Development of a Tool to Predict Risk of Behavioral Health Evacuation From Combat.

In the present study, we examined administrative data on 667,437 deployments of at least 30 days duration to Iraq and Afghanistan from 2011 through the end of 2016 to determine risk factors for evacuation from the combat zone for behavioral health reasons. Demographic data, military-specific data, responses on predeployment mental health assessments, and presence of previous treatment for psychiatric conditions were entered into a logistic regression based on expert determination, distinguishing the 2,133 behavioral health evacuations from those deployments that either did not end in evacuation or included evacuations for reasons other than behavioral health. The model, derived from a random half of the sample (training set), was verified on the other half (validation set). Predictor variables used in the model were calendar year; gender; age; rank; marital status; parental status; number of prior war zone deployments; branch of service; screens for symptoms of posttraumatic stress disorder, depression, and hazardous alcohol use on the predeployment mental health assessment; and prior substance- and non-substance-related behavioral health diagnoses. Odds ratios (range: 1.05-3.85) for selected variables that contributed to the model were used to assign risk scores in the Behavioral Health Evacuation Risk Tool, which can aid predicting which service members are more likely to be evacuated from combat for behavioral health reasons, thus indicating where resources can be allocated for behavioral health referrals and war zone care.

Accelerated resolution therapy: an innovative mental health intervention to treat post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is a disabling trauma and stress-related disorder that may occur after a person experiences a traumatic event, and evokes a combination of intrusion and avoidance symptoms, negative alterations in cognitions and mood, and alterations in arousal and reactivity. Accelerated resolution therapy (ART) is an emerging psychotherapy that provides fast and lasting resolution for mental health problems such as PTSD. ART has been shown to achieve a positive result in one to five sessions, typically over a 2-week period, and requires no homework, skills practice or repeated exposure to targeted events. Initial research, including one randomised control trial, has demonstrated that ART interventions can significantly reduce symptoms of psychological trauma in both civilians and US service members and veterans. These results suggest that ART be considered as either a primary treatment option or for refractory PTSD in those with a suboptimal response to endorsed first-line therapies. Conservative estimates indicate substantial potential cost savings in PTSD treatment. Despite the need for more definitive clinical trials, there is increasing interest in ART in the USA, including in the US Army. The growing positive empirical evidence is compelling, and there appears to be sufficient evidence to warrant UK researchers undertaking ART research. The armed forces offer the potential for comparative international trials. However, equally important are veterans, emergency services personnel and those subjected to violence. ART appears to also have application in other conditions, including depression, anxiety disorders, and alcohol or drug misuse. ART can potentially help personnel traumatised by the unique challenges of war and conflict zones by providing brief psychotherapy in a readily accessible and culturally competent manner. ART facilitates the provision of interventions and resolutions in theatre, thus enhancing forces' fighting capability.

[Modern state and prospects of development of medical-and-psychological support of military servicemen of the Armed Forces of the Russian Federation].

The authors analysed state and prospects of medical-and-psychological support of military servicemen, which is supposed to consider as a complex of measures aimed at monitoring of professional psychological health, professional-and-psychological expertise, psychophysiological and pharmacological, correction, and medical-and-psychological rehabilitation. Organisation and maintaince of the above mentioned measures should be carried out by specialists of medical--and-psychological support groups and medical-and-psychological correction.

The Psychiatrist as Leader-Teacher: Promoting Learning Beyond Residency.

In today's fast-paced, data-saturated, zero-tolerance practice environment, psychiatrists and other health care providers are expected to maintain clinical, fiscal, and administrative competence. The authors present a unique type of psychiatric leader­the leader-teacher­who incorporates teaching of these elements into day-to-day practice, enhancing lifelong learning for credentialed staff and increasing their confidence in managing complex clinical and administrative issues. Particular emphasis is placed on leader-teachers working in military environments. The article discusses the primary characteristics of this type of leader, including their tendency to (1) seek clarification, (2) distill information, (3) communicate guidance, and (4) catalogue products. The authors also address the advantages and disadvantages of being a leader-teacher and present several illustrative cases.

[Prospects of IT usage in the field of military psychiatry].

Development of effective information support for monitoring of internal health, based on the principles of complex diagnostics, provides the necessary tools objektive evaluation and prediction of mental health in servicemen. Effectiveness of psychiatric prophylaxys technologies depends on compliance with a number of fundamental principles, the main of which should be considered as a multidimensional assessment of mental health in servicemen and real cooperation of different specialists (commanders, specialists of medical and psychological service) for its implementation. In this case, an introduction of information and communication technologies on the basis of the district (fleet) and the Central Military Hospital, as well as other bodies of military control will be almost justified only when creating a full-fledged "information field of military psychiatry" that implements the basic principles of the monitoring system of mental health and includes necessary infrastructure. The practical implementation of this system will allow to personjfyfy medical and psychological assistance to military personnel, to improve early diagnosis of mental disorders, addictive .and suicidal behaviour, and thus increase the effectiveness throughout psychiatric prophylaxis in the army.

A pilot study of an enhanced mental health assessment during routine and discharge medicals in the British Armed Forces.

OBJECTIVES: A pilot study to assess the practicality of introducing an enhanced mental health assessment (EMHA) into all routine and discharge medicals of the UK Armed Forces in order to facilitate treatment prior to and on return to civilian life. METHODS: A pilot study was conducted using an EMHA questionnaire with questions about depression, anxiety, post-traumatic stress disorder, alcohol use, sleep and anger/irritability. At pilot sites, the EMHA was completed during all routine and discharge medicals between May 2011 and July 2011. At the end of the study period, qualitative data were collected from participating medical officers and practice managers regarding their opinions about the pilot study. RESULTS: The quantitative data revealed an average pick-up rate for mental health (MH) problems. Out of the four military medical centres who participated and the 325 questionnaires collected, one referral to a Department of Community Mental Health was made. 26 (8%) patients were categorised as 'some concern and patient offered advice and/or reassurance'. The vast majority of patients were found to have no evidence of MH problems. However, using a validated alcohol screening tool, 64% of service personnel were found to have a score indicating 'higher risk drinking'. Analysis of the qualitative data suggests that the EMHA is an easy tool to implement with minimal additional time and resources needed. The interviewees pointed out a number of limitations and suggestions for possible further studies. CONCLUSIONS: The pilot study successfully demonstrated that the EMHA questionnaire is easy to administer, does not take up a large amount of additional resources or manpower and provides a useful check of MH status. The study picked up an average number of MH cases and the questions on alcohol consumption highlighted that military personnel may be at a 'higher risk of drinking'.

[Psychology and psychopathology of information warfare].

Tension of information warfare as a form of modern war has a global character nowadays. Topicality of research of psychological reaction peculiarities and psychopathology phenomena developing during information warfare is determined by necessity of scientific development of the effective means of diagnosis and prophylaxis of these phenomena. The article is devoted to analytical review of modern articles about aim, goals and methods of information warfare, covering some signs of manipulative influence on people's mind. Authors set forward opinion about possible psychological peculiarities and psychopathological consequences of targeted aggressive information influence and also suggest some methods against this influence.

What explains post-traumatic stress disorder (PTSD) in UK service personnel: deployment or something else?

BACKGROUND: In previous studies an association between deployment to Iraq or Afghanistan and an overall increased risk for post-traumatic stress disorder (PTSD) in UK armed forces has not been found. The lack of a deployment effect might be explained by including, in the comparison group, personnel deployed on other operations or who have experienced traumatic stressors unrelated to deployment. METHODS: The sample comprised 8261 regular UK armed forces personnel who deployed to Iraq, Afghanistan or other operational areas or were not deployed. Participants completed the PTSD CheckList-Civilian Version (PCL-C) and provided information about deployment history, demographic and service factors, serious accidents and childhood experiences. RESULTS: Deployment to Iraq or Afghanistan [odds ratio (OR) 1.2, 95% confidence interval (CI) 0.6-2.2] or elsewhere (OR 1.1, 95% CI 0.6-2.0) was unrelated to PTSD although holding a combat role was associated with PTSD if deployed to Iraq or Afghanistan (OR 2.7, 95% CI 1.9-3.9). Childhood adversity (OR 3.3, 95% CI 2.1-5.0), having left service (OR 2.7, 95% CI 1.9-4.0) and serious accident (OR 2.1, 95% CI 1.4-3.0) were associated with PTSD whereas higher rank was protective (OR 0.3, 95% CI 0.12-0.76). CONCLUSIONS: For the majority of UK armed forces personnel, deployment whether to Iraq, Afghanistan or elsewhere confers no greater risk for PTSD than service in the armed forces per se but holding a combat role in those deployed to Iraq or Afghanistan is associated with PTSD. Vulnerability factors such as lower rank, childhood adversity and leaving service, and having had a serious accident, may be at least as important as holding a combat role in predicting PTSD in UK armed forces personnel.

Military sexual trauma as a determinant in the development of mental and physical illness in male and female veterans.

BACKGROUND: Military Sexual Trauma (MST) is defined as sexual harassment and or sexual assault experienced by a military service member. It is much more widespread and common than reported. It is associated with pre-combat traumatic experiences and pathologic sequelae including mental and medical illness. METHODS: An electronic search of the major behavioral science databases was conducted to retrieve studies detailing the social, epidemiological and clinical characteristics of MST and its relationship to psychiatric and medical illness. RESULTS: Studies indicate that military sexual trauma is related to an increase in psychiatric pathology, including posttraumatic stress disorder (PTSD), substance abuse and dependence, depression, anxiety, eating disorders and suicidal behavior. MST is also related to an increase in medical illness, primarily pain-related symptoms involving multiple organ systems, including gastrointestinal, neurological, genitourinary and musculoskeletal. CONCLUSION: MST is associated with an increased prevalence of mental and physical illness. Although there are some gender differences in the reported rates of MST and there may be some variables, such as prior traumatic experiences, that may make an individual more vulnerable to the psychiatric and medical sequela of MST, it is clear that MST is a major healthcare issue that affects both sexes and warrants further attention and an increase in clinical resources devoted to it. Some preventive measures for decreasing the prevalence of MST may include increasing education and legal prosecution of perpetrators in the military, and increasing access to mental health services for individuals who have suffered from MST.

Challenges, solutions, and best practices in telemental health service delivery across the pacific rim-a summary.

The Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Materiel Command, in conjunction with the American Telemedicine Association's Annual Mid-Year Meeting, conducted a 1-day workshop on how maturing and emerging processes and applications in the field of telemental health (TMH) can be expanded to enhance access to behavioral health services in the Pacific Rim. The purpose of the workshop was to bring together experts in the field of TMH from the military, federal agencies, academia, and regional healthcare organizations serving populations in the Pacific Rim. The workshop reviewed current technologies and systems to better understand their current and potential applications to regional challenges, including the Department of Defense and other federal organizations. The meeting was attended by approximately 100 participants, representing military, government, academia, healthcare centers, and tribal organizations. It was organized into four sessions focusing on the following topic areas: (1) Remote Screening and Assessment; (2) Post-Deployment Adjustment Mental Health Treatment; (3) Suicide Prevention and Management; and (4) Delivery of Training, Education, and Mental Health Work Force Development. The meeting's goal was to discuss challenges, gaps, and collaborative opportunities in this area to enhance existing or create new opportunities for collaborations in the delivery of TMH services to the populations of the Pacific Rim. A set of recommendations for collaboration are presented.

Development and testing of virtual reality exposure therapy for post-traumatic stress disorder in active duty service members who served in Iraq and Afghanistan.

This study was an open-label, single-group, treatment-development project aimed at developing and testing a method for applying virtual reality exposure therapy (VRET) to active duty service members diagnosed with combat post-traumatic stress disorder (PTSD). Forty-two service members with PTSD were enrolled, and 20 participants completed treatment. The PTSD Checklist-Military version, Patient Health Questionnaire-9 for depression, and the Beck Anxiety Inventory were used as outcome measures. Of those who completed post-treatment assessment, 75% had experienced at least a 50% reduction in PTSD symptoms and no longer met DSM-IV criteria for PTSD at post treatment. Average PSTD scores decreased by 50.4%, depression scores by 46.6%, and anxiety scores by 36%. Intention-to-treat analyses showed that statistically significant improvements in PTSD, depression, and anxiety occurred over the course of treatment and were maintained at follow up. There were no adverse events associated with VRET treatment. This study provides preliminary support for the use of VRET in combat-related PTSD. Further study will be needed to determine the wider utility of the method and to determine if it offers advantages over other established PTSD treatment modalities.

[Peculiarities of adaptation of servicemen service].

Review of issues about the adaptation of servicemen in the process of military service is presented. Characteristics of military service, conditions and levels of official-military activity, peculiarities of adaptation, factors providing progression of psychosomatic diseases and dysaptation, concept "occupational health" are considered.

[Clinical-diagnostic aspects of post-traumatic combat stress disorders].

Article is devoted to the clinical description of fighting posttraumatic stress disorder, and also questions of their early diagnostics in the conditions of military unit. The characteristics of the basic clinical variants of posttraumatic stress disorder and postfighting personal changes at combatants are resulted. Concept substantive provisions "combatant accentuation" is stated the person. It is underlined necessity of the earliest rendering of the mediko-psychological (psychotherapeutic) help to the military men who have transferred fighting stress.

[Peculiarities of mental disorders and evaluation of life quality in military personnel wounded in local military conflicts].

The goal of research is the study of the peculiarities of clinico- psychopathologic varients of development of mental disorders and life quality in military personnel, wounded in local military conflicts in conditions of multidisciplinary military hospital. 317 patients aged 19-45 with mine-explosive wounds got in the Chechen Republic and Dagestan were examined. Analysis performed in early and secondary post stress period showed the predominance of border-line psychopathologic disorders and detected some peculiarities.

[Mental disorders in young serviceman with cardiological emergencies].

Investigated 82 young servicemen with cardiological emergencies (acute cardiac syndrome, hypertension events, rhythm pace disturbance). Divided three periods of mental disorders: acute, subacute and long-term effects. Found that in 95.1% of patients after emergencies developed state of mental maladaptation of varying degree. In further 47.1% of cases of mental disorders place in the form of psychogenic and somatogenically caused disorders of prenosological level. Among clinically executed forms predominated depressive disorder spectrum (nozogennye reaction and state). In the remote period prevailed somatoform dysfunction and manifestations of personality pathology. Shows the clinical and psychopathological features of these disorders and their effects on military service.

Predictors of Suicide Attempt Within 30 Days After First Medically Documented Suicidal Ideation in U.S. Army Soldiers.

OBJECTIVE: The authors sought to identify predictors of imminent suicide attempt (within 30 days) among U.S. Army soldiers following their first documented suicidal ideation. METHODS: Using administrative data from the Army Study to Assess Risk and Resilience in Servicemembers, the authors identified 11,178 active-duty Regular Army enlisted soldiers (2006-2009) with medically documented suicidal ideation and no prior medically documented suicide attempts. The authors examined risk factors for suicide attempt within 30 days of first suicidal ideation using logistic regression analyses, including sociodemographic and service-related characteristics, psychiatric diagnoses, physical health care visits, injuries, and history of family violence or crime perpetration or victimization. RESULTS: Among soldiers with first documented suicidal ideation, 830 (7.4%) attempted suicide, 46.3% of whom (N=387) attempted suicide within 30 days (rate, 35.4 per 1,000 soldiers). Following a series of multivariate analyses, the final model identified females (odds ratio=1.3, 95% CI=1.0, 1.8), combat medics (odds ratio=1.6, 95% CI=1.1, 2.2), individuals with an anxiety disorder diagnosis prior to suicidal ideation (odds ratio=1.3, 95% CI=1.0, 1.6), and those who received a sleep disorder diagnosis on the same day as the recorded suicidal ideation (odds ratio=2.3, 95% CI=1.1, 4.6) as being more likely to attempt suicide within 30 days. Black soldiers (odds ratio=0.6, 95% CI=0.4, 0.9) and those who received an anxiety disorder diagnosis on the same day as suicidal ideation (odds ratio=0.7, 95% CI=0.5, 0.9) were less likely. CONCLUSIONS: Suicide attempt risk is highest in the first 30 days following ideation diagnosis and is more likely among women, combat medics, and soldiers with an anxiety disorder diagnosis before suicidal ideation and a same-day sleep disorder diagnosis. Black soldiers and those with a same-day anxiety disorder diagnosis were at decreased risk. These factors may help identify soldiers at imminent risk of suicide attempt.

So you think you're bulletproof: Development and validation of the Invincibility Belief Index (IBI).

Risk-taking propensity can be influenced by sensation-seeking traits and self-perceived invincibility. We hypothesized that the latter factor may reflect a stable trait that endures across situations and may influence risk-taking behavior. We developed and validated a 20-item scale, the Invincibility Belief Index (IBI) to measure this construct. The IBI demonstrated good internal consistency and excellent test-retest reliability in the development sample (n = 100) and sustained similar levels of reliability in a cross-validation sample (n = 74). Principal components analysis yielded three orthogonal factors measuring self-perceived impunity (immunity from consequences), boldness/audacity (self-assuredness and competitiveness), and adroitness (mental agility and survival skill). In the prediction of risk taking, IBI scores contributed additional unique variance beyond sensation-seeking scores alone. IBI scores demonstrated convergent and discriminant validity with concurrently administered measures. These preliminary results support the reliability and validity of the IBI as a brief measure of self-perceived vulnerability-invincibility in the face of adversity.

Stress Gym: Feasibility of deploying a web-enhanced behavioral self-management program for stress in a military setting.

Stress and depression can adversely impact the performance of military personnel. Cognitive-behavioral (CBT) interventions for managing stress are efficacious in traditional face-to-face formats, but the Internet supports a broader reach of these programs. This study reports on the feasibility of using an Internet-based self-help stress-management intervention in military personnel. There were 142 officers/enlisted sailors at a Naval Medical Center who completed the program. Evaluation of the program titled "Stress Gym" was positive for the user interface, content, feasibility, and satisfaction. Positive evaluation was not influenced by rank/status, sex, or previous deployment. Stress ratings also decreased significantly while using the program. These data support Stress Gym as being an online CBT-based self-help intervention that is feasible to deploy, accepted by the intended end users, and demonstrates the intended goal of reducing stress.

One Shot-One Kill: a culturally sensitive program for the warrior culture.

Despite efforts to reduce the stigma of mental health services across branches of the United States military, lasting change among this warrior culture remains an uphill battle. Difficulty affecting change can be attributed in part to stigma associated with psychological services and largely, mental health providers' difficulty tailoring traditional models of treatment to military personnel. We will discuss the development of One Shot - One Kill (OSOK), a culturally sensitive mental health prevention program piloted to reduce stigma and improve help seeking behaviors among the warrior culture. Three hundred and twenty military members completed the OSOK performance enhancement and resiliency program piloted at Tallil, Iraq in 2008. Pilot data were collected to assess military members' perceptions of the training program. Results indicated positive responses demonstrating the OSOK program as a culturally sound program that could increase help seeking behaviors among military members.

Evaluation of the Military Acute Concussion Evaluation for use in combat operations more than 12 hours after injury.

The diagnosis and management of concussion can be difficult in a combat environment, especially in the absence of loss of consciousness or post-traumatic amnesia. As no validated test exists to diagnose or grade neurocognitive impairment from a concussion, the military currently employs the Military Acute Concussion Evaluation (MACE) in Iraq. This is a two-part test, which incorporates the standardized assessment of concussion (SAC) as its objective score, although it has not been shown to be valid unless administered shortly after injury. A research team deployed to Iraq between January and April 2009 to examine the validity of several tests of neurocognitive function following a concussion, including the MACE. When administered more than 12 hours after the concussive injury, the MACE lacked sufficient sensitivity and specificity to be clinically useful.