1
|
Porter AC, Bishop TM. Daily sleepiness magnifies the relation between same-day passive and active suicide ideation. J Psychiatr Res 2024; 175:140-143. [PMID: 38733928 DOI: 10.1016/j.jpsychires.2024.04.034] [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: 04/25/2023] [Revised: 04/07/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024]
Abstract
Disrupted sleep has been linked to suicidal thoughts and behavior. Less is known, however, about the underlying mechanisms of this relationship. A more nuanced understanding of the link between sleep and suicide may help inform treatment decisions and the development of prevention and intervention strategies. The present study examined daily average sleepiness as a moderator to the relation between same-day passive and active suicide ideation (SI). Fifty-nine young adults (mean age = 21.04; SD = 2.22) endorsing SI at least twice in the two weeks prior to baseline completed 3-5 daily surveys of sleepiness and SI over 2 weeks as part of a broader study. Across several indicators of sleepiness (desire to stay awake, desire to fall asleep), passive SI (desire to die, desire to live), and active SI (occurrence, intensity, duration, and controllability), the overall findings demonstrated that daily average sleepiness magnified the relation between same-day passive SI and active SI severity. These findings indicate that being sleepier than usual may increase the likelihood that passive SI transitions to active SI. Future research is needed to test the causal influence of sleepiness on this transition.
Collapse
Affiliation(s)
- Andrew C Porter
- Department of Psychology, University of Rochester, Rochester, NY, USA.
| | - Todd M Bishop
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA; VA Center of Excellence for Suicide Prevention, Finger Lakes Healthcare System, Canandaigua, NY, USA; Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| |
Collapse
|
2
|
Boska RL, Bishop TM, Capron DW, Paxton Willing MM, Ashrafioun L. Difficulties with emotion regulation within PTSD clusters and moral injury subtypes. Mil Psychol 2024:1-9. [PMID: 38421375 DOI: 10.1080/08995605.2024.2322904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
Treatment and research centered on trauma-related mental health issues have largely focused on posttraumatic stress disorder (PTSD); however, moral injury is another important mental health concern requiring attention. There is a paucity of research examining how PTSD and moral injury affect emotion regulation. The current investigation examined how PTSD clusters and moral injury subtypes were uniquely associated with difficulties with emotion regulation. Participants consisted of 253 previously deployed military personnel who were recruited online. To be included in the study, participants had to verify that they had served in the U.S. Military, had been deployed as part of their military service, and endorsed elevated levels of symptoms associated with PTSD and/or moral injury. A hierarchical linear regression was conducted to examine the association between PTSD symptom clusters, moral injury subtypes, and difficulties with emotion regulation. Results indicated that alterations in arousal and reactivity was the only PTSD symptom cluster associated with difficulties with emotion regulation. Self-transgressions was the only facet of moral injury significantly associated with difficulties with emotion regulation. This is the first study to examine the association between emotion dysregulation, PTSD symptom clusters, and moral injury in previously deployed U.S. Military.
Collapse
Affiliation(s)
- Rachel L Boska
- The War Related Illness and Injury Study Center, The VA New Jersey Healthcare System, East Orange, New Jersey
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York
| | - Todd M Bishop
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York
- Department of Psychiatry, University of Rochester School of Medicine & Dentistry, Rochester, New York
| | - Daniel W Capron
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana
| | - Maegan M Paxton Willing
- Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
| | - Lisham Ashrafioun
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York
- Department of Psychiatry, University of Rochester School of Medicine & Dentistry, Rochester, New York
| |
Collapse
|
3
|
Pigeon WR, Youngren W, Carr M, Bishop TM, Seehuus M. Relationship of insomnia to sexual function and sexual satisfaction: Findings from the sleep and sex survey II. J Psychosom Res 2023; 175:111534. [PMID: 37871507 DOI: 10.1016/j.jpsychores.2023.111534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE Research suggests that healthy sleep is a key component of sexual function. When evaluating sexual function, however, poor sleep is often overlooked as a contributing factor. This cross-sectional survey expands prior work by exploring relationships among insomnia severity, sexual satisfaction, and sexual function with an updated battery of measures for the Sleep and Sex Survey. METHOD The sample (N = 1266) consisted of 618 men, 648 women recruited via Prolific, an online survey platform. The Sleep and Sex Survey II included measures addressing insomnia, fear of sleep, nightmares, sexual function, sexual satisfaction, sexual activity, depression, anxiety, posttraumatic stress, and alcohol use. RESULTS Recent sexual activity was correlated with better sleep, lower anxiety, and lower scores on a posttraumatic stress disorder screener. Insomnia severity was negatively correlated with sexual satisfaction (r = 0.22, p < .001) and the presence of insomnia was associated with higher rates of sexual dysfunction in women (53.8% vs. 31.8%; p < .001) and men (22.7% vs. 12.5%; p = .036). In regression analyses, after accounting for depression and anxiety, insomnia had a statistically significant association with sexual function for women (β = 0.12; p < .01) but not men (β = 0.11; p = .60). CONCLUSION Findings support a relationship of insomnia to sexual function and satisfaction with some gender differences. Future work may be enhanced by assessing these relationships in a gender diverse population including objective sleep measures and addressing contributing mechanisms. Clinically, findings support the assessment of sleep when evaluating patients for sexual dysfunction.
Collapse
Affiliation(s)
- Wilfred R Pigeon
- University of Rochester Medical Center, Department of Psychiatry, USA; U.S. Department of Veterans Affairs, VISN 2 Center of Excellence for Suicide Prevention, USA.
| | - Westley Youngren
- University of Missouri-Kansas City, Department of Psychology, USA
| | - Michelle Carr
- University of Montreal, Department of Psychiatry and Addictology, Canada
| | - Todd M Bishop
- University of Rochester Medical Center, Department of Psychiatry, USA; U.S. Department of Veterans Affairs, VISN 2 Center of Excellence for Suicide Prevention, USA
| | - Martin Seehuus
- Middlebury College, Psychology Department, USA; University of Vermont, Vermont Psychological Services, USA
| |
Collapse
|
4
|
Hamilton NA, Russell JA, Youngren WA, Gallegos AM, Crean HF, Cerulli C, Bishop TM, Hamadah K, Schulte M, Pigeon WR, Heffner KL. Cognitive behavioral therapy for insomnia treatment attrition in patients with weekly nightmares. J Clin Sleep Med 2023; 19:1913-1921. [PMID: 37421316 PMCID: PMC10620662 DOI: 10.5664/jcsm.10710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/10/2023]
Abstract
STUDY OBJECTIVES This study's objective was to evaluate the effect of nightmares (NMs) on attrition and symptom change following cognitive behavioral therapy for insomnia (CBT-I) treatment using data from a successful CBT-I randomized controlled trial delivered to participants with recent interpersonal violence exposure. METHODS The study randomized 110 participants (107 women; mean age: 35.5 years) to CBT-I or to an attention-control group. Participants were assessed at 3 time periods: baseline, post-CBT-I (or attention control), and at time 3 (T3) post-cognitive processing therapy received by all participants. NM reports were extracted from the Fear of Sleep Inventory. Participants with weekly NMs were compared with those with fewer than weekly NMs on outcomes including attrition, insomnia, posttraumatic stress disorder, and depression. Change in NM frequency was examined. RESULTS Participants with weekly NMs (55%) were significantly more likely to be lost to follow-up post-CBT-I (37%) compared with participants with infrequent NMs (15.6%) and were less likely to complete T3 (43%) than patients with less frequent NMs (62.5%). NMs were unrelated to differential treatment response in insomnia, depression, or posttraumatic stress disorder. Treatment with CBT-I was not associated with reduced NM frequency; however, change in sleep-onset latency from post-CBT-I to T3 predicted fewer NMs at T3. CONCLUSIONS Weekly NMs were associated with attrition but not a reduced change in insomnia symptoms following CBT-I. NM symptoms did not change as a function of CBT-I, but change in sleep-onset latency predicted lower NM frequency. CBT-I trials should screen for NMs and consider augmenting CBT-I to specifically address NMs. CITATION Hamilton NA, Russell JA, Youngren WA, et al. Cognitive behavioral therapy for insomnia treatment attrition in patients with weekly nightmares. J Clin Sleep Med. 2023;19(11):1913-1921.
Collapse
Affiliation(s)
| | | | - Westley A. Youngren
- U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention, Finger Lakes Health Care System, Canandaigua, New York
| | - Autumn M. Gallegos
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Hugh F. Crean
- U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention, Finger Lakes Health Care System, Canandaigua, New York
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Catherine Cerulli
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
- Susan B. Anthony Center and Laboratory of Interpersonal Violence and Victimization, University of Rochester Medical Center, Rochester, New York
| | - Todd M. Bishop
- U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention, Finger Lakes Health Care System, Canandaigua, New York
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | | | | | - Wilfred R. Pigeon
- U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention, Finger Lakes Health Care System, Canandaigua, New York
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Kathi L. Heffner
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester Medical Center, Rochester, New York
- Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| |
Collapse
|
5
|
Pigeon WR, Bishop TM, Bossarte RM, Schueller SM, Kessler RC. A two-phase, prescriptive comparative effectiveness study to optimize the treatment of co-occurring insomnia and depression with digital interventions. Contemp Clin Trials 2023; 132:107306. [PMID: 37516163 DOI: 10.1016/j.cct.2023.107306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Insomnia and depression frequently co-occur. Significant barriers preclude a majority of patients from receiving first line treatments for both disorders in a sequential treatment episode. Although digital versions of cognitive behavioral therapy for insomnia (CBTI) and for depression (CBTD) hold some promise to meet demand, especially when paired with human support, it is unknown whether heterogeneity of treatment effects exist, such that some patients would be optimally treated with single or sequential interventions. OBJECTIVE Describe the protocol for a two-phase, prescriptive comparative effectiveness study to develop and evaluate an individualized intervention rule (IIR) for prescribing the optimal digital treament of co-occurring insomnia and depression. METHODS The proposed sample size is 2300 U.S. military veterans with insomnia and depression recruited nationally (Phase 1 = 1500; Phase 2 = 800). In each phase, the primary endpoint will be remission of both depression and insomnia 3 months following a 12-week intervention period. Phase 1 is a 5-arm randomized trial: two single digital interventions (CBT-I or CBT-D); two sequenced interventions (CBT-I + D or CBT-D + I); and a mood monitoring control condition. A cutting-edge ensemble machine learning method will be used to develop the IIR. Phase 2 will evaluate the IIR by randomizing participants with equal allocation to either the IIR predicted optimal intervention for that individual or by randomization to one the four CBT interventions. RESULTS Study procedures are ongoing. Results will be reported in future manuscripts. CONCLUSION The study will generate evidence on the optimal scalable approach to treat co-occurring insomnia and depression.
Collapse
Affiliation(s)
- Wilfred R Pigeon
- Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard - Box PSYCH, Rochester, NY 14642, USA; U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention (37B), Canandaigua VA Medical Center, 400 Fort Hill Ave, Canandaigua, NY 14424, USA.
| | - Todd M Bishop
- Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard - Box PSYCH, Rochester, NY 14642, USA; U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention (37B), Canandaigua VA Medical Center, 400 Fort Hill Ave, Canandaigua, NY 14424, USA
| | - Robert M Bossarte
- Department of Psychiatry and Behavioral Neurology, University of South Florida, 3515 E. Fletcher Ave Tampa, FL 33620, USA
| | - Stephen M Schueller
- Department of Health Care Policy, Harvard Medical School, 108 Longwood Ave, Boston, MA 02115, USA
| | - Ronald C Kessler
- Department of Psychological Science, University of California at Irvine, 4341 Social and Behavioral Sciences Gateway, 214 Pereira Dr, Irvine, CA 92617, USA
| |
Collapse
|
6
|
Kessler RC, Bauer MS, Bishop TM, Bossarte RM, Castro VM, Demler OV, Gildea SM, Goulet JL, King AJ, Kennedy CJ, Landes SJ, Liu H, Luedtke A, Mair P, Marx BP, Nock MK, Petukhova MV, Pigeon WR, Sampson NA, Smoller JW, Miller A, Haas G, Benware J, Bradley J, Owen RR, House S, Urosevic S, Weinstock LM. Evaluation of a Model to Target High-risk Psychiatric Inpatients for an Intensive Postdischarge Suicide Prevention Intervention. JAMA Psychiatry 2023; 80:230-240. [PMID: 36652267 PMCID: PMC9857842 DOI: 10.1001/jamapsychiatry.2022.4634] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/09/2022] [Indexed: 01/19/2023]
Abstract
Importance The months after psychiatric hospital discharge are a time of high risk for suicide. Intensive postdischarge case management, although potentially effective in suicide prevention, is likely to be cost-effective only if targeted at high-risk patients. A previously developed machine learning (ML) model showed that postdischarge suicides can be predicted from electronic health records and geospatial data, but it is unknown if prediction could be improved by adding additional information. Objective To determine whether model prediction could be improved by adding information extracted from clinical notes and public records. Design, Setting, and Participants Models were trained to predict suicides in the 12 months after Veterans Health Administration (VHA) short-term (less than 365 days) psychiatric hospitalizations between the beginning of 2010 and September 1, 2012 (299 050 hospitalizations, with 916 hospitalizations followed within 12 months by suicides) and tested in the hospitalizations from September 2, 2012, to December 31, 2013 (149 738 hospitalizations, with 393 hospitalizations followed within 12 months by suicides). Validation focused on net benefit across a range of plausible decision thresholds. Predictor importance was assessed with Shapley additive explanations (SHAP) values. Data were analyzed from January to August 2022. Main Outcomes and Measures Suicides were defined by the National Death Index. Base model predictors included VHA electronic health records and patient residential data. The expanded predictors came from natural language processing (NLP) of clinical notes and a social determinants of health (SDOH) public records database. Results The model included 448 788 unique hospitalizations. Net benefit over risk horizons between 3 and 12 months was generally highest for the model that included both NLP and SDOH predictors (area under the receiver operating characteristic curve range, 0.747-0.780; area under the precision recall curve relative to the suicide rate range, 3.87-5.75). NLP and SDOH predictors also had the highest predictor class-level SHAP values (proportional SHAP = 64.0% and 49.3%, respectively), although the single highest positive variable-level SHAP value was for a count of medications classified by the US Food and Drug Administration as increasing suicide risk prescribed the year before hospitalization (proportional SHAP = 15.0%). Conclusions and Relevance In this study, clinical notes and public records were found to improve ML model prediction of suicide after psychiatric hospitalization. The model had positive net benefit over 3-month to 12-month risk horizons for plausible decision thresholds. Although caution is needed in inferring causality based on predictor importance, several key predictors have potential intervention implications that should be investigated in future studies.
Collapse
Affiliation(s)
- Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Mark S. Bauer
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
| | - Todd M. Bishop
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Robert M. Bossarte
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa
| | - Victor M. Castro
- Research Information Science and Computing, Mass General Brigham, Somerville, Massachusetts
| | - Olga V. Demler
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Computer Science, ETH Zurich, Zurich, Switzerland
| | - Sarah M. Gildea
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Joseph L. Goulet
- Pain, Research, Informatics, Multi-morbidities and Education Center, VA Connecticut Healthcare System, West Haven
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Andrew J. King
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Chris J. Kennedy
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Sara J. Landes
- Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock
| | - Howard Liu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York
| | - Alex Luedtke
- Department of Statistics, University of Washington, Seattle
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Patrick Mair
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Brian P. Marx
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Maria V. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Wilfred R. Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Jordan W. Smoller
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Center for Precision Psychiatry, Massachusetts General Hospital, Boston
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Gretchen Haas
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - John Bradley
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
| | - Richard R. Owen
- Central Arkansas Veterans Healthcare System, Little Rock
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Samuel House
- Central Arkansas Veterans Healthcare System, Little Rock
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Snezana Urosevic
- Minneapolis VA Healthcare System, Minneapolis, Minnesota
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis
| | - Lauren M. Weinstock
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| |
Collapse
|
7
|
Boska RL, Dunlap S, Bishop TM, Goldstrom D, Tomberlin D, Baxter S, Kopacz M, Quigley KS, Harris JI. Chaplains' perspectives on standardizing spiritual assessments. Psychol Serv 2023; 20:30-39. [PMID: 36469435 PMCID: PMC10165507 DOI: 10.1037/ser0000726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Chaplains are an integral part of mental health treatment within the Veterans Health Administration (VHA) and over the past decade, efforts have been made to integrate chaplain services into behavioral health treatment. One unique duty of chaplains is to conduct spiritual assessments, which are characterized as collaborative discussions with veterans to understand their overall religious and belief system, identify spiritual injuries, and how to integrate one's spiritual values into medical care. Although spiritual assessments in Veterans Affairs Medical Centers have evolved throughout the years to adopt a more structured approach, spiritual assessments can vary depending on site, clinical setting, and medical center. The present study sought to examine chaplains' perspectives on standardizing spiritual assessments and incorporating empirically validated measures into the assessments. Thematic analysis was conducted on two focus groups of chaplains from a large VHA medical center. Overall, chaplains appeared interested in standardizing spiritual assessments, with an expressed desire to maintain their current conversational format. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
- Rachel L. Boska
- VA Center of Excellence for Suicide Prevention; Department of Psychiatry, University of Rochester Medical Center
| | - Shawn Dunlap
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Health Care System
| | - Todd M. Bishop
- VA Center of Excellence for Suicide Prevention; Department of Psychiatry, University of Rochester Medical Center
| | | | | | | | - Marek Kopacz
- Fors Marsh Group, Military Health & Wellbeing Research, Arlington, VA
| | - Karen S. Quigley
- Department of Psychology, Northeastern University & VA Bedford Health Care System
| | - J. Irene Harris
- University of Minnesota Medical School, VA Bedford Health Care System
| |
Collapse
|
8
|
Kearns JC, Lachowitz M, Bishop TM, Pigeon WR, Glenn CR. Agreement between actigraphy and sleep diaries: A 28-day real-time monitoring study among suicidal adolescents following acute psychiatric care. J Psychosom Res 2023; 164:111097. [PMID: 36455300 PMCID: PMC9839523 DOI: 10.1016/j.jpsychores.2022.111097] [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: 05/24/2022] [Revised: 11/08/2022] [Accepted: 11/13/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the agreement between, and adherence to, wrist actigraphy and digital sleep diaries as methods for sleep assessment among high-risk adolescents in the 28 days following discharge from acute psychiatric care. Sleep parameters included: number of nighttime awakenings (NWAK), sleep efficiency (SE), sleep onset latency (SOL), total sleep time (TST), and wake after sleep onset (WASO). METHODS Fifty-three adolescents (12-18 years) were recruited following discharge from acute psychiatric care for suicide risk. Adolescents completed a baseline assessment followed by a 28-day monitoring period with daily sleep diaries and continuous wrist actigraphy. Bland-Altman and multi-level models examined agreement. RESULTS Adherence to actigraphy was high, but lower for sleep diaries; a similar pattern of adherence emerged on weekdays vs. weekends. Bland-Altman analyses revealed no clinically meaningful bias for sleep parameters (except NWAK), but the limits of agreement make interpretation ambiguous. Our base model indicated strong agreement between actigraphy and sleep diaries for TST (r = 0.850), moderate for SOL (r = 0.325) and SE (r = 0.322), and weak for WASO (r = -0.049) and NWAK (r = 0.114). A similar pattern emerged with the insomnia severity models with baseline insomnia influencing agreement on all parameters. There were significant weekday-weekend differences for WASO and NWAK, but not for SOL, SE, and TST. CONCLUSION Results suggest that it may be beneficial to find a modeling approach to account for the concordant and discordant information and relevant time-level variables.
Collapse
Affiliation(s)
- Jaclyn C Kearns
- Department of Psychology, University of Rochester, Rochester, NY, USA.
| | | | - Todd M Bishop
- VA Center for Excellence for Suicide Prevention, Finger Lakes Healthcare System, Canandaigua, NY, USA; Sleep and Neurophysiology Research Lab, Department of Psychiatry, University of Rochester Medical Center Rochester, Rochester, NY, USA
| | - Wilfred R Pigeon
- VA Center for Excellence for Suicide Prevention, Finger Lakes Healthcare System, Canandaigua, NY, USA; Sleep and Neurophysiology Research Lab, Department of Psychiatry, University of Rochester Medical Center Rochester, Rochester, NY, USA
| | - Catherine R Glenn
- Department of Psychology, Old Dominion University, Norfolk, VA, USA; Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
| |
Collapse
|
9
|
Kopacz M, Bishop TM, Ayre A, Boska RL, Goldstrom D, Tomberlin D, Baxter S, Dunlap S, Harris JI. Feasibility of using moral injury screening instruments in VA chaplaincy spiritual assessments. J Health Care Chaplain 2022; 28:S89-S100. [PMID: 35130126 DOI: 10.1080/08854726.2022.2032980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Some veterans experience symptoms of moral injury after being exposed to the ethical and moral challenges associated with military service. While it is well known that moral injury is associated with an increased risk for suicide as well as other mental health concerns, few tools exist to systematically screen for moral injury in chaplaincy settings. This preliminary study examines the psychometric properties as well as feasibility of applying two new moral injury screening tools that could be used with routine spiritual assessments, purposefully designed to assess for moral injury in chaplaincy settings at Department of Veterans Affairs (VA) Medical Centers. The results provide preliminary psychometric evidence to support the reliability and validity of these two new screening tools, which were shown to be feasible for use in VA chaplaincy settings.
Collapse
Affiliation(s)
- Marek Kopacz
- Military Analytics, Fors Marsh Group, Arlington, VA, USA
| | - Todd M Bishop
- VA Center of Excellence for Suicide Prevention, Washington, DC, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Amanda Ayre
- VA Bedford Health Care System, Bedford, MA, USA
| | - Rachel L Boska
- VA Center of Excellence for Suicide Prevention, Washington, DC, USA
| | | | | | | | - Shawn Dunlap
- Center for Healthcare Organization and Implementation Research, Bedford, MA, USA
| | - J Irene Harris
- VA Bedford Health Care System, Bedford, MA, USA.,University of Minnesota Medical School, Minneapolis, MN, USA
| |
Collapse
|
10
|
Ashrafioun L, Saulnier KG, Allan NP, Bishop TM, Stecker T. Pain intensity trajectories among veterans seeking mental health treatment: Association with mental health symptoms and suicidal thoughts and behaviors. J Affect Disord 2022; 297:586-592. [PMID: 34728278 DOI: 10.1016/j.jad.2021.10.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 07/21/2021] [Accepted: 10/23/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of this study was to identify classes of pain intensity trajectories among veterans reporting suicidal ideation with no prior mental health treatment experience. We were interested in also assessing factors associated with the pain trajectory classes. METHODS A total 747 participants completed measures of pain, depression, suicide ideation and behaviors, insomnia, substance use, and PTSD. Follow-up assessments were completed at 1-, 3-, 6-, and 12-months post-baseline. Growth mixture modeling was conducted, and pain trajectories were modeled from baseline to month 12. RESULTS Three classes were identified: mild pain intensity that increased over time to severe pain intensity (Increasing-Severe; n = 9), low pain intensity that decreased over time (Mild-Decreasing; n = 172), and moderate pain intensity that remained relatively stable over time (Moderate-Stable; n = 566). The Moderate-Stable trajectory had more severe PTSD symptoms, more frequent depression symptoms, and more severe insomnia. The odds of endorsing suicide ideation at month 12 were significantly higher in the Moderate-Stable trajectory compared to the Mild-Decreasing trajectory. CONCLUSIONS This was the first study to assess classes of pain intensity trajectories among individuals who were treatment naïve for mental health issues. The findings suggest that a moderate stable trajectory of pain intensity over the course of 12 months is common and associated with a more severe clinical profile, including suicide ideation. This study underscores the importance of addressing pain intensity among individuals seeking mental health treatment, particularly for those with pain intensity that is moderate and stable over time.
Collapse
Affiliation(s)
- Lisham Ashrafioun
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY, United States; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States.
| | - Kevin G Saulnier
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Nicholas P Allan
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY, United States; Department of Psychology, Ohio University, Athens, OH, United States
| | - Todd M Bishop
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY, United States; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
| | - Tracy Stecker
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY, United States; College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| |
Collapse
|
11
|
Boska RL, Bishop TM, Ashrafioun L. Pain Conditions and Suicide Attempts in Military Veterans: A Case-Control Design. Pain Med 2021; 22:2846-2850. [PMID: 34550391 DOI: 10.1093/pm/pnab287] [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] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/19/2021] [Accepted: 09/15/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Specific pain conditions such as back pain and migraines are associated with increased risk of suicide mortality after accounting for key covariates. The purpose of the current study was to assess the associations of specific pain conditions with suicide attempts. DESIGN Case-control. SETTING Veterans Health Administration (VHA). SUBJECTS Individuals who utilized VHA services with a record of a suicide attempt (N = 30,051) in Fiscal Years 2013 and 2014 were identified and propensity score matched with controls with no such record (N = 30,051). METHODS Data on pain condition diagnoses (back pain, arthritis, migraine, headaches, psychogenic pain, neuropathy, fibromyalgia) psychiatric diagnoses, medical comorbidity, and demographics were extracted from VHA medical record and suicide surveillance datasets. RESULTS Unadjusted logistic regression analyses found that each of the pain conditions were associated with suicide attempts (e.g., back pain: Odds ratio [OR]=3.25, 95% Confidence Interval [CI]=3.12-3.39). After adjusting for mental health conditions, medical comorbidity, and each of the pain conditions, the effects were attenuated across pain conditions; however, remained significant for each of the pain conditions except for fibromyalgia. Specifically, back pain (OR = 1.25, 95% CI = 1.19-1.32), migraines (OR = 1.29, 95% CI = 1.14-1.46), headaches (OR = 1.33, 95% CI = 1.19-1.48), and neuropathic pain (OR = 1.52, 95% CI = 1.33-1.74) were each associated with increased odds of a suicide attempt. Fibromyalgia was the only pain condition associated with re-attempt status (OR = 1.25, 95% CI = 1.08-1.45). CONCLUSIONS Specific pain conditions are associated with increased odds of suicide attempts even after including key covariates. LIMITATIONS Limitations of the study include the retrospective study design and lack of examination into additional variables including prescription opioid use, pain intensity, and pain duration. The case-control design also limits the ability to draw causal or temporal conclusions.
Collapse
Affiliation(s)
- Rachel L Boska
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA.,Canandaigua VA Medical Center, Canandaigua, New York, USA.,VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York, USA
| | - Todd M Bishop
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York, USA.,Department of Psychiatry, University of Rochester School of Medicine & Dentistry, Rochester, New York, USA
| | - Lisham Ashrafioun
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York, USA.,Department of Psychiatry, University of Rochester School of Medicine & Dentistry, Rochester, New York, USA
| |
Collapse
|
12
|
Bishop TM, Crean HF, Funderburk JS, Pigeon WR. Initial Session Effects of Brief Cognitive Behavioral Therapy for Insomnia: A Secondary Analysis of A Small Randomized Pilot Trial. Behav Sleep Med 2021; 19:769-782. [PMID: 33410336 DOI: 10.1080/15402002.2020.1862847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective/Background: While cognitive-behavioral therapy for insomnia (CBT-I) is typically delivered over six-eight sessions, the field has introduced ever briefer versions. We examined session by session effects on both insomnia and depression outcomes in a brief, four-session version of CBT-I.Participants: This is a secondary analysis of data drawn from participants randomized to brief cognitive behavioral therapy for insomnia (bCBTi) in a pilot clinical trial. All participants (n = 19) were veterans enrolled in primary care who screened positive for insomnia and co-occurring PTSD and/or depression.Methods: Participants received four, weekly, individual sessions of bCBTi during which they provided self-report data on insomnia, depression, and sleep parameters over the preceding week. Baseline and follow-up assessments were also collected.Results: Changes in insomnia and depression severity between baseline and the beginning of session one were non-significant. Statistically significant decreases were observed, however, for insomnia severity between sessions one to two (g = -.65) and sessions two to three (g = -.59). This pattern was mirrored for depression severity with significant decreases between sessions one and two (g = -.65) and sessions two to three (g = -.68). However, there was little change for either outcome from session three to session four (insomnia g = -.16; depression g = -.14).Conclusions: This session by session analyses of bCBTi revealed that the majority of the treatment effect occurred over the first two sessions. Findings suggest that even brief interventions addressing insomnia may have a positive impact on both insomnia and co-occurring depression.
Collapse
Affiliation(s)
- Todd M Bishop
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA.,Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York, USA
| | - Hugh F Crean
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Jennifer S Funderburk
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA.,Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York, USA.,Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Wilfred R Pigeon
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA.,Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York, USA
| |
Collapse
|
13
|
Boska RL, Dunlap S, Kopacz M, Bishop TM, Harris JI. Understanding Moral Injury Morbidity: A Qualitative Study Examining Chaplain's Perspectives. J Relig Health 2021; 60:3090-3099. [PMID: 34480691 PMCID: PMC8418282 DOI: 10.1007/s10943-021-01414-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 06/13/2023]
Abstract
Moral injury tends to be conceptualized through an interplay of psychological and religious concerns. Recent qualitative research has begun utilizing chaplains to bolster the understanding of moral injury within veterans. The current study examined qualitative data regarding how moral injury is viewed through the lens of Chaplain Services within the Veterans Health Administration (VA). Specifically, chaplains were asked to describe how moral injury presents, what kinds of complaints veterans voice with regard to moral injury, and how moral injury impacts social functioning. Chaplains highlighted how moral injury is a pervasive issue affecting veterans across multiple domains. Clinical implications discussed further.
Collapse
Affiliation(s)
- Rachel L Boska
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, NY, 14424, USA.
| | - Shawn Dunlap
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, 01730, USA
| | | | - Todd M Bishop
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, NY, 14424, USA
- Department of Psychiatry, University of Rochester School of Medicine & Dentistry, Rochester, NY, 14642, USA
| | - J Irene Harris
- VISN 1 MIRECC, VA Bedford Healthcare System, Bedford, MA, 01730, USA
- University of Minnesota Medical School, Minneapolis, MN, 55455, USA
| |
Collapse
|
14
|
Ashrafioun L, Bishop TM, Pigeon WR. The Relationship Between Pain Severity, Insomnia, and Suicide Attempts Among a National Veteran Sample Initiating Pain Care. Psychosom Med 2021; 83:733-738. [PMID: 34297006 DOI: 10.1097/psy.0000000000000975] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We assessed the longitudinal association of suicide attempts by moderate to severe pain and insomnia before and after the initiation of pain services among veterans. METHODS A cohort of 221,817 veterans initiating pain care was divided into four subgroups: a) no/mild pain + no insomnia (LowPain-NoINS), b) no/mild pain + insomnia (LowPain-INS), c) moderate/severe pain + no insomnia (HighPain-NoINS), and d) moderate/severe pain + insomnia (HighPain-INS). Data on diagnoses, pain severity, demographics, medications, and suicide attempts were extracted from Veterans Health Administration data sets. RESULTS Overall, there were 2227 (1.0%) suicide attempts before initiating pain services and 1655 (0.8%) after initiating pain services. Cox proportional hazard models accounting for key covariates revealed that patients in the HighPain-INS group were significantly more likely to attempt suicide in the year after the initiation of pain services relative to all subgroups (versus LowPain-NoINS: hazard ratio [HR] = 1.44, 95% confidence interval [CI] = 1.21-1.72; versus LowPain-INS: HR = 1.71, 95% CI = 1.23-2.38; versus HighPain-NoINS: HR = 1.17, 95% CI = 1.01-1.34) even after accounting for prior attempts. Adjusted logistic regression analyses found that patients with moderate/severe pain and insomnia had higher odds of attempting suicide in the year before initiating pain services compared to all subgroups (versus LowPain-NoINS: HR = 1.75, 95% CI = 1.50-2.05; versus LowPain-INS: HR = 1.41, 95% CI = 1.09-1.82; versus HighPain-NoINS: HR = 1.21, 95% CI = 1.07-1.37). CONCLUSIONS These results suggest that those with both moderate/severe pain and insomnia are more likely to have a history of suicide attempts and are at greater risk of a suicide attempt relative to those with insomnia with low/mild pain and those with moderate/severe pain with no insomnia. Suicide prevention efforts for chronic pain and insomnia could address pain and insomnia within the same intervention or in parallel.
Collapse
Affiliation(s)
- Lisham Ashrafioun
- From the VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System (Ashrafioun, Bishop, Pigeon), Canandaigua; and Department of Psychiatry (Ashrafioun, Bishop, Pigeon), University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | | |
Collapse
|
15
|
Pigeon WR, Crean HF, Cerulli C, Gallegos AM, Bishop TM, Heffner KL. A Randomized Clinical Trial of Cognitive-Behavioral Therapy for Insomnia to Augment Posttraumatic Stress Disorder Treatment in Survivors of Interpersonal Violence. Psychother Psychosom 2021; 91:50-62. [PMID: 34265777 PMCID: PMC8760360 DOI: 10.1159/000517862] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 06/11/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Individuals exposed to interpersonal violence (IPV) commonly develop posttraumatic stress disorder (PTSD) with co-occurring depression and insomnia. Standard PTSD interventions such as cognitive processing therapy (CPT) do not typically lead to remission or improved insomnia. Cognitive behavioral therapy for insomnia (CBTi) improves insomnia in individuals with PTSD, but PTSD severity remains elevated. OBJECTIVE To determine whether sequential treatment of insomnia and PTSD is superior to treatment of only PTSD. METHODS In a 20-week trial, 110 participants exposed to IPV who had PTSD, depression and insomnia were randomized to CBTi followed by CPT or to attention control followed by CPT. Primary outcomes following CBTi (or control) were the 6-week change in score on the Insomnia Severity Index (ISI), the Clinician-Administered PTSD Scale (CAPS), and the Hamilton Rating Scale for Depression (HAM-D). Primary outcomes following CPT were the 20-week change in scores. RESULTS At 6 weeks, the CBTi condition had greater reductions in ISI, HAM-D, and CAPS scores than the attention control condition. At 20 weeks, participants in the CBTi+CPT condition had greater reductions in ISI, HAM-D, and CAPS scores compared to control+CPT. Effects were larger for insomnia and for depression than for PTSD. Similar patterns were observed with respect to clinical response and remission. A tipping point sensitivity analyses supported the plausibility of the findings. CONCLUSIONS The sequential delivery of CBTi and CPT had plausible, significant effects on insomnia, depression, and PTSD compared to CPT alone. The effects for PTSD symptoms were moderate and clinically meaningful.
Collapse
Affiliation(s)
- Wilfred R. Pigeon
- Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA
- U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention, Finger Lakes Health Care System, Canandaigua, NY USA
| | - Hugh F. Crean
- U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention, Finger Lakes Health Care System, Canandaigua, NY USA
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester Medical Center, Rochester, NY, USA
| | - Catherine Cerulli
- Susan B. Anthony Center and Laboratory of Interpersonal Violence and Victimization, University of Rochester Medical Center, Rochester, NY, USA
| | - Autumn M. Gallegos
- Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA
| | - Todd M. Bishop
- Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA
- U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention, Finger Lakes Health Care System, Canandaigua, NY USA
| | - Kathi L. Heffner
- Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
16
|
Perlis ML, Pigeon WR, Grandner MA, Bishop TM, Riemann D, Ellis JG, Teel JR, Posner DA. Why Treat Insomnia? J Prim Care Community Health 2021; 12:21501327211014084. [PMID: 34009054 PMCID: PMC8138281 DOI: 10.1177/21501327211014084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/31/2021] [Accepted: 04/05/2021] [Indexed: 12/20/2022] Open
Abstract
"Why treat insomnia?" This question grows out of the perspective that insomnia is a symptom that should only receive targeted treatment when temporary relief is needed or until more comprehensive gains may be achieved with therapy for the parent or precipitating medical or psychiatric disorders. This perspective, however, is untenable given recent data regarding the prevalence, course, consequences, and costs of insomnia. Further, the emerging data that the treatment of insomnia may promote better medical and mental health (alone or in combination with other therapies) strongly suggests that the question is no longer "why treat insomnia," but rather "when isn't insomnia treatment indicated?" This perspective was recently catalyzed with the American College of Physicians' recommendation that chronic insomnia should be treated and that the first line treatment should be cognitive-behavioral therapy for insomnia (CBT-I).
Collapse
Affiliation(s)
| | - Wilfred R. Pigeon
- University of Rochester,
Rochester, NY, USA
- Center of Excellence for Suicide
Prevention Canandaigua VA Medical Center, Canandaigua, NY, USA
| | - Michael A. Grandner
- University of Rochester,
Rochester, NY, USA
- Center of Excellence for Suicide
Prevention Canandaigua VA Medical Center, Canandaigua, NY, USA
| | - Todd M. Bishop
- University of Rochester,
Rochester, NY, USA
- Center of Excellence for Suicide
Prevention Canandaigua VA Medical Center, Canandaigua, NY, USA
| | | | - Jason G. Ellis
- Northumbria University, Newcastle
upon Tyne, Tyne and Wear, UK
| | | | - Donn A. Posner
- Stanford University School of
Medicine, Stanford, CA, USA
| |
Collapse
|
17
|
Abstract
BACKGROUND The purpose of this study was to assess the associations of comorbid opioid use disorders and psychiatric disorders with suicide attempts among veterans seeking pain care. METHODS The cohort (N = 226 444) was selected by identifying pain care initiation from 2012 to 2014 using national Veterans Health Administration (VHA) data. Data on opioid use disorders (OUD), psychiatric disorders, medical comorbidity, demographics at baseline, and suicide attempts in the year following the initiation of pain care were extracted from VHA databases. Relative excess risk due to interaction (RERI) was used to assess departure from additivity of effects. RESULTS Adjusted models indicated that both comorbid OUD and depression (RERI = 1.07) and comorbid OUD and AUD (RERI = 1.23) were significantly associated with additive risk of suicide attempt. In adjusted multiplicative interaction models, only comorbid OUD and bipolar disorder was significantly associated with suicide attempts; however, this association was protective (HR = 0.54). CONCLUSIONS The current findings highlight the importance of addressing opioid use disorders and alcohol use disorders and depression together to mitigate the risk of suicidal behavior.
Collapse
Affiliation(s)
- Lisham Ashrafioun
- Department of Veterans Affairs Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY14424, USA
- Department of Psychiatry, University of Rochester School of Medicine & Dentistry, 300 Crittenden Boulevard, Rochester, NY14642, USA
| | - Kotwoallama R A Zerbo
- Department of Veterans Affairs Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY14424, USA
| | - Todd M Bishop
- Department of Veterans Affairs Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY14424, USA
- Department of Psychiatry, University of Rochester School of Medicine & Dentistry, 300 Crittenden Boulevard, Rochester, NY14642, USA
| | - Peter C Britton
- Department of Veterans Affairs Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY14424, USA
- Department of Psychiatry, University of Rochester School of Medicine & Dentistry, 300 Crittenden Boulevard, Rochester, NY14642, USA
| |
Collapse
|
18
|
Pigeon WR, Funderburk JS, Cross W, Bishop TM, Crean HF. Brief CBT for insomnia delivered in primary care to patients endorsing suicidal ideation: a proof-of-concept randomized clinical trial. Transl Behav Med 2020; 9:1169-1177. [PMID: 31271210 DOI: 10.1093/tbm/ibz108] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [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
Insomnia co-occurs frequently with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD); all three conditions are prevalent among primary care patients and associated with suicidal ideation (SI). The purpose of the article was to test the effects of a brief cognitive behavioral therapy for insomnia (bCBTi) and the feasibility of delivering it to primary care patients with SI and insomnia in addition to either MDD and/or PTSD. Fifty-four patients were randomized to receive either bCBTi or treatment-as-usual for MDD and/or PTSD. The primary outcome was SI intensity as measured by the Columbia-Suicide Severity Rating Scale; secondary clinical outcomes were measured by the Insomnia Severity Index, Patient Health Questionnaire for depression, and PTSD Symptom Checklist. Effect sizes controlling for baseline values and sample size were calculated for each clinical outcome comparing pre-post differences between the two conditions with Hedge's g. The effect size of bCBTi on SI intensity was small (0.26). Effects were large on insomnia (1.91) and depression (1.16) with no effect for PTSD. There was a marginally significant (p = .069) effect of insomnia severity mediating the intervention's effect on SI. Findings from this proof-of-concept trial support the feasibility of delivering bCBTi in primary care and its capacity to improve mood and sleep in patients endorsing SI. The results do not support bCBTi as a stand-alone intervention to reduce SI, but this or other insomnia interventions may be considered as components of suicide prevention strategies.
Collapse
Affiliation(s)
- Wilfred R Pigeon
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.,Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Jennifer S Funderburk
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.,Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.,Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Wendi Cross
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Todd M Bishop
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.,Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Hugh F Crean
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
19
|
Bishop TM, Crean HF, Funderburk JS, Speed KJ, Pigeon WR. 1087 Early Session Effects of CBT-I on Insomnia and Depression. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Cognitive behavioral therapy for insomnia (CBT-I) has been shown to reduce depressive symptomatology among patients with co-occurring insomnia and depression. Brief forms of CBT-I have been tested in various settings including primary care. As delivery formats of CBT-I broaden, it is important to enhance our understanding of what doses and what components of CBT-I, provide the optimal balance of treatment efficacy and brevity. In the present study, we examine session-by-session effects of CBT-I on insomnia and depression.
Methods
Fifty-four Veterans with insomnia and co-occurring depression or posttraumatic stress disorder were randomized to either four sessions of CBT-I or treatment as usual in a published parent study. We report here on the effects among those who received CBT-I (n =22). At each session participants provided a completed sleep diary and completed the Insomnia Severity Index (ISI) and Patient Health Questionnaire-9 for depression (PHQ-9).
Results
At baseline, participants endorsed a moderate level of both insomnia (ISI score = 18.5 [SD=4.2]) and depression (PHQ-9 score = 15.6 [SD=5.2]). A mean decrease of 4.0 points in ISI total score was observed between sessions 1 and 2 [t(21)=-3.88, p<.001] and a 3.3 points between sessions 2 and 3 [t(19)=-2.63, p<.05]. Mean PHQ-9 scores decreased by 2.9 points between sessions 1 and 2 [t(21)=-2.84, p<.01] and a 2.8 points between sessions 2 and 3 [t(19)=-2.77, p<.05]. In contrast, changes in ISI and PHQ-9 scores between baseline and session 1, and sessions 3 and 4 did not reach significance.
Conclusion
The majority of improvements in both insomnia and depression were observed following sessions 1 and 2 of CBT-I. Findings suggest that even a limited exposure to CBT-I may have a clinically significant impact on functioning across multiple domains. Whether such early improvements represent an optimal balance compared with the more modest additional improvements achieved by adding more sessions is discussed.
Support
This work was supported by the VISN 2 Center of Excellence for Suicide Prevention at the Canandaigua VAMC.
Collapse
Affiliation(s)
- T M Bishop
- VA Center of Excellence for Suicide Prevention, Canandaigua, NY
| | - H F Crean
- VA Center of Excellence for Suicide Prevention, Canandaigua, NY
| | | | - K J Speed
- VA Center of Excellence for Suicide Prevention, Canandaigua, NY
| | - W R Pigeon
- VA Center of Excellence for Suicide Prevention, Canandaigua, NY
| |
Collapse
|
20
|
Kessler RC, Bauer MS, Bishop TM, Demler OV, Dobscha SK, Gildea SM, Goulet JL, Karras E, Kreyenbuhl J, Landes SJ, Liu H, Luedtke AR, Mair P, McAuliffe WHB, Nock M, Petukhova M, Pigeon WR, Sampson NA, Smoller JW, Weinstock LM, Bossarte RM. Using Administrative Data to Predict Suicide After Psychiatric Hospitalization in the Veterans Health Administration System. Front Psychiatry 2020; 11:390. [PMID: 32435212 PMCID: PMC7219514 DOI: 10.3389/fpsyt.2020.00390] [Citation(s) in RCA: 25] [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: 12/13/2019] [Accepted: 04/17/2020] [Indexed: 12/11/2022] Open
Abstract
There is a very high suicide rate in the year after psychiatric hospital discharge. Intensive postdischarge case management programs can address this problem but are not cost-effective for all patients. This issue can be addressed by developing a risk model to predict which inpatients might need such a program. We developed such a model for the 391,018 short-term psychiatric hospital admissions of US veterans in Veterans Health Administration (VHA) hospitals 2010-2013. Records were linked with the National Death Index to determine suicide within 12 months of hospital discharge (n=771). The Super Learner ensemble machine learning method was used to predict these suicides for time horizon between 1 week and 12 months after discharge in a 70% training sample. Accuracy was validated in the remaining 30% holdout sample. Predictors included VHA administrative variables and small area geocode data linked to patient home addresses. The models had AUC=.79-.82 for time horizons between 1 week and 6 months and AUC=.74 for 12 months. An analysis of operating characteristics showed that 22.4%-32.2% of patients who died by suicide would have been reached if intensive case management was provided to the 5% of patients with highest predicted suicide risk. Positive predictive value (PPV) at this higher threshold ranged from 1.2% over 12 months to 3.8% per case manager year over 1 week. Focusing on the low end of the risk spectrum, the 40% of patients classified as having lowest risk account for 0%-9.7% of suicides across time horizons. Variable importance analysis shows that 51.1% of model performance is due to psychopathological risk factors accounted, 26.2% to social determinants of health, 14.8% to prior history of suicidal behaviors, and 6.6% to physical disorders. The paper closes with a discussion of next steps in refining the model and prospects for developing a parallel precision treatment model.
Collapse
Affiliation(s)
- Ronald C Kessler
- Deparment of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Mark S Bauer
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States.,Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, United States
| | - Todd M Bishop
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States
| | - Olga V Demler
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Steven K Dobscha
- VA Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States
| | - Sarah M Gildea
- Deparment of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Joseph L Goulet
- Pain, Research, Informatics, Multimorbidities & Education Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Elizabeth Karras
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States
| | - Julie Kreyenbuhl
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, MD, United States.,Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Sara J Landes
- South Central Mental Illness Research Education Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Howard Liu
- Deparment of Health Care Policy, Harvard Medical School, Boston, MA, United States.,Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States
| | - Alex R Luedtke
- Department of Statistics, University of Washington, Seattle, WA, United States.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Patrick Mair
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | | | - Matthew Nock
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Maria Petukhova
- Deparment of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
| | - Nancy A Sampson
- Deparment of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Jordan W Smoller
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Lauren M Weinstock
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Robert M Bossarte
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States.,West Virginia University Injury Control Research Center and Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, WV, United States
| |
Collapse
|
21
|
Bower ES, Simons K, Walsh PG, Ashrafioun L, Orden KAV, Bishop TM. PHYSICAL CONDITIONS ASSOCIATED WITH SUICIDE ATTEMPTS: DO RISKS DIFFER AMONG OUR OLDER VETERANS? Innov Aging 2019. [PMCID: PMC6845604 DOI: 10.1093/geroni/igz038.3038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Physical illness confers risk for late-life suicide, yet few studies report whether risks differ with older age and among Veterans. We examined age-stratified associations between physical illness and suicide attempt among Veterans 65+ years (n=8452, 97% male) from a larger retrospective case-control study that utilized secondary data from the Veterans Affairs Corporate Data Warehouse and Suicide Prevention Applications Network. Controls were matched by age, sex, and mental health treatment utilization. Risk estimates for 15 conditions and a combined comorbidity score were stratified by young-old (65-74), middle-old (75-84), and oldest-old (85+), adjusting for age and sex within strata. Neurodegenerative disorder (ORs=4.5, 6.0, 6.5) or dementia (ORs=5.0, 5.7, 4.4) diagnosis within 180 days conferred the highest risks across young-, middle-, and oldest-old. Cerebrovascular disorder was associated with higher risk among the oldest-old versus young-old (ORs=6.1 vs 2.2). Findings differ from reported risks for suicide death. Illness may be experienced differently across later-life.
Collapse
Affiliation(s)
- Emily S Bower
- VISN Center of Excellence for Suicide Prevention, Canandaigua, New York, United States
| | - Kelsey Simons
- VISN Center of Excellence for Suicide Prevention, Canandaigua, New York, United States
| | - Patrick G Walsh
- VISN Center of Excellence for Suicide Prevention, Canandaigua, New York, United States
| | - Lisham Ashrafioun
- VISN Center of Excellence for Suicide Prevention, Canandaigua, New York, United States
| | | | - Todd M Bishop
- VISN Center of Excellence for Suicide Prevention, Canandaigua, New York, United States
| |
Collapse
|
22
|
Kittel JA, Bishop TM, Ashrafioun L. Sex differences in binge drinking and suicide attempts in a nationally representative sample. Gen Hosp Psychiatry 2019; 60:6-11. [PMID: 31284001 DOI: 10.1016/j.genhosppsych.2019.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 04/04/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Prevalence of suicide continues to present a major public health problem, particularly among women. Identifying risk factors for suicide is vital to reduce the number of suicide deaths per year. Alcohol use is a well-known risk factor for suicidal behavior, but the association between binge drinking and suicide attempts across genders is less clear. METHODS The current study used combined 2008-2014 National Survey on Drug Use and Health data (n = 269,078) to examine the association between binge drinking and suicidal ideation and suicide attempts across sex. RESULTS Logistic regression analyses revealed that binge drinking was associated with suicide attempts in females (OR = 1.37, 95% CI: 1.09-1.73) but not in males (OR = 1.07, 95% CI: 0.80-1.43). Binge drinking was not associated with suicidal ideation in either males or females. CONCLUSIONS Identifying and addressing binge drinking in women may be useful as part of a suicide prevention strategy.
Collapse
Affiliation(s)
- Julie A Kittel
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States of America.
| | - Todd M Bishop
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14642, United States of America; VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States of America.
| | - Lisham Ashrafioun
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14642, United States of America; VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States of America.
| |
Collapse
|
23
|
Bishop TM, Ashrafioun L, Pigeon WR. The Association Between Sleep Apnea and Suicidal Thought and Behavior: An Analysis of National Survey Data. J Clin Psychiatry 2019; 79. [PMID: 29286590 DOI: 10.4088/jcp.17m11480] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 07/18/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Sleep disturbances have been associated with increased risk for suicidal thought and behavior. The literature in regard to sleep and suicide, however, has focused predominantly on generalized sleep disturbance or insomnia. The purpose of the current study is to examine relationships among sleep apnea and suicidal thought and behavior using a nationally representative sample. METHODS We conducted a secondary analysis of 2014 data from the National Survey on Drug Use and Health. Respondents from a random sample of US households who were 18 years or older (N = 40,149) completed an interview including items assessing past-year sleep apnea, suicidal ideation, suicide planning, and suicide attempt. RESULTS Among respondents with sleep apnea (2.9%; n = 1,155), prevalence of suicidality was reported to be 9.7% for suicidal ideation, 3.4% for suicide planning, and 1.0% for suicide attempt compared with 4.9%, 1.4%, and 0.7%, respectively, for those without sleep apnea. Multiple logistic regression analyses revealed that sleep apnea was significantly associated with both suicidal ideation (OR = 1.50; 95% CI, 1.18-1.91) and suicide planning (OR = 1.56; 95% CI, 1.08-2.26) after controlling for age, sex, ethnicity, past-year substance use disorder, self-rated overall health, past-year sedative-hypnotic misuse, past-year depressive episode, heart disease, high blood pressure, stroke, diabetes, and body mass index. Sleep apnea was not significantly associated with report of past-year suicide attempt (OR = 1.22; 95% CI, 0.66-2.26). CONCLUSIONS Suicidal ideation and suicide planning were more likely to be endorsed by respondents with sleep apnea compared to those without after accounting for key covariates. Diagnosis of sleep apnea may represent an early opportunity for providers to discuss suicide and mental health with their patients.
Collapse
Affiliation(s)
- Todd M Bishop
- Center of Excellence for Suicide Prevention, Canandaigua VAMC, 400 Fort Hill Ave, Canandaigua, NY 14244. .,VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Lisham Ashrafioun
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Wilfred R Pigeon
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| |
Collapse
|
24
|
Ashrafioun L, Kane C, Bishop TM, Britton PC, Pigeon WR. The Association of Pain Intensity and Suicide Attempts Among Patients Initiating Pain Specialty Services. The Journal of Pain 2019; 20:852-859. [DOI: 10.1016/j.jpain.2019.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/02/2019] [Accepted: 01/08/2019] [Indexed: 01/27/2023]
|
25
|
Bishop TM, Crean HF, Hoff RA, Pigeon WR. Suicidal ideation among recently returned veterans and its relationship to insomnia and depression. Psychiatry Res 2019; 276:250-261. [PMID: 31125902 DOI: 10.1016/j.psychres.2019.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 11/19/2018] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 11/25/2022]
Abstract
Suicide is a significant public health problem associated with numerous health factors such as insomnia. Suicidal ideation is common among veterans, who often present with multiple comorbidities. The present study examined direct and indirect relationships among suicidal ideation, insomnia, depression, and alcohol use. U.S. veterans (n = 850) recently separated from military service completed phone-based interviews covering multiple domains. Tests of indirect effects and bias-corrected confidence intervals were used to conduct a cross-sectional analysis of baseline data from a larger parent study examining relationships among the latent variables of suicidal ideation, insomnia, alcohol use, and depression. In this analysis insomnia did not have direct associations with suicidal ideation (Β = 0.06, t = 0.29, p = .772) or alcohol use (Β = 0.07, t = 1.73, p = .084). Insomnia severity was, however, significantly and positively related to depression severity (Β = 0.58, t = 21.70, p < .001). Additionally, more severe depression was associated with greater intensity of suicidal ideation (Β = 0.59, t = 3.64, p < .001). Notably, insomnia's indirect effect on suicidal ideation was driven by depression. In this sample of returning veterans, insomnia appears to indirectly impact suicidal ideation through its relationship with depression. This finding suggests the potential utility of addressing insomnia as part of an overall approach to reducing depressive symptomatology and indirectly, suicidal ideation.
Collapse
Affiliation(s)
- Todd M Bishop
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States.
| | - Hugh F Crean
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
| | - Rani A Hoff
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; VISN 1 MIRECC, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Wilfred R Pigeon
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
| |
Collapse
|
26
|
Ashrafioun L, Heavey S, Canarapen T, Bishop TM, Pigeon WR. The relationship between past 12-month suicidality and reasons for prescription opioid misuse. J Affect Disord 2019; 249:45-51. [PMID: 30753953 PMCID: PMC7870327 DOI: 10.1016/j.jad.2019.02.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/30/2019] [Accepted: 02/05/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Understanding reasons for prescription opioid misuse can help elucidate suicide prevention efforts. The goal of the current study is to assess associations of reasons for prescription opioid misuse subtypes and suicide-related variables. We also assessed whether prescription opioid misuse differentiates ideators from those who attempt suicide. METHODS Using data from the 2015-2017 National Survey of Drug Use and Health (N = 45,074), prescription opioid misuse subtypes were grouped as follows: (a) Pain only, (b) Other reasons, and (c) Mixed reasons (i.e., pain and at least one other reason). Logistic regressions examined associations of misuse subtypes and past 12-month suicide-related variables (ideation, planning, attempts) relative to non-misusers. Logistic regression analyses were also conducted among the subset reporting ideation to assess whether prescription opioid misuse differentiated ideators with no attempt from ideators with an attempt. RESULTS In adjusted models, the Pain only and the Other reasons subtypes were associated with ideation and planning, but not attempts. The Mixed reasons subtype had higher odds of suicide ideation and planning compared to those not misusing prescription opioids and the Pain only misuse subtype. The Mixed reasons subtype had higher odds of a suicide attempt only when compared to those not misusing prescription opioids. Prescription opioid misuse was also associated with suicide attempts among the subset of ideators. CONCLUSIONS Findings indicate that people misuse prescription opioids for various reasons, and misuse subtypes are associated with past 12-month suicidality. Addressing pain and other reasons for misuse together through use of evidence-based treatments may help mitigate suicide risk.
Collapse
Affiliation(s)
- Lisham Ashrafioun
- Department of Psychiatry, University of Rochester Medical Center, USA; VA Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, USA.
| | - Sarah Heavey
- Department of Psychiatry, University of Rochester Medical Center
| | | | - Todd M. Bishop
- Department of Psychiatry, University of Rochester Medical Center,VA Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center
| | - Wilfred R. Pigeon
- Department of Psychiatry, University of Rochester Medical Center,VA Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center
| |
Collapse
|
27
|
Li YI, Cerulli C, Heffner KL, Crean HF, Bishop TM, Pigeon WR. 0881 Cognitive-Behavioral Therapy for Insomnia in PTSD: Differential Relationships with Symptom Clusters. Sleep 2019. [DOI: 10.1093/sleep/zsz067.879] [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: 11/12/2022] Open
Affiliation(s)
- Yihan Irina Li
- Clinical and Social Psychology, University of Rochester, Rochester, NY, USA
| | - Catherine Cerulli
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Kathi L Heffner
- School of Nursing, University of Rochester Medical Center, Rochester, NY, USA
| | - Hugh F Crean
- School of Nursing, University of Rochester Medical Center, Rochester, NY, USA
| | - Todd M Bishop
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Wilfred R Pigeon
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
28
|
Bishop TM, Walsh PG, Ashrafioun L, Speed KJ, Lad SS, Pigeon WR. 0923 Insomnia and Suicide Attempts following Discharge from Residential Treatment. Sleep 2019. [DOI: 10.1093/sleep/zsz067.921] [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: 11/12/2022] Open
Affiliation(s)
- Todd M Bishop
- VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY, USA
| | - Patrick G Walsh
- VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY, USA
| | - Lisham Ashrafioun
- VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY, USA
| | - Katrina J Speed
- Department of Psychology, Mississippi State University, Starkville, MS, USA
| | - Sagar S Lad
- Department of Psychology, William James College, Newton, MA, USA
| | - Wilfred R Pigeon
- VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY, USA
| |
Collapse
|
29
|
Britton PC, McKinney JM, Bishop TM, Pigeon WR, Hirsch JK. Insomnia and risk for suicidal behavior: A test of a mechanistic transdiagnostic model in veterans. J Affect Disord 2019; 245:412-418. [PMID: 30423469 DOI: 10.1016/j.jad.2018.11.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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] [Received: 03/30/2018] [Revised: 09/28/2018] [Accepted: 11/03/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insomnia has been shown to have direct and indirect associations with suicidal ideation, attempts, and death in U.S. military and veteran populations. However, transdiagnostic models of insomnia and psychopathology have not been used to examine the contribution of psychopathology. METHOD The present study is a secondary analysis examining the associations among insomnia symptoms, posttraumatic stress disorder (PTSD) and depressive symptoms, interpersonal theory of suicide variables, and risk for suicidal behavior in community veterans (n = 392). Serial mediation was used to test sequential associations, allowing for examination of direct and indirect associations. RESULTS The model with insomnia, PTSD, and depressive symptoms, and thwarted belongingness, accounted for 29% of the variance in risk. Insomnia symptoms had an indirect association through PTSD and depressive symptoms, and thwarted belongingness. The model with insomnia, PTSD, and depressive symptoms, and perceived burdensomeness accounted for 35% of the variance in risk. Insomnia symptoms had an indirect association through PTSD and depressive symptoms, and perceived burdensomeness. LIMITATIONS Data are cross-sectional, precluding the testing of causal associations. CONCLUSIONS In veterans, insomnia symptoms may be associated with increased PTSD and depressive symptoms, which may be associated with increased risk for suicidal behavior directly and indirectly through relationship disruptions.
Collapse
Affiliation(s)
- Peter C Britton
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, United States; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States.
| | | | - Todd M Bishop
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, United States; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Wilfred R Pigeon
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, United States; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Jameson K Hirsch
- East Tennessee State University, Johnson City, TN, United States
| |
Collapse
|
30
|
Abstract
OBJECTIVE Conceptual understandings of meaning-making suggest that it may have protective value in regard to alcohol misuse and suicidal behavior. Accordingly, the aim of this study was to examine whether meaning-making attenuated the relationship between alcohol misuse and suicide risk severity in a population of active-duty service members. METHODS The sample (N = 97) was recruited while presenting for emergency behavioral health services in circumstances indicative of high-risk suicidality: endorsing current suicidal ideation with intent to die. Those who reported ideation with a lifetime history of a past suicide attempt were conceptualized as being in a more severe category of suicide risk than ideation without a lifetime history of a past suicide attempt. Participants completed the Suicidal Behaviors Questionnaire-Revised, Meaning in Life Questionnaire, Alcohol Use Disorders Identification Test consumption questions, and items that assessed demographic variables. Data were analyzed using chi-squared test of independence, Fisher's exact test, Kendall rank correlation coefficient, and logistic regression modeling. RESULTS Regression analysis identified a statistically significant association between number of drinks consumed daily and reporting a lifetime history of a past suicide attempt, odds ratio (OR) = 1.60, 95% confidence interval (CI) [1.11, 2.32], p = .01. Number of drinks consumed remained significant even after adjusting for both the search for and presence of meaning, OR = 1.70, 95% CI [1.16, 2.51], p = .01. These results remained unchanged even when adjusting for gender, race, ethnicity, and relationship status. No statistically significant interaction effects were noted between meaning-making and alcohol consumption. CONCLUSIONS Meaning-making did not appear to attenuate the effect of alcohol misuse on suicide risk severity in a sample of service members at high-risk of suicidality. Additional research is needed to better understand the relationship among meaning-making, alcohol misuse, and suicidal behavior.
Collapse
Affiliation(s)
- Marek S Kopacz
- a U.S. Department of Veterans Affairs , VISN 2 Center of Excellence for Suicide Prevention , Canandaigua , New York , USA.,b U.S. Department of Veterans Affairs , Mid-Atlantic Mental Illness Research, Education and Clinical Center, Mental Health and Chaplaincy , Durham , North Carolina , USA
| | - Craig J Bryan
- c National Center for Veterans Studies , The University of Utah , Salt Lake City , Utah , USA
| | - Todd M Bishop
- a U.S. Department of Veterans Affairs , VISN 2 Center of Excellence for Suicide Prevention , Canandaigua , New York , USA.,d University of Rochester Medical Center , Rochester , NY , USA
| | - Lisham Ashrafioun
- a U.S. Department of Veterans Affairs , VISN 2 Center of Excellence for Suicide Prevention , Canandaigua , New York , USA.,d University of Rochester Medical Center , Rochester , NY , USA
| |
Collapse
|
31
|
Pigeon WR, Taylor M, Bui A, Oleynk C, Walsh P, Bishop TM. Validation of the Sleep-Wake Scoring of a New Wrist-Worn Sleep Monitoring Device. J Clin Sleep Med 2018; 14:1057-1062. [PMID: 29852899 DOI: 10.5664/jcsm.7180] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 07/19/2017] [Accepted: 01/31/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To test the sleep-wake scoring reliability of a new wrist-worn sleep monitoring device. METHODS Twenty-seven adult good sleepers underwent 1 night of polysomnography (PSG) while wearing both the new device (myCadian [MC]; CurAegis Technologies, Rochester, New York, United States) and commercially available actigraphy (Actiwatch 2 [AW]; Philips Respironics, Murrysville, Pennsylvania, United States) on their nondominant wrist. PSG tests were manually stage scored. After excluding missing data, 20 participants had full-night data on all three devices with 17,734 total 30-second epochs. Using PSG as the gold standard, pooled epoch-by-epoch agreement for sleep and wake was calculated for each device using percent agreement and Cohen kappa statistic. Positive predictive values for both sleep and wake epochs, as well as sleep continuity statistics, were calculated. RESULTS Percent agreement with PSG-scored wake and sleep was 91.3% for MC (kappa = 0.67) and 87.7% for AW (kappa = 0.50). Positive predictive values for sleep epochs were 94.4% and 90.8% for MC and AW, respectively, and 74.5% and 65.6% for wake. Both devices underestimated wake and overestimated sleep compared to PSG. Descriptively, compared to PSG, sleep latency was higher with MC and wake after sleep onset higher with AW. Total sleep time and sleep efficiency were more similar across devices. CONCLUSIONS The kappa statistic for MC is consistent with a high level of agreement with PSG. Overall, the reliability of MC compared to PSG scoring was slightly more favorable than that of AW. Findings suggest that MC provides reliable sleep-wake scoring during a nocturnal sleep period for good sleepers.
Collapse
Affiliation(s)
- Wilfred R Pigeon
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York.,VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York
| | - Maddison Taylor
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Ashley Bui
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Courteney Oleynk
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Patrick Walsh
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Todd M Bishop
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York.,VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York
| |
Collapse
|
32
|
Bishop TM, Ashrafioun L, Walsh PG, Klein JS, Brown TJ, Pigeon WR. 0952 Sleep, Suicide Risk, and the Protective Role Of Sleep Medicine. Sleep 2018. [DOI: 10.1093/sleep/zsy061.951] [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: 11/13/2022] Open
Affiliation(s)
- T M Bishop
- VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY
| | - L Ashrafioun
- VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY
| | - P G Walsh
- VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY
| | - J S Klein
- VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY
| | - T J Brown
- VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY
| | - W R Pigeon
- VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY
| |
Collapse
|
33
|
Ashrafioun L, Bishop TM, Conner KR, Pigeon WR. Frequency of prescription opioid misuse and suicidal ideation, planning, and attempts. J Psychiatr Res 2017; 92:1-7. [PMID: 28364579 DOI: 10.1016/j.jpsychires.2017.03.011] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [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: 08/03/2016] [Revised: 03/14/2017] [Accepted: 03/17/2017] [Indexed: 10/19/2022]
Abstract
The goal of this study was to examine the relationship between past-year frequency of prescription opioid misuse and past-year suicidal ideation, suicide planning, and suicide attempts. Secondary data analyses were conducted using data from 41,053 participants of the 2014 National Survey of Drug Use and Health. Past-year frequency of prescription opioid misuse was grouped into 4 categories: none, less than monthly (1-11 times), monthly to weekly (12-51 times), and weekly or more (52 times or more). Binomial logistic regression analyses adjusted for demographics, overall health rating, depression, anxiety, and substance use disorders to test the associations between frequency of prescription opioid misuse and suicide-related variables. Compared to those who did not endorse prescription opioid misuse in the past year, prescription opioid misuse was significantly associated with suicidal ideation, suicide planning, and suicide attempts for each frequency of use category in unadjusted models (p < 0.05). In adjusted models, frequency of prescription opioid misuse remained significantly associated with suicidal ideation (p < 0.05 for each frequency category); however, only the group reporting weekly or more use on average was associated with suicide planning and attempts (p < 0.05). The findings provide novel specificity regarding prescription opioid use in relation to suicide-related outcomes further supporting enhanced access to suicide prevention and nonpharmacological approaches to pain management across various settings.
Collapse
Affiliation(s)
- Lisham Ashrafioun
- VA VISN 2 Center for Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
| | - Todd M Bishop
- VA VISN 2 Center for Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Kenneth R Conner
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA; Department of Emergency Medicine, University of Rochester Center, Rochester, NY, USA
| | - Wilfred R Pigeon
- VA VISN 2 Center for Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
34
|
Pigeon WR, Funderburk J, Bishop TM, Crean HF. Brief cognitive behavioral therapy for insomnia delivered to depressed veterans receiving primary care services: A pilot study. J Affect Disord 2017; 217:105-111. [PMID: 28395207 DOI: 10.1016/j.jad.2017.04.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 02/23/2017] [Accepted: 04/02/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Depression and insomnia are treatable, often co-occur and are common among primary care patients. Treatments designed for primary care must be brief, effective and ideally have the potential to address multiple symptoms. A brief form of cognitive behavioral therapy for insomnia (CBT-I) was piloted among depressed primary care patients with insomnia some of whom endorsed suicidal ideation. METHODS Veterans Affairs primary care patients were randomized to either CBT-I or sleep hygiene. CBT-I consisted of two, 20-40min in-person sessions and two 15-20min telephone sessions; SH consisted of one in-person and one telephone session. Participants were assessed at baseline, post-treatment, and a 3 month follow-up. RESULTS Compared to SH (n=14), brief CBT-I (n=13) had large effects on insomnia severity, sleep efficiency, number of awakenings, and time awake after sleep onset with between group effect sizes ranging from .75 to 1.09 at post-treatment and .66-.89 at follow-up, though significance was not maintained at follow-up. Although both groups experienced significant reductions in depression severity, statistically significant group by time interactions were not observed for depression. LIMITATIONS Notable limitations include the small sample size, having excluded patients with the most severe suicide risk, and the absence of objective testing to detect presence of sleep disorders other than insomnia. CONCLUSIONS The effects observed for insomnia outcomes, corroborate support for using CBT-I in depressed patients and extend this support to a brief from of CBT-I structured for delivery in primary care. Whether a brief form of CBT-I delivered to patients in primary care who endorse suicidal ideation would have a significant effect on depressive symptoms and/or suicidal ideation remains to be tested in a fully powered trial.
Collapse
Affiliation(s)
- Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, USA; Center for Integrated Healthcare, Syracuse VA Medical Center, USA; University of Rochester Medical Center, Department of Psychiatry, USA.
| | - Jennifer Funderburk
- Center for Integrated Healthcare, Syracuse VA Medical Center, USA; University of Rochester Medical Center, Department of Psychiatry, USA; Syracuse University, USA
| | - Todd M Bishop
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, USA; Center for Integrated Healthcare, Syracuse VA Medical Center, USA; University of Rochester Medical Center, Department of Psychiatry, USA
| | - Hugh F Crean
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, USA; University of Rochester School of Nursing, USA
| |
Collapse
|
35
|
|
36
|
Pigeon WR, Crean H, Cerulli C, Walsh P, Gallegos A, Bishop TM, Casey C, Gorman C, Bui A, Oleynk C, Heffner KL. 0339 DOES COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA ENHANCE THE EFFECTS OF COGNITIVE PROCESSING THERAPY FOR PTSD AMONG SURVIVORS OF INTERPERSONAL VIOLENCE? Sleep 2017. [DOI: 10.1093/sleepj/zsx050.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
37
|
Bishop TM, Simons KV, King DA, Pigeon WR. Sleep and Suicide in Older Adults: An Opportunity for Intervention. Clin Ther 2016; 38:2332-2339. [DOI: 10.1016/j.clinthera.2016.09.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/22/2016] [Accepted: 09/26/2016] [Indexed: 01/09/2023]
|
38
|
Kent M, Glass EN, Haley AC, Shaikh LS, Sequel M, Blas-Machado U, Bishop TM, Holmes SP, Platt SR. Hydrocephalus secondary to obstruction of the lateral apertures in two dogs. Aust Vet J 2016; 94:415-422. [PMID: 27785804 DOI: 10.1111/avj.12510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 01/24/2016] [Accepted: 01/27/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Traditionally, hydrocephalus is divided into communicating or non-communicating (obstructive) based on the identification of a blockage of cerebrospinal fluid (CSF) flow through the ventricular system. Hydrocephalus ex vacuo refers to ventricular enlargement as a consequence of neuroparenchymal loss. Hydrocephalus related to obstruction of the lateral apertures of the fourth ventricles has rarely been described. CASE REPORT The clinicopathologic findings in two dogs with hydrocephalus secondary to obstruction of the lateral apertures of the fourth ventricle are reported. Signs were associated with a caudal cervical spinal cord lesion in one dog and a caudal brain stem lesion in the other dog. Magnetic resonance imaging (MRI) disclosed dilation of the ventricular system, including the lateral recesses of the fourth ventricle. In one dog, postmortem ventriculography confirmed obstruction of the lateral apertures. Microscopic changes were identified in the choroid plexus in both dogs, yet a definitive cause of the obstructions was not identified. The MRI findings in both dogs are similar to membranous occlusion of the lateral and median apertures in human patients. CONCLUSION MRI detection of dilation of the entire ventricular system in the absence of an identifiable cause should prompt consideration of an obstruction of the lateral apertures. In future cases, therapeutic interventions aimed at re-establishing CSF flow or ventriculoperitoneal catheterisation should be considered.
Collapse
Affiliation(s)
- M Kent
- University of Georgia, Department of Small Animal Medicine and Surgery, Athens, Georgia, USA.
| | - E N Glass
- Red Bank Veterinary Hospital, Tinton Falls, New Jersey, USA
| | - A C Haley
- University of Georgia, Department of Small Animal Medicine and Surgery, Athens, Georgia, USA
| | - L S Shaikh
- University of Georgia, Veterinary Biosciences and Diagnostic imaging, Athens, GA, USA
| | - M Sequel
- University of Georgia, Department of Pathology, Athens, GA, USA
| | - U Blas-Machado
- Athens Veterinary Diagnostic Laboratory, University of Georgia, Athens, GA, USA
| | - T M Bishop
- Upstate Veterinary Specialists, Latham, New York, USA
| | - S P Holmes
- University of Georgia, Veterinary Biosciences and Diagnostic imaging, Athens, GA, USA
| | - S R Platt
- University of Georgia, Department of Small Animal Medicine and Surgery, Athens, Georgia, USA
| |
Collapse
|
39
|
Bishop TM, Maisto SA, Britton PC, Pigeon WR. Considerations in the Use of Interactive Voice Recording for the Temporal Assessment of Suicidal Ideation and Alcohol Use. Crisis 2016; 37:370-376. [DOI: 10.1027/0227-5910/a000408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background: A greater understanding of the temporal variation of suicidal ideation and suicidal behavior is needed to inform more effective prevention efforts. Interactive voice recording (IVR) allows for the study of temporal relationships that cannot be captured with most traditional methodologies. Aims: To examine the feasibility of implementing IVR for the assessment of suicidal ideation. Method: Participants (n = 4) receiving a brief intervention based on dialectical behavior therapy were asked to respond to three phone-based surveys each day over 6 weeks that assessed suicidal ideation and alcohol consumption. Results: Participants completed 77.7% of daily assessments, reported that calls were not burdensome, and indicated that calls were sometimes helpful in interrupting suicidal ideation. Conclusion: The preliminary data reported here provide optimism for the use of IVR and other forms of ecological momentary assessment in the exploration of the antecedents of suicidal behavior.
Collapse
Affiliation(s)
- Todd M. Bishop
- Center of Excellence for Suicide Prevention, Canandaigua VAMC, Canandaigua, NY, USA
- Psychiatry Department, University of Rochester Medical Center, Rochester, NY, USA
| | - Stephen A. Maisto
- Department of Psychology, Syracuse University, Syracuse, NY, USA
- Center for Integrated Healthcare, Syracuse VAMC, Syracuse, NY, USA
| | - Peter C. Britton
- Center of Excellence for Suicide Prevention, Canandaigua VAMC, Canandaigua, NY, USA
| | - Wilfred R. Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VAMC, Canandaigua, NY, USA
- Psychiatry Department, University of Rochester Medical Center, Rochester, NY, USA
- Center for Integrated Healthcare, Syracuse VAMC, Syracuse, NY, USA
| |
Collapse
|
40
|
Abstract
OBJECTIVE Rates of HIV remain elevated in select populations such as those with severe mental illness and also among those who abuse cocaine, a vehicle through which risky sexual behavior may occur. The objective of the present narrative review was to synthesize the literature regarding stimulant use and its association with sexual risk among individuals with severe mental illness. METHODS This narrative review of the literature utilized Boolean search logic and the PsycINFO and PsycARTICLES databases to identify articles that explored the relationships among stimulant use, risky sexual behavior, and severe mental illness. Only one article was identified that examined a stimulant other than cocaine. Thus, the review was further limited to the impact that cocaine has on risky sexual behavior among those with severe mental illness. RESULTS Of the 87 abstracts obtained, 58 underwent a full text review and eight were included in the final review. Studies had a mean sample size of 110 and predominantly consisted of male (64%) outpatients. Study designs were largely cross-sectional and almost exclusively relied on retrospective participant report of sexual behavior and drug use. The extant literature indicates a positive association between cocaine and risky sexual behavior among those with a diagnosed severe mental illness. Risky behaviors associated with cocaine included reporting a greater number of partners as well as a higher degree of involvement in the sex trade. The positive association observed between cocaine and partner-related risk, however, did not extend to condom use. CONCLUSIONS Further research that utilizes better defined and operationalized constructs to investigate relationships among stimulant use, severe mental illness, and sexual risk, particularly condom use, is warranted and is necessary to advance the field.
Collapse
Affiliation(s)
- Todd M Bishop
- a Center of Excellence for Suicide Prevention, Canandaigua VAMC , Canandaigua , New York , USA.,b Department of Psychiatry , University of Rochester Medical Center , Rochester , New York , USA
| | - Stephen A Maisto
- c Department of Psychology , Syracuse University , Syracuse , New York , USA.,d Center for Integrated Healthcare, Syracuse VAMC , Syracuse , New York , USA
| | - Suzanne Spinola
- c Department of Psychology , Syracuse University , Syracuse , New York , USA.,d Center for Integrated Healthcare, Syracuse VAMC , Syracuse , New York , USA
| |
Collapse
|
41
|
Pigeon WR, Bishop TM, Titus CE. The Relationship Between Sleep Disturbance, Suicidal Ideation, Suicide Attempts, and Suicide Among Adults: A Systematic Review. Psychiatr Ann 2016. [DOI: 10.3928/00485713-20160128-01] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
42
|
Kopacz MS, Connery AL, Bishop TM, Bryan CJ, Drescher KD, Currier JM, Pigeon WR. Moral injury: A new challenge for complementary and alternative medicine. Complement Ther Med 2016; 24:29-33. [DOI: 10.1016/j.ctim.2015.11.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 08/03/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022] Open
|
43
|
Bishop TM, Britton PC, Knox KL, Pigeon WR. Cognitive Behavioral Therapy for Insomnia and Imagery Rehearsal in Combat Veterans with Comorbid Posttraumatic Stress: A Case Series. ACTA ACUST UNITED AC 2015; 4:58-64. [PMID: 27695657 DOI: 10.1080/21635781.2015.1100564] [Citation(s) in RCA: 6] [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] [Indexed: 10/23/2022]
Abstract
Disrupted sleep is common among combat veterans and can negatively impact response to mental health treatments. A trial of cognitive behavioral therapy for insomnia (CBT-I) and imagery rehearsal therapy (IRT) for nightmares was conducted with 14 combat veterans diagnosed with insomnia, and who were experiencing posttraumatic stress and/or depression. In the case-series that follows veterans experienced clinically significant changes in sleep, and statistically significant reductions in insomnia, nightmare, depression and posttraumatic stress severity following treatment. Combined CBT-I and IRT is a promising treatment for patients with combat-related trauma and psychiatric morbidity.
Collapse
Affiliation(s)
- Todd M Bishop
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
| | - Peter C Britton
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
| | - Kerry L Knox
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
| | - Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY; Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY
| |
Collapse
|
44
|
Abstract
Insomnia is highly prevalent and associated with considerable morbidity. Several very efficacious treatments, both pharmacologic and non-pharmacologic, exist for the management of insomnia. New modes of delivery and new formulations of existing sedative-hypnotic medications have been introduced. Novel agents are still being developed and tested to arrive at a hypnotic that has limited side effects while still being efficacious. Innovations with respect to behavioral interventions, which are drastically under-utilized, have focused mainly on making these interventions more widely available through dissemination efforts, briefer formats and more accessible platforms.
Collapse
Affiliation(s)
- Wilfred R. Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center400 Fort Hill Avenue, Canandaigua, NY 14424USA
- Center for Integrated Healthcare800 Irving Avenue, Syracuse, NY 13210USA
- Department of Psychiatry, University of Rochester Medical CenterRochester, NY 14642USA
| | - Todd M. Bishop
- Center for Integrated Healthcare800 Irving Avenue, Syracuse, NY 13210USA
- Department of Psychology430 Huntington Hall, Syracuse UniversitySyracuse
| | - Jonathan A. Marcus
- Department of Neurology, University of Rochester Medical CenterRochester, NY 14642USA
| |
Collapse
|
45
|
|
46
|
Possemato K, Bishop TM, Willis MA, Lantinga LJ. Healthcare Utilization and Symptom Variation Among Veterans Using Behavioral Telehealth Center Services. J Behav Health Serv Res 2013; 40:416-26. [DOI: 10.1007/s11414-013-9338-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
47
|
Abstract
Meningioangiomatosis (MA) is a proliferative disorder of the central nervous system (CNS) that has been reported rarely in humans and sporadically in dogs. Meningioangiomatosis may occur in the brainstem or cervical spinal cord of young dogs and can be identified tentatively by magnetic resonance imaging. The histopathologic hallmark of MA is a leptomeningeal plaque that extends along the CNS microvasculature and invades the adjacent neural parenchyma. This case series describes the neurologic signs, clinical progression, diagnostic imaging, and neuropathology of 4 dogs with MA. The 4 dogs with MA are compared and contrasted with 4 previously reported cases in dogs as well as with their human counterpart.
Collapse
Affiliation(s)
- Todd M Bishop
- Department of Clinical Studies, The Mathew J. Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | |
Collapse
|
48
|
Bishop TM, Morrison J, Summers BA, deLahunta A, Schatzberg SJ. Meningioangiomatosis in Young Dogs: A Case Series and Literature Review. J Vet Intern Med 2004. [DOI: 10.1111/j.1939-1676.2004.tb02578.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|