Psychosocial Risk Factors and Other Than Honorable Military Discharge: Providing Healthcare to Previously Ineligible Veterans.

INTRODUCTION: In response to a strong focus on suicide prevention for all veterans, the Department of Veterans Affairs (VA) recently revised policy to provide emergency mental healthcare for veterans who received Other Than Honorable (OTH) discharges from the military. This current study takes a preliminary step toward identifying demographic, historic, military, clinical, and social characteristics of veterans with OTH discharges. MATERIALS AND METHODS: N = 1,172 Iraq/Afghanistan-era veterans were evaluated between 2005 and 2016 in the multi-site VA Mid-Atlantic Mental Illness, Research, Education and Clinical Center (MIRECC) Study of Post-Deployment Mental Health (PDMH Study). RESULTS: Veterans with OTH discharges constituted 2.7% of our sample, approximating the estimated rate in the overall U.S. veteran population. Compared to veterans discharged under honorable conditions, veterans with OTH discharges were more likely to be younger and have greater odds of reporting family history of drug abuse and depression. Further, veterans with OTH discharges reported a lower level of social support and were more likely to be single, endorse more sleep problems, score higher on measures of drug misuse, have a history of incarceration, and meet diagnostic criteria for major depressive disorder. A subsequent matching analysis provided further evidence of the association between OTH discharge and two risk factors: drug misuse and incarceration. CONCLUSION: These findings elucidate potential factors associated with veterans with OTH discharges, particularly substance abuse and criminal justice involvement. Results also indicate higher incidence of risk factors that often accompany suicidal ideation and should be a highlighted component of healthcare delivery to this vulnerable cohort of veterans.

Work stressors, depressive symptoms and sleep quality among US Navy members: a parallel process latent growth modelling approach across deployment.

The present study examined whether work stressors contribute to sleep problems and depressive symptoms over the course of deployment (i.e. pre-deployment, post-deployment and 6-month reintegration) among US Navy members. Specifically, we examined whether depressive symptoms or sleep quality mediate the relationships between work stressors and these outcomes. Participants were 101 US Navy members who experienced an 8-month deployment after Operational Enduring Freedom/Operation Iraqi Freedom. Using piecewise latent growth models, we found that increased work stressors were linked to increased depressive symptoms and decreased sleep quality across all three deployment stages. Further, increases in work stressors from pre- to post-deployment contributed to poorer sleep quality post-deployment via increasing depressive symptoms. Moreover, sleep quality mediated the association between increases in work stressors and increases in depressive symptoms from pre- to post-deployment. These effects were maintained from post-deployment through the 6-month reintegration. Although preliminary, our results suggest that changes in work stressors may have small, but significant implications for both depressive symptoms and quality of sleep over time, and a bi-directional relationship persists between sleep quality and depression across deployment. Strategies that target both stress and sleep could address both precipitating and perpetuating factors that affect sleep and depressive symptoms.

Ecological momentary assessment of posttraumatic stress disorder symptoms during a smoking quit attempt.

INTRODUCTION: Smokers with posttraumatic stress disorder (PTSD) tend to lapse more quickly following a quit attempt, which might be explained by changes in PTSD symptoms during a quit attempt. The present study examines changes in PTSD symptoms, negative affect, and craving before and during a quit attempt. METHODS: Participants in this study were 52 smokers with PTSD who completed random-alarm ecological momentary assessments of PTSD symptoms, negative affect, cigarette craving, and smoking behavior throughout a prequit phase of ad hoc smoking, a phase of abstinence from smoking, and a postlapse phase. RESULTS: Relative to the prequit phase, the abstinent phase was marked by decreases in PTSD reexperiencing, avoidance, and numbing clusters (ps ≤ .01). The odds of PTSD symptom or negative affect variability from one reading in the ecological momentary assessment (EMA)to the next reading was decreased in PTSD reexperiencing, avoidance, and numbing clusters (ps ≤ .02). Smoking cravings were also mildly decreased in the abstinent and postlapse phases (ps < .01), although some cravings in both phases were rated at the maximum intensity. Increased craving was predicted by the previous EMA reading of PTSD symptoms. CONCLUSIONS: Results suggested that smoking abstinence is not associated with exacerbation of PTSD symptoms, but PTSD symptoms during abstinence were related to craving levels during the quit attempt.

The Association of Sleep Duration, Mental Health, and Health Risk Behaviors among U.S. Afghanistan/Iraq Era Veterans.

STUDY OBJECTIVES: Short and long sleep duration have been linked with higher rates of comorbid medical and mental health issues, as well as increased mortality. The current study examined the association between sleep duration, mental health problems, and health risk behaviors in a large sample of U.S. Afghanistan/Iraq era veterans. DESIGN: NA. SETTING: Mid-Atlantic VA Medical Center(s). PATIENTS/PARTICIPANTS: The sample (N = 1,640) included 20% women (n = 333) and had an average age of 37 years (SD = 10.0). INTERVENTIONS: NA. MEASUREMENTS AND RESULTS: Results from logistic regression analyses that included age, minority status, gender, military rank, number of deployments, combat exposure, and health risk behaviors as covariates indicated that very short sleep duration (≤ 5 h of sleep) and long sleep duration (≥ 9 h) were each associated with increased odds of current post traumatic stress disorder (PTSD), major depressive disorder (MDD), and smoking; while poor sleep quality was associated with PTSD, panic disorder (PD), MDD, suicidal ideation (SI), and risky drinking. CONCLUSIONS: Sleep duration may be an important marker for psychiatric and health risk behavior problems, and our results suggest that clinical assessment of sleep disturbance in this veteran group is warranted to assess for both short and long sleep. CITATION: Swinkels CM; Ulmer CS; Beckam JC; Buse N; the VA Mid-Atlantic MIRECC Registry Workgroup; Calhoun PS. The association of sleep duration, mental health, and health risk behaviors among U.S. Afghanistan/Iraq era veterans. SLEEP 2013;36(7):1019-1025.

Diagnostic efficiency of the AUDIT-C in U.S. veterans with military service since September 11, 2001.

BACKGROUND: Alcohol screening with the 3-item alcohol use disorders identification test (AUDIT-C) has been implemented throughout the U.S. Veterans Health Administration. Validation of the AUDIT-C, however, has been conducted with samples of primarily older veterans. This study examined the diagnostic efficiency of the AUDIT-C in a younger cohort of veterans who served during Operation Enduring Freedom and/or Operation Iraqi Freedom (OEF/OIF). METHODS: Veteran participants (N=1775) completed the alcohol use disorders identification test (AUDIT) and underwent the structured clinical interview for DSM-IV-TR for Axis I disorders (SCID) in research settings within four VA medical Centers. Areas under receiver operating characteristic curves (AUCs) measured the effiency of the full AUDIT and AUDIT-C in identifying SCID-based diagnoses of past year alcohol abuse or dependence. RESULTS: Both measures performed well in detecting alcohol use disorders. In the full sample, the AUDIT had a better AUC (.908; .881-.935) than the AUDIT-C (.859; .826-.893; p<.0001). It is notable that this same result was found among men but not women, perhaps due to reduced power. Diagnostic efficiency statistics for the AUDIT and AUDIT-C were consistent with results from older veteran samples. The diagnostic efficiency of both measures did not vary with race or age. CONCLUSIONS: Both the AUDIT and AUDIT-C appear to be valid instruments for identifying alcohol abuse or dependence among the most recent cohort of U.S. veterans with service during OEF/OIF within research settings.

The incidence and temporal patterning of insomnia: a pilot study.

To date very little research has been conducted on night-to-night variability in the incidence of insomnia. It is unclear from prior research whether subjects with primary insomnia (PI) exhibit good sleep (or better than average sleep) on some interval basis. In the present study, pilot data are provided on: (1) the frequency with which 'good sleep' occurs in subjects with PI; and (2) whether these events occur in a non-random manner. Ten subjects with PI participated in this 'naturalistic' study. All subjects completed daily sleep diaries for a minimum of 20 days. None of the subjects received treatment for their insomnia during the monitoring period. The night-to-night data were evaluated by typing each night's sleep as 'Good' or 'Bad', and then by determining the number of bad nights that occurred prior to a good night for each subject. Good and bad nights were typed in two ways: (1) using a > or =85% cut-off and (2) using a better than the individual's mean sleep efficiency (idiographic cut-off). Subjects exhibited good sleep on between 29% (>85% criteria) and 55% (idiographic criteria) of the nights evaluated. The temporal patterning analysis (based on an idiographic cut-off) revealed that better than average sleep most frequently occurred (>89% of instances) following one to three nights of poor sleep. These data suggest that insomnia severity may be mediated/moderated by sleep homeostasis and that the homeostat, or input to the homeostat, may be abnormal in patients with PI.