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1.
Artículo en Inglés | MEDLINE | ID: mdl-38649010

RESUMEN

OBJECTIVE: To assess injured military veterans' experiences, beliefs, and daily physical and psychosocial functioning in relation to food and nutrition. DESIGN: We used a convergent mixed-methods study design and the International Classification of Functioning, Disability, and Health to operationalize the core constructs and influencing factors related to physical and psychosocial functioning, food, and nutrition. SETTING: Three Veterans Affairs polytrauma rehabilitation centers. PARTICIPANTS: Veterans who served in the United States military on or after September 11, 2001, and whose medical diagnoses met the criteria for polytrauma; at least 1 mild traumatic brain injury and at least 1 associated comorbidity (eg, posttraumatic stress disorder, chronic musculoskeletal pain, vestibular disturbances), for a total N of 43. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Themes from survey responses and semistructured interview data were pooled into core constructs and influencing factors. RESULTS: Thirty-seven veterans completed all surveys and participated in recorded interviews. Based on qualitative and quantitative data, veterans' relation to food and nutrition (ie, nutritional functioning) was found to be characterized by 5 core constructs, including food background, nutrition knowledge, meal aptitude, resource navigation, and navigation to/of food spaces. Nutritional functioning was found to be shaped by 5 influencing factors, including injuries and health conditions, ideological and cultural exposures, relations, current beliefs, and current behaviors. CONCLUSIONS: Nutritional functioning (food background, nutrition knowledge, meal aptitude, resource navigation, navigation to/of food spaces) among injured veterans is complex and shaped by multiple physical, psychosocial, economic, and cultural factors.

2.
Artículo en Inglés | MEDLINE | ID: mdl-38259092

RESUMEN

OBJECTIVE: To identify distinct subgroups of veterans with mild traumatic brain injury (mTBI) based on configurations of postconcussive symptom (PCS) endorsement, and to examine predictors of subgroup membership. SETTING: Outpatient Veterans Health Administration (VHA). PARTICIPANTS: Veterans with clinician-confirmed mTBI who completed the Neurobehavioral Symptom Inventory (NSI), determined using the Comprehensive Traumatic Brain Injury Evaluation database. Individuals who tended to overreport symptoms were excluded via an embedded symptom validity scale. DESIGN: Retrospective cohort study leveraging national VHA clinical data from 2012 to 2020. Latent class analysis (LCA) with a split-sample cross-validation procedure was used to identify subgroups of veterans. Multinomial logistic regression was used to examine predictors of subgroup membership. MAIN MEASURES: Latent classes identified using NSI items. RESULTS: The study included 72 252 eligible veterans, who were primarily White (73%) and male (94%). The LCA supported 7 distinct subgroups of veterans with mTBI, characterized by diverging patterns of risk for specific PCS across vestibular (eg, dizziness), somatosensory (eg, headache), cognitive (eg, forgetfulness), and mood domains (eg, anxiety). The most prevalent subgroup was Global (20.7%), followed by Cognitive-Mood (16.3%), Headache-Cognitive-Mood (H-C-M; 16.3%), Headache-Mood (14.2%), Anxiety (13.8%), Headache-Sleep (10.3%), and Minimal (8.5%). The Global class was used as the reference class for multinomial logistic regression because it was distinguished from others based on elevated risk for PCS across all domains. Female (vs male), Black (vs White), and Hispanic veterans (vs non-Hispanic) were less likely to be members of most subgroups characterized by lesser PCS endorsement relative to the Global class (excluding Headache-Mood). CONCLUSION: The 7 distinct groups identified in this study distill heterogenous patterns of PCS endorsement into clinically actionable phenotypes that can be used to tailor clinical management of veterans with mTBI. Findings reveal empirical support for potential racial, ethnic, and sex-based disparities in PCS among veterans, informing efforts aimed at promoting equitable recovery from mTBI in this population.

3.
Behav Sleep Med ; 22(4): 553-570, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38420915

RESUMEN

OBJECTIVE: To understand factors influencing adherence to recommended treatment for insomnia and obstructive sleep apnea (OSA) among Veterans with mild traumatic brain injury (mTBI). METHOD: Semi-structured interviews (n = 49) with 29 clinical stakeholders and 20 Veterans were conducted. Clinical stakeholders included Veterans Health Administration providers and policymakers involved in the management of mTBI and/or sleep disorders. Veterans included those with a clinician-confirmed mTBI with a recent history of insomnia disorder and/or OSA treatment. Themes were identified using a Descriptive and Interpretive approach. RESULTS: Barriers to sleep disorder treatment adherence included factors associated with the patient (e.g., negative appraisal of treatment benefit), intervention (e.g., side effects), health conditions (e.g., cognitive challenges), health care system (e.g., limited availability of care), and socioeconomic status (e.g., economic instability). Similarly, facilitators of adherence included patient- (e.g., positive appraisal of treatment benefit), intervention- (e.g., flexible delivery format), condition- (e.g., accommodating cognitive impairments), health care system- (e.g., access to adherence support), and socioeconomic-related factors (e.g., social support). CONCLUSIONS: Interviews revealed the multi-faceted nature of factors influencing adherence to sleep disorder treatment among Veterans with mTBI. Findings can inform the development of novel interventions and care delivery models that meet the complex needs of this population.


Asunto(s)
Conmoción Encefálica , Apnea Obstructiva del Sueño , Trastornos del Inicio y del Mantenimiento del Sueño , Veteranos , Humanos , Apnea Obstructiva del Sueño/terapia , Veteranos/estadística & datos numéricos , Veteranos/psicología , Trastornos del Inicio y del Mantenimiento del Sueño/terapia , Masculino , Femenino , Persona de Mediana Edad , Adulto , Conmoción Encefálica/complicaciones , Conmoción Encefálica/terapia , Estados Unidos , Cooperación del Paciente/estadística & datos numéricos , Cumplimiento y Adherencia al Tratamiento/estadística & datos numéricos
4.
Med Care ; 59: S23-S30, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33438879

RESUMEN

BACKGROUND: The extent to which female veterans are willing to seek Veterans Health Administration (VHA) and non-VHA care when they are suicidal or experiencing mental health (MH) concerns is unknown. OBJECTIVES: The objectives of this study were to: (1) examine whether current, past, and never VHA using female veterans' willingness to seek VHA care differs from their willingness to seek non-VHA care if suicidal or experiencing MH symptoms; (2) examine if VHA use, military sexual trauma, and suicidal ideation and attempt are associated with female veterans' willingness to use VHA and non-VHA care when experiencing suicidal thoughts or MH symptoms. RESEARCH DESIGN: A cross-sectional anonymous survey. SUBJECTS: Four hundred thirty nine female veterans, including current, past, and never VHA users were included. MEASURES: General Help-Seeking Questionnaire, Self-Injurious Thoughts and Behaviors Interview, and the VA Military Sexual Trauma Screening Questions. RESULTS: Current VHA users reported more willingness to use VHA than non-VHA care; conversely, past and never VHA users reported less willingness to use VHA care relative to non-VHA care. Military sexual assault and none or past VHA use were associated with lower willingness to use VHA care if suicidal or experiencing MH symptoms. In contrast, those with none or past VHA use reported greater willingness to use non-VHA care if suicidal or experiencing MH symptoms, while prior suicide attempt was associated with lower willingness. CONCLUSIONS: Ensuring that acceptable and effective suicide prevention services are available to female veterans in both VHA and community settings is critical. Increasing help-seeking intentions among female veterans who have attempted suicide or experienced military sexual assault is also essential.


Asunto(s)
Conducta de Búsqueda de Ayuda , Aceptación de la Atención de Salud/estadística & datos numéricos , Prevención del Suicidio , Veteranos/psicología , Mujeres/psicología , Adulto , Anciano , Estudios Transversales , Utilización de Instalaciones y Servicios , Femenino , Humanos , Servicios de Salud Mental , Persona de Mediana Edad , Encuestas y Cuestionarios , Estados Unidos , Servicios de Salud para Veteranos
5.
J Clin Psychol ; 76(3): 377-391, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31714610

RESUMEN

OBJECTIVE: We examined Veterans' perspectives on discussing moral injury in veterans affairs (VA) evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD) and other VA treatment. METHODS: Fourteen male warzone veterans (ages 25-74) who completed an EBP for PTSD within the past year participated in semistructured interviews related to discussing moral injury in VA treatment (e.g., EBPs for PTSD, chaplaincy). Qualitative interviews were evaluated using a thematic analysis. RESULTS: Four themes were identified; moral injury is often not identified or discussed during therapy, therapeutic relationships can promote or inhibit discussion of moral injury, treatment has limited impact on moral injury, and it is difficult to cope with moral injury even after treatment. CONCLUSION: The majority of Veterans interviewed identified moral injury persisting within a year of completing a PTSD EBP. These findings highlight the value of asking about, assessing, and treating moral injury in Veterans. Our results suggest the importance of developing specific moral injury interventions for warzone Veterans.


Asunto(s)
Psicoterapia/métodos , Trastornos por Estrés Postraumático/terapia , Veteranos/psicología , Adulto , Anciano , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Estados Unidos , United States Department of Veterans Affairs
6.
J Head Trauma Rehabil ; 34(5): E36-E44, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30829818

RESUMEN

OBJECTIVE: Evaluate postconcussive symptom reporting and recovery. SETTING: Public high school. PARTICIPANTS: Unmatched controls (n = 760); students who sustained a sports-related concussion (n = 77); matched controls (gender, grade, sport) (n = 77). DESIGN: Prospective longitudinal cohort study. OUTCOME MEASURE: Immediate Postconcussion Assessment and Cognitive Testing. RESULTS: At baseline, athletes who went on to sustain concussions were more likely than unmatched controls to be younger (P = .02), male (P = .001), and participate in different sports (P < .0001) such as football (concussed = 52%, unmatched controls = 20%). Differences were also noted regarding a previous history of concussion (P = .045; concussed athletes = 26%; unmatched control athletes = 16%) and lifetime number of concussions (P = .05). At baseline, those whose sustained concussions during the study period were more likely than matched controls to report numbness (P = .01) and concentration problems (P = .01) and more likely than unmatched controls to report dizziness (P = .02), sensitivity to light (P = .01), sensitivity to noise (P = .002), and numbness (P = .02). However, when data were reanalyzed and those with a previous history of concussion were removed, differences between those who sustained concussions during the study period and matched controls were no longer significant; when compared to unmatched controls, sensitivity to light (P = .01) and vision problems (P = .04) remained significant. Among those who sustained concussions, median time to recovery was 6 days (95% confidence interval: 4-9), and 71 out of 77 (92%) recovered by the fourth postinjury evaluation (median: 20 days postinjury). CONCLUSIONS: Course and time frame of recovery were variable. Data also suggest that a previous history of concussion may be contributing to baseline symptom reporting and highlight the potential enduring impact of history of concussion on sensorimotor function. However, further research as to whether preinjury measures of sensorimotor function may increase understanding regarding concussion risk is warranted.


Asunto(s)
Traumatismos en Atletas/epidemiología , Conmoción Encefálica/epidemiología , Adolescente , Estudios de Casos y Controles , Estudios de Cohortes , Colorado/epidemiología , Mareo/epidemiología , Femenino , Humanos , Hiperacusia/epidemiología , Hipoestesia/epidemiología , Estudios Longitudinales , Masculino , Pruebas Neuropsicológicas , Fotofobia/epidemiología , Recuperación de la Función , Factores de Tiempo
8.
J Head Trauma Rehabil ; 33(2): E7-E15, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-28422900

RESUMEN

OBJECTIVES: To examine whether the association between posttraumatic stress disorder (PTSD) and injury perceptions (ie, consequences, emotional representations, and coherence) differs for Veterans with mild traumatic brain injury (mTBI) compared with Veterans with non-TBI (ie, orthopedic). PARTICIPANTS: Eighty Veterans injured during post-9/11 deployments. DESIGN: Observational, 2×2 factorial design. MAIN MEASURES: Injury histories ascertained using the Ohio State University TBI-Identification Method and Deployment Injury Questionnaire; Injury Perception Questionnaire-Revised (injury perceptions); Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (PTSD diagnosis); and PTSD Symptom Checklist-Civilian Version (PTSD symptoms). RESULTS: The association between PTSD diagnosis and injury perceptions did not differ between Veterans with mTBI and those with non-TBIs, adjusting for age, subjective pain, and depressive symptoms. PTSD symptom severity was significantly associated with injury consequences (P < .0001) and emotional representations (P < .0001), irrespective of injury type (mTBI vs non-TBI). Only injury coherence was associated with a significant interaction between PTSD symptom severity and mTBI (P = .04). CONCLUSION: PTSD symptom severity influences perceptions about mTBI and non-TBIs sustained during deployment. Altering injury perceptions may be an important treatment target for Veterans with co-occurring PTSD and deployment-related injuries.


Asunto(s)
Lesiones Traumáticas del Encéfalo/psicología , Emociones , Sentido de Coherencia , Trastornos por Estrés Postraumático/psicología , Veteranos/psicología , Heridas y Lesiones/psicología , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
9.
J Clin Psychol ; 73(12): 1655-1669, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28186637

RESUMEN

OBJECTIVE: Military sexual trauma (MST) is prevalent among female Veterans and is associated with increased risk for suicidal self-directed violence. Yet research examining processes which contribute to suicidal ideation and attempts among MST survivors has been sparse, focusing primarily on psychiatric symptoms or diagnoses, rather than employing a theory-driven approach. The interpersonal-psychological theory (Joiner, 2005) is a leading theory of suicide that may be particularly relevant for understanding suicidal ideation among female Veterans who have experienced MST. We examined whether constructs derived from the interpersonal-psychological theory of suicide (perceived burdensomeness, thwarted belongingness, and fearlessness about death; Joiner, 2005) were associated with suicidal ideation among female Veterans who had experienced MST, when adjusting for known risk factors for suicide. METHOD: Ninety-two female Veterans with a history of MST completed the Interpersonal Needs Questionnaire, Acquired Capability for Suicide Scale - Fearlessness about Death Scale, and Beck Scale for Suicide Ideation. RESULTS: Perceived burdensomeness, thwarted belongingness, and fearlessness about death were each associated with suicidal ideation in the past week, adjusting for prior suicide attempts, current depressive symptoms, and current symptoms of posttraumatic stress disorder. When including all three interpersonal-psychological constructs in the model, only perceived burdensomeness and fearlessness about death were significantly associated with suicidal ideation. CONCLUSION: These findings provide knowledge regarding interpersonal processes that may contribute to suicidal ideation among this high-risk, yet understudied, population. These results also underscore the importance of assessing for interpersonal-psychological constructs-particularly perceived burdensomeness and fearlessness about death-when working with female Veterans who have experienced MST.


Asunto(s)
Actitud Frente a la Muerte , Relaciones Interpersonales , Trauma Psicológico/psicología , Autoimagen , Delitos Sexuales/psicología , Identificación Social , Ideación Suicida , Veteranos/psicología , Adulto , Femenino , Humanos , Persona de Mediana Edad , Teoría Psicológica , Estados Unidos , United States Department of Veterans Affairs
10.
J Clin Psychol ; 72(7): 743-55, 2016 07.
Artículo en Inglés | MEDLINE | ID: mdl-27007795

RESUMEN

OBJECTIVES: We examined perceptions of institutional betrayal among Veterans exposed to military sexual trauma (MST) and whether perceptions of institutional betrayal are associated with symptoms of posttraumatic stress disorder (PTSD), depression, and suicidal ideation and attempt after MST. METHOD: A total of 49 Veterans with MST completed self-report measures and interviews in a Veterans Health Administration setting. RESULTS: Many participants reported perceptions that a military institution created an environment in which MST seemed common, likely to occur, and did not proactively prevent such experiences. Many participants expressed difficulty reporting MST and indicated that the institutional response to reporting was inadequate. Over two-thirds perceived that the institution had created an environment in which they no longer felt valued or in which continued membership was difficult. Perceptions of institutional betrayal were associated with PTSD symptoms, depressive symptoms, and increased odds of attempting suicide after MST. In contrast, perceptions of institutional betrayal were not associated with post-MST suicidal ideation. Among the subsample of Veterans exposed to military sexual assault, the association between institutional betrayal and PTSD symptoms approached significance. CONCLUSIONS: Perceptions regarding institutional betrayal appear to be highly relevant to MST and its sequelae. These findings underscore the importance of Veterans' perceptions of the military institution's efforts to prevent and respond to MST to individual recovery from sexual trauma. Additional research regarding the association between institutional betrayal and health-related outcomes is needed.


Asunto(s)
Personal Militar/psicología , Cultura Organizacional , Trauma Psicológico/psicología , Delitos Sexuales/psicología , Trastornos por Estrés Postraumático/psicología , Intento de Suicidio/psicología , United States Department of Defense , Veteranos/psicología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ideación Suicida , Estados Unidos
11.
J Trauma Stress ; 28(4): 283-8, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-26190530

RESUMEN

Compelling evidence has emerged on the association between military sexual trauma and suicide attempt; however, research investigating how sexual trauma during deployment relates to suicidal ideation has received considerably less attention and has yielded mixed findings. Furthermore, such research has not accounted for other types of trauma that may occur during deployment. Our objectives were to examine whether sexual trauma during deployment was associated with recent suicidal ideation, adjusting for exposure to combat. Our sample included 199 Operation Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) veterans entering inpatient trauma-focused treatment who completed the Beck Scale for Suicide Ideation (Beck & Steer, ) and the Deployment Risk and Resilience Inventory Sexual Harassment and Combat Experiences Scales (King, King, Vogt, Knight, & Samper, ). Deployment-related sexual trauma was significantly associated with recent suicidal ideation, adjusting for age and gender (ß = .18, ηp (2) = .03) and additionally for combat (ß = .17, ηp (2) = .02). These findings underscore the importance of assessing for deployment-related sexual trauma when assessing suicide risk in OEF/OIF/OND veterans in inpatient settings.


Asunto(s)
Delitos Sexuales/psicología , Acoso Sexual/psicología , Ideación Suicida , Veteranos/psicología , Guerra , Adulto , Campaña Afgana 2001- , Femenino , Humanos , Guerra de Irak 2003-2011 , Masculino , Escalas de Valoración Psiquiátrica , Estados Unidos
12.
J Affect Disord ; 349: 1-7, 2024 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-38154586

RESUMEN

BACKGROUND: Bright light therapy (BLT) is efficacious for seasonal and non-seasonal depression. However, the current state of BLT use in practice is unknown, impeding efforts to identify and address utilization gaps. This study's objective was to investigate BLT delivery in a nationwide U.S. healthcare system. METHODS: This was a retrospective observational study of electronic medical records from all veterans who received outpatient mood disorder-related care in the Veterans Health Administration (VHA) from October 2008 through September 2020. BLT delivery was measured through the placement of light box consults. RESULTS: Of the 3,442,826 veterans who received outpatient mood disorder care, only 57,908 (1.68 %) received a light box consult. Consults increased by 548.44 % (99.9 % credible interval: 467.36 %, 638.74 %) over the timeframe and displayed a robust yearly cycle that peaked on either December 21st or December 22nd. Past mental health treatment for a mood disorder was associated with a higher probability of a consult (relative risk = 4.79, 99.9 % CI: 4.21, 5.60). There was low representation related to veteran age, gender, race, and ethnicity. LIMITATIONS: No information on patients who declined light boxes or actual light box use following consult placement. CONCLUSIONS: Outpatient BLT delivery for mood disorders in the VHA remains low, despite significant growth over the past decade. It also displays a strong seasonal rhythm that peaks on the winter solstice, suggesting a limited focus on seasonal depression and a suboptimal reactive approach to changing sunlight. Overall, there exists ample opportunity for novel implementation efforts aimed at increasing utilization of BLT.


Asunto(s)
Trastorno Afectivo Estacional , Veteranos , Humanos , Estados Unidos , Salud de los Veteranos , Fototerapia , Trastorno Afectivo Estacional/terapia , Trastornos del Humor , Estudios Retrospectivos , United States Department of Veterans Affairs
13.
Gen Hosp Psychiatry ; 87: 7-12, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38266442

RESUMEN

OBJECTIVE: While screening and treatment options for patients who disclose suicidal ideation in clinical settings have grown in recent decades, little is known about patient experiences following disclosure. We characterize patient perspectives of responses following disclosure of suicidal ideation in Veteran Health Administration (VHA) primary care and mental health settings. METHOD: Qualitative thematic analysis using a conventional/directed hybrid approach. RESULTS: A national sample comprised of sixty participants who recently screened for suicidal ideation in primary care (n = 28) and mental health (n = 32) settings completed interviews. Many patients described therapeutic experiences following disclosure, including caring staff, timely follow-up care, and offers of multiple treatment options. Other patients, however, reported deficits in staff empathy, long waits for follow-up care, or inadequate treatment options. CONCLUSIONS: While many VA clinical settings provided empathic and helpful responses, these experiences were not universal. Our findings reinforce the importance of a patient-centered approach to screening and response to disclosure, including collaboration with patients in treatment planning. Improved follow-up care coordination processes are needed. Following disclosure, contact with the staff who received the disclosure also helps patients feel cared about, and provides opportunity to troubleshoot barriers a patient may experience in accessing care.


Asunto(s)
Ideación Suicida , Veteranos , Humanos , Veteranos/psicología , Revelación , Salud Mental , Atención Primaria de Salud
14.
J Clin Sleep Med ; 20(5): 801-812, 2024 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-38189353

RESUMEN

STUDY OBJECTIVES: We elicited perspectives of clinical stakeholders and Veterans regarding barriers and facilitators to implementing shared decision-making (SDM) for comorbid mild traumatic brain injury (mTBI) and sleep disorders in the Veterans Health Administration. We also compared the perspectives of clinical stakeholders and Veterans regarding determinants of SDM. METHODS: Semistructured interviews were conducted with 29 clinical stakeholders and 20 Veterans (n = 49). Clinical stakeholders included Veterans Health Administration providers and policymakers involved in the management of mTBI and/or sleep disorders (insomnia disorder, obstructive sleep apnea). Veterans included those with a clinician-confirmed mTBI who received care for insomnia disorder and/or obstructive sleep apnea within the past year. Themes were identified using a descriptive and interpretive approach to qualitative analysis. We compared results across clinical stakeholders and Veterans. RESULTS: Barriers to implementing SDM were identified by both groups at the patient (eg, mTBI sequalae), provider (eg, deprioritization of Veteran preferences), encounter (eg, time constraints), and facility levels (eg, reduced care access). Similarly, both groups identified facilitators at the patient (eg, enhanced trust), provider (eg, effective communication), encounter (eg, decision support), and facility levels (eg, mitigating access barriers). Integrated services and provider discontinuity were factors identified by clinical stakeholders and Veterans alone, respectively. CONCLUSIONS: Our study revealed factors shaping the implementation of SDM at the levels of the patient, provider, encounter, and facility. Findings can inform the development of strategies aimed at implementing SDM for comorbid mTBI and sleep disorders, promoting patient-centered care and enhancing clinical outcomes. CITATION: Kinney AR, Brenner LA, Nance M, et al. Factors influencing shared decision-making for insomnia and obstructive sleep apnea treatment among Veterans with mild traumatic brain injury. J Clin Sleep Med. 2024;20(5):801-812.


Asunto(s)
Conmoción Encefálica , Toma de Decisiones Conjunta , Apnea Obstructiva del Sueño , Trastornos del Inicio y del Mantenimiento del Sueño , Veteranos , Humanos , Apnea Obstructiva del Sueño/terapia , Apnea Obstructiva del Sueño/complicaciones , Veteranos/estadística & datos numéricos , Veteranos/psicología , Trastornos del Inicio y del Mantenimiento del Sueño/terapia , Trastornos del Inicio y del Mantenimiento del Sueño/complicaciones , Masculino , Femenino , Persona de Mediana Edad , Conmoción Encefálica/complicaciones , Conmoción Encefálica/terapia , Estados Unidos , Adulto , Investigación Cualitativa , United States Department of Veterans Affairs
15.
Contemp Clin Trials ; 141: 107525, 2024 06.
Artículo en Inglés | MEDLINE | ID: mdl-38604497

RESUMEN

BACKGROUND: Individuals with a history of moderate-severe traumatic brain injury (TBI) experience a significantly higher prevalence of insomnia compared to the general population. While individuals living with TBI have been shown to benefit from traditional insomnia interventions (e.g., face-to-face [F2F]), such as Cognitive Behavioral Therapy for Insomnia (CBTI), many barriers exist that limit access to F2F evidence-based treatments. Although computerized CBT-I (CCBT-I) is efficacious in terms of reducing insomnia symptoms, individuals with moderate-severe TBI may require support to engage in such treatment. Here we describe the rationale, design, and methods of a randomized controlled trial (RCT) assessing the efficacy of a guided CCBT-I program for reducing insomnia symptoms for participants with a history of moderate-severe TBI. METHODS: This is an RCT of a guided CCBT-I intervention for individuals with a history of moderate-severe TBI and insomnia. The primary outcome is self-reported insomnia severity, pre- to post-intervention. Exploratory outcomes include changes in sleep misperception following CCBT-I and describing the nature of guidance needed by the Study Clinician during the intervention. CONCLUSION: This study represents an innovative approach to facilitating broader engagement with an evidence-based online treatment for insomnia among those with a history of moderate-severe TBI. Findings will provide evidence for the level and nature of support needed to implement guided CCBT-I. Should findings be positive, this study would provide support for a strategy by which to deliver guided CCBT-I to individuals with a history of moderate-severe TBI.


Asunto(s)
Lesiones Traumáticas del Encéfalo , Terapia Cognitivo-Conductual , Trastornos del Inicio y del Mantenimiento del Sueño , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Lesiones Traumáticas del Encéfalo/complicaciones , Lesiones Traumáticas del Encéfalo/terapia , Terapia Cognitivo-Conductual/métodos , Trastornos del Inicio y del Mantenimiento del Sueño/terapia , Trastornos del Inicio y del Mantenimiento del Sueño/etiología , Ensayos Clínicos Controlados Aleatorios como Asunto
16.
Chronobiol Int ; 40(2): 204-214, 2023 02.
Artículo en Inglés | MEDLINE | ID: mdl-36369785

RESUMEN

Bright light therapy (BLT) is a promising non-pharmacological treatment for a range of psychiatric conditions. The goal of this review was to provide a comprehensive overview of the efficacy of BLT across mental and behavioral illnesses. Using systematic umbrella review methodology, we searched Ovid MEDLINE, Embase, PsycInfo, Web of Science, and Google Scholar for systematic reviews of randomized controlled trials (RCTs) evaluating BLT for any mental or behavioral illness from the date of inception until March 2021. Review quality was assessed using the AMSTAR 2 tool and summary efficacy data were extracted from recent reviews. Of 792 unique records, 67 systematic reviews were included which targeted a range of disorders related to mood, neurocognition, sleep, and eating. Recent meta-analyses targeting seasonal or non-seasonal depression found that BLT outperformed light-related control conditions. Reviews of other disorders identified few RCTs and generally did not support the efficacy of BLT for various outcomes. Overall, the extant literature supports the efficacy of BLT for seasonal and non-seasonal depression, although higher quality systematic reviews are needed to increase confidence in these findings. There was no specific funding for this review, and it was preregistered on Prospero (ID: CRD42021240751).


Asunto(s)
Ritmo Circadiano , Trastornos Mentales , Humanos , Fototerapia/métodos , Sueño , Revisiones Sistemáticas como Asunto
17.
Obstet Gynecol ; 141(1): 15-21, 2023 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-36701606

RESUMEN

The U.S. Supreme Court's 2022 ruling in Dobbs v Jackson Women's Health Organization held that the U.S. Constitution does not confer the right to an abortion, which set into motion an overhaul of reproductive health care services in certain states. Health care professionals are now operating within a rapidly changing landscape of clinical practice in which they may experience conflict between personal and professional morals (eg, bodily autonomy, patient advocacy), uncertainty regarding allowable practices, and fear of prosecution (eg, loss of medical license) related to reproductive health care services. The ethical dilemmas stemming from Dobbs create a context for exposure to potentially morally injurious events, moral distress, and moral injury (ie, functional impairment stemming from exposure to moral violations) among health care professionals. Considerations related to clinical intervention and approaches to policy are reviewed. Early identification of health care professionals' potentially morally injurious event exposure related to restricted reproductive services is critical for preventing and intervening on moral injury, with implications for improving functioning and retention within the medical field.


Asunto(s)
Aborto Inducido , Trastornos por Estrés Postraumático , Femenino , Humanos , Embarazo , Principios Morales , Políticas , Trastornos por Estrés Postraumático/etiología , Salud de la Mujer
18.
Psychol Trauma ; 15(1): 131-139, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35816586

RESUMEN

OBJECTIVE: Kibler et al. (2009) reported that hypertension was related to PTSD independent of depression. These two conditions have significant diagnostic overlap. The present study sought to conceptually replicate this work with a veteran sample, using Bayesian estimation to directly update past results, as well as examine symptom severity scores in relation to hypertension. METHOD: This was a secondary analysis of data obtained from the United States-Veteran Microbiome Project. Lifetime diagnoses of PTSD and major depressive disorder (MDD) were obtained from a structured clinical interview and hypertension diagnoses were extracted from electronic medical records. PTSD and depressive symptom severity were obtained from self-report measures. Logistic regressions with Bayesian estimation were used to estimate the associations between hypertension and (a) psychiatric diagnostic history and (b) symptom severity scores. RESULTS: Compared with veterans without lifetime diagnoses of either disorder, the PTSD-only group was estimated to have a 29% increase in hypertension risk, and the PTSD + MDD group was estimated to have a 66% increase in hypertension risk. Additionally, higher levels of PTSD symptom severity were associated with a higher risk of hypertension. CONCLUSION: PTSD diagnosis and symptom severity are uniquely associated with hypertension, independent of MDD or depressive symptom severity. These results support previous findings that PTSD might be a modifiable risk factor for the prevention and treatment of hypertension. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Asunto(s)
Trastorno Depresivo Mayor , Hipertensión , Trastornos por Estrés Postraumático , Veteranos , Humanos , Estados Unidos/epidemiología , Trastornos por Estrés Postraumático/psicología , Veteranos/psicología , Teorema de Bayes , Trastorno Depresivo Mayor/epidemiología , Comorbilidad , Hipertensión/epidemiología
19.
Psychol Trauma ; 15(1): 121-130, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35862085

RESUMEN

OBJECTIVE: Bayesian meta-analyses offer several advantages over traditional approaches, including improved accuracy when using a small number of studies and enhanced estimation of heterogeneity. However, psychological trauma research has yet to see widespread adoption of these statistical methods, potentially due to researchers' unfamiliarity with the processes involved. The purpose of this article is to provide a practical tutorial for conducting random-effects Bayesian meta-analyses. METHOD: Explanations and recommendations are provided for completing the primary steps of a Bayesian meta-analysis, ranging from model specification to interpretation of results. Furthermore, an illustrative example is used to demonstrate the application of each step. In the example, results are synthesized from six studies included in a previously published systematic review (Holliday et al., 2020), with a combined sample size of 21,244,109, examining the association between posttraumatic stress disorder and risk of suicide in veterans and military personnel. RESULTS: The posterior distributions for each model estimate, such as the pooled effect size and the heterogeneity parameter, are discussed and interpreted with regard to the probability of increased suicide risk. CONCLUSIONS: Our hope is that this tutorial, along with the provided data and code, facilitate the use of Bayesian meta-analyses in the study of psychological trauma. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Asunto(s)
Trauma Psicológico , Suicidio , Humanos , Teorema de Bayes , Personal Militar , Veteranos , Metaanálisis como Asunto , Revisiones Sistemáticas como Asunto
20.
Psychiatr Serv ; 74(2): 206-209, 2023 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-36039552

RESUMEN

The U.S. Veterans Health Administration developed a suicide prediction statistical model and implemented a novel clinical program, Recovery Engagement and Coordination for Health-Veterans Enhanced Treatment (REACH VET). This high-value suicide prevention program aims to efficiently identify patients at risk and connect them with care. Starting in April 2017, national REACH VET metric data were collected from electronic health records to evaluate required task completion. By October 2020, 98% of veterans identified (N=6,579) were contacted by providers and had their care evaluated. In the nation's largest health care system, it was feasible to implement a clinical program based on a suicide prediction model.


Asunto(s)
Suicidio , Veteranos , Estados Unidos , Humanos , Salud de los Veteranos , United States Department of Veterans Affairs , Prevención del Suicidio
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