Vietnamese Insights into Cognitive Aging Program (VIP): Objectives, study design, and cohort description.

Introduction: There is a dearth of research on cognitive aging and dementia in Asian Americans, particularly in Vietnamese Americans, the fourth largest Asian subgroup in the United States. Methods: The Vietnamese Insights into Cognitive Aging Program (VIP) investigates early life adversity and war-related trauma and their associations with cognitive health in a community-based sample of older Vietnamese Americans in Northern California (i.e., Sacramento and Santa Clara counties). Baseline measurements include a comprehensive neuropsychological battery, including measures of global cognition along with executive function, semantic memory, and episodic memory. Data also include measures of functioning, early life adversity and trauma exposure, and psychosocial and traditional cardiovascular disease risk factors. Cognitive assessments will be repeated twice over the course of the data collection period, approximately 12- and 24- months post-baseline. Blood samples collected during Wave 2 will be assayed for biochemical risk factors. Results: Baseline assessments were conducted from January 2022 to November 2023, with N = 548 Vietnamese Americans; mean age ± SD was 73 ± 5.31 years and 55% of participants were women. There were significant differences in social factors by site, with Santa Clara participants having higher education (some college or higher: Sacramento, ≈25%; Santa Clara: ≈48%) and marginally higher incomes compared to Sacramento participants. A higher percentage of Santa Clara participants reported speaking English well or very well (24%) compared to Sacramento participants (13%), although the majority of the entire sample (81%) reported speaking some to no English (response options: not at all; some/a little bit; well/very well). Discussion: This longitudinal study providea a unique opportunity to more fully delineate psychosocial factors that contribute to dementia disparities in diverse and under-engaged populations. Future work will examine cognition, the prevalence of mild cognitive impairment and dementia, and other health outcomes, while controlling for site differences in all analyses. Highlights: Vietnamese Insights into Cognitive Aging Program (VIP) is a new study.VIP has detailed early life and health data on 548 older Vietnamese Americans.History of war and trauma may contribute to Alzheimer's disease and related dementias (ADRD)-related burden.VIP may provide insight into ADRD burden in other understudied groups.

Factors Associated With Increased Substance Use Disorder Care in VA PTSD Specialty Outpatient Treatment.

OBJECTIVE: Substance use disorders (SUDs) commonly co-occur with posttraumatic stress disorder (PTSD). Understanding PTSD clinics that serve higher percentages of patients with PTSD/SUD is crucial for improving SUD care in clinics with lower percentages of such patients. This study examined the differences between Veterans Affairs (VA) PTSD treatment sites with higher percentages ("High%") and lower percentages ("Low%") of patients with PTSD/SUD as well as exploring the roles of the PTSD/SUD specialists. METHODS: The study collected quantitative and qualitative data from 18 clinic directors and 21 specialists from 33 VA PTSD specialty outpatient clinics from 2014 to 2016. The clinics were chosen from the top and bottom quartiles based on two criteria: (1) the percentage of patients with PTSD/SUD and (2) the percentage of patients with PTSD/SUD who completed at least three SUD visits within the first month of their SUD treatment. The interviews sought to identify distinguishing characteristics between the High% and Low% clinics in terms of treatment access and practices for patients with PTSD/SUD. RESULTS: More of the High% clinics reported providing evidence-based, patient-centered, and integrated/concurrent PTSD/SUD treatment and had staff members with more up-to-date knowledge and skills than the Low% clinics. We also found the roles of the PTSD/SUD specialists were demanding and confusing, leading to high turnover rates. CONCLUSIONS: The two groups of PTSD clinics differed in three key factors: Resources, knowledge and skills of staff members, and local policies. Future research should focus on addressing resource limitations, knowledge gaps, and local policy disparities in Low% clinics. By emulating the practices of High% clinics, VA PTSD clinics can improve SUD care for patients with PTSD/SUD.

Diagnostic Accuracy of the Primary Care PTSD for DSM-5 Screen (PC-PTSD-5) in Demographic and Diagnostic Subgroups of Veterans.

BACKGROUND: The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) is a screening instrument designed to identify patients with probable PTSD and is mandated to be used in VA primary care settings. However, validation of the diagnostic accuracy of the instrument is lacking in various demographic and diagnostic groups. OBJECTIVE: To evaluate the diagnostic accuracy of the PC-PTSD-5 in demographically and diagnostically stratified groups of VA primary care patients. DESIGN, SETTING, AND PARTICIPANTS: Based on a sample of 519 VA primary care patients (40.61% response rate), the PC-PTSD-5 was evaluated against a criterion measure, examining its sensitivity, specificity, and other diagnostic properties. Evaluations were conducted in demographically stratified patient groups, including gender, age, race/ethnicity, marital status, and education, as well as diagnostically stratified groups, in patients with and without a depression, alcohol use, and drug use disorder. MAIN MEASURES: The MINI-International Neuropsychiatric Interview was the criterion measure against which the PC-PTSD-5 was evaluated. KEY RESULTS: Among the 10 demographically stratified groups of patients, the PC-PTSD-5 demonstrated a sensitivity between 81.25% (95% C.I.: 54.35 - 05.95) and 100% (95% C.I.: 63.06 - 1000) and its specificity ranged from 80.54% (95% C.I.: 74.70 - 85.55) to 88.31% (95% C.I.: 83.45 - 92.15). Among the 6 diagnostically stratified groups of patients (with and without depression, alcohol use, and drug use disorders), the PC-PTSD-5 exhibited a sensitivity between 88.89% (95% C.I.: 65.29 - 98.62) and 95.92% (95% C.I.: 86.02 - 99.50), and its specificity varied from 60.00% (95% C.I.: 40.60 - 77.34) to 88.14% (95% C.I.: 84.50 - 91.19). CONCLUSIONS: The PC-PTSD-5, suitable for a diverse range of VA primary care patients, shows satisfactory sensitivity and specificity across various demographic and diagnostic groups. Healthcare providers should be cautious of false positives in patients with depression or substance use disorders, given the potential symptom overlap with PTSD.

Inclusion of Vietnamese Americans: Opportunities to understand dementia disparities.

There is a dearth of research on cognitive aging and dementia in Asian Americans, particularly Vietnamese Americans, who are the fourth largest Asian subgroup in the United States. The National Institutes of Health is mandated to make certain that racially and ethnically diverse populations are included in clinical research. Despite the widespread recognition to ensure that research findings can be generalizable to all groups, there are no estimates of the prevalence or incidence of mild cognitive impairment and Alzheimer's disease and related dementias (ADRD) in Vietnamese Americans, nor do we understand ADRD risk and protective factors in this group. In this article, we posit that studying Vietnamese Americans contributes to a better understanding of ADRD in general and offers unique opportunities for elucidating life course and sociocultural factors that contribute to cognitive aging disparities. That is, the unique context of Vietnamese Americans may provide understanding in terms of within-group heterogeneity and key factors in ADRD and cognitive aging. Here, we provide a brief history of Vietnamese American immigration and describe the large but often ignored heterogeneity of Asian Americans in the United States, elucidate how early life adversity and stress might influence late-life cognitive aging, and provide a basis for the role of sociocultural and health factors in the study of Vietnamese cognitive aging disparities. Research with older Vietnamese Americans provides a unique and timely opportunity to more fully delineate the factors that contribute to ADRD disparities for all populations.

Prevalence of medical and nonmedical cannabis use among veterans in primary care.

OBJECTIVE: This study examined past-year cannabis use prevalence and sociodemographic and clinical correlates of cannabis use among Veterans Health Administration (VHA) primary care patients in a state with legalized medical cannabis. METHOD: Participants were 1,072 predominantly white, male, VHA primary care patients enrolled in a drug screening validation study (2012-2014). Sociodemographic and clinical correlates were examined by past-year cannabis use status. Multivariate regression models, adjusted for demographics, estimated cannabis use prevalence and clinical correlates among recreational, medical, and both medical and recreational users. RESULTS: Nearly one in five (18.7%) veterans endorsed past-year cannabis use, with 14.1% of the total sample reporting any recreational use and 7.0% reporting any medical use. Correlates of any past-year use included younger age, period of service, being unmarried, lower education, lower income, other substance use, meeting criteria for an alcohol or drug use disorder or posttraumatic stress disorder, higher pain rating, and lower self-reported well-being. Compared to veterans endorsing only recreational use, veterans endorsing only medical use reported more cannabis use days but had lower odds of other drug use, alcohol or drug-related problems, or alcohol or drug use disorders. Differences between recreational only users and those using medical and recreational cannabis were minimal. CONCLUSIONS: Veterans enrolled in VHA in states with legalized cannabis may be particularly likely to use cannabis. Veterans identifying as recreational users may be at increased risk for adverse clinical outcomes compared to medical-only users. Prevalence monitoring, assessment, and intervention services should be considered, particularly in states with legalized cannabis. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Strong associations among PTSD, pain, and alcohol and drug use disorders in VA primary care patients.

AIMS: PTSD, pain, and alcohol and drug use disorders (AUD and DUDs) are prevalent, debilitating, and costly. Clinicians benefit from understanding the co-occurrence among these conditions, especially cocaine and opioid use disorders. This is the first study to examine (1) the odds of having one condition in the presence of one of the other conditions, and (2) the extent to which having PTSD, pain, or an AUD raises the odds of having a DUD in VA primary care patients. METHODS: We used cross-sectional archival data from 1283 primary care patients recruited in VA primary care clinics. Pain was measured by the numeric rating scale. PTSD, AUD, and DUDs (i.e., cannabis, opioid, cocaine, and any drug use disorder) were measured by the Mini International Diagnostic Interview. We conducted logistic regression analyses to examine the odds of having one condition in the presence of other conditions. RESULTS: A total of 14.9 % of patients had PTSD, 52.8 % of patients had moderate or severe pain, 12.8 % had an AUD, and 10.4 % had any DUD. Patients who had one condition (PTSD, pain, AUD, or DUD) were highly likely to have one or more of the other conditions, with or without controlling for demographic variables. CONCLUSIONS: VA Patients who had PTSD, moderate or severe pain, or an AUD were highly likely to have an opioid or cocaine use disorder, and therefore should be screened for DUDs in VA primary care.

Screen of drug use: Diagnostic accuracy for stimulant use disorder.

AIMS: Stimulant misuse, overdose, and related deaths have increased dramatically. Identifying and referring individuals with stimulant use disorder to treatment may reduce misuse and overdose. This study validated the 2-item Screen of Drug Use (SoDU; Tiet et al., 2015) to screen for stimulant use disorder (and for cocaine and amphetamine use disorders) in a VA primary care setting, and to establish its concurrent diagnostic validity among diverse subgroups of patients, including age, gender, race/ethnicity, marital status, educational level, and PTSD status. METHODS: Archival data from 1283 VA primary care patients recruited in California were examined. This predominantly male sample matched general VA primary care patient population characteristics. A total of 79 individuals (6.2%) met criteria for a stimulant use disorder. The criterion for having a stimulant use disorder was a DSM-IV cocaine use disorder and/or amphetamine use disorder diagnosis based on the Mini International Diagnostic Interview. RESULTS: For stimulant use disorder, the 2-item SoDU was 93.67% sensitive (95% confidence interval [CI], 85.84%-97.91%), and 89.12% specific (95% CI, 87.22%-90.82%). When tested in diverse subgroups of patients, the sensitivity ranged from 66.67% to 100% and specificity ranged from 76.81% to 94.17%. When a follow-up question was added, the sensitivity was unchanged and the specificity was 99%, with lower false positive rate. CONCLUSIONS: The SoDU, especially with a follow-up question, is an appropriate instrument for routine screening of stimulant use disorder in VA primary care settings. It has good concurrent diagnostic validity for diverse groups of patients.

Creating a Practice-Based Implementation Network: Facilitating Practice Change Across Health Care Systems.

A proof-of-concept practice-based implementation network was developed in the US Departments of Veteran Affairs (VA) and Defense to increase the speed of implementation of mental health practices, derive lessons learned prior to larger-scale implementation, and facilitate organizational learning. One hundred thirty-four clinicians in 18 VA clinics received brief training in the use of the PTSD checklist (PCL) in clinical care. Two implementation strategies, external facilitation and technical assistance, were used to encourage the use of outcomes data to inform treatment decisions and increase discussion of results with patients. There were mixed results for changes in the frequency of PCL administration, but consistent increases in clinician use of data and incorporation into the treatment process via discussion. Programs and clinicians were successfully recruited to participate in a 2-year initiative, suggesting the feasibility of using this organizational structure to facilitate the implementation of new practices in treatment systems.

Advancing family dementia caregiver interventions in low- and middle-income countries: A pilot cluster randomized controlled trial of Resources for Advancing Alzheimer's Caregiver Health in Vietnam (REACH VN).

INTRODUCTION: Low- and middle-income countries have rapidly increasing numbers of people with dementia, yet little evidence on family caregiving interventions. We tested the preliminary efficacy and feasibility of a family caregiving intervention in northern Vietnam. METHODS: Nine clusters comprising 60 family caregivers were randomized to a culturally adapted version of a four- to six-session, multicomponent intervention delivered in-home over 2 to 3 months, or enhanced control. Eligible caregivers were ≥18 years of age and scored ≥6 on the Zarit Burden Inventory (ZBI). RESULTS: Fifty-one caregivers (85%) completed the study. Using analysis of covariance with 3-month assessment as the outcome and baseline assessment as a covariate, intervention group caregivers had an average ZBI (primary outcome) score 1.2 standard deviation (SD) lower (P = .02) and Patient Health Questionnaire-4 (psychological distress) score 0.7 SD lower (P = .03) than controls. DISCUSSION: In the first study of its kind in Vietnam, a culturally adapted, manualized, family caregiver intervention was both efficacious and feasible.

Vietnamese American Dementia Caregivers' Perceptions and Experiences of a Culturally Tailored, Evidence-Based Program to Reduce Stress and Depression.

Vietnamese American dementia caregivers are at increased risk for adverse mental health compared to the general U.S. population given their sociodemographic and immigration experiences, yet programs that address their needs are lacking. The current article describes Vietnamese American dementia caregivers' perceptions and experiences of a culturally tailored, evidence-based intervention to reduce stress and depression. A convenience sample of caregivers was recruited from the San Francisco Bay area and randomly assigned to intervention ("Our Family Journey"; OFJ) (n = 30) or control (written dementia caregiving information) (n = 30) groups. All intervention and 76.7% of control caregivers reported that the OFJ or educational materials, respectively, were very/somewhat helpful. Three or more skills were refined/learned by 96.7% of OFJ and 36.6% of control participants. Qualitative findings indicated that the intervention had positive effects on well-being and taught new caregiving skills. This first U.S. study to address the mental health needs of Vietnamese American dementia caregivers shows positive perceptions/experiences and demonstrates a model to address a significant need in the community. [Journal of Gerontological Nursing, 45(9), 39-50.].

Promising results from a pilot study to reduce distress in Vietnamese American dementia and memory loss caregivers.

INTRODUCTION: This study developed and examined the feasibility of a culturally tailored, evidence-based skill-building program to reduce stress and depression of Vietnamese American dementia caregivers. METHODS: This pilot randomized controlled trial included pretest and posttest measures using the Center for Epidemiologic Studies-Depression Scale and the Revised Memory and Behavior Problems Checklist. The intervention (n = 30) group participated in a culturally tailored, 4-week Vietnamese-language cognitive-behavioral skills evidenced-based program (Our Family Journey); caregivers in the control condition (n = 30) received dementia-related educational materials (education control condition). RESULTS: Our Family Journey caregivers showed significantly lower somatic scores on the Center for Epidemiologic Studies-Depression Scale and reported lower frequency of care recipients' disruptive behaviors. However, they also reported being more stressed by their care recipients' depressive symptoms on the Revised Memory and Behavior Problems Checklist compared to caregivers in the education control condition. DISCUSSION: These promising results suggest that a culturally adapted program can benefit Vietnamese dementia caregivers. Additional research is needed to develop and evaluate stronger, more impactful interventions for this underserved group.

Screen of drug use: Diagnostic accuracy for cannabis use disorder.

OBJECTIVE: As cannabis has been legalized for medicinal and recreational use, rates of cannabis misuse and cannabis use disorder (CUD) have increased. However, only a small percentage of individuals with CUD seek treatment. A practical screening instrument is needed to detect CUD in primary care (PC) to address the needs of individuals with CUD. This study seeks to validate the 2-item Screen of Drug Use (SoDU) to help detect CUD in the PC setting. METHOD: We used archival data from 1283 patients recruited in the Department of Veterans Affairs (VA) PC clinics. A total of 51 individuals (4%) met DSM-IV criteria for CUD (abuse or dependence; with or without other drug use disorders). A diagnosis of CUD based on the Mini International Diagnostic Interview (MINI) was used as the criterion. Concurrent diagnostic properties of the SoDU were examined against the MINI. RESULTS: The SoDU was 100% sensitive (95% confidence interval [CI], 93.00% - 100%), and 87.50% specific (95% CI, 85.53% - 89.23%). When tested in subgroups of patients varying in age, gender, race/ethnicity, marital status, educational level, and PTSD status, the SoDU maintained 100% sensitivity in all subgroups; specificity ranged from 76.26% to 94.34%. CONCLUSIONS: The SoDU is an appropriate instrument to help identify CUD in primary care. It is brief, easy to use, and has good concurrent diagnostic validity for diverse groups of patients.

Screen of drug use: Diagnostic accuracy for opioid use disorder.

AIMS: Opioid related deaths have more than tripled in recent years. Identifying and referring individuals with opioid use disorder (OUD) to treatment is one of the promising approaches to reduce opioid related deaths. However, using urine toxicology to identify opioid misuse is not reliable. This study validates the Screen of Drug Use (SoDU) to screen for OUD in the primary care setting, and establish its concurrent diagnostic validity among diverse subgroups of patients, including age, gender, race/ethnicity, marital status, educational level, and PTSD status. METHODS: We used data from 1283 primary care patients recruited in the VA in CA. This sample matched patient characteristics general VA population with mean age = 62, and 95% men. A total of 10.4% met DSM-5 criteria for any drug use disorder and 2.7% met criteria for OUD (with or without other drug use disorders). An opioid use abuse or dependence diagnosis based on the Mini International Diagnostic Interview was used as the criterion for having a DSM-5 opioid use disorder. RESULTS: The SoDU was 100% sensitive (95% confidence interval [CI], 89.9%-100%), and 86.3% specific (95% CI, 84.3%-88.1%). When tested in subgroups of patients, the SoDU maintained 100% sensitivity in all subgroups. Specificity ranged from 74.5% to 94.2% for diverse subgroups of patients. CONCLUSIONS: The SoDU is an appropriate instrument to screen for opioid use disorder in primary care. It is brief, easy to use, and has good concurrent diagnostic validity for diverse groups of patients.

Impulsivity, Painful and Provocative Events, and Suicide Intent: Testing the Interpersonal Theory of Suicide.

OBJECTIVE: The Interpersonal Theory of Suicide (IPTS; Joiner, 2005. Why People Die by Suicide. Cambridge, MA: Harvard University Press) hypothesizes that repeated exposure to painful and provocative events (PPE) increases capability for suicide (CS), therefore facilitating the development of suicidal intent, and that impulsive individuals are more likely to experience these painful and provocative events, creating an indirect relationship between impulsivity and CS. Research to date largely supports this hypothesis but has not translated this theory to actual suicidal intent. METHOD: The present study used data from the MacArthur Violence Risk Assessment Study to examine the relationship between PPE and intent, and the indirect relationship between impulsivity and intent among a sample of 245 recent suicide attempters, using the clinician-rated Suicide Intent Scale as an objective measure of intent. RESULTS: Results supported the hypothesized direct relationship between PPE and intent, and the indirect relationship between impulsivity and intent through PPE. There was no direct relationship between impulsivity and intent, suggesting that the relationship between impulsivity and intent occurs entirely through exposure to PPE. CONCLUSIONS: These findings suggest that assessing exposure to painful and provocative events is critical in evaluating risk of suicide, and that impulsivity itself does not confer an increased risk of lethal or nearly lethal attempts.

PTSD coach mobile application with brief telephone support: A pilot study.

The number of health care mobile applications (MAs) has increased drastically in recent years, but research on efficacy and approaches to provide MA intervention is lacking. The PTSD Coach was designed to help individuals with posttraumatic stress disorder (PTSD) symptoms to understand and manage symptoms. Use of MA tends to drop off quickly; this pilot study tested the use of the PTSD Coach with brief telephone support by paraprofessionals. A total of 29 participants with elevated PTSD symptoms recruited from Veterans Affairs primary care clinics completed baseline and 4-month follow-up surveys including the PTSD Checklist, Patient Health Questionnaire for depressive symptoms, and Quality of Life Enjoyment and Satisfaction Questionnaire. Participants received PTSD Coach MA intervention plus paraprofessional brief telephone support reported the phone support was helpful and greater than 70% of participants maintained use of the MA throughout the 3-month intervention period. Results indicated that participants showed significant improvement on PTSD reexperiencing symptoms, depressive symptoms, and quality of life after intervention. The PTSD Coach MA plus brief telephone support is a promising approach for primary care patients managing psychiatric symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Perspectives and Insights from Vietnamese American Mental Health Professionals on How to Culturally Tailor a Vietnamese Dementia Caregiving Program.

OBJECTIVE: Little is known about dementia and caregiving among the rapidly growing Vietnamese American population. This qualitative study elicited insights on culturally tailoring an intervention to address mental health needs in Vietnamese American dementia caregivers from Vietnamese American mental health professionals. METHODS: Eight Vietnamese American mental health professionals were interviewed to explore: experiences working with and needs of the community; Vietnamese attitudes toward treatment; and acculturation in Vietnamese caregiving. Participants provided recommendations on tailoring a program for Vietnamese dementia caregivers. Content analysis of their responses was conducted. RESULTS: Themes included: a) caregivers' unique needs and experiences; b) different waves of immigration and acculturation levels affect views on mental health, treatment, and caregiving; c); traditions and beliefs on caregiving; d) mental health, help-seeking and health services; e) how to culturally tailor a program for Vietnamese dementia caregivers; and f) cultural acceptance of the program. CONCLUSIONS: An intervention to reduce stress and depression among Vietnamese American dementia caregivers should recognize the special risks of the experiences of war and immigration of the caregivers as well as the pressure of the expectations of the Vietnamese culture on family care. For the program to be acceptable and effective, it needs to consider all aspects of caregivers' health, and incorporate Vietnamese cultural values/beliefs. CLINICAL IMPLICATIONS: A successful Vietnamese dementia caregiver intervention should include traditional Vietnamese values/beliefs, holistic experiences, spirituality, and background/immigration experiences. Evidence-based programs may be used with this population if they are culturally tailored.

Diagnostic accuracy of a two-item Drug Abuse Screening Test (DAST-2).

OBJECTIVE: Drug use is prevalent and costly to society, but individuals with drug use disorders (DUDs) are under-diagnosed and under-treated, particularly in primary care (PC) settings. Drug screening instruments have been developed to identify patients with DUDs and facilitate treatment. The Drug Abuse Screening Test (DAST) is one of the most well-known drug screening instruments. However, similar to many such instruments, it is too long for routine use in busy PC settings. This study developed and validated a briefer and more practical DAST for busy PC settings. METHOD: We recruited 1300 PC patients in two Department of Veterans Affairs (VA) clinics. Participants responded to a structured diagnostic interview. We randomly selected half of the sample to develop and the other half to validate the new instrument. We employed signal detection techniques to select the best DAST items to identify DUDs (based on the MINI) and negative consequences of drug use (measured by the Inventory of Drug Use Consequences). Performance indicators were calculated. RESULTS: The two-item DAST (DAST-2) was 97% sensitive and 91% specific for DUDs in the development sample and 95% sensitive and 89% specific in the validation sample. It was highly sensitive and specific for DUD and negative consequences of drug use in subgroups of patients, including gender, age, race/ethnicity, marital status, educational level, and posttraumatic stress disorder status. CONCLUSIONS: The DAST-2 is an appropriate drug screening instrument for routine use in PC settings in the VA and may be applicable in broader range of PC clinics.

An RCT of Effects of Telephone Care Management on Treatment Adherence and Clinical Outcomes Among Veterans With PTSD.

OBJECTIVE: This study assessed whether adding telephone care management to usual outpatient mental health care improved treatment attendance, medication compliance, and clinical outcomes of veterans with posttraumatic stress disorder (PTSD). METHODS: In a multisite randomized controlled trial, 358 veterans were assigned to either usual outpatient mental health treatment (N=165) or usual care plus twice-a-month telephone care management (TCM) and support in the first three months of treatment (N=193). Treatment utilization and medication refills were determined from U.S. Department of Veterans Affairs administrative data. PTSD, depression, quality of life, aggressive behavior, and substance use were assessed with self-report questionnaires at intake, four months, and 12 months. RESULTS: Telephone care managers reached 95% of TCM participants (N=182), completing an average 5.1 of 6.0 planned telephone calls. During the three-month intervention period, TCM participants completed 43% more mental health visits (M±SD=5.9±6.8) than did those in usual care (4.1±4.2) (incident rate ratio=1.36, χ2=6.56, df=1, p<.01). Treatment visits in the nine-month follow-up period and medication refills did not differ by condition. Only 9% of participants were scheduled to receive evidence-based psychotherapy. Slopes of improvement in PTSD, depression, alcohol misuse, drug problems, aggressive behavior, and quality of life did not differ by condition or treatment attendance. CONCLUSIONS: TCM improved PTSD patients' treatment attendance but not their outcomes. TCM can enhance treatment engagement, but outcomes depend on the effectiveness of the treatments that patients receive.

The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): Development and Evaluation Within a Veteran Primary Care Sample.

BACKGROUND: Posttraumatic Stress Disorder (PTSD) is associated with increased health care utilization, medical morbidity, and tobacco and alcohol use. Consequently, screening for PTSD has become increasingly common in primary care clinics, especially in Veteran healthcare settings where trauma exposure among patients is common. OBJECTIVE: The objective of this study was to revise the Primary Care PTSD screen (PC-PTSD) to reflect the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for PTSD (PC-PTSD-5) and to examine both the diagnostic accuracy and the patient acceptability of the revised measure. DESIGN: We compared the PC-PTSD-5 results with those from a brief psychiatric interview for PTSD. Participants also rated screening preferences and acceptability of the PC-PTSD-5. PARTICIPANTS: A convenience sample of 398 Veterans participated in the study (response rate = 41 %). Most of the participants were male, in their 60s, and the majority identified as non-Hispanic White. MEASURES: The PC-PTSD-5 was used as the screening measure, a modified version of the PTSD module of the MINI-International Neuropsychiatric Interview was used to diagnose DSM-5 PTSD, and five brief survey items were used to assess acceptability and preferences. KEY RESULTS: The PC-PTSD-5 demonstrated excellent diagnostic accuracy (AUC = 0.941; 95 % C.I.: 0.912- 0.969). Whereas a cut score of 3 maximized sensitivity (κ[1]) = 0.93; SE = .041; 95 % C.I.: 0.849-1.00), a cut score of 4 maximized efficiency (κ[0.5] = 0.63; SE = 0.052; 95 % C.I.: 0.527-0.731), and a cut score of 5 maximized specificity (κ[0] = 0.70; SE = 0.077; 95 % C.I.: 0.550-0.853). Patients found the screen acceptable and indicated a preference for administration by their primary care providers as opposed to by other providers or via self-report. CONCLUSIONS: The PC-PTSD-5 demonstrated strong preliminary results for diagnostic accuracy, and was broadly acceptable to patients.

Diagnostic accuracy of a two-item screen for drug use developed from the alcohol, smoking and substance involvement screening test (ASSIST).

AIMS: The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is a screening instrument to detect substance use in primary care (PC). To screen for illicit substances (excluding tobacco and alcohol), the ASSIST consists of 8-57 questions and requires complicated scoring. To improve the efficiency of screening of drug misuse in PC, this study constructed and validated a two-item screen for drug use from the ASSIST. METHODS: Guided by previous reviews, the ASSIST was revised. Patients were recruited in VA primary care clinics (N=1283). Half of the sample was used to develop the ASSIST-Drug; the other half was used to validate it. The Mini International Neuropsychiatric Interview (MINI) and the Inventory of Drug Use Consequences were the criterion measures. RESULTS: A brief, two-item ASSIST-Drug was constructed. Based on the development sample, the ASSIST-Drug was 94.1% sensitive and 89.6% specific for drug use disorders. Based on the validation sample, it was 95.4% sensitive and 87.8% specific. The ASSIST-Drug also had comparable sensitivity and specificity to identify drug use negative consequences, as well as for diverse subgroups of patients in terms of gender, age, race/ethnicity, marital status, educational levels, and post traumatic stress disorder status. CONCLUSIONS: The ASSIST-Drug may be a useful screening tool for PC settings. It is reliable, brief, and easy to remember, administer and score. It is sensitive and specific for drug use disorders and drug use negative consequences, and the predictive properties are consistent across subgroup of patients.