Heart rate reactivity to trauma-related imagery as a measure of PTSD symptom severity: Examining a new cohort of Veterans.

For over three decades, there has been considerable research documenting increased physiological reactivity to trauma-related stimuli as a characteristic feature of posttraumatic stress disorder (PTSD). The present study explored the potential for physiological assessment to aid in defining and validating screening criteria for the presence of significant PTSD-related symptoms in a sample of OEF/OIF/OND Veterans seeking care in a VA post-deployment health clinic. Heart rate reactivity scores during the imagining phase of the script-driven imagery paradigm were compared across groups of individuals with and without probable PTSD diagnoses, as defined by PCL-IV cutoff scores ranging from 40 to 60. Significant differences were found for groups defined by PCL-IV cutoff scores of 50 and 60, with 50 producing the largest effect size. Diagnosing PTSD is made challenging by the presence of overlapping symptoms shared with other diagnoses, as well as by the necessity for patients to accurately report their symptoms. An objective physiological measure capable of accurately differentiating individuals with and without PTSD provides potential adjunctive diagnostic and treatment information to clinicians. The present findings support the validity of physiological reactivity during SDI as a NIMH RDoC measure that can be used in research and clinical applications assessing trauma-related symptom severity.

Retraining walking adaptability following incomplete spinal cord injury.

INTRODUCTION: Functional walking requires the ability to modify one's gait pattern to environmental demands and task goals-gait adaptability. Following incomplete spinal cord injury (ISCI), gait rehabilitation such as locomotor training (Basic-LT) emphasizes intense, repetitive stepping practice. Rehabilitation approaches focusing on practice of gait adaptability tasks have not been established for individuals with ISCIs but may promote recovery of higher level walking skills. The primary purpose of this case series was to describe and determine the feasibility of administering a gait adaptability retraining approach-Adapt-LT-by comparing the dose and intensity of Adapt-LT to Basic-LT. CASE PRESENTATION: Three individuals with ISCIs (>1 year, AIS C or D) completed three weeks each (15 sessions) of Basic-LT and Adapt-LT. Interventions included practice on a treadmill with body weight support and practice overground (≥30 mins total). Adapt-LT focused on speed changes, obstacle negotiation, and backward walking. Training parameters (step counts, speeds, perceived exertion) were compared and outcomes assessed pre and post interventions. Based on completion of the protocol and similarities in training parameters in the two interventions, it was feasible to administer Adapt-LT with a similar dosage and intensity as Basic-LT. Additionally, the participants demonstrated gains in walking function and balance following each training type. DISCUSSION: Rehabilitation that includes stepping practice with adaptability tasks is feasible for individuals with ISCIs. Further investigation is needed to determine the efficacy of Adapt-LT.

Mental health, help seeking, and stigma and barriers to care among 3- and 12-month postdeployed and never deployed U.S. Army Combat Medics.

U.S. Army Combat Medic serves as both Soldier and provider of combat casualty care, often in the heat of battle and with limited resources. Yet little is known about their help-seeking behavior and perceived stigma and barriers to care. Participants were three groups of U.S. Army Combat Medics surveyed at 3- and 12-months postdeployment from assignment with line units vs. those Medics who had never deployed to combat. The primary data source was surveys of mental health service utilization, perceived stigma and barriers to care, and depression and post-traumatic stress disorder screens. Medics who received help in the past year from a mental health professional ranged from 18% to 30%, with 18% to 30% seeking mental health assistance from other sources. Previously deployed Medics were more likely to obtain assistance than those who never deployed. Those meeting a mental health screening criteria were more likely to report associated stigma and barriers to care. Findings indicate that Medics in need of assistance report greater perceived barriers to mental health care, as well as stigma from seeking treatment, and that depression may be a salient issue for Medics. The longitudinal nature of the ongoing study will help determine the actual trajectory and onset of depression and post-traumatic stress disorder.

Gender differences in combat medic mental health services utilization, barriers, and stigma.

Military health care providers experience considerable stressors related to their exposure to death and traumatic injuries in others. This study used survey data from 799 active duty U.S. Army Combat Medics deployed to Operation Iraqi Freedom/Operation Enduring Freedom. Military experiences, combat exposures, and mental health care seeking of active duty Combat Medics were explored and compared across both genders. Barriers to care were also assessed. Male and female Combat Medics reported surprisingly similar experiences, exposures, and health issues. Overall, results indicate no striking differences in barriers for females compared to their male counterparts, suggesting the barriers to utilization of mental health services may be consistent across gender. Although medics endorsed barriers and stigma related to mental health counseling services, they still sought these health services. Female and male medics who endorsed barriers were more likely to report seeking services than those who did not endorse barriers. This study provides an initial description of utilization of mental health counseling services for U.S. Army Combat Medics, the majority of whom were involved in combat operations in Afghanistan or Iraq. Our findings indicate that comprehensive assessment of the military experiences and combat exposures is needed to appreciate their potential influence on military health care providers.

Training, deployment preparation, and combat experiences of deployed health care personnel: key findings from deployed U.S. Army combat medics assigned to line units.

OBJECTIVE: To describe the perceptions of training and deployment preparation and combat experiences and exposures of U.S. Army combat medics. METHODS: Data were from the first year of a 3-year longitudinal study designed to assess the impact of combat on the behavioral health and resilience of 347 combat medics surveyed 3 to 6 months after returning from a 12-month deployment to Operation Enduring Freedom/Operation Iraqi Freedom theatre and assigned to brigade combat teams. RESULTS: Analyses indicated that combat medics may benefit from better preparation in types of shifts required during deployment, type and intensity of combat likely to be seen and experienced, more adequate training in the area of stress and mental health care management, and easier access to behavioral mental health care. CONCLUSIONS: The military has shown considerable progress in addressing and understanding the mental health care needs of Soldiers. However, challenges remain. Additional emphasis should be placed on reducing the stigma and barriers related to mental health care both in theatre and garrison and on developing an evidence-based, validated program for medics and other Soldiers to recognize stress and mental health issues on the battlefield. For medics, this should be from two perspectives-that of a combat Soldier and that of a medical provider.

Well-being in a deeply religious society in the shadows of war: results of a household survey of Kuwaitis.

The present study was designed to determine the current level and distribution of well-being among Kuwaiti citizens who have lived either in the middle or in the shadows of war since Kuwait was invaded by Iraq in August 1990. A measure of Kuwaiti well-being, the Kuwaiti Raha Scale, was developed and utilized as the primary indicator in the first National Household Survey (NHS) of well-being in Kuwait. The findings presented are part of an international program of research focusing on national trauma and mental health for which the Kuwaiti NHS was developed. From a population of 935,922 (2004), 830 households were randomly drawn, from which 487 were approached and 416 successfully recruited and surveyed. In contrast to prevailing views in the literature, level of well-being (Raha) was not associated with either educational attainment or wealth. Rather, the results indicate that well-being is more associated with health and religion. Implications of these findings for a new theory of well-being in a deeply religious society are offered along with suggestions for a program of research. The policy implications of the NHS are also discussed.

Readdressing gender bias in the Coopersmith Self-Esteem Inventory-short form.

The short form of the Coopersmith Self-Esteem Inventory (SEI) was evaluated for gender bias. The authors replicated a study by L. Francis and D. James (1998) and administered the SEI to 361 middle and high school students (146 boys, 2l5 girls). They found that gender bias existed in 6 of the 25 items on the SEI, with 5 of those items favoring boys. Because recent literature indicates that male and female adolescents experience problems in different areas of their lives, the authors suggest that researchers consider such differences when selecting items for a standardized measure.