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Beentjes TAA, Teerenstra S, Vermeulen H, Goossens PJJ, der Sanden MWGNV, van Gaal BGI. Identifying the minimal important difference in patient-reported outcome measures in the field of people with severe mental illness: a pre-post-analysis of the Illness Management and Recovery Programme. Qual Life Res 2021; 30:1723-1733. [PMID: 33594528 PMCID: PMC8178137 DOI: 10.1007/s11136-021-02779-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 11/30/2022]
Abstract
Purpose Complementary interventions for persons with severe mental illness (SMI) focus on both personal recovery and illness self-management. This paper aimed to identify the patient-reported outcome measures (PROMs) associated with the most relevant and meaningful change in persons with SMI who attended the Illness Management and Recovery Programme (IMR). Methods The effect of the IMR was measured with PROMs concerning recovery, illness self-management, burden of symptoms and quality of life (QoL). From the QoL measures, an anchor was chosen based on the most statistically significant correlations with the PROMs. Then, we estimated the minimal important difference (MID) for all PROMs using an anchor-based method supported by distribution-based methods. The PROM with the highest outcome for effect score divided by MID (the effect/MID index) was considered to be a measure of the most relevant and meaningful change. Results All PROMs showed significant pre–post-effects. The QoL measure ‘General Health Perception (Rand-GHP)’ was identified as the anchor. Based on the anchor method, the Mental Health Recovery Measure (MHRM) showed the highest effect/MID index, which was supported by the distribution-based methods. Because of the modifying gender covariate, we stratified the MID calculations. In most MIDs, the MHRM showed the highest effect/MID indexes. Conclusion Taking into account the low sample size and the gender covariate, we conclude that the MHRM was capable of showing the most relevant and meaningful change as a result of the IMR in persons with SMI.
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Affiliation(s)
- Titus A A Beentjes
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.
- Center for Nursing Research, Saxion University of Applied Science, Deventer/Enschede, The Netherlands.
- Dimence Group Mental Health Care Centre, Deventer, The Netherlands.
| | - Steven Teerenstra
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department for Health Evidence, Group Biostatistics, Nijmegen, The Netherlands
| | - Hester Vermeulen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Peter J J Goossens
- Dimence Group Mental Health Care Centre, Deventer, The Netherlands
- University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Betsie G I van Gaal
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
- HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, The Netherlands
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Egeland KM, Hauge MI, Ruud T, Ogden T, Heiervang KS. Significance of Leaders for Sustained Use of Evidence-Based Practices: A Qualitative Focus-Group Study with Mental Health Practitioners. Community Ment Health J 2019; 55:1344-53. [PMID: 31190179 DOI: 10.1007/s10597-019-00430-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 06/05/2019] [Indexed: 11/29/2022]
Abstract
Evidence-based practices that are implemented in mental health services are often challenging to sustain. In this focus-group study, 26 mental health practitioners with high fidelity scores were interviewed regarding their experiences with implementing the illness management and recovery, an evidence-based practice for people with severe mental disorders, in their services and how this could influence further use. Findings indicate that high fidelity is not equivalent to successful implementation. Rather, to sustain the practice in services, the practitioners emphasized the importance of their leaders being positive and engaged in the intervention, and hold clear goals and visions for the intervention in the clinic. In addition, the practitioners' understanding of outcome monitoring as a resource for practice improvement must be improved to avoid random patient experiences becoming the decisive factor in determining further use.Trial registration: ClinicalTrials.gov NCT02077829. Registered 25 February 2014.
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Jensen SB, Eplov LF, Gammelgaard I, Mueser KT, Petersen KS. Participants' Lived Experience with the Illness Management and Recovery (IMR) Program in Relation to their Recovery-Process. Community Ment Health J 2019; 55:983-993. [PMID: 30810903 DOI: 10.1007/s10597-019-00383-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 04/30/2018] [Accepted: 02/15/2019] [Indexed: 12/01/2022]
Abstract
The Illness Management and Recovery program (IMR) is developed to support people with severe mental illnesses in their recovery-process. The theory behind the program highlight the importance of helping people develop tailored illness management skills which will help achieve personal and clinical recovery. However, little is known about participants' experience with IMR in relation to their recoveryprocess. The aim of the present study is to describe the participants' lived experience with IMR, explore whether they experienced changes, and examine how these changes related to their recovery during or after their participation in IMR. A Qualitative study. The participants' experience with the IMR program in relation to their recovery unveiled three main themes; "Social connection with other IMR-group members', 'In IMR, we talked about our everyday lives with mental illness' and 'In IMR we learned about recovery as a personal experience'.
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Affiliation(s)
- Sofie B Jensen
- Mental Health Center Copenhagen, Copenhagen Research Center for Mental Health - CORE, Kildegårdsvej 28, opg. 15, 4 floor, 2900, Hellerup, Copenhagen, Denmark.
| | - Lene F Eplov
- Mental Health Center Copenhagen, Copenhagen Research Center for Mental Health - CORE, Kildegårdsvej 28, opg. 15, 4 floor, 2900, Hellerup, Copenhagen, Denmark
| | - Iben Gammelgaard
- Research Unit of Mental Health, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kim T Mueser
- Boston University Center for Psychiatric Rehabilitation, Boston, MA, USA
| | - Kirsten S Petersen
- Department of Health Science and Technology, The Faculty of Medicine, University of Aalborg, Aalborg, Denmark
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Jensen SB, Dalum HS, Korsbek L, Hjorthøj C, Mikkelsen JH, Thomsen K, Kistrup K, Olander M, Lindschou J, Mueser KT, Nordentoft M, Eplov LF. Illness management and recovery: one-year follow-up of a randomized controlled trial in Danish community mental health centers: long-term effects on clinical and personal recovery. BMC Psychiatry 2019; 19:65. [PMID: 30744590 PMCID: PMC6371462 DOI: 10.1186/s12888-019-2048-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 04/16/2018] [Accepted: 01/31/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Illness Management and Recovery (IMR) is a curriculum-based rehabilitation program for people with severe mental illness with the short-term aim of improving illness self-management and the long-term aim of helping people achieve clinical and personal recovery. METHOD Participants with schizophrenia or bipolar disorders were recruited from three community mental health centers in the Capital Region of Denmark and randomized to receive group-based IMR and treatment as usual or only the usual intervention. All outcomes were assessed at baseline, postintervention, and the one-year follow-up. Long-term outcomes were categorized according to clinical recovery (i.e., symptoms, global functioning, and hospitalization) and personal recovery (i.e., hope and personal agency). Generalized linear mixed model regression analyses were used in the intent-to-treat analysis. RESULTS A total of 198 participants were included. No significant differences were found between the IMR and control groups in the Global Assessment of Functioning one year after the intervention, nor were there significant differences in symptoms, number of hospital admissions, emergency room visits, or outpatient treatment. CONCLUSION The present IMR trial showed no significant effect on clinical and personal recovery at the one-year follow-up. Together with the results of other IMR studies, the present study indicates that the effect of IMR on symptom severity is unclear, which raises questions regarding the impact of IMR on functioning. Additionally, IMR did not affect personal recovery. Although more research is needed, the results indicate that the development of other interventions should be considered to help people with severe mental illness achieve a better level of functioning and personal recovery. TRIAL REGISTRATION Trial registered at http://www.clinicaltrials.gov ( NCT01361698 ).
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Affiliation(s)
- Sofie Bratberg Jensen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Helle Stentoft Dalum
- 0000 0004 0646 843Xgrid.416059.fRegion Zealand, University Hospital Roskilde, Roskilde, Denmark
| | - Lisa Korsbek
- Competence Center for Rehabilitation and, Recovery, Mental Health Center Ballerup, Ballerup, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - John Hagel Mikkelsen
- Community Mental Health Center Frederiksberg-Vanløse, Mental Health Center Frederiksberg, Frederiksberg, Denmark
| | - Karin Thomsen
- Community Mental Health Center Ballerup-Egedal-Herlev, Mental Health Center Ballerup, Ballerup, Denmark
| | | | | | - Jane Lindschou
- 0000 0004 0646 7373grid.4973.9Copenhagen Trial Unit, Center for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kim T. Mueser
- 0000 0004 1936 7558grid.189504.1Boston University Center for Psychiatric Rehabilitation, Boston, USA
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lene Falgaard Eplov
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
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Beentjes TAA, Goossens PJJ, Vermeulen H, Teerenstra S, Nijhuis-van der Sanden MWG, van Gaal BGI. E-IMR: e-health added to face-to-face delivery of Illness Management & Recovery programme for people with severe mental illness, an exploratory clustered randomized controlled trial. BMC Health Serv Res 2018; 18:962. [PMID: 30541536 PMCID: PMC6292084 DOI: 10.1186/s12913-018-3767-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 11/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND E-mental health holds promise for people with severe mental illness, but has a limited evidence base. This study explored the effect of e-health added to face-to-face delivery of the Illness Management and Recovery Programme (e-IMR). METHOD In this multi-centre exploratory cluster randomized controlled trial, seven clusters (n = 60; 41 in intervention group and 19 in control group) were randomly assigned to e-IMR + IMR or IMR only. Outcomes of illness management, self-management, recovery, symptoms, quality of life, and general health were measured at baseline (T0), halfway (T1), and at twelve months (T2). The data were analysed using mixed model for repeated measurements in four models: in 1) we included fixed main effects for time trend and group, in 2) we controlled for confounding effects, in 3) we controlled for interaction effects, and in 4) we performed sub-group analyses within the intervention group. RESULTS Notwithstanding low activity on e-IMR, significant effects were present in model 1 analyses for self-management (p = .01) and recovery (p = .02) at T1, and for general health perception (p = .02) at T2, all in favour of the intervention group. In model 2, the confounding covariate gender explained the effects at T1 and T2, except for self-management. In model 3, the interacting covariate non-completer explained the effects for self-management (p = .03) at T1. In model 4, the sub-group analyses of e-IMR-users versus non-users showed no differences in effect. CONCLUSION Because of confounding and interaction modifications, effectiveness of e-IMR cannot be concluded. Low use of e-health precludes definite conclusions on its potential efficacy. Low use of e-IMR calls for a thorough process evaluation of the intervention. TRIAL REGISTRATION The Dutch Trial Register ( NTR4772 ).
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Affiliation(s)
- Titus A A Beentjes
- Titus Beentjes, IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, the Netherlands. .,Center for Nursing Research, Saxion University of Applied Science, Deventer/Enschede, the Netherlands. .,Dimence Group Mental Health Care Centre, Deventer, the Netherlands.
| | - Peter J J Goossens
- Dimence Group Mental Health Care Centre, Deventer, the Netherlands.,Department of Public Health, Faculty of Medicine and Health Sciences, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Hester Vermeulen
- Titus Beentjes, IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Steven Teerenstra
- Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Group Biostatistics, Nijmegen, the Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Titus Beentjes, IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Betsie G I van Gaal
- Titus Beentjes, IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, the Netherlands.,Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, the Netherlands
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McGuire AB, Luther L, White D, White LM, McGrew J, Salyers MP. The "Critical" Elements of Illness Management and Recovery: Comparing Methodological Approaches. Adm Policy Ment Health 2017; 43:1-10. [PMID: 25425013 DOI: 10.1007/s10488-014-0614-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined three methodological approaches to defining the critical elements of Illness Management and Recovery (IMR), a curriculum-based approach to recovery. Sixty-seven IMR experts rated the criticality of 16 IMR elements on three dimensions: defining, essential, and impactful. Three elements (Recovery Orientation, Goal Setting and Follow-up, and IMR Curriculum) met all criteria for essential and defining and all but the most stringent criteria for impactful. Practitioners should consider competence in these areas as preeminent. The remaining 13 elements met varying criteria for essential and impactful. Findings suggest that criticality is a multifaceted construct, necessitating judgments about model elements across different criticality dimensions.
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Affiliation(s)
- Alan B McGuire
- Roudebush VA Medical Center, Indianapolis, IN, USA.
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
- ACT Center of Indiana, Indianapolis, IN, USA.
| | - Lauren Luther
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
- ACT Center of Indiana, Indianapolis, IN, USA
| | - Dominique White
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
- ACT Center of Indiana, Indianapolis, IN, USA
| | - Laura M White
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
- ACT Center of Indiana, Indianapolis, IN, USA
| | - John McGrew
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
- ACT Center of Indiana, Indianapolis, IN, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
- ACT Center of Indiana, Indianapolis, IN, USA
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Roosenschoon BJ, Mulder CL, Deen ML, van Weeghel J. Effectiveness of illness management and recovery (IMR) in the Netherlands: a randomised clinical trial. BMC Psychiatry 2016; 16:73. [PMID: 26995361 PMCID: PMC4799598 DOI: 10.1186/s12888-016-0774-0] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 03/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Illness Management and Recovery (IMR) is intended to provide a structured psychosocial programme that helps to manage the disabling effects of severe mental illnesses such as schizophrenia and bipolar disorders. It is curriculum based and aims to improve different aspects of illness management and recovery through interventions such as goal-setting, psycho-education, coping and social skills training. Its overall aim is to improve illness outcomes and support subjective and objective recovery. To date there have been four RCTs on IMR; as these yielded mixed results, further research is needed. Our hypotheses aim to test the interrelatedness assumed in Mueser's Conceptual Framework for IMR for the many aspects of illness management, illness management outcomes and recovery. METHODS/DESIGN This randomised multi-centre, single-blinded clinical trial is intended to compare IMR with treatment as usual for 200 outpatient clients with a severe and persistent mental illness (SMI). We will investigate whether IMR leads to better illness management, fewer symptoms and fewer relapses, and also to better subjective and objective recovery. The primary outcome measure is the score on the client version of the Illness Management and Recovery Scale. Secondary outcome measures are the clinician version of the Illness Management and Recovery scale, measures of illness management, coping, symptoms, the number of relapses, and measures of recovery. Measurement will take place before randomisation, and 12 and 18 months after randomisation. DISCUSSION Overall, our study has the following strengths: 1.) our use of an RCT design in a country where the earlier RCTs on IMR were not conducted; 2.) the fact that participants will consist not only of people with a diagnosis of schizophrenia, but also of those with various types of SMI; 3.) our inclusion of 200 participants; and 4.) the fact that we will explore the working mechanisms described in Mueser's Conceptual Framework for IMR. Finally, 5.) because the RCT will be conducted in everyday clinical practice, we believe that the generalisability of our results will be good. TRIAL REGISTRATION The Netherlands National Trial Register (identifier: NTR 5033 ). Date registered: 13 January 2015.
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Affiliation(s)
- Bert-Jan Roosenschoon
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus University Medical Centre, 's-Gravendijkwal 230, Rotterdam, CE, 3015, The Netherlands. .,Parnassia Psychiatric Institute The Hague, Kiwistraat 32, Den Haag, 2552 DH, The Netherlands.
| | - Cornelis L. Mulder
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus University Medical Centre, ‘s-Gravendijkwal 230, Rotterdam, CE 3015 The Netherlands ,Parnassia Psychiatric Institute, Bavo-Europoort, Prins Constantijnweg 48-54, Rotterdam, 3066 TA The Netherlands
| | - Mathijs L. Deen
- Parnassia Psychiatric Institute The Hague, Kiwistraat 32, Den Haag, 2552 DH The Netherlands ,Faculty of Social and Behavioral Sciences, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
| | - Jaap van Weeghel
- Tilburg School of Social and Behavioral Sciences, Department of TRANZO, Tilburg University, Warandelaan 2, Tilburg, 5037 AB The Netherlands ,Parnassia Psychiatric Institute, Dijk en Duin, Oude Parklaan 125, Castricum, 1901 ZZ The Netherlands
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McGuire AB, Bonfils KA, Kukla M, Myers L, Salyers MP. Measuring participation in an evidence-based practice: illness management and recovery group attendance. Psychiatry Res 2013; 210:684-9. [PMID: 24011850 PMCID: PMC3971633 DOI: 10.1016/j.psychres.2013.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 10/31/2012] [Revised: 08/05/2013] [Accepted: 08/08/2013] [Indexed: 10/26/2022]
Abstract
Given the important role of treatment attendance as an indicator of program implementation and as a potential moderator of program effectiveness, this study sought to develop useful indicators of attendance for evidence-based practices. The current study examined consumer attendance patterns in a randomized controlled trial comparing illness management and recovery (n=60) to a problem solving control condition (n=58). Associations were examined between consumer clinical indicators, demographics, and level of recovery and indices of attendance. Attendance was poor, but comparable to rates found in many other studies. Four indicators of attendance (percent sessions attended, time enrolled, periods of attendance, and longest period of attendance) were highly inter-related and were more sensitive to baseline differences than a traditional approach of dichotomizing participants into "attenders" and "non-attenders." Older age, lower hostility, fewer psychotic symptoms, and more education were associated with higher group attendance in both treatment conditions; the client-reported illness management and recovery scale was associated with attendance in the control group. Indicators of attendance were an advancement over dichotomous classification. Strategies to increase attendance are still needed, particularly for younger consumers with greater positive symptoms.
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Affiliation(s)
- Alan B. McGuire
- Health Services Research and Development, Richard L Roudebush VAMC, IN, USA, Department of Psychology, Indiana University Purdue University Indianapolis, IN, USA, Correspondence to: Health Services Research & Development, Richard L. Roudebush VAMC, 1481W. 10th St. (11H) Rm. C8108, IN 46202, United States. Tel.: +1 317 988 2725; fax: +1 317 988 5290. (A.B. McGuire)
| | - Kelsey A. Bonfils
- Department of Psychology, Indiana University Purdue University Indianapolis, IN, USA
| | - Marina Kukla
- Health Services Research and Development, Richard L Roudebush VAMC, IN, USA
| | - Laura Myers
- Health Services Research and Development, Richard L Roudebush VAMC, IN, USA
| | - Michelle P. Salyers
- Department of Psychology, Indiana University Purdue University Indianapolis, IN, USA
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