice beverages. The BRAVO study seeks to determine if dietary supplementation with n-3 HUFAs reduces the risk for serious suicidal behaviors, suicidal thinking, negative emotions, and symptoms associated with suicide risk. Sub-analyses will evaluate efficacy in reducing depressive symptoms, alcohol, and nicotine use. A sub-study utilizes functional magnetic resonance imaging (fMRI) to evaluate the neuropsychological and neurophysiological effects of n-3 HUFAs. We also outline selection of appropriate proxy outcome measures for detecting response to treatment and collection of ancillary data, such as diet and substance use, that are critical for interpretation of results.
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Affiliation(s)
- Bernadette P Marriott
- Nutrition Section, Division of Gastroenterology and Hepatology, Department of Medicine, and Military Division, Department of Psychiatry, College of Medicine, Medical University of South Carolina, 114 Doughty Street, Ste. 630D, MSC774, Charleston, SC 29425, USA.
| | - Joseph R Hibbeln
- Section on Nutritional Neurosciences, LMBB, NIAAA, NIH 5625 Fishers Lane, Rm 3N-07, MSC 9410, Bethesda, MD 20892, USA
| | - Therese K Killeen
- Department of Psychiatry and Behavioral Sciences, Addiction Sciences Division, Medical University of South Carolina, 67 President St., PO Box 25086, Charleston, SC 29425, USA
| | - Kathryn M Magruder
- Department of Psychiatry & Behavioral Sciences, Military Science Division, Department of Public Health Sciences, Division of Epidemiology, Office of Research Integrity, Medical University of South Carolina, 109 Bee Street, Charleston, SC 29401, USA
| | - Kelly Holes-Lewis
- Department of Psychiatry and Behavioral Sciences, Division of Brain Research and Integrative Neuropsychopharmacology, Medical University of South Carolina, 67 President Street, Charleston, SC 29425, USA
| | - Bryan K Tolliver
- Department of Psychiatry and Behavioral Sciences, Division of Addiction Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425, USA
| | - Travis H Turner
- Ralph H. Johnson VAMC, 109 Bee Street, Charleston, SC 29410, USA; Department of Psychiatry and Behavioral Sciences, Department of Neurosciences/Neurology, Medical University of South Carolina, 67 President St., Charleston, SC 29425, USA
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15
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Goldberg J, Magruder KM, Forsberg CW, Friedman MJ, Litz BT, Vaccarino V, Heagerty PJ, Gleason TC, Huang GD, Smith NL. Prevalence of Post-Traumatic Stress Disorder in Aging Vietnam-Era Veterans: Veterans Administration Cooperative Study 569: Course and Consequences of Post-Traumatic Stress Disorder in Vietnam-Era Veteran Twins. Am J Geriatr Psychiatry 2016; 24:181-91. [PMID: 26560508 PMCID: PMC5928006 DOI: 10.1016/j.jagp.2015.05.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 07/16/2014] [Revised: 05/01/2015] [Accepted: 05/12/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The prevalence of post-traumatic stress disorder (PTSD) among aging Vietnam-era veterans is not well characterized. METHODS In a cross-sectional study, 5,598 male Vietnam-era veterans and members of the Vietnam Era Twin Registry were assessed for PTSD using the Composite International Diagnostic Interview. Current symptoms were measured with the PTSD Checklist (PCL). PTSD was estimated according to age (<60 or ≥ 60) and Vietnam theater service. RESULTS The lifetime prevalence of PTSD in theater veterans aged at least 60 years was 16.9% (95% CI: 13.9%-20.5%) and higher than the 5.5% (95% CI: 4.3%-7.0%) among nontheater veterans. Among veterans younger than 60 years, the comparable prevalence was 22.0% for theater (95% CI: 16.7%-28.4%) and 15.7% for nontheater (95% CI: 13.4%-18.2%) veterans. Similar results were found for theater service and current PTSD prevalence (past 12 months). PCL scores were significantly higher in theater compared with nontheater veterans in both younger and older cohorts. In both the younger and older cohorts significant differences in lifetime and current PTSD prevalence and PCL scores persisted in theater service discordant twin pairs. CONCLUSION Vietnam service is related to elevated PTSD prevalence and current symptom burden in aging veterans. More than 30 years after the end of the Vietnam conflict, many veterans continue to suffer from PTSD, which highlights the need for continuing outreach throughout the life course.
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Affiliation(s)
- Jack Goldberg
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA.
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16
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Abstract
Positive personal gain after adverse life events and traumas is known as posttraumatic growth (PTG). Several factors are suggested to promote PTG after stressful events, including type of trauma, in addition to younger age and female gender. Although conflicting findings exist, studies suggest that there may be less growth associated with personal traumas (i.e., physical or sexual assault, accidents) and more growth associated with shared traumas (i.e., disasters, loss). We examined whether certain types of war-related traumas are associated with more PTG in a sample of 203 Iraqi students living in Turkey who had experienced severe war-related traumatic events. They were assessed in group sessions, using a self-report battery that included the Post-Traumatic Growth Inventory and War Trauma Questionnaire. War experiences were categorized into three types of trauma: trauma to self, trauma to loved ones, and adversity. Growth was measured by the Turkish version of the Post-Traumatic Growth Inventory. Adversity-type events positively predicted growth, whereas trauma to self predicted growth negatively. Males and females showed a different pattern of relationship with growth. Correlations of growth with younger age and adversity observed in females were not seen in males. Our results show that different trauma types may lead to differing levels of growth, and this difference may be more pronounced when gender is taken into account.
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Affiliation(s)
- C Kılıç
- Hacettepe University, Turkey
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17
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Magruder KM, Goldberg J, Forsberg CW, Friedman MJ, Litz BT, Vaccarino V, Heagerty PJ, Gleason TC, Huang GD, Smith NL. Long-Term Trajectories of PTSD in Vietnam-Era Veterans: The Course and Consequences of PTSD in Twins. J Trauma Stress 2016; 29:5-16. [PMID: 26764215 PMCID: PMC5884065 DOI: 10.1002/jts.22075] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We estimated the temporal course of posttraumatic stress disorder (PTSD) in Vietnam-era veterans using a national sample of male twins with a 20-year follow-up. The complete sample included those twins with a PTSD diagnostic assessment in 1992 and who completed a DSM-IV PTSD diagnostic assessment and a self-report PTSD checklist in 2012 (n = 4,138). Using PTSD diagnostic data, we classified veterans into 5 mutually exclusive groups, including those who never had PTSD, and 4 PTSD trajectory groups: (a) early recovery, (b) late recovery, (c) late onset, and (d) chronic. The majority of veterans remained unaffected by PTSD throughout their lives (79.05% of those with theater service, 90.85% of those with nontheater service); however, an important minority (10.50% of theater veterans, 4.45% of nontheater veterans) in 2012 had current PTSD that was either late onset (6.55% theater, 3.29% nontheater) or chronic (3.95% theater, 1.16% nontheater). The distribution of trajectories was significantly different by theater service (p < .001). PTSD remains a prominent issue for many Vietnam-era veterans, especially for those who served in Vietnam.
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Affiliation(s)
- Kathryn M. Magruder
- Mental Health Service, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jack Goldberg
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Christopher W. Forsberg
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Matthew J. Friedman
- National Center for Posttraumatic Stress Disorder, Department of Veterans Affairs, White River Junction, Vermont, USA
- Departments of Psychiatry and Pharmacology & Toxicology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Brett T. Litz
- Massachusetts Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Viola Vaccarino
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Patrick J. Heagerty
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Theresa C. Gleason
- Cooperative Studies Program, Clinical Science Research and Development, VA Office of Research and Development, Washington, DC, USA
| | - Grant D. Huang
- Cooperative Studies Program, Clinical Science Research and Development, VA Office of Research and Development, Washington, DC, USA
| | - Nicholas L. Smith
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
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18
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Magruder KM, Kassam-Adams N, Thoresen S, Olff M. Prevention and public health approaches to trauma and traumatic stress: a rationale and a call to action. Eur J Psychotraumatol 2016; 7:29715. [PMID: 26996536 PMCID: PMC4800286 DOI: 10.3402/ejpt.v7.29715] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 01/01/2016] [Accepted: 01/03/2016] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The field of trauma and traumatic stress is dominated by studies on treatments for those who experience adversity from traumatic experiences. While this is important, we should not neglect the opportunity to consider trauma in a public health perspective. Such a perspective will help to develop prevention approaches as well as extend the reach of early interventions and treatments. The purpose of this paper is to provide an introduction to a public health approach to trauma and traumatic stress and identify key opportunities for trauma professionals and our professional societies (such as the International Society for Traumatic Stress Studies [ISTSS] and the European Society for Traumatic Stress Studies [ESTSS]) to increase our societal impact by adopting such an approach. METHOD This paper reviews and summarizes key findings related to the public health impact of trauma. The special case of children is explored, and a case example of the Norwegian terrorist attacks in 2011 illustrates the potential for improving our response to community level traumatic events. We also discuss how professional organizations such as ESTSS and ISTSS, as well as individual trauma professionals, can and should play an important role in promoting a public health approach. RESULTS Trauma is pervasive throughout the world and has negative impacts at the personal, family, community, and societal levels. A public health perspective may help to develop prevention approaches at all of these levels, as well as extend the reach of early interventions and treatments. CONCLUSIONS Professional organizations such as ESTSS and ISTSS can and should play an important role in promoting a public health approach. They should promote the inclusion of trauma in the global public health agenda and include public health in their activities.
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Affiliation(s)
- Kathryn M Magruder
- Department of Psychiatry & Behavioral Sciences, Military Science Division, Medical University of South Carolina, Charleston, SC, USA.,Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston, SC, USA;
| | - Nancy Kassam-Adams
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Siri Thoresen
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Miranda Olff
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Arq Psychotrauma Expert Group, Diemen, The Netherlands
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19
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Magruder KM, Kılıç C, Koryürek MM. Relationship of posttraumatic growth to symptoms of posttraumatic stress disorder and depression: A pilot study of Iraqi students. Int J Psychol 2015; 50:402-6. [DOI: 10.1002/ijop.12146] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 01/13/2015] [Accepted: 01/15/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Kathryn M. Magruder
- Department of Psychiatry & Behavioral Sciences; Medical University of South Carolina; Charleston SC USA
- Fulbright Senior Research Scholar; Hacettepe University; Ankara Turkey
| | - Cengiz Kılıç
- Department of Psychiatry; Hacettepe University; Ankara Turkey
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20
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Engel CC, Litz B, Magruder KM, Harper E, Gore K, Stein N, Yeager D, Liu X, Coe TR. Delivery of self training and education for stressful situations (DESTRESS-PC): a randomized trial of nurse assisted online self-management for PTSD in primary care. Gen Hosp Psychiatry 2015; 37:323-8. [PMID: 25929985 PMCID: PMC4762212 DOI: 10.1016/j.genhosppsych.2015.04.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [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] [Received: 02/20/2015] [Revised: 04/08/2015] [Accepted: 04/09/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This randomized controlled trial examined the effectiveness of a nurse assisted online cognitive-behavioral self-management intervention for war-related posttraumatic stress disorder (PTSD), compared to optimized usual primary care PTSD Treatment (OUC) to reduce PTSD symptoms. METHOD Participants were 80 veterans of recent military conflicts with PTSD as assessed by the PTSD Checklist (PCL) seeking primary care treatment at one of three Veterans Affairs (VA) and four Army clinics. DESTRESS-PC consisted of logins to a secure website three times per week for 6 weeks with monitoring by a study nurse. All participants received nurse care management in the form of phone check-ins every two weeks and feedback to their primary care providers. Blinded raters assessed outcomes 6, 12, and 18 weeks post-randomization. RESULTS DESTRESS-PC was associated with a significantly greater decrease in PTSD symptoms compared to OUC (F(3, 186)=3.72, p=.012). The effect was largest at the 12-week assessment (∆PCL=12.6±16.6 versus 5.7±12.5, p<0.05) with the treatment effect disappearing by the 18-week follow-up. Notably, there was a dose effect; number of logins correlated significantly with PTSD outcomes, with more logins associated with greater PTSD symptom improvement. None of the secondary outcomes (depression, anxiety, somatic symptoms, and functional status) showed statistically significant improvement; however, the treatment effect on depression approached significance (F(3, 186)=2.17, p=.093). CONCLUSIONS DESTRESS-PC shows promise as a means of delivering effective, early PTSD treatment in primary care. Larger trials are needed.
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Affiliation(s)
- Charles C. Engel
- Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, USA,Corresponding author at: RAND Corporation, 1200 South Hayes Street, Arlington, VA, 22202. Tel.: +1 703 413 1100x5466; fax: +1 703 414 4725. (C.C. Engel)
| | - Brett Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, 150 S. Huntington Ave, Jamaica Plain, MA, USA,Department of Psychiatry, Boston University, 715 Albany St., M-8th Floor, Boston, MA, USA
| | - Kathryn M. Magruder
- Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC, USA,Department of Psychiatry, Medical University of South Carolina, 67 President Street, Charleston, SC, USA
| | - Elizabeth Harper
- Deployment Health Clinical Center, Walter Reed National Military Medical Center, Building 8, 2nd Floor, Room 2220, 8901 Wisconsin Avenue, Bethesda, MD, USA
| | - Kristie Gore
- Deployment Health Clinical Center, Walter Reed National Military Medical Center, Building 8, 2nd Floor, Room 2220, 8901 Wisconsin Avenue, Bethesda, MD, USA
| | - Nathan Stein
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, 150 S. Huntington Ave, Jamaica Plain, MA, USA,Department of Psychiatry, Boston University, 715 Albany St., M-8th Floor, Boston, MA, USA
| | - Derik Yeager
- Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC, USA,Department of Psychiatry, Medical University of South Carolina, 67 President Street, Charleston, SC, USA
| | - Xian Liu
- Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, USA,Deployment Health Clinical Center, Walter Reed National Military Medical Center, Building 8, 2nd Floor, Room 2220, 8901 Wisconsin Avenue, Bethesda, MD, USA,Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Department of Psychiatry, 4301 Jones Bridge Road, Bethesda, MD, USA
| | - T. Ray Coe
- Womack Army Medical Center, 2817 Reilly Rd, Fort Bragg, NC, USA
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Vaccarino V, Goldberg J, Magruder KM, Forsberg CW, Friedman MJ, Litz BT, Heagerty PJ, Huang GD, Gleason TC, Smith NL. Posttraumatic stress disorder and incidence of type-2 diabetes: a prospective twin study. J Psychiatr Res 2014; 56:158-64. [PMID: 24950602 PMCID: PMC4086302 DOI: 10.1016/j.jpsychires.2014.05.019] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [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: 05/26/2014] [Accepted: 05/29/2014] [Indexed: 10/25/2022]
Abstract
Growing evidence has linked posttraumatic stress disorder (PTSD) to insulin resistance and type-2 diabetes, but most previous studies were cross-sectional. We examined the association between PTSD and incidence of diabetes in a prospective study of middle-aged male twins from the Vietnam Era Twin Registry. Lifetime PTSD was diagnosed at baseline with the Diagnostic Interview Schedule (DIS) according to DSM-III-R criteria. Subthreshold PTSD was defined by meeting some, but not all, criteria for PTSD. A total of 4340 respondents without self-reported diabetes at baseline were included. Of these, 658 reported a new diagnosis of treated diabetes over a median of 19.4 years of follow-up. At baseline, twins with PTSD showed more behavioral and metabolic risk factors such as overweight and hypertension. The age-adjusted cumulative incidence of diabetes was significantly higher in twins with PTSD (18.9%) than those without PTSD (14.4%), [odds ratio (OR) = 1.4, 95% confidence interval (CI) 1.03-1.8], and intermediate in those with subthreshold PTSD (16.4%) (OR = 1.2, 95% CI 0.9-1.5, p for trend = 0.03). Adjustment for military, lifestyle and metabolic factors diminished the association. No significant association was found comparing twin pairs discordant for PTSD. In conclusion, PTSD was prospectively associated with a 40% increased risk of new-onset type-2 diabetes which was partially explained by a cluster of metabolic and behavioral risk factors known to influence insulin resistance. Shared biological or behavioral precursors which occur within families may lead to both PTSD and insulin resistance/diabetes. Thus, PTSD could be a marker of neuroendocrine and metabolic dysregulation which may lead to type-2 diabetes.
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Affiliation(s)
- Viola Vaccarino
- Department of Epidemiology, Emory University, Atlanta, GA, United States.
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22
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Abstract
OBJECTIVE To assess the diagnostic performance of the PTSD Checklist (PCL) for three age groups (<50, 50-64, and ≥65 years). METHODS The PCL was compared with the Clinician Administered PTSD Scale, a gold standard for the diagnosis of post-traumatic stress disorder. Receiver operating characteristic curves and the corresponding area under the receiver operating characteristic curve (AUC) and measures of sensitivity and specificity were used to assess the performance of and to determine optimal cutscores for the PCL across the three groups. Analyses were based on 858 randomly selected primary care patients who participated in a study conducted at four Veterans Administration medical centers. RESULTS AUCs were high for all three age groups (87.55%-88.26%), and there were no significant differences in AUCs across age groups χ(2). Optimal cutscores, however, varied considerably: 24 for the oldest group, 34 for the middle group, and 43 for the youngest group. CONCLUSION Recommend use of lower PCL cutscore for older Veterans Administration primary care patients.
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Affiliation(s)
- Derik E Yeager
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC.
| | - Kathryn M Magruder
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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23
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Goldberg J, Magruder KM, Forsberg CW, Kazis LE, Ustün TB, Friedman MJ, Litz BT, Vaccarino V, Heagerty PJ, Gleason TC, Huang GD, Smith NL. The association of PTSD with physical and mental health functioning and disability (VA Cooperative Study #569: the course and consequences of posttraumatic stress disorder in Vietnam-era veteran twins). Qual Life Res 2013; 23:1579-91. [PMID: 24318083 DOI: 10.1007/s11136-013-0585-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the relationship of posttraumatic stress disorder (PTSD) with health functioning and disability in Vietnam-era Veterans. METHODS A cross-sectional study of functioning and disability in male Vietnam-era Veteran twins. PTSD was measured by the Composite International Diagnostic Interview; health functioning and disability were assessed using the Veterans RAND 36-Item Health Survey (VR-36) and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). All data collection took place between 2010 and 2012. RESULTS Average age of the 5,574 participating Veterans (2,102 Vietnam theater and 3,472 non-theater) was 61.0 years. Veterans with PTSD had poorer health functioning across all domains of VR-36 and increased disability for all subscales of WHODAS 2.0 (all p < .001) compared with Veterans without PTSD. Veterans with PTSD were in poorer overall health on the VR-36 physical composite summary (PCS) (effect size = 0.31 in theater and 0.47 in non-theater Veterans; p < .001 for both) and mental composite summary (MCS) (effect size = 0.99 in theater and 0.78 in non-theater Veterans; p < .001 for both) and had increased disability on the WHODAS 2.0 summary score (effect size = 1.02 in theater and 0.96 in non-theater Veterans; p < .001 for both). Combat exposure, independent of PTSD status, was associated with lower PCS and MCS scores and increased disability (all p < .05, for trend). Within-pair analyses in twins discordant for PTSD produced consistent findings. CONCLUSIONS Vietnam-era Veterans with PTSD have diminished functioning and increased disability. The poor functional status of aging combat-exposed Veterans is of particular concern.
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Affiliation(s)
- Jack Goldberg
- Seattle Epidemiologic Research and Information Center (S-152-E), VA Puget Sound Health Care System, 1600 South Columbian Way, Seattle, WA, 98108, USA,
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24
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Milanak ME, Gros DF, Magruder KM, Brawman-Mintzer O, Frueh BC. Prevalence and features of generalized anxiety disorder in Department of Veteran Affairs primary care settings. Psychiatry Res 2013; 209:173-9. [PMID: 23659756 PMCID: PMC4026032 DOI: 10.1016/j.psychres.2013.03.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 03/24/2013] [Accepted: 03/26/2013] [Indexed: 12/28/2022]
Abstract
Generalized anxiety disorder (GAD) is a highly prevalent distressing condition for individuals in both community and community primary care settings. However, despite the high prevalence of GAD identified in epidemiological studies, little is known about GAD and its related symptoms and impairments in veteran populations. The present study investigated the prevalence, comorbidity, physical and mental health impairment, and healthcare utilization of veteran participants with GAD, as well as comparing symptoms of GAD and posttraumatic stress disorder (PTSD). Veterans (N=884) participated in a cross-sectional investigation in primary care clinics in four Veteran Affairs Medical Centers (VAMCs) and completed diagnostic interviews and self-report questionnaires; a chart review was conducted to assess their VAMC healthcare utilization. A large number of participants (12%) met diagnostic criteria for GAD, reporting significantly worse emotional health, pain, and general health, in addition to increased mental healthcare utilization and antidepressant medications. In addition, GAD was found in 40% of participants with PTSD, resulting in more severe symptoms and impairment than in patients with GAD alone. These findings provide evidence of high prevalence and severe impairment associated with GAD in veterans and highlight the need for improved recognition, assessment, and treatments for GAD.
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25
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LeardMann CA, Pietrucha A, Magruder KM, Smith B, Murdoch M, Jacobson IG, Ryan MA, Gackstetter G, Smith TC. Combat Deployment Is Associated with Sexual Harassment or Sexual Assault in a Large, Female Military Cohort. Womens Health Issues 2013; 23:e215-23. [DOI: 10.1016/j.whi.2013.05.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 05/16/2013] [Accepted: 05/17/2013] [Indexed: 11/25/2022]
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26
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Abstract
Over the past decade there has been consistent criticism of the diagnostic criteria of posttraumatic stress disorder (PTSD) because of its high comorbidity with other mental disorders. Part of the problem surrounding PTSD may be related to the heterogeneity of its symptoms. In fact, recent research has identified a subset of PTSD symptoms, including symptoms of numbing and dysphoria, that may explain much of the overlap between PTSD and major depressive disorder (MDD). The present study sought to extend prior work by investigating the various subsets of PTSD symptoms in individuals from all four diagnostic combinations of PTSD and MDD (no MDD-PTSD, MDD-only, PTSD-only, and comorbid MDD-PTSD). Consenting participants completed diagnostic interviews and were categorized into the four groups. Based on responses to a self-report measure of PTSD symptoms, participants with no MDD-PTSD reported the least severe symptoms while the participants with comorbid MDD-PTSD reported the most severe symptoms. Interesting, participants in the MDD-only and PTSD-only groups consistently reported similar scores across all PTSD symptom scales. These findings further highlight the problematic diagnostic criteria and comorbidity in PTSD and emphasize the need to incorporate transdiagnostic treatment practices that focus on the overlapping symptoms, rather than specific diagnostic categories.
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Affiliation(s)
- Daniel F Gros
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA.
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27
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Forbes D, Elhai JD, Lockwood E, Creamer M, Frueh BC, Magruder KM. The structure of posttraumatic psychopathology in veterans attending primary care. J Anxiety Disord 2012; 26:95-101. [PMID: 22036064 DOI: 10.1016/j.janxdis.2011.09.004] [Citation(s) in RCA: 16] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 09/20/2011] [Accepted: 09/24/2011] [Indexed: 10/17/2022]
Abstract
This study attempted to extend research indicating that posttraumatic stress disorder (PTSD) factors of Re-experiencing, Avoidance and Hyperarousal are more related to Fear/phobic disorders, while PTSD Dysphoria is more related to Anxious-Misery disorders. Trauma exposure, PTSD and comorbidity data for 668 veteran patients were analysed using confirmatory factor analyses and relative strengths of the relationships between PTSD factors and the Fear and Anxious-Misery factors were assessed. Combining Simms, Watson, and Doebbeling's (2002) model of PTSD symptoms and Krueger's (1999) Fear/Anxious Misery model of mood and anxiety disorders fit the data well. Contrary to previous research, PTSD Re-experiencing, Avoidance and Hyperarousal did not correlate more with the Fear factor; nor did PTSD Dysphoria correlate more with Anxious-Misery. Hyperarousal was more closely related to Fear than was Re-experiencing; however, Avoidance was not. Dysphoria was more closely related to the Anxious-Misery factor than all other PTSD factors.
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Affiliation(s)
- David Forbes
- Australian Centre for Posttraumatic Mental Health and Department of Psychiatry, University of Melbourne, Level 1/340 Albert St., East Melbourne, Victoria 3002, Australia.
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28
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Korte JE, Magruder KM, Chiuzan CC, Logan SL, Killeen T, Bandyopadhyay D, Brady KT. Assessing drug use during follow-up: direct comparison of candidate outcome definitions in pooled analyses of addiction treatment studies. Am J Drug Alcohol Abuse 2011; 37:358-66. [PMID: 21854278 DOI: 10.3109/00952990.2011.602997] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Selection of appropriate outcome measures is important for clinical studies of drug addiction treatment. Researchers use various methods for collecting drug use outcomes and must consider substances to be included in a urine drug screen (UDS); accuracy of self-report; use of various instruments and procedures for collecting self-reported drug use; and timing of outcome assessments. OBJECTIVES We sought to define a set of candidate measures to (1) assess their intercorrelation and (2) identify any differences in results. METHODS Data were combined from completed protocols in the National Institute on Drug Abuse Clinical Trials Network (CTN), with a total of 1897 participants. We defined nine outcome measures based on UDS, self-report, or a combination. Multivariable, multilevel generalized estimating equation models were used to assess subgroup differences in intervention success, controlling for baseline differences and accounting for clustering by CTN protocols. RESULTS There were high correlations among all candidate outcomes. All outcomes showed consistent overall results with no significant intervention impact on drug use during follow-up. However, with most UDS variables, but not with self-report or "corrected self-report," we observed a significant gender-ethnicity interaction with benefit shown in African American women, White women, and Hispanic men. CONCLUSION Despite strong associations between candidate measures, we found some important differences in results. SCIENTIFIC SIGNIFICANCE In this study, we demonstrated the potential utility and impact of combining UDS and self-report data for drug use assessment. Our results suggest possible differences in intervention efficacy by gender and ethnicity, but highlight the need to cautiously interpret observed interactions.
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Affiliation(s)
- Jeffrey E Korte
- Division of Biostatistics and Epidemiology, Department of Medicine, Medical University of South Carolina, Charleston, 29425, USA.
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29
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Gros DF, Frueh BC, Magruder KM. Prevalence and features of panic disorder and comparison to posttraumatic stress disorder in VA primary care. Gen Hosp Psychiatry 2011; 33:482-8. [PMID: 21816481 DOI: 10.1016/j.genhosppsych.2011.06.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 06/21/2011] [Accepted: 06/21/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Although panic disorder (PD) is a highly prevalent condition in both community and community primary care settings, little is known about PD in veteran populations, especially in comparison to posttraumatic stress disorder (PTSD). The present study investigated prevalence, comorbidity, physical and mental health impairment, and health care utilization of veterans with PD and PTSD. METHOD A total of 884 veterans participated in a cross-sectional investigation in primary care clinics in four Veteran Affairs Medical Centers (VAMCs). Participants completed diagnostic interviews and self-report questionnaires, and a chart review was completed to assess their VAMC health care utilization. RESULTS A large number of veterans (8.3%) met the diagnostic criteria for PD and reported significantly more severe physical health impairment (pain, general health), mental health impairment (emotional well-being, role limitations) and social functioning than veterans without PD. Veterans with PD also had increased health care utilization for mental health. Further, PD was highly comorbid with PTSD, with similar symptoms across all measures. CONCLUSIONS These findings demonstrate the high prevalence and severe impairment associated with PD in veterans and highlight the need for improved recognition, assessment and specialized treatments for PD in VAMCs and other care settings.
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Affiliation(s)
- Daniel F Gros
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC 29401, USA.
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30
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Yuen HK, Wiegand RE, Hill EG, Magruder KM, Slate EH, Salinas CF, London SD. Factors associated with toothache among African American adolescents living in rural South Carolina. Soc Work Public Health 2011; 26:695-707. [PMID: 22085328 PMCID: PMC3515648 DOI: 10.1080/19371918.2010.525152] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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: 05/31/2023]
Abstract
The aim of this study is to explore behavioral factors associated with toothache among African American adolescents living in rural South Carolina. Using a self-administered questionnaire, data were collected on toothache experience in the past 12 months, oral hygiene behavior, dental care utilization, and cariogenic snack and nondiet soft drink consumption in a convenience sample of 156 African American adolescents age 10 to 18 years living in rural South Carolina. Univariable and multivariable logistic regression analyses were used to assess the associations between reported toothache experience and sociodemographic variables, oral health behavior, and snack consumption. Thirty-four percent of adolescents reported having toothache in the past 12 months. In univariable modeling, age, dental visit in the last 2 years, quantity and frequency of cariogenic snack consumption, and quantity of nondiet soft drink consumption were each significantly associated with experiencing toothache in the past 12 months (all p values < 0.05). Multivariable logistic regression analysis indicated that younger age, frequent consumption of cariogenic snacks, and number of cans of nondiet soft drink consumed during the weekend significantly increased the odds of experiencing toothache in the past 12 months (all p values ≤ 0.01). Findings indicate age, frequent consumption of cariogenic snacks, and number of cans of nondiet soft drinks are related to toothache in this group. Public policy implications related to selling cariogenic snacks and soft drink that targeting children and adolescents especially those from low income families are discussed.
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Affiliation(s)
- Hon K. Yuen
- Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, 77 President St. P. O. BOX 250700, Charleston, SC 29425. Tel: 843-792-3788; Fax: 843-792-0710
| | - Ryan E. Wiegand
- Department of Biostatistics, Bioinformatics & Epidemiology, Medical University of South Carolina
| | - Elizabeth G. Hill
- Department of Biostatistics, Bioinformatics & Epidemiology, Medical University of South Carolina
| | - Kathryn M. Magruder
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
| | - Elizabeth H. Slate
- Department of Biostatistics, Bioinformatics & Epidemiology, Medical University of South Carolina
| | - Carlos F. Salinas
- Division Craniofacial Genetics, College of Dental Medicine, Medical University of South Carolina
| | - Steven D. London
- Stony Brook University, School of Dental Medicine, 150 Rockland Hall, Stony Brook, New York 11794-8700
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31
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Elhai JD, Palmieri PA, Biehn TL, Frueh BC, Magruder KM. Posttraumatic stress disorder's frequency and intensity ratings are associated with factor structure differences in military veterans. Psychol Assess 2010; 22:723-8. [DOI: 10.1037/a0020643] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [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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32
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Freedy JR, Steenkamp MM, Magruder KM, Yeager DE, Zoller JS, Hueston WJ, Carek PJ. Post-traumatic stress disorder screening test performance in civilian primary care. Fam Pract 2010. [PMID: 20622049 DOI: 10.1093/fam-pra/cmq049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
PURPOSE we determined the test performance characteristics of four brief post-traumatic stress disorder (PTSD) screening tests in a civilian primary care setting. METHODS this was a cross-sectional cohort study of adults attending a family medicine residency training clinic in the southeastern USA. Four hundred and eleven participants completed a structured telephone interview that followed an index clinic visit. Screening tests included: PTSD Symptom Checklist-Civilian Version (17 items), SPAN (four items), Breslau's scale (seven items) and Primary Care PTSD screen (PC-PTSD) (four items). A modified Clinician-Administered PTSD Scale was used to determine past month PTSD for comparison. Receiver operating characteristic analysis based on area under the curve (AUC) was used to assess diagnostic efficiency (>0.80 desired). Cut-off scores were selected to yield optimal sensitivity and specificity (>80%). RESULTS past month PTSD was substantial (women = 35.8% and men = 20.0%; P < 0.01). AUC values were PTSD Symptom Checklist (PCL) (0.897), SPAN (0.806), Breslau's scale (0.886) and PC-PTSD (0.885). Optimal cut-scores yielded the following sensitivities and specificities: PCL (80.0% and 80.7%; cut-off = 43), SPAN (75.9% and 71.6%; cut-off = 3), Breslau's scale (84.5% and 76.4%; cut-off = 4) and PC-PTSD (85.1% and 82.0%; cut-off = 3). Overall and gender-specific screening test performances were explored. CONCLUSIONS results confirm: (i) PTSD was common, especially among women; (ii) all four PTSD screening tests were diagnostically adequate; (iii) Two of four PTSD screening tests showed adequate sensitivity and specificity (>80%) and (iv) The PC-PTSD screening test (four items) appeared to be the best single screening test. There are few studies to establish the utility of PTSD screening tests within civilian primary care.
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Affiliation(s)
- John R Freedy
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
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33
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Freedy JR, Steenkamp MM, Magruder KM, Yeager DE, Zoller JS, Hueston WJ, Carek PJ. Post-traumatic stress disorder screening test performance in civilian primary care. Fam Pract 2010; 27:615-24. [PMID: 20622049 DOI: 10.1093/fampra/cmq049] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [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: 12/30/2022] Open
Abstract
PURPOSE we determined the test performance characteristics of four brief post-traumatic stress disorder (PTSD) screening tests in a civilian primary care setting. METHODS this was a cross-sectional cohort study of adults attending a family medicine residency training clinic in the southeastern USA. Four hundred and eleven participants completed a structured telephone interview that followed an index clinic visit. Screening tests included: PTSD Symptom Checklist-Civilian Version (17 items), SPAN (four items), Breslau's scale (seven items) and Primary Care PTSD screen (PC-PTSD) (four items). A modified Clinician-Administered PTSD Scale was used to determine past month PTSD for comparison. Receiver operating characteristic analysis based on area under the curve (AUC) was used to assess diagnostic efficiency (>0.80 desired). Cut-off scores were selected to yield optimal sensitivity and specificity (>80%). RESULTS past month PTSD was substantial (women = 35.8% and men = 20.0%; P < 0.01). AUC values were PTSD Symptom Checklist (PCL) (0.897), SPAN (0.806), Breslau's scale (0.886) and PC-PTSD (0.885). Optimal cut-scores yielded the following sensitivities and specificities: PCL (80.0% and 80.7%; cut-off = 43), SPAN (75.9% and 71.6%; cut-off = 3), Breslau's scale (84.5% and 76.4%; cut-off = 4) and PC-PTSD (85.1% and 82.0%; cut-off = 3). Overall and gender-specific screening test performances were explored. CONCLUSIONS results confirm: (i) PTSD was common, especially among women; (ii) all four PTSD screening tests were diagnostically adequate; (iii) Two of four PTSD screening tests showed adequate sensitivity and specificity (>80%) and (iv) The PC-PTSD screening test (four items) appeared to be the best single screening test. There are few studies to establish the utility of PTSD screening tests within civilian primary care.
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Affiliation(s)
- John R Freedy
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
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34
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Freedy JR, Magruder KM, Mainous AG, Frueh BC, Geesey ME, Carnemolla M. Gender differences in traumatic event exposure and mental health among veteran primary care patients. Mil Med 2010; 175:750-8. [PMID: 20968265 DOI: 10.7205/milmed-d-10-00123] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE This study evaluated gender differences in lifetime traumatic events, PTSD, and depression among VA primary care patients. METHOD Participants were 865 adults attending primary care at one of four VA health centers (n = 681 males, 184 females). RESULTS Mental health findings included: male PTSD 12.3% vs. female PTSD 9.2% (p > 0.05); male depression 15.9% vs. female depression 29.3% (p < 0.001). Men reported more war zone exposure (p < 0.001). Women reported more physical and sexual victimization (p < 0.001). Male logistic regression equations determined PTSD was associated with disability (OR = 3.42; 1.74-6.72, 95% CI) and war zone exposure (OR = 7.14; 3.82-13.30, 95% CI); depression was associated with war zone exposure (OR = 2.27; 1.40-3.68, 95% CI) and interpersonal violence (OR = 1.75; 1.10-2.79, 95% CI). Female PTSD was associated with sexual victimization (OR = 4.50; 1.20-16.80, 95% CI); depression was not predicted. CONCLUSIONS We discuss findings in terms of the crucial need to improve identification and management of PTSD within VA primary care settings.
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Affiliation(s)
- John R Freedy
- Department of Family Medicine, Medical University of South Carolina, 295 Calhoun Street, Charleston, SC 29425, USA
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Yuen HK, Wolf BJ, Bandyopadhyay D, Magruder KM, Selassie AW, Salinas CF. Factors that limit access to dental care for adults with spinal cord injury. Spec Care Dentist 2010; 30:151-6. [PMID: 20618781 DOI: 10.1111/j.1754-4505.2010.00146.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study investigated dental care service utilization among adults with spinal cord injury (SCI) and identified barriers and other factors affecting utilization among this population. There were 192 subjects with SCI who participated in the oral health survey assessing dental care service utilization and they were compared with subjects from the 2004 Behavioral Risk Factors Surveillance System (BRFSS). There was no significant difference in the proportion of subjects with SCI who visited the dentist for any reason in the past year compared to the general population (65.5% vs. 68.8%, p= .350). However, subjects with SCI were less likely to go to the dentist for a dental cleaning in the past year compared to the general population (54.6% vs. 69.4%, p < .001). The three most commonly reported barriers to accessing dental care were cost (40.1%), physical barriers (22.9%), and dental fear (15.1%). Multivariate modeling showed that physical barriers and fear of dental visits were the two significant factors deterring subjects from dental visits in the past year. Physical barriers preventing access to dental facilities and dental fear are prevalent and significantly impede the delivery of dental health care to adults with SCI. Dentists should undertake necessary physical remodeling of their facilities to accommodate wheelchair users and implement appropriate strategies for the management of dental fear among patients with SCI.
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Affiliation(s)
- Hon K Yuen
- Occupational Therapy Division, Department of Health Professions, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA.
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Freedy JR, Magruder KM, Zoller JS, Hueston WJ, Carek PJ, Brock CD. Traumatic events and mental health in civilian primary care: implications for training and practice. Fam Med 2010; 42:185-192. [PMID: 20204894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Primary care research into post-traumatic stress disorder (PTSD) is less developed than primary care depression research. This study documents lifetime traumatic events and past month depression and PTSD in adult patients of a large family medicine residency practice. METHODS We used a telephone survey of 411 adult patients from a family medicine residency practice in the Southeastern United States. Standardized measures were used. RESULTS Seventy-nine percent of study enrollees completed the study. Women were significantly more likely than men to have been diagnosed with PTSD (35.8% versus 20.0%) or depression (36.1% versus 21.1%), with a high degree of diagnosis overlap (76.5%). Most adults (>90%) reported one or more traumatic events. Men reported more war zone/combat events; women reported more sexual victimization. More than 80% of patients thought family physicians should ask about traumatic events; only a minority recalled being asked (26.8% men, 43.6% women). Regression models determined that current depression and several traumatic events were significant correlates of current PTSD. CONCLUSIONS Key gender differences in frequency of lifetime traumatic events, past month depression and PTSD, and patient attitudes about trauma questions existed. Current PTSD was best predicted by a combination of coexisting depression and traumatic events. Discussion explores training and practice implications.
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Affiliation(s)
- John R Freedy
- Department of Family Medicine, Medical University of South Carolina. 9228 Medical Plaza Drive, Charleston, SC 29406, USA.
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Yuen HK, Wolf BJ, Bandyopadhyay D, Magruder KM, Salinas CF, London SD. Oral health knowledge and behavior among adults with diabetes. Diabetes Res Clin Pract 2009; 86:239-46. [PMID: 19800143 PMCID: PMC2791496 DOI: 10.1016/j.diabres.2009.09.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 09/08/2009] [Accepted: 09/10/2009] [Indexed: 12/17/2022]
Abstract
The purpose of this study was to determine levels of oral health knowledge and factors associated with adequate oral health knowledge in adults with diabetes. A convenience sample of 253 adult US residents with diabetes completed an oral health survey to assess their knowledge. Results showed that only 47% of the participants answered five or more (out of a maximum of seven) oral health knowledge items related to diabetes correctly. Participants who received oral health information related to diabetes have 2.9 times the odds of possessing adequate oral health knowledge (i.e., answered five or more items correctly) compared to participants who did not received that information controlling for education and race (OR=2.86, 95% CI 1.31-6.24, P=0.008). Given that oral health information provided by health professionals (dental and/or medical) contributes to improve oral health knowledge among adults with diabetes, health professionals should take the opportunity to educate patients with diabetes about the oral manifestations (e.g., dry mouth) and complications (e.g., periodontitis and oral candidiasis) of diabetes and to promote proper oral health behaviors.
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Affiliation(s)
- Hon K. Yuen
- Associate Professor, Occupational Therapy Division, Department of Health Professions, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425
| | - Bethany J. Wolf
- Division of Biostatistics and Epidemiology, Department of Medicine, MUSC, Charleston, SC 29425
| | - Dipankar Bandyopadhyay
- Assistant Professor, Division of Biostatistics and Epidemiology, Department of Medicine, MUSC, SC 29425
| | - Kathryn M. Magruder
- Professor, Department of Psychiatry & Behavioral Sciences, MUSC, Charleston, SC 29425
| | - Carlos F. Salinas
- Professor, Director, Division Craniofacial Genetics, College of Dental Medicine, Medical University of South Carolina
| | - Steven D. London
- Associate Dean for Academic Affairs, Professor of Oral Biology & Pathology, Stony Brook University, School of Dental Medicine, 150 Rockland Hall, Stony Brook, New York 11794-8700
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Yuen HK, Mountford WK, Magruder KM, Bandyopadhyay D, Hudson PL, Summerlin LM, Salinas CF. Adequacy of oral health information for patients with diabetes. J Public Health Dent 2009; 69:135-41. [PMID: 19192104 DOI: 10.1111/j.1752-7325.2008.00111.x] [Citation(s) in RCA: 13] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We investigated the perception of dental hygienists regarding their adequacy of providing diabetics with diabetes-related oral health preventive education. METHODS A one-page questionnaire printed on both sides was mailed to 2,237 licensed registered dental hygienists with a South Carolina (SC) mailing address. In addition to the dental hygienists' background and practice characteristics, their perception of adequacy for educating patients with diabetes on various diabetes-related oral health topics and reasons for inadequate coverage of materials were queried in the survey. RESULTS After two follow-up mailings, 995 completed and usable surveys were returned. An average of 93.6 percent of respondents indicated that they adequately covered topics of oral hygiene and general oral health issues. However, about 60 percent of respondents reported not covering all essential materials related to oral health when educating diabetic patients. The three most common reasons were: a) insufficient time (60.1 percent); b) patient disinterest (41.2 percent); and c) insufficient information on oral care and diabetes (39.7 percent). Respondents reporting insufficient information were less likely to adequately address the effect of periodontal disease on diabetes (P < 0.001), effect of uncontrolled diabetes on periodontal disease (P < 0.001), and dry mouth management (P = 0.03). CONCLUSION This study indicates that SC dental hygienists do not routinely provide patient education on diabetes-related oral health and healthy lifestyle topics. Lack of time, patient disinterest, and insufficient information were the three main reasons for respondents not covering these essentials. A practical method for improving dental hygienists' comprehensive service to patients with diabetes is to offer them more continuing education on diabetes and oral health to supplement their knowledge, skills, and confidence to educate this growing population.
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Affiliation(s)
- Hon K Yuen
- Occupational Therapy Division, Department of Health Professions, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA.
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Abstract
BACKGROUND Differential attrition by minority participants can be as limiting to interpreting final results as poor initial recruitment of minority participants. This is especially important in drug abuse treatment studies, as minorities are over-represented in substance abuse clinical treatment programs. PURPOSE The specific aims of this secondary data analysis were to: (1) determine if there are differences in study retention rates by race/ethnicity and age, and (2) explore other client characteristics, as well as protocol and treatment program factors, that could account for differential retention rates. METHODS We conducted a secondary analysis using data from 1737 participants in the first six clinical trials whose databases were locked in the NIDA Clinical Trials Network. Protocol level characteristics were also abstracted from these studies, and we used data from a study which assessed characteristics of community treatment programs that participated in these studies. Logistic regression was used to study the effect on retention of: client, protocol, and program characteristics. RESULTS In the model of client characteristics, a significant age by race/ethnicity interaction term was detected based on a threshold of 0.1, with younger African Americans having the lowest odds of retention. Primary drug of abuse was also a significant factor in determining study retention, with heroin, methadone, and opiate users having the greatest odds of retention and polydrug users the lowest. Similar analyses testing treatment program characteristics found that only the presence of HIV risk screening and decreasing levels of female admissions (as a percent of total admissions) were related to study retention. In our final model, there was an effect of age, but not race/ethnicity, with younger participants having lower odds of retention. A multivariable model including protocol variables could not be developed due to the high correlation among protocol variables. LIMITATIONS We excluded those of multi-race/ethnicity and those from minority groups other than Hispanic or African American due to small numbers. Additionally, only three therapy types were represented among the six studies. Some potential variables that would influence retention, such as client housing, and client comorbidities, the race/ethnicity and gender of the staff who conducted study follow-up assessments, and reasons for loss to follow-up, were not collected by the CTN. CONCLUSIONS Although in our client model older African Americans and Caucasians had the greatest odds of retention and younger African Americans the lowest, in our final model, only age was significantly related to study retention. Additionally, primary drug of abuse, having HIV risk screening as a program benefit, and lower percentages of female admissions were significantly related to study retention. Efforts should be made to increase the study retention of younger participants to improve the validity and generalizability of drug abuse treatment study results.
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Affiliation(s)
- Kathryn M Magruder
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA.
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Freed MC, Yeager DE, Liu X, Gore KL, Engel CC, Magruder KM. Preference-weighted health status of PTSD among veterans: an outcome for cost-effectiveness analysis using clinical data. Psychiatr Serv 2009; 60:1230-8. [PMID: 19723738 DOI: 10.1176/ps.2009.60.9.1230] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is a highly prevalent, chronic, disabling but treatable condition. Preference-based measures (for example, health utilities) are recommended for and useful in cost-effectiveness analyses and for policy decisions because they reflect a population's valuation of the desirability of disease states. However, no such measures exist for PTSD. This study aimed to estimate preference-weighted health status associated with PTSD and common co-occurring mental disorders in a sample of veterans by transforming health-related quality-of-life data into preference-weighted health status scores (PWHS scores), develop a usable regression model to predict PWHS scores from other data sets, and compare preference-weighted health status of PTSD with that of another chronic disorder, chronic obstructive pulmonary disease (COPD). METHODS A secondary analysis was performed on data from a random sample of 808 veterans (79% male; 12% met criteria for PTSD) in four primary care clinics. Veterans responded to the PTSD Checklist (PCL), Clinician-Administered PTSD Scale, Mini-International Neuropsychiatric Interview, and Medical Outcomes Survey Short Form-36. RESULTS PWHS scores were .029 lower among veterans with PTSD compared with veterans without PTSD, all else being equal. However, scores depended on PTSD severity, when the analysis controlled for other model variables. Specifically, PWHS scores dropped by .004 with a 1-unit increase in PCL scores among veterans without PTSD. Among veterans with PTSD, the reduction was .002. PTSD was associated with lower preference-weighted health status than COPD. CONCLUSIONS This is the first study to estimate preference-weighted health status of persons with PTSD. These PWHS scores can be helpful in cost-effectiveness studies of PTSD treatments.
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Affiliation(s)
- Michael C Freed
- Deployment Health Clinical Center, Walter Reed Army Medical Center, Building 2, Room 3E01, 6900 Georgia Ave., N.W., Washington, D.C. 20307, USA.
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Abstract
BACKGROUND Only limited empirical data support the existence of delayed-onset post-traumatic stress disorder (PTSD). AIMS To expand our understanding of delayed-onset PTSD prevalence and phenomenology. METHOD A cross-sectional, epidemiological design (n = 747) incorporating structured interviews to obtain relevant information for analyses in a multisite study of military veterans. RESULTS A small percentage of veterans with identified current PTSD (8.3%, 7/84), current subthreshold PTSD (6.9%, 2/29), and lifetime PTSD only (5.4%, 2/37) met criteria for delayed onset with PTSD symptoms initiating more than 6 months after the index trauma. Altogether only 0.4% (3/747) of the entire sample had current PTSD with delayed-onset symptoms developing more than 1 year after trauma exposure, and no PTSD symptom onset was reported more than 6 years post-trauma. CONCLUSIONS Retrospective reports of veterans reveal that delayed-onset PTSD (current, subthreshold or lifetime) is extremely rare 1 year post-trauma, and there was no evidence of PTSD symptom onset 6 or more years after trauma exposure.
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Yuen HK, Shotwell MS, Magruder KM, Slate EH, Salinas CF. Factors associated with oral problems among adults with spinal cord injury. J Spinal Cord Med 2009; 32:408-15. [PMID: 19777862 PMCID: PMC2830680 DOI: 10.1080/10790268.2009.11753207] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Accepted: 02/01/2009] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To explore factors associated with self-reported current oral (tooth and gum) problems and oral pain in the past 12 months among adults with spinal cord injury. METHODS An online oral health survey on the South Carolina Spinal Cord Injury Association website. Respondents were 192 adult residents of the US who identified themselves as having spinal cord injury at least 1 year before the survey date. RESULTS Approximately 47% of respondents reported having oral problems at the time of the survey, and 42% reported experiencing oral pain in the 12 months before the survey date. Multiple predictor analyses (controlling for age, gender, income, and dental insurance) indicated that current oral problems were positively associated with dry mouth symptoms, financial barriers to dental care access, smoking, and paraplegia. Oral pain experienced in the past 12 months was positively associated with dry mouth symptoms, financial barriers to dental care access, minority race, and paraplegia. CONCLUSIONS Adults with spinal cord injury reported a high prevalence of oral problems and oral pain. Those with paraplegia were more likely to report problems than those with tetraplegia. Because dry mouth and smoking were significantly associated with these problems, patient education from both dental and medical providers should emphasize awareness of the side effects of xerostomia-causing medications, dry mouth management, and smoking cessation. Findings also indicate unmet needs for low-cost preventive and treatment dental services for this vulnerable population.
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Affiliation(s)
- Hon K Yuen
- Medical University of South Carolina, CHP Complex Bldg B, 151 Rutledge Avenue, Charleston, SC 29425, USA.
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Magruder KM. Patient factors relating to detection of posttraumatic stress disorder in Department of Veterans Affairs primary care settings. ACTA ACUST UNITED AC 2008; 45:371-81. [DOI: 10.1682/jrrd.2007.06.0091] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Grubaugh AL, Slagle DM, Long M, Frueh BC, Magruder KM. Racial Disparities In Trauma Exposure, Psychiatric Symptoms, and Service Use Among Female Patients In Veterans Affairs Primary Care Clinics. Womens Health Issues 2008; 18:433-41. [PMID: 19041595 DOI: 10.1016/j.whi.2008.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 07/31/2008] [Accepted: 08/04/2008] [Indexed: 11/29/2022]
Affiliation(s)
- Anouk L Grubaugh
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
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Zinzow HM, Grubaugh AL, Frueh BC, Magruder KM. Sexual assault, mental health, and service use among male and female veterans seen in Veterans Affairs primary care clinics: a multi-site study. Psychiatry Res 2008; 159:226-36. [PMID: 18423615 DOI: 10.1016/j.psychres.2007.04.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [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: 06/12/2006] [Revised: 11/16/2006] [Accepted: 04/07/2007] [Indexed: 10/22/2022]
Abstract
This study examined the nature and prevalence of sexual assault (SA), as well as its relationship to psychiatric sequelae and service use, among the veteran population. We performed a secondary data analysis of a cross-sectional dataset consisting of 643 male and 173 female veterans seen in four Veterans Affairs (VA) primary care clinics. Original data were obtained through semi-structured clinic assessments, structured telephone interviews, and medical chart reviews. Analyses included descriptive statistics, chi-square, analysis of variance (ANOVA), and logistic regression. The lifetime prevalence of SA was 38% among women and 6% among men. Of veterans reporting a history of SA, most experienced child sexual abuse and sexual revictimization. SA victims also had a more extensive trauma history and demonstrated greater psychological impairment in comparison to veterans reporting other types of trauma. However, only 25% of male SA survivors and 38% of female SA survivors used mental health services in the past year. These findings suggest that VA primary care clinics may benefit from expanding the current mandated screen for military sexual trauma to include lifetime experiences and trauma-related symptoms, thereby connecting more veterans with needed mental health services.
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Affiliation(s)
- Heidi M Zinzow
- Department of Psychology, University of Georgia, GA, United States
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Yuen HK, Wiegand RE, Slate EH, Magruder KM, Salinas CF, London SD. Dental health knowledge in a group of Black adolescents living in rural South Carolina. J Allied Health 2008; 37:15-21. [PMID: 18444435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This study investigated levels of dental health knowledge and factors associated with adequate dental health knowledge in a group of black adolescents living in rural areas. Using a self-administered questionnaire, data were collected on a convenience sample of 151 black adolescents aged 10 to 18 yrs living in rural South Carolina. The mean percent correct on the dental health knowledge questions was 55.0%. Using 75% as the cutoff for adequate dental health knowledge, only 7.9% of the respondents achieved this level. Two thirds of the younger adolescents (aged 10-12 yrs) were below the median on dental health knowledge. Respondents selected dental health professionals, family, and school as the three main sources of dental health information. Results from univariate logistic regression analyses indicated that being older, having a regular dentist for routine care, and having learned about dental health from dental health professionals, family, mass media, and friends were significantly associated with adequate dental health knowledge. After adjusting for other explanatory factors, adequate dental health knowledge was associated with being older and having learned about dental health from friends. This group of adolescents seems to have limited dental health knowledge with misconceptions concerning periodontal health and caries prevention. This was especially evident in younger adolescents. Incorporation of peer dental health education in school is worthwhile to investigate as a means to enhance the dental health knowledge of these adolescents.
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Affiliation(s)
- Hon K Yuen
- Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA.
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McCarty D, Fuller B, Kaskutas LA, Wendt WW, Nunes EV, Miller M, Forman R, Magruder KM, Arfken C, Copersino M, Floyd A, Sindelar J, Edmundson E. Treatment programs in the National Drug Abuse Treatment Clinical Trials Network. Drug Alcohol Depend 2008; 92:200-7. [PMID: 17875368 PMCID: PMC2223274 DOI: 10.1016/j.drugalcdep.2007.08.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Revised: 08/04/2007] [Accepted: 08/06/2007] [Indexed: 10/22/2022]
Abstract
Drug abuse treatment programs and university-based research centers collaborate to test emerging therapies for alcohol and drug disorders in the National Drug Abuse Treatment Clinical Trials Network (CTN). Programs participating in the CTN completed Organizational Surveys (n=106 of 112; 95% response rate) and Treatment Unit Surveys (n=348 of 384; 91% response rate) to describe the levels of care, ancillary services, patient demographics, patient drug use and co-occurring conditions. Analyses describe the corporations participating in the CTN and provide an exploratory assessment of variation in treatment philosophies. A diversity of treatment centers participate in the CTN; not for profit organizations with a primary mission of treating alcohol and drug disorders dominate. Compared to National Survey of Substance Abuse Treatment Services (N-SSATS), programs located in medical settings are over-represented and centers that are mental health clinics are under-represented. Outpatient, methadone, long-term residential and inpatient treatment units differed on patients served and services provided. Larger programs with higher counselor caseloads in residential settings reported more social model characteristics. Programs with higher social model scores were more likely to offer self-help meetings, vocational services and specialized services for women. Conversely, programs with accreditation had less social model influence. The CTN is an ambitious effort to engage community-based treatment organizations into research and more fully integrate research and practice.
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Affiliation(s)
- Dennis McCarty
- Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CB669, Portland, OR 97239, USA.
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Frueh BC, Grubaugh AL, Acierno R, Elhai JD, Cain G, Magruder KM. Age differences in posttraumatic stress disorder, psychiatric disorders, and healthcare service use among veterans in Veterans Affairs primary care clinics. Am J Geriatr Psychiatry 2007; 15:660-72. [PMID: 17670996 DOI: 10.1097/jgp.0b013e3180487cc2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To expand our understanding of posttraumatic stress disorder (PTSD) prevalence, its psychiatric characteristics, and service use among elderly veterans in Veterans Affairs (VA) primary care clinics. METHODS A cross-sectional, epidemiological design (N = 745) incorporating self-report measures, structured interviews, and chart reviews was used to obtain relevant information for analyses. RESULTS The oldest group of veterans (>or=65 years; N = 318) had lower prevalence of most psychiatric diagnoses than the youngest (18-44 years; N = 69) and middle-aged (45-64 years; N = 358) groups. Despite having higher rates of combat exposure, veterans in the oldest group (6.3%) had one-third the prevalence of PTSD than those in the middle-aged group (18.6%). A similar pattern was found across other psychiatric diagnoses. For example, those in the oldest group (7.5%) had one-third the prevalence of major depression as those in the two younger groups (21.7% and 22.9%). These differences were maintained after controlling for relevant demographic covariates (race, sex). Results from examination of VA health care service use across the three groups were consistent with the findings that the oldest veteran group is functioning significantly better across mental health domains. CONCLUSION Elderly veterans who use VA primary care services evidence lower rates of PTSD and other psychiatric disorders, and they use significantly less VA mental health services. They also do not appear to show evidence of worse physical health functioning or use VA health care services or disability benefits at a meaningfully higher rate than their younger counterparts.
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Affiliation(s)
- B Christopher Frueh
- Department of Psychology, University of Hawaii at Hilo, Hilo, HI 96720, USA.
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Yeager DE, Magruder KM, Knapp RG, Nicholas JS, Frueh BC. Performance characteristics of the posttraumatic stress disorder checklist and SPAN in Veterans Affairs primary care settings. Gen Hosp Psychiatry 2007; 29:294-301. [PMID: 17591505 DOI: 10.1016/j.genhosppsych.2007.03.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [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] [Received: 06/21/2006] [Revised: 03/17/2007] [Accepted: 03/21/2007] [Indexed: 01/11/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a treatable disorder, and individuals with this condition may benefit from early detection. Many people with PTSD are not aware of its symptoms and do not seek treatment, making a brief and targeted screening program a worthwhile endeavor. For this reason, research aimed at improving screening instruments could yield substantial benefits. OBJECTIVES The primary objective of this research was to assess the diagnostic performance of two popular PTSD screening assessments, the PTSD Checklist (PCL) and the SPAN, in a Veterans Affairs (VA) primary care setting. Additionally, we compared the screening performance of these two assessments by sex and race. METHODS The PCL and SPAN were compared with a gold standard, the Clinician-Administered PTSD Scale. Receiver operating characteristic curves were used in conjunction with sensitivity and specificity measures to assess the performance of each screening assessment. These analyses are based on a large database (n=1076) that was derived from a multisite cross-sectional study conducted at four southeastern VA medical centers. RESULTS Results for the PCL support cutoff scores lower than those previously published, whereas results for the SPAN support the previously recommended cutoff score of 5 (sensitivity of 73.68% and specificity of 81.99%). We found no significant difference in areas under the curve (AUCs) by sex and by race between the PCL and SPAN. We did find that there was a highly significant difference (P<.0006) in overall diagnostic ability (as measured by the AUC) between the PCL (AUC=0.882) and SPAN (AUC=0.837), making the PCL the preferred screening tool, unless brevity is essential. CONCLUSIONS Clinicians and researchers should consider lower cutoff scores for the PCL, but the originally suggested cutoff score for the SPAN is appropriate.
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Affiliation(s)
- Derik E Yeager
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29452, USA
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