Measurement-based care: Use of the Beck Anxiety Inventory (BAI) in a veteran population.

The Beck Anxiety Inventory (BAI) is widely used within the Veterans Health Administration (VHA), both as an assessment tool and as a part of measurement-based care practices. However, there is preliminary evidence that the BAI may perform uniquely in veteran samples, emphasizing the need for a comprehensive investigation of the BAI in this population. The present study compared the normative data reported by Beck and Steer (1993) to secondary data generated by a nationwide sample of U.S. military veterans receiving treatment through the VHA. Secondary data, including initial BAI scores, demographic characteristics, treatment location, and diagnoses originally recorded during the course of usual VHA care over a 5-year period for 57,088 individual veterans, were extracted through the VA Informatics and Computing Infrastructure. BAI scores were compared across samples and various veteran subgroups. Exploratory and confirmatory factor analyses were also conducted. Results revealed that the BAI performed similarly across veteran and normative samples. Male and older veterans were found to have lower BAI scores than their respective counterparts. Factor analyses indicated that a three-factor model best fit the veteran data. Additionally, a cut score of 18 best differentiated between veterans with and without anxiety and related disorders. This study helps support the use of the BAI as a reliable and valid instrument for assessing anxiety symptoms in veterans. Additional research is recommended to better guide BAI interpretation across age groups and sexes/genders. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Daily Drinking Is Associated with Increased Mortality.

BACKGROUND: There is evidence that low-level alcohol use, drinking 1 to 2 drinks on occasion, is protective for cardiovascular disease, but increases the risk of cancer. Synthesizing the overall impact of low-level alcohol use on health is therefore complex. The objective of this paper was to examine the association between frequency of low-level drinking and mortality. METHODS: Two data sets with self-reported alcohol use and mortality follow-up were analyzed: 340,668 individuals from the National Health Interview Survey (NHIS) and 93,653 individuals from the Veterans Health Administration (VA) outpatient medical records. Survival analyses were conducted to evaluate the association between low-level drinking frequency and mortality. RESULTS: The minimum risk drinking frequency among those who drink 1 to 2 drinks per occasion was found to be 3.2 times weekly in the NHIS data, based on a continuous measure of drinking frequency, and 2 to 3 times weekly in the VA data. Relative to these individuals with minimum risk, individuals who drink 7 times weekly had an adjusted hazard ratio (HR) of all-cause mortality of 1.23 (p < 0.0001) in the NHIS data, and individuals who drink 4 to 7 times weekly in the VA data also had an adjusted HR of 1.23 (p = 0.01). Secondary analyses in the NHIS data showed that the minimum risk was drinking 4 times weekly for cardiovascular mortality, and drinking monthly or less for cancer mortality. The associations were consistent in stratified analyses of men, women, and never smokers. CONCLUSIONS: The minimum risk of low-level drinking frequency for all-cause mortality appears to be approximately 3 occasions weekly. The robustness of this finding is highlighted in 2 distinctly different data sets: a large epidemiological data set and a data set of veterans sampled from an outpatient clinic. Daily drinking, even at low levels, is detrimental to one's health.

Examining the performance of the brief addiction monitor.

The Center for Excellence in Drug Abuse Treatment and Education (Center for Excellence in Substance Abuse Treatment and Education (CESATE; 2010). Brief Addiction Monitor: Manual of Operations. Philadelphia, PA) recently suggested that Veterans Affairs' (VA) addictions treatment programs, in order to encourage measurement based care, begin using a new measure of substance abuse, the Brief Addictions Monitor (BAM). To date, only one study Caccolia et al, 2013. Development and initial evaluation of the Brief Addiction Monitor (BAM). Journal of Substance Abuse Treatment, 44, 256-63. doi: http://dx.doi.org/10.1016/j.jsat.2012.07.013) has examined the psychometric properties of a version of this instrument. However, this study did not use the version of the BAM currently available to most VA providers via the mental health assistant software; rather, the authors reported the properties of a BAM where most of the items had continuous (or near continuous) response options. The current study seeks to provide data on the version of the BAM which uses 5 point Likert scale response options for its questions, the version available on the mental health assistant software. Based on data from more than 700 veterans enrolled in out-patient (OP) and in-patient (IP) addictions treatment programs, this study examined the factor structure, reliability, and validity of this version of the BAM. Across both groups, results suggested that the BAM lacked a reliable factor structure, in contrast to the findings from the earlier study. However, a single scale, composed of a minority of items on the BAM, showed promise. A minority of the items (five) provided valid information across both OP and IP samples when applied individually, as indicated by convergent and divergent validity comparisons with other measures of functioning; tracking changes in functioning over the course of treatment; and correlating with changes in convergent and divergent validity measures. This partially supported the CESATE (CESATE; 2010). Brief Addiction Monitor: Manual of Operations. Philadelphia, PA) call to use the individual BAM items. Overall, results suggested that changing the structure of the response options may have had a negative impact on the psychometric properties of the BAM.

Evaluation of a Shortened South Oaks Gambling Screen in veterans with addictions.

Rates of pathological gambling have increased with the availability of legalized gambling. Substance-abuse units increasingly recognize the need to assess for gambling problems. The South Oaks Gambling Screen (SOGS; H. R. Lesieur & S. B. Blume, 1987) has filled this need. Previous research (M. Oehlert & K. Nelson, 2004) has considered the feasibility of reducing the length of the SOGS while maintaining its ability to identify people at risk for problematic gambling. In this study, the authors examined the utility of a shortened SOGS (SSOGS) in a 2nd sample of veterans with addictions. The authors used data analysis to explore SSOGS psychometric properties and to provide additional support for use of the shorter instrument.