Sleep Quality Moderates the Relationship between Anxiety Sensitivity and PTSD Symptoms in Combat-exposed Veterans.

Objective/Background: Posttraumatic stress disorder (PTSD) and related conditions (e.g., depression) are common in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) veterans. High anxiety sensitivity (AS), defined as fear of anxiety and anxiety-related consequences, is related to greater PTSD and depressive symptoms; however, few studies have identified possible modifiers of these associations. The current study examined the moderating role of sleep quality in the associations between AS and PTSD and depressive symptoms. Participants: Participants were 155 OEF/OIF/OND community veterans ages 21-40 (12.3% women). Methods: Participants completed a semi-structured clinical interview for DSM-IV PTSD symptoms (Clinician Administered PTSD Scale; CAPS) and self-report measures of anxiety sensitivity (Anxiety Sensitivity Index), sleep quality (Pittsburgh Sleep Quality Index global score; PSQI), and depressive symptoms (Beck Depression Inventory-II; BDI-II). Results: Results of hierarchical linear regression models indicated that the main effects of AS and global PSQI score were significantly associated with greater PTSD and depressive symptoms (both with sleep items removed), above and beyond the covariates of trauma load and military rank. Sleep quality moderated the relationship between AS and PTSD symptoms (but not depressive symptoms), such that greater AS was associated with greater PTSD symptoms for individuals with good sleep quality, but not poor sleep quality. Conclusions: Sleep quality and AS account for unique variance in PTSD and depressive symptoms in combat-exposed veterans. AS may be less relevant to understanding risk for PTSD among combat-exposed veterans experiencing poor sleep quality.

Health symptoms after war zone deployment-related mild traumatic brain injury: contributions of mental disorders and lifetime brain injuries.

PRIMARY OBJECTIVE: To gain a better understanding of the complex relationship between combat deployment-related mild traumatic brain injury (mTBI) and persistent post-concussive symptoms (PPCSs), taking into consideration a wide range of potentially mediating and confounding factors. RESEARCH DESIGN: Cross-sectional. METHODS AND PROCEDURES: Subjects were 613 U. S. military Veterans and Service Members who served during operations Enduring Freedom, Iraqi Freedom, or New Dawn (OEF/OIF/OND) and completed a structured interview of mental disorders and a battery of questionnaires. Hierarchical binary logistic regression analyses were used to test the hypotheses. MAIN OUTCOMES AND RESULTS: After accounting for mental disorders, lifetime mTBIs outside of OEF/OIF/OND deployment, medical conditions, and injury/demographic characteristics, deployment-related mTBI continued to be associated with several PPCSs (headaches, sleep disturbance, and difficulty making decisions). Deployment-related mTBI was also associated with two symptoms not normally associated with mTBI (nausea/upset stomach and numbness/tingling). CONCLUSIONS: After adjusting for a wide range of factors, OEF/OIF/OND deployment-related mTBI was still associated with PPCSs on average 10 years after the injury. These findings suggest that mTBI sustained during OEF/OIF/OND deployment may have enduring negative health effects. More studies are needed that prospectively and longitudinally track health and mental health outcomes after TBI.

Employment, health outcomes, and life satisfaction after spinal cord injury: comparison of veterans and nonveterans.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To explore differences between veterans and nonveterans with spinal cord injury (SCI) for employment, health, and satisfaction with life outcomes after controlling for demographic and injury characteristics. SETTING: Hospitals in the Spinal Cord Injury Model System of care. METHODS: A total of 9754 (85% nonveterans and 15% veterans) adults with traumatic SCI interviewed from 2000 and 2015 and completed follow-up years 1, 5, and 10 were included in this study. Employment status and the Craig Handicap Assessment and Reporting Technique-Short Form (CHART-SF) measured employment. The SF-36 for self-perceived health status, CHART-SF, and rehospitalization determined health outcomes. Satisfaction with life was measured by the Satisfaction with Life Scale (SWLS). Secondary data analyses using χ2, t-tests, and generalized estimating equations (GEEs) model to determine group differences with control of demographic and injury characteristics. RESULTS: There were no significant differences for employment and SWL between nonveterans and veterans. There were some differences in health outcomes; whereas, veterans had better physical independence and mobility compared with nonveterans. CONCLUSION: Interventions for both groups should target adults with a disability from SCI, be customized for varying levels of injury that address differences in healthcare systems, demographic backgrounds, economic resources, disincentives, and motivation.

Path analytic modeling of psychologists' openness to performing clinical work with telepsychology: A national study.

OBJECTIVE: To examine whether the Theory of Reasoned Action (TRA) and Technology Acceptance Model (TAM) apply to psychologists' openness to using telepsychology. METHOD: Participants were 1,791 psychologists currently practicing psychotherapy. Participants represented all 50 US states and averaged 26.33 (SD = 11.18) years in clinical practice. The study used a cross-sectional, national online design. RESULTS: Path analyses derived from the TRA and TAM evidenced poor fit. A newly-developed, third model achieved adequate to fit in which perceived attitudes of others concerning telepsychology were associated with perceived ease of use (ß = 0.25, p < .001) and usefulness (ß = 0.30, p < .001) of telepsychology. Perceived ease of use (ß = 0.30, p < .001) and usefulness (ß = 0.32, p < .001) of telepsychology both uniquely predicted current use of telepsychology. CONCLUSIONS: Organizations should adopt methods for delivering telepsychology that are easy to use and possess demonstrable utility.

Exploring the factor structure of a battery of neuropsychological assessments among the CENC cohort.

OBJECTIVE: The goal of the Chronic Effects of Neurotrauma Consortium (CENC) study is to explore the effects of concussions among Service Members and Veterans. A factor model was fit to selected neuropsychological measures to identify potentially useful relationships between assessments collected on CENC-enrolled participants. METHOD: 492 post-9/11 participants with combat exposure were enrolled across four VA study sites. Participants completed assessments including concussion history, neurocognitive functioning, and self-report questionnaires. Exploratory factor analyses (EFA) using four different methods with varimax and promax rotations were used to analyse the cognitive variables. Final model selection was based on factor loadings towards simple structure. RESULTS: The scree plot suggested the number of factors to be extracted was between 4 and 5. EFA produced a 5-factor MINRES model with promax rotation that resulted in a factor loading with variables loading on only one factor with a predefined threshold (0.40). Variables loaded on five cognition domains: list learning, working memory/executive skills, cognitive control, fluency, and memory. CONCLUSION: These results provide reasonable evidence that data collected from the CENC neuropsychological battery can be reduced to five clinically useful factors. This will enable us to use the factors for further study of the impact of concussion on neurodegeneration.

Validation of Veterans Affairs Electronic Medical Record Smoking Data Among Iraq- and Afghanistan-Era Veterans.

BACKGROUND: Research using the Veterans Health Administration (VA) electronic medical records (EMR) has been limited by a lack of reliable smoking data. OBJECTIVE: To evaluate the validity of using VA EMR "Health Factors" data to determine smoking status among veterans with recent military service. DESIGN: Sensitivity, specificity, area under the receiver-operating curve (AUC), and kappa statistics were used to evaluate concordance between VA EMR smoking status and criterion smoking status. PARTICIPANTS: Veterans (N = 2025) with service during the wars in Iraq/Afghanistan who participated in the VA Mid-Atlantic Post-Deployment Mental Health (PDMH) Study. MAIN MEASURES: Criterion smoking status was based on self-report during a confidential study visit. VA EMR smoking status was measured by coding health factors data entries (populated during automated clinical reminders) in three ways: based on the most common health factor, the most recent health factor, and the health factor within 12 months of the criterion smoking status data collection date. KEY RESULTS: Concordance with PDMH smoking status (current, former, never) was highest when determined by the most commonly observed VA EMR health factor (κ = 0.69) and was not significantly impacted by psychiatric status. Agreement was higher when smoking status was dichotomized: current vs. not current (κ = 0.73; sensitivity = 0.84; specificity = 0.91; AUC = 0.87); ever vs. never (κ = 0.75; sensitivity = 0.85; specificity = 0.90; AUC = 0.87). There were substantial missing Health Factors data when restricting analyses to a 12-month period from the criterion smoking status date. Current smokers had significantly more Health Factors entries compared to never or former smokers. CONCLUSIONS: The use of computerized tobacco screening data to determine smoking status is valid and feasible. Results indicating that smokers have significantly more health factors entries than non-smokers suggest that caution is warranted when using the EMR to select cases for cohort studies as the risk for selection bias appears high.

The prevalence of binge drinking and receipt of provider drinking advice among US veterans with military service in Iraq or Afghanistan.

BACKGROUND: Binge drinking is a significant public health concern linked to a number of health and psychosocial problems. Military service in Afghanistan (OEF) and Iraq (OIF) has been associated with posttraumatic stress disorder (PTSD) and increased hazardous drinking. Brief alcohol interventions may reduce hazardous drinking but are infrequently provided to at-risk drinkers. OBJECTIVES: This study examined the association of combat exposure, PTSD symptoms, binge drinking, use of VA and non-VA healthcare services, and the incidence of provider drinking advice. METHODS: OEF/OIF veterans (n = 1087) completed measures of demographics, military history, combat exposure, PTSD symptoms, and binge drinking as part of a confidential mail survey study conducted in 2009 and 2010 (response rate = 29%). Patient report of receiving advice in the past year from a provider about their drinking was queried for frequent binge drinkers. The association of demographic variables, combat exposure, PTSD, and use of healthcare services with binge drinking and receipt of provider drinking advice was estimated using logistic regression. RESULTS: Overall, 51% of the sample reported at least one episode of binge drinking in the past year and 19% were identified as frequent binge drinkers. PTSD was related to frequent binge drinking. At-risk veterans using VA healthcare services were significantly more likely to receive provider drinking advice (50%) than veterans not using VA (13.4%). CONCLUSIONS: There is a need for increased vigilance and action to identify and counsel at-risk veterans about alcohol misuse in this population.

Identification of transient altered consciousness induced by military-related blast exposure and its relation to postconcussion symptoms.

BACKGROUND: The ongoing controversy whether mild traumatic brain injury (TBI) can cause chronic sequel is partly due to diagnostic limitations. Diagnosing mild TBI is particularly challenging when assessment is not immediate, and when informed, first responder documentation or witness corroboration is absent. In this common scenario, the diagnosis is made entirely on self-report of an initial period of alteration of consciousness (AOC) associated with a plausible injury mechanism. Yet, there is scant published empirical guidance on methods for accurately detecting historical AOC. OBJECTIVES: To assess the value that recalled AOC symptoms collected via questionnaire have in evaluating individuals exposed to blast during recent military deployment. More specifically, to analyze the concrete AOC items (those signifying unconsciousness and/or posttraumatic amnesia) for their (1) frequency and distribution of positive versus negative responses, (2) interitem agreement, and (3) relation to current neuropsychiatric symptoms including those consistent with postconcussion syndrome (PCS). PARTICIPANTS: Eighty-seven active duty or Veteran subjects who experienced acute effects from a blast within the past 2 years while deployed for Operations Enduring and Iraqi Freedom. RESULTS: : Twenty-nine participants (33.3%) responded positively to at least 1 of 3 concrete AOC items: gap in memory (17.2%), memory not continuous (13.8%), and/or told by observer they had loss of consciousness (20.7%). Alteration of consciousness items were associated with but nondiscriminate of current symptom distress on standardized measures of PCS (Rivermead Postconcussion Symptom Questionnaire), posttraumatic stress disorder (PTSD; PTSD Checklist), depression (Centers for Epidemiological Studies Depression Scale), and pain (Short Form McGill Pain Questionnaire). CONCLUSIONS: The positive association between subjects' questionnaire-based AOC item responses and current symptom complex measures suggests that mild TBI has a role in the development of chronic neuropsychiatric symptoms after blast exposure. The lack of symptom- complex discrimination, and the inconsistencies found in subjects' item responses suggest that a structured interview may improve postacute diagnostic specificity for mild TBI.

VA family service access and utilization in a national sample of veterans.

Relationship and family difficulties are common experiences for military veterans, who are able to access family services (i.e., couple and family therapy) through the Veterans Affairs (VA) Healthcare System. This study examines demographic, mental health, military, and referral source variables associated with referral to and utilization of family services using a large national VA dataset of 22,969 veterans who were referred to couple or family therapy from 2016 to 2019. Of those referred, 44.39% had a completed referral; among those who initiated therapy, 31.11% attended five or more sessions. Logistic regression was used to evaluate predictors of completed referrals and of attending five or more sessions of couple or family therapy. Veterans identifying as Black/African American, American Indian or Alaska Native were less likely to have a completed referral than non-Hispanic White veterans; moreover, veterans identifying as Black/African American or Hispanic were less likely to attend five or more sessions. Lower likelihood of a completed referral was also associated with rural county residence, being separated, post-9/11 service era, a substance use disorder diagnosis, and being referred by a psychiatrist, neurologist, physician, or nursing staff rather than a psychologist. Lower likelihood of attending five or more sessions was associated with a delay of 22 or more days to intake, an adjustment disorder diagnosis, and being referred from VA specialty care, or by a psychiatrist or neurologist. These findings may help inform efforts for outreach and service retention within VA family services in order to ensure equity in access to care and healthcare utilization. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Relation of Aerobic Activity to Cognition and Well-being in Chronic Mild Traumatic Brain Injury: A LIMBIC-CENC Study.

INTRODUCTION: Because chronic difficulties with cognition and well-being are common after mild traumatic brain injury (mTBI) and aerobic physical activity and exercise (PAE) is a potential treatment and mitigation strategy, we sought to determine their relationship in a large sample with remote mTBI. MATERIALS AND METHODS: The Long-Term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium prospective longitudinal study is a national multicenter observational study of combat-exposed service members and veterans. Study participants with positive mTBI histories (n = 1,087) were classified as "inactive" (23%), "insufficiently active" (46%), "active" (19%), or "highly active" (13%) based on the aerobic PAE level. The design was a cross-sectional analysis with multivariable regression. PAE was reported on the Behavioral Risk Factor Surveillance System. Preselected primary outcomes were seven well-validated cognitive performance tests of executive function, learning, and memory: The California Verbal Learning Test-Second Edition Long-Delay Free Recall and Total Recall, Brief Visuospatial Memory Test-Revised Total Recall, Trail-Making Test-Part B, and NIH Toolbox for the Assessment of Neurological Behavior and Function Cognition Battery Picture Sequence Memory, Flanker, and Dimensional Change Card Sort tests. Preselected secondary outcomes were standardized self-report questionnaires of cognitive functioning, life satisfaction, and well-being. RESULTS: Across the aerobic activity groups, cognitive performance tests were not significantly different. Life satisfaction and overall health status scores were higher for those engaging in regular aerobic activity. Exploratory analyses also showed better working memory and verbal fluency with higher aerobic activity levels. CONCLUSIONS: An association between the aerobic activity level and the preselected primary cognitive performance outcome was not demonstrated using this study sample and methods. However, higher aerobic activity levels were associated with better subjective well-being. This supports a clinical recommendation for regular aerobic exercise among persons with chronic or remote mTBI. Future longitudinal analyses of the exercise-cognition relationship in chronic mTBI populations are recommended.

Pre-COVID-19 deterrents to practicing with videoconferencing telepsychology among psychologists who didn't.

Telepsychology has the potential to help mental health service providers reach millions of people in rural areas or those limited by other factors. This study examined pre-COVID-19 deterrents reported by psychologists who did not use telepsychology. Participants were 1,400 psychologists with an average of 26.3 (SD = 11.18) years in practice who were currently practicing within the United States but did not currently use telepsychology. All 50 states were represented as well as Washington, DC. The most commonly reported deterrents, from most to least frequent, were insufficient training, client safety/crisis concerns, privacy, legality, ethics, reimbursement, efficacy, prohibitive organizational policies/culture, and insufficient demand. Logistic regression analyses suggested that psychologists' deterrents varied based in part on demographic and practice characteristics. Psychologists practicing within medical centers or Veterans Affairs facilities were less likely to indicate safety, privacy, legal issues, ethics, and efficacy as a concern. Older psychologists were less deterred by reimbursement issues and more concerned about effectiveness. Those using cognitive-behavioral approaches were less likely to report efficacy and safety concerns. Cisgender men were less likely to be deterred by safety or privacy issues, and White psychologists were less likely to indicate safety as a deterrent. Additional telepsychology training and information for psychologists may increase its use and foster improved mental health care access for populations unable to attend in-person sessions. A more focused approach to training and implementation of telepsychology that considers the needs and concerns of the target psychologist group could benefit organizations promoting its use. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Olfactory Changes After Military Deployment Are Associated With Emotional Distress but Not With Mild Traumatic Brain Injury History.

OBJECTIVE: The aim of the study was to identify the impact of mild traumatic brain injury history and current emotional status on olfactory functioning. DESIGN: This was a cross-sectional study of 49 predominantly male, military veterans, reservists, and active duty service members with Operations Enduring Freedom, Iraqi Freedom, and New Dawn deployments and varying mild traumatic brain injury histories. RESULTS: Those with a positive history of mild traumatic brain injury (n = 32) endorsed significantly higher rates of self-reported olfactory disturbance. However, there were no differences between the mild traumatic brain injury and no mild traumatic brain injury groups for rates of objective odor identification dysfunction (none vs. microsmia or more severe) or overall accuracy of odor identification. In keeping with this, self-reported olfactory disturbance also failed to associate with odor identification dysfunction. In both groups, those self-reporting olfactory disturbance reported significantly greater emotional distress, severity of posttraumatic stress symptoms, and attentional impulsivity. However, self-reported olfactory disturbance was not associated with other behavioral factors frequently attributed to TBI, such as aggression, motor impulsiveness, poor planning, and cognitive flexibility. CONCLUSIONS: These findings indicate mild traumatic brain injury is not a risk factor for postacute microsomia among Operations Enduring Freedom, Iraqi Freedom, and New Dawn military veterans. Higher observed rates of self-reported olfactory disturbance in patients with mild traumatic brain injury may be a function of emotional distress rather than organic brain injury.

Pain, mental health, life satisfaction, and understanding from others in veterans with spinal cord injury.

PURPOSE/OBJECTIVE: This study evaluated the relationships among pain, mental health symptom severity, life satisfaction, and understanding from others in veterans with spinal cord injury (SCI). RESEARCH METHOD/DESIGN: A sample of 221 individuals with SCI were interviewed by a psychologist during their annual evaluation in a Veterans Affairs medical center in an urban Mid-Atlantic region. Participants completed single-item, Likert-scale measures of life satisfaction (McGuire Health Impact on Participation [M-HIP]), pain severity (M-HIP), and understanding of others (from a modified Appraisals of DisAbility Primary and Secondary Scale-Short Form [ADAPSS-sf]), along with the Patient Health Questionnaire-4 (PHQ-4), a measure of mental health symptom severity. RESULTS: In linear regression models, pain (ß = .29, p < .001) and understanding from others (ß = -.28, p < .001) were significantly associated with mental health symptom severity with a marginally significant interaction effect (ß = -.32, p = .099). Pain (ß = -.33, p < .001) and understanding from others (ß = .32, p < .001) were also significantly associated with life satisfaction; however, there was no significant interaction (ß = .22, p = .234). CONCLUSION/IMPLICATIONS: This study showed that understanding from others and pain are important factors related to mental health and life satisfaction for veterans with SCI and highlights interventions targeting these relations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Use of telemental health for VA family services before and during the COVID-19 pandemic.

Military veterans experiencing relationship or family difficulties are able to access family services (i.e., couple and family therapy) through the Veterans Affairs (VA) Health Care System. Although family services have historically been provided face-to-face (F2F), the COVID-19 pandemic necessitated a sudden shift to the provision of care via telemental health, which includes videoconferencing (TMH-V) or audio-only phone appointments. This study demonstrated an unprecedented 16-fold increase in the number of TMH-V appointments for family services in VA during the first 9 months of the pandemic. The present study also examined demographic, mental health, and military variables associated with TMH-V utilization before and during the pandemic using a large national VA data set of 13,344 veterans who were referred to couple or family therapy from October 2017 through December 2020. Logistic regression was used to evaluate predictors of having any appointments via TMH-V before and during COVID-19, respectively, as well as predictors of having 50% or more of family service appointments via TMH-V versus phone versus face-to-face appointments during the COVID-19 era. Pre-COVID predictors of TMH-V utilization were limited to obsessive-compulsive disorder diagnosis and history of psychiatric hospitalization, suggesting that TMH-V usage was largely related to clinical indications. In the COVID-19 era, older and rural veterans were less likely to attend appointments via TMH-V than younger and suburban/urban veterans, while Hispanic veterans were more likely to do so than non-Hispanic veterans. The findings from the present study may aid efforts to ensure equity in access to care among veterans in the VA Health Care System. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Does Prior Civilian Trauma Moderate the Relationship Between Combat Trauma and Post-deployment Mental Health Symptoms?

In addition to combat trauma, childhood and adult non-military, interpersonal trauma exposures have been linked to a range of psychiatric symptoms (e.g., alcohol use problems, posttraumatic stress disorder [PTSD], depression symptoms) in veterans. However, few studies simultaneously explore the associations between these civilian and combat trauma types and mental health outcomes. Using a sample of combat-exposed veterans who were previously deployed to Iraq and Afghanistan (N = 302), this study sought to (a) understand the independent associations of civilian interpersonal trauma (i.e., childhood trauma and non-military adult trauma) and combat-related trauma with post-deployment alcohol use, PTSD symptoms, and depressive symptoms, respectively and (b) to examine the interactive effects of trauma type to test whether childhood and non-military adult trauma moderate the association of combat trauma with these outcomes. A path analytic framework was used to allow for the simultaneous prediction of these associations. In the final model non-military adult trauma and combat trauma were found to be significantly associated with PTSD symptoms and depression symptoms, but not average amount of drinks consumed per drinking day. Childhood trauma was not associated with any outcomes (i.e., PTSD symptoms, depression symptoms, average amount of drinks consumed per day). Only combat trauma was significantly associated with average amount of drinks consumed per day. Results underscore the importance of assessing multiple trauma types and considering trauma as a non-specific risk factor, as different trauma types may differentially predict various mental health outcomes other than PTSD. Further, results highlight the noteworthiness of considering co-occurring outcomes within the veteran community. Limitations, future directions, and implications of diversity are discussed.

The Implications of Power Mobility on Body Weight in a Veteran Population.

BACKGROUND: The prevalence of obesity is increasing in the United States. A common concern among health care providers is that prescribing a power mobility device (PMD) may decrease physical activity and lead to obesity and increasing morbidity. This study analyzes the effect of PMD prescriptions over a 2-year period on body mass index (BMI) and body weight in a population of veterans both as a whole and in BMI/age subgroups. METHODS: Prosthetics department medical records of veterans who received PMDs for the first time between January 1, 2011 and June 30, 2012 were reviewed. Of 399 records reviewed, 185 veterans met criteria for data analysis. The primary outcome measure was the change in BMI and body weight from time 1 (date of PMD prescription) to time 2 (2 years later). RESULTS: There was a significant decrease in BMI and weight in the first 2 years after receiving a PMD prescription. However, age moderated the relationship between BMI and time. CONCLUSIONS: PMD use does not seem to be associated with significant weight change. Further studies using control groups and assessing comorbidities are needed.

Telehealth Transition Assistance Program for Acute Spinal Cord Injury Caregivers: Protocol for a Mixed-Methods, Randomized Controlled Trial.

BACKGROUND: While spinal cord injury (SCI) caregiving can be a rewarding experience, caregivers often experience reduced mental and physical health. OBJECTIVE: This article describes the methodology of a study examining the efficacy of a newly developed telehealth Transition Assistance Program (TAP) for caregivers of individuals with acute SCI. METHODS: A mixed-methods, randomized controlled trial is comparing TAP outcomes to that of a standard-of-care control. The study is recruiting for 48 months and incorporating quantitative outcome measures. RESULTS: This study was funded by the Craig H. Neilsen Foundation in April 2017. It was approved by the institutional review boards at Virginia Commonwealth University and the Hunter Holmes McGuire Veterans Affairs Medical Center that same year. Participant recruitment and data collection began in 2018. CONCLUSIONS: This study is implementing and testing an SCI caregiver intervention unlike any created before, targeting a critical time period that, until now, other SCI caregiver interventions have overlooked. Research personnel intend to disseminate the intervention and study findings through the publication of manuscripts and presentations at conferences. If the current study shows improvements in caregiver or patient well-being, the TAP for SCI caregivers could become part of the standard of care for acute SCI. TRIAL REGISTRATION: ClinicalTrials.gov NCT03244098; https://www.clinicaltrials.gov/ct2/show/NCT03244098. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/28256.

Research Participant Recruitment Strategies Among Individuals with Acute Spinal Cord Injury and Their Caregivers: A Pre-Post Study.

STUDY DESIGN: Pre-post study. OBJECTIVE: To evaluate the efficiency of a series of recruitment strategies in a longitudinal study of individuals with SCI and their informal caregivers. Primary strategies included (a) rapport building in advance, (b) warm handoffs from another healthcare provider who already had a relationship with the potential participant, (c) ensuring the potential participant had information about the study prior to the initial contact by the research coordinator (RC), (d) attempting informed consent only when both the patient and informal caregiver were present, and (e) ensuring the RC had at least 30 minutes to explain the study when attempting recruitment. SUMMARY OF BACKGROUND DATA: While a fairly large body of research has been conducted on general recruitment strategies for clinical trials, very little has examined the efficacy of these strategies within neurological conditions and almost none within SCI. METHODS: Individuals with an acute SCI and their informal caregivers were recruited from acute spinal cord rehabilitation units with a Veteran's Affairs medical center and an academic medical center in the same urban area. Of 49 eligible dyads, 41 were approached for consent, with 27 consenting to join the study (9 from the academic medical center; 18 from the VA). RESULTS: There was a significant difference in enrollment rates after implementing the recruitment strategies, χ2(1) = 7.572, P = 0.006, with the per month participant enrollment rate nearly doubling after implementation. CONCLUSION: Using a multiteam and multidisciplinary approach to recruitment may increase the likelihood that individuals with an acute SCI and their caregivers enroll in research.Level of Evidence: 3.

Drinking Patterns of Post-Deployment Veterans: The Role of Personality, Negative Urgency, and Posttraumatic Stress.

Rates of posttraumatic stress disorder (PTSD) and alcohol misuse are known to be high among post-deployment Veterans. Previous research has found that personality factors may be relevant predictors of post-deployment drinking, yet results have been inconsistent and may be influenced by the selection of drinking outcome. This study aimed to examine relations between PTSD, negative urgency, and the five factor models of personality with multiple alcohol consumption patterns, including maximum drinks in a day, number of binge drinking episodes, at-risk drinking, and average weekly drinks in a sample of 397 Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Veterans. The pattern of results suggested that the association between personality, PTSD, and drinking may depend on which drinking outcome is selected. For example, maximum drinks in a day was significantly associated with younger age, male gender, low agreeableness, and an interaction between negative urgency and PTSD, whereas number of binge drinking days was significantly associated with younger age, extraversion, low agreeableness, and negative urgency. This study highlights the heterogeneity of drinking patterns among Veterans and the need for careful consideration and transparency of outcomes selection in alcohol research.

Clinical utility of the Primary Care--PTSD Screen among U.S. veterans who served since September 11, 2001.

Posttraumatic stress disorder (PTSD) is a prevalent anxiety disorder that is often undetected among primary care patients. The Department of Veterans Affairs has implemented the Primary Care-PTSD Screen (PC-PTSD) to screen for PTSD; however, minimal research has examined its utility. This study was designed to assess the diagnostic accuracy of the PC-PTSD among veterans who had served since 9/11/2001, including operations in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom). Signal detection analyses were used to evaluate the performance of the PC-PTSD and two other screens, the Davidson Trauma Scale (DTS) and the SPAN, in a sample of 220 veterans with military service since 9/11/2001. The reference standard for PTSD was Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) diagnosis based upon structured clinical interview. The impact of demographic variables on test performance was examined. A cutting score of 3 on the PC-PTSD maximized efficiency (85%; sensitivity=0.83; and specificity=0.85). Although analyses supported the utility of the PC-PTSD (area under the curve (AUC)=0.875), the measure was outperformed by both the DTS (AUC=0.944) and the SPAN (AUC=0.931). Results suggest that the PC-PTSD is an acceptable screen for PTSD among veterans. Within primary care settings, the PC-PTSD may be most advantageously employed in the context of staged screening, given the measure's relative susceptibility to false positives.