Risk factors for acute mental health symptoms and tobacco initiation in Coast Guard Responders to the Deepwater Horizon oil spill.

Acute mental health symptoms experienced during oil spill response work are understudied, especially among nonlocal responders. We assessed potential risk factors for acute mental health symptoms and tobacco initiation among U.S. Coast Guard responders to the 2010 Deepwater Horizon (DWH) oil spill who completed a deployment exit survey. Cross-sectional associations among responder characteristics, deployment-related stressors (deployment duration, timing, crude oil exposure, physical symptoms, injuries), and professional help-seeking for stressors experienced with concurrent depression/anxiety and tobacco initiation were examined. Log-binomial regression was used to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals. Sensitivity analyses excluded responders with a history of mental health conditions using health encounter data from the Military Health System Data Repository. Of the 4,855 responders, 75.5% were deployed from nonlocal/non-Gulf home stations, 5.8% reported concurrent depression and anxiety, and 2.8% reported the initiation of any tobacco product during oil spill response. Self-report of concurrent depression and anxiety was more prevalent among female responders and positively associated with longer deployments, crude oil exposure via inhalation, physical symptoms and injuries, and professional help-seeking during deployment, aPRs = 1.54-6.55. Tobacco initiation was inversely associated with older age and officer rank and positively associated with deployment-related stressors and depression/anxiety during deployment, aPRs = 1.58-4.44. Associations remained robust after excluding responders with a history of mental health- and tobacco-related health encounters up to 3 years before deployment. Depression, anxiety, and tobacco initiation were cross-sectionally associated with oil spill response work experiences among DWH responders, who largely originated outside of the affected community.

Primary Care Behavioral Health (PCBH) Model Research: Current State of the Science and a Call to Action.

The Primary Care Behavioral Health (PCBH) model of service delivery is being used increasingly as an effective way to integrate behavioral health services into primary care. Despite its growing popularity, scientifically robust research on the model is lacking. In this article, we provide a qualitative review of published PCBH model research on patient and implementation outcomes. We review common barriers and potential solutions for improving the quantity and quality of PCBH model research, the vital data that need to be collected over the next 10 years, and how to collect those data.

Integration of behavioral health and primary care: current knowledge and future directions.

Integrated behavioral health in primary care has spread rapidly over the past three decades, although significant questions remain unanswered regarding best practices in clinical, financial and operational worlds. Two key models have emerged over time: care management and Primary Care Behavioral Health. Research to date has been promising; however, there is a significant need for more sophisticated multi-level scientific methodologies to fill in the gaps in current knowledge of integrated primary care. In this paper, we summarize current scientific knowledge about integrated primary care and critically evaluate the strengths and weaknesses of this knowledge base, focusing on clinical, financial and operational factors. Finally, we recommended priorities for future research, dissemination, real-world implementation, and health policy implications.

Tipping points in the Department of Defense's experience with psychologists in primary care.

Psychologists played a crucial role in the successful implementation of integrated behavioral health care services in Department of Defense (DoD) primary care clinics. On the front lines of policy development, training programs, clinical care, and program evaluations, psychologists successfully promoted integrated care as a core component of the DoD patient-centered medical home. We review the development of integrated care and discuss the roles of psychologists in the DoD to provide an exemplar of the impact psychologists can have on the implementation and sustainment of integrated care.

Operational and clinical components for integrated-collaborative behavioral healthcare in the patient-centered medical home.

Behavioral healthcare will be an essential piece of meeting the patient-centered medical home (PCMH) principles of easy access and whole person, coordinated, and integrated care as primary care clinics transform themselves into PCMHs. As this transformation occurs, PCMH clinic staff and behavioral health providers must carefully consider how to adapt their operations to include the provision of integrated-collaborative behavioral health services within the PCMH. Without this careful consideration, integrated-collaborative behavioral healthcare will likely fail to reach its full potential. We discuss the operational and clinical components that appear to be important for success when integrating behavioral healthcare into the PCMH.

Transfer of heart rate feedback training to reduce heart rate response to laboratory tasks.

To examine whether transfer of heart rate (HR) feedback training to tasks not used during training could be improved by using multiple tasks during training, a modified multiple baseline across tasks, single subject design study was conducted using six high HR-reactive young adults. Participants received HR feedback training during the presentation of a videogame, and transfer of training was assessed to a mental arithmetic challenge and handgrip task. Transfer of training was next assessed following training with the mental arithmetic challenge and handgrip task. HR responses to each training task with no HR feedback were assessed during a pre-treatment session, an immediate post-training period following training on each task, a short delay (1-2 days) post-training session, and a long delay (1-2 weeks) post-training session. HR response to a novel speech task was assessed at pre-treatment and during short delay and long delay post-training sessions. Results revealed that participants reduced HR during training and generally maintained this reduction in HR during the immediate post-training assessment when HR feedback was not present. Participants were not able to reduce HR responses to tasks during short delay and long delay post-training sessions, and they were unable to transfer HR reduction skills to the speech task. Transfer of HR feedback training to new tasks was limited in nature and efforts to train across multiple stressors did not appear to improve transfer of training.