Alcohol use and craving among Veterans with mental health disorders and mild traumatic brain injury.

Mental health disorders (MHDs), mild traumatic brain injury (mTBI), and alcohol use disorder (AUD) are endemic among recent Veterans, resulting in a population with heterogeneous, co-occurring conditions. While alcohol craving negatively affects rehabilitation and leads to relapse, no studies have examined alcohol craving among Veterans with co-occurring MHDs and mTBI. The purpose of this preliminary cohort study is to describe alcohol craving in a convenience sample of Iraq and Afghanistan Veterans (n = 48), including those exposed to traumatic events and experiencing active symptoms. Veterans completed weekly telephone interviews that included the Alcohol Use Disorder Identification Test, consumption questions (AUDIT-C) (week 1) and the Penn Alcohol Craving Scale (PACS) (weeks 1-6). Sixty percent of the sample screened positive on the AUDIT-C for probable AUD. Using Rasch analysis, the person separation reliability of the PACS was strong (0.87) among AUDIT-C positive Veterans. Higher PACS scores were reported among AUDIT-C positive versus AUDIT-C negative Veterans (mixed effects analysis, p < 0.001). PACS scores were higher among AUDIT-C positive Veterans with MHDs with and without mTBI versus AUDIT-C positive combat comparison Veterans (pairwise comparison, p < 0.001). Rates of hazardous alcohol use are high among Iraq and Afghanistan conflict Veterans and suggest that alcohol craving is elevated among those with MHDs with and without mTBI.

Diagnostic accuracy studies in mild traumatic brain injury: a systematic review and descriptive analysis of published evidence.

OBJECTIVES: To synthesize evidence and report findings from a systematic search and descriptive analysis of peer-reviewed published evidence of the accuracy of tests used for diagnosing mild traumatic brain injury (mTBI). The article also summarizes points of concurrence and divergence regarding case definitions of mTBI identified during the review. TYPE: Systematic review and descriptive analysis of published evidence. LITERATURE SURVEY: A search of PubMed, PsychInfo, and the Cochrane Library for peer-reviewed publications between 1990 and July 6, 2011, identified 1218 abstracts; 277 articles were identified for full review, and 13 articles met the criteria for evaluation. METHODOLOGY: Manuscript inclusion criteria were (1) reported sensitivity (Se) and specificity (Sp), or reported data were sufficient to compute Se and Sp; (2) >1 participant in the study; (3) at least 80% of the study cohort was ≥18 years of age; and (4) written in English. Articles describing clinical practice guidelines, opinions, theories, or clinical protocols were excluded. Seven investigators independently evaluated each article according to the Standards for Reporting of Diagnostic Accuracy (STARD) criteria. SYNTHESIS: Findings indicate that all 13 studies involved civilian noncombat populations. In 7 studies, authors examined acute mTBI, and in 4 studies, historical remote mTBI was examined. In the 13 studies, Se ranged from 13%-92% and Sp ranged from 72%-99%, but confidence in these findings is problematic because the STARD review indicates opportunities for bias in each study. CONCLUSIONS: Findings indicate that no well-defined definition or clinical diagnostic criteria exist for mTBI and that diagnostic accuracy is currently insufficient for discriminating between mTBI and co-occurring mental health conditions for acute and historic mTBI. Findings highlight the need for research examining the diagnostic accuracy for acute and historic mTBI.

Evaluating psychometric properties of a clinical and a self-report blind rehabilitation outcome measure.

This study assessed the psychometric properties and evaluated the compatibility of two blind and low-vision rehabilitation outcome instruments, the VA-13 and the Functional Assessment of Self-Reliance on Tasks (FAST). Legally blind veterans (N = 190) from a Department of Veterans Affairs inpatient blind rehabilitation center completed the VA-13 (a retrospective pretest and posttest) at 6 weeks postdischarge. Clinicians rated veterans on the FAST at admission and discharge. The psychometric properties of the two instruments and their compatibility were evaluated with the use of a Rasch model analysis. The two instruments functioned consistently as screens and showed a ceiling effect at posttest; however, the VA-13 showed poor sensitivity to change. In contrast, the FAST showed more reliable change, but a few items changed in unexpected ways. Our conclusions show that the two instruments are currently not compatible for calibration; however, this can be improved with proper attention to scaling inadequacies, test administration times, and content coverage.