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1.
Gene ; 803: 145898, 2021 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-34391864

RESUMO

Chronic inflammation is a key factor in symptomology and comorbidities of post-traumatic stress disorder (PTSD). Levels of a proinflammatory marker, C-reactive protein (CRP) are increased in individuals with PTSD but it is not clear if this is due to trauma exposure or PTSD. Our study aimed to assess the relationship between serum CRP levels, CRP SNPs, methylation, mRNA expression and PTSD in a homogenous trauma exposed Australian Vietnam veteran cohort. We hypothesized that decreased DNA methylation would be associated with increased gene expression and increased peripheral CRP levels in PTSD patients and that this would be independent of trauma. Participants were 299 Vietnam veterans who had all been exposed to trauma and approximately half were diagnosed with PTSD. We observed higher levels of serum CRP in the PTSD group compared to the non-PTSD group but after controlling for BMI and triglycerides the association did not remain significant. No association was found between CRP SNPs and PTSD or CRP levels. Absent in Melanoma 2 (AIM2) which is a mediator of inflammatory response and a determinant of CRP levels was analysed for DNA methylation and mRNA expression. We observed a trend level association between PTSD and AIM2 methylation after controlling for age, smoking, triglycerides, BMI and cell types. There was no significant interaction between PTSD and CRP levels on AIM2 methylation after controlling for covariates. We observed that as AIM2 methylation levels decreased, AIM2 mRNA expression increased. Elevated CRP levels were associated with AIM2 mRNA in the trauma exposed cohort but there was no significant interaction effect with PTSD. Our results could not confirm that CRP is a marker of PTSD independent of trauma in this group of older veterans. CRP may be a broad marker of disease risk, or a marker of PTSD in younger cohorts than those in this study.


Assuntos
Proteína C-Reativa/genética , Metilação de DNA , Proteínas de Ligação a DNA/genética , Proteínas do Tecido Nervoso/sangue , Proteínas do Tecido Nervoso/genética , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Veteranos/psicologia , Idoso , Austrália , Estudos de Casos e Controles , Epigênese Genética , Estudos de Associação Genética , Humanos , Masculino , Polimorfismo de Nucleotídeo Único , Transtornos de Estresse Pós-Traumáticos/sangue , Transtornos de Estresse Pós-Traumáticos/genética , Regulação para Cima , Guerra do Vietnã
2.
J Consult Clin Psychol ; 89(6): 551-562, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34264702

RESUMO

Though popular across many audiences, engagement with a service dog has undergone limited empirical evaluation as a complementary or alternative treatment for posttraumatic stress disorder (PTSD). The present study took advantage of a service dog training intervention underway in a Department of Veterans Affairs residential PTSD treatment program to perform a within-subjects comparison of a range of phenotypic markers. The present report considers negative and positive affect, assessed throughout the day, contrasting weeks when participants were or were not accompanied by their service dog. Fifty-four veterans were studied for 2-6 weeks. Negative and positive affect were sampled five times per day using items from the Positive and Negative Affect Schedule. Participants also wore a single-patch ECG/activity recorder and slept on beds recording sleep actigraphically. Linear mixed effects regression was employed to estimate the effect of the presence of service dog on momentary affect in the context of other presumable influences. Missing data were managed using methods applicable to random and nonrandom missingness. In this sample, the presence of a service dog was associated with reduced negative and increased positive affect, with both effects diminishing over time. Only negative affect was associated with time in residential treatment, and only positive affect was associated with concurrent heart rate, activity, and the interaction of activity and prior-night actigraphic sleep efficiency. These results concur with prior reports of reduced PTSD symptomology in association with the presence of a service dog, and with the distinct neurocircuitries underlying defensive and appetitive emotion and motivation. Limitations derive from the artificial environment and brief duration of study. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Terapia Assistida com Animais/métodos , Tratamento Domiciliar/métodos , Animais de Trabalho , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos/psicologia , Adulto , Afeto , Animais , Cães , Frequência Cardíaca , Humanos , Pacientes Internados , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Sono
3.
Am J Psychiatry ; 178(10): 932-940, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34256606

RESUMO

OBJECTIVE: Effectiveness of antipsychotic drugs is inferred from relatively small randomized clinical trials conducted with carefully selected and monitored participants. This evidence is not necessarily generalizable to individuals treated in daily clinical practice. The authors compared the clinical effectiveness between all oral and long-acting injectable (LAI) antipsychotic medications used in the treatment of schizophrenia in the U.S. Department of Veterans Affairs (VA) health care system. METHODS: This was an observational study utilizing VA pharmacy data from 37,368 outpatient veterans with schizophrenia. Outcome measures were all-cause antipsychotic discontinuation and psychiatric hospitalizations. Oral olanzapine was used as the reference group. RESULTS: In multivariable analysis, clozapine (hazard ratio=0.43), aripiprazole long-acting injectable (LAI) (hazard ratio=0.71), paliperidone LAI (hazard ratio=0.76), antipsychotic polypharmacy (hazard ratio=0.77), and risperidone LAI (hazard ratio=0.91) were associated with reduced hazard of discontinuation compared with oral olanzapine. Oral first-generation antipsychotics (hazard ratio=1.16), oral risperidone (hazard ratio=1.15), oral aripiprazole (hazard ratio=1.14), oral ziprasidone (hazard ratio=1.13), and oral quetiapine (hazard ratio=1.11) were significantly associated with an increased risk of discontinuation compared with oral olanzapine. No treatment showed reduced risk of psychiatric hospitalization compared with oral olanzapine; quetiapine was associated with a 36% worse outcome in terms of hospitalizations compared with olanzapine. CONCLUSIONS: In a national sample of veterans with schizophrenia, those treated with clozapine, two of the LAI second-generation antipsychotics, and antipsychotic polypharmacy continued the same antipsychotic therapy for a longer period of time compared with the reference drug. This may reflect greater overall acceptability of these medications in clinical practice.


Assuntos
Antipsicóticos , Hospitalização/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Esquizofrenia , Veteranos , Administração Oral , Antipsicóticos/classificação , Antipsicóticos/uso terapêutico , Pesquisa Comparativa da Efetividade , Preparações de Ação Retardada/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiologia , Esquizofrenia/terapia , Resultado do Tratamento , Estados Unidos/epidemiologia , United States Department of Veterans Affairs/estatística & dados numéricos , Veteranos/psicologia , Veteranos/estatística & dados numéricos , Suspensão de Tratamento/estatística & dados numéricos
4.
Medicine (Baltimore) ; 100(25): e26508, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160471

RESUMO

ABSTRACT: This study was conducted to examine whether Korean veterans from the US-Vietnam War who had a diagnosis of type II diabetes mellitus (T2DM) as well as past history of exposure to agent orange (AO) are vulnerable to hyperglycemia when receiving intra-articular corticosteroid injection (IACI) for pain relief.The current study included a total of 49 patients (n = 49) who received an injection of triamcinolone 20 or 40 mg to the shoulder under sonographic guidance or did that of dexamethasone 10 mg or triamcinolone 40 mg combined with dexamethasone 20 mg to the spine under fluoroscopic guidance. Their 7-day fasting blood glucose (FBG) levels were measured and then averaged, serving as baseline levels. This is followed by measurement of FBG levels for 14 days of IACI. Respective measurements were compared with baseline levels. The patients were also evaluated for whether there are increases in FBG levels depending on insulin therapy as well as HbA1c ≥ 7% or HbA1c < 7%.Overall, there were significant increases in FBG levels by 64.7 ±â€Š42.5 mg/dL at 1 day of IACI from baseline (P < .05). HbA1c ≥ 7% and HbA1c < 7% showed increases in FBG levels by 106.1 ±â€Š49.0 mg/dL and 46.5 ±â€Š3.8 mg/dL, respectively, at 1 day of IACI from baseline (P < .05). In the presence and absence of insulin therapy, there were significant increases in them by 122.6 ±â€Š48.7 mg/dL and 48.0 ±â€Š20.4 mg/dL, respectively, at 1 day of IACI from baseline (P < .05). But there were decreases in them to baseline levels at 2 days of IACI.Clinicians should consider the possibility of hyperglycemia when using corticosteroids for relief of musculoskeletal pain in Korean veterans from the US-Vietnam War who had a history of exposure to AO.


Assuntos
Agente Laranja/efeitos adversos , Artralgia/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Glucocorticoides/efeitos adversos , Hiperglicemia/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Idoso , Glicemia/análise , Dexametasona/administração & dosagem , Dexametasona/efeitos adversos , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Seguimentos , Glucocorticoides/administração & dosagem , Humanos , Hiperglicemia/sangue , Hiperglicemia/diagnóstico , Hiperglicemia/etiologia , Injeções Intra-Articulares , Insulina/administração & dosagem , Masculino , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/psicologia , Triancinolona/administração & dosagem , Triancinolona/efeitos adversos , Veteranos/psicologia , Veteranos/estatística & dados numéricos , Guerra do Vietnã , Exposição à Guerra/efeitos adversos
5.
Drug Alcohol Depend ; 225: 108818, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34171825

RESUMO

BACKGROUND: There have been reports of increased alcohol consumption during the COVID-19 pandemic in the general population. However, little is known about the impact of the pandemic on the prevalence of alcohol use disorder (AUD), especially in high-risk samples such as U.S. military veterans. METHODS: Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative, prospective cohort of 3078 U.S. veterans. Pre-pandemic and 1-year peri-pandemic risk and protective factors associated with incident and chronic probable AUD were examined. RESULTS: A total of 6.9 % (n = 183) of veterans were classified as chronic probable AUD, 3.2 % (n = 85) as remitted from AUD, and 2.7 % (n = 71) as incident probable AUD during the pandemic; the prevalence of probable AUD in the full sample remained stable -10.1 % pre-pandemic and 9.6 % peri-pandemic. Younger age, greater pre-pandemic alcohol use severity, and COVID-related stressors were associated with incident AUD during the pandemic, whereas higher pre-pandemic household income was associated with lower risk of this outcome. Younger age, combat experience, lifetime substance use disorder, greater drug use severity, lower dispositional optimism, and more COVID-related worries and social restriction stress were associated with higher risk of chronic AUD. CONCLUSIONS: Nearly 1-in-10 US veterans screened positive for AUD 1-year into the pandemic; however, the pre- and 1-year peri-pandemic prevalence of probable AUD remained stable. Veterans who are younger, have served in combat roles, endorse more COVID-related stressors, and have fewer socioeconomic resources may be at higher risk for AUD during the pandemic.


Assuntos
Alcoolismo/epidemiologia , COVID-19/psicologia , Pandemias , Veteranos/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de Proteção , Fatores de Risco , Estados Unidos/epidemiologia , Veteranos/estatística & dados numéricos , Adulto Jovem
6.
Law Hum Behav ; 45(2): 152-164, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-34110876

RESUMO

OBJECTIVE: Perceptions of the legitimacy of a society's legal system help explain individual responses to courts and legal actors. Normative considerations such as fair and respectful treatment as well as social identification have demonstrated the ability to enhance perceived legal legitimacy and future cooperation. Veterans treatment courts (VTCs) are a rapidly disseminating and understudied intervention. Their targeting of a socially esteemed group presents an interesting venue to explore normative theories of justice. The present study tested a modified version of Tyler's theory of procedural justice in this setting. HYPOTHESES: We hypothesized that procedural justice, social bonds, and receipt of gratitude for military service would be positively associated with veteran identity and legal legitimacy. We further hypothesized that participants' identification as veterans would mediate the relationships between the three independent variables and legitimacy. METHOD: A cross-sectional survey design was used with a convenience sample (N = 191) of participants in two VTCs. Analyses controlled for race, ethnicity, recidivism risk, and combat exposure. RESULTS: Perceptions of procedural justice, social bonds, and receipt of gratitude were positively associated with veteran identity and perceptions of legal legitimacy. Further, veteran identity was found to be a significant mediator between the first three constructs and legal legitimacy. CONCLUSIONS: The results support the importance of procedural justice in explaining perceptions of legal legitimacy in a novel context that is rapidly proliferating and understudied and has unique social identity considerations. The addition of gratitude and veteran identity to Tyler's model raises implications for VTC practice and further inquiry. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Direito Penal/organização & administração , Identificação Social , Serviços de Saúde para Veteranos Militares/organização & administração , Veteranos/psicologia , Adulto , Idoso , Estudos Transversais , Emoções Manifestas , Feminino , Humanos , Masculino , Análise de Mediação , Pessoa de Meia-Idade , Percepção Social , Estados Unidos , Adulto Jovem
7.
J Consult Clin Psychol ; 89(5): 379-392, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34124925

RESUMO

Objective: Psychotherapy for depression is effective for many veterans, but the relationship between number of treatment sessions and symptom outcomes is not well established. The Dose-Effect model predicts that greater psychotherapeutic dose (total sessions) yields greater symptom improvement with each additional session resulting in smaller session-to-session improvement. In contrast, the Good-Enough Level (GEL) model predicts that rate of symptom improvement varies by total psychotherapeutic dose with faster improvement associated with earlier termination. This study compared the dose-effect and GEL model among veterans receiving psychotherapy for depression within the Veterans Health Administration. Method: The sample included 13,647 veterans with ≥2 sessions of psychotherapy for depression with associated Patient Health Questionnaire-9 (PHQ-9) scores in primary care (n = 7,502) and specialty mental health clinics (n = 6,145) between October 2014 and September 2018. Multilevel longitudinal modeling was used to compare the Dose-Effect and GEL models within each clinic type. Results: The GEL model demonstrated greater fit for both clinic types relative to dose-effect models. In both treatment settings, veterans with fewer sessions improved faster than those with more sessions. In primary care clinics, veterans who received 4-8 total sessions achieved similar levels of symptom response. In specialty mental health clinics, increased psychotherapeutic dose was associated with greater treatment response up to 16 sessions. Veterans receiving 20 sessions demonstrated minimal treatment response. Conclusions: These findings support the GEL model and suggest a flexible approach to determining length of psychotherapy for depression may be useful for optimizing treatment response and allocation of clinical resources. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Depressão/terapia , Atenção Primária à Saúde/estatística & dados numéricos , Psicoterapia/métodos , Veteranos/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
8.
West J Emerg Med ; 22(3): 525-532, 2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34125022

RESUMO

INTRODUCTION: Presence of a firearm is associated with increased risk of violence and suicide. United States military veterans are at disproportionate risk of suicide. Routine healthcare provider screening of firearm access may prompt counseling on safe storage and handling of firearms. The objective of this study was to determine the frequency with which Veterans Health Administration (VHA) healthcare providers document firearm access in electronic health record (EHR) clinical notes, and whether this varied by patient characteristics. METHODS: The study sample is a post-9-11 cohort of veterans in their first year of VHA care, with at least one outpatient care visit between 2012-2017 (N = 762,953). Demographic data, veteran military service characteristics, and clinical comorbidities were obtained from VHA EHR. We extracted clinical notes for outpatient visits to primary, urgent, or emergency clinics (total 105,316,004). Natural language processing and machine learning (ML) approaches were used to identify documentation of firearm access. A taxonomy of firearm terms was identified and manually annotated with text anchored by these terms, and then trained the ML algorithm. The random-forest algorithm achieved 81.9% accuracy in identifying documentation of firearm access. RESULTS: The proportion of patients with EHR-documented access to one or more firearms during their first year of care in the VHA was relatively low and varied by patient characteristics. Men had significantly higher documentation of firearms than women (9.8% vs 7.1%; P < .001) and veterans >50 years old had the lowest (6.5%). Among veterans with any firearm term present, only 24.4% were classified as positive for access to a firearm (24.7% of men and 20.9% of women). CONCLUSION: Natural language processing can identify documentation of access to firearms in clinical notes with acceptable accuracy, but there is a need for investigation into facilitators and barriers for providers and veterans to improve a systemwide process of firearm access screening. Screening, regardless of race/ethnicity, gender, and age, provides additional opportunities to protect veterans from self-harm and violence.


Assuntos
Documentação , Armas de Fogo/estatística & dados numéricos , Pessoal de Saúde/psicologia , Programas de Rastreamento/estatística & dados numéricos , Suicídio/prevenção & controle , Veteranos/estatística & dados numéricos , Adulto , Estudos de Coortes , Estudos Transversais , Atenção à Saúde , Feminino , Humanos , Masculino , Programas de Rastreamento/organização & administração , Pessoa de Meia-Idade , Pesquisa , Estudos Retrospectivos , Estados Unidos , Veteranos/psicologia
9.
J Clin Psychiatry ; 82(4)2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-34133087

RESUMO

Objective: The current study is an analysis of predictors of posttraumatic stress disorder (PTSD) treatment response in a clinical trial comparing (1) prolonged exposure plus placebo (PE + PLB), (2) PE + sertraline (PE + SERT), and (3) sertraline + enhanced medication management (SERT + EMM) with predictors including time since trauma (TST), self-report of pain, alcohol use, baseline symptoms, and demographics.Methods: Participants (N = 196) were veterans with combat-related PTSD (DSM-IV-TR) of at least 3 months' duration recruited between 2012 and 2016 from 4 sites in the 24-week PROlonGed ExpoSure and Sertraline (PROGrESS) clinical trial (assessments at weeks 0 [intake], 6, 12, 24, 36, and 52).Results: Across treatment conditions, (1) longer TST was predictive of greater week 24 PTSD symptom improvement (ß = 1.72, P = .01) after adjusting for baseline, (2) higher baseline pain severity was predictive of smaller symptom improvement (ß = -2.96, P = .003), and (3) Hispanic patients showed greater improvement than non-Hispanic patients (ß = 12.33, P = .03). No other baseline characteristics, including alcohol consumption, were significantly predictive of week 24 improvement. Comparison of TST by treatment condition revealed a significant relationship only in those randomized to the PE + SERT condition (ß = 2.53, P = .03). Longitudinal analyses showed similar results.Conclusions: The finding that longer TST shows larger symptom reductions is promising for PTSD patients who might not seek help for years following trauma. Higher baseline pain severity robustly predicted attenuated and slower response to all treatment conditions, suggesting a common neuropathologic substrate. Finally, in the current study, alcohol use did not impede the effectiveness of pharmacotherapy for PTSD.Trial Registration: ClinicalTrials.gov identifier: NCT01524133.


Assuntos
Terapia Implosiva/métodos , Inibidores de Captação de Serotonina/uso terapêutico , Sertralina/uso terapêutico , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos/psicologia , Adulto , Terapia Combinada , Método Duplo-Cego , Feminino , Humanos , Masculino , Autorrelato , Fatores de Tempo
10.
Clin Neurophysiol ; 132(7): 1389-1397, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34023623

RESUMO

OBJECTIVE: Emotion regulation and cognitive executive control are significantly impaired in both post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). These illnesses are increasingly common in veterans and their co-occurrence may exacerbate symptoms and recovery. The current study sought to investigate neural correlates of these impairments via event-related potentials (ERPs) and examined the association of PTSD symptom severity and impulsivity with these correlates. METHODS: Electroencephalographic data from seventy-nine veterans with PTSD and TBI and 17 control participants were recorded during a visual emotional oddball task and analyzed for the N2 and P3b ERPs. RESULTS: Results revealed that veterans showed a reduced P3b ERP in response to both target images and standard images. However, for standard images that followed a negative emotional distractor, the veterans showed a heightened N2 amplitude while the controls did not. In addition, impulsivity predicted modulation of the P3b across stimulus conditions, with a greater P3b amplitude associated with an increase in impulsivity. CONCLUSIONS: These findings suggest that veterans showed hyper-responsivity to background information and reduced ERPs to task-relevant information. SIGNIFICANCE: These findings may reflect heightened internal states that create neural noise and a reduced ability to modulate relevant responses.


Assuntos
Lesões Encefálicas Traumáticas/psicologia , Cognição/fisiologia , Emoções/fisiologia , Potenciais Evocados/fisiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia , Adulto , Lesões Encefálicas Traumáticas/epidemiologia , Lesões Encefálicas Traumáticas/fisiopatologia , Comorbidade , Eletroencefalografia/métodos , Feminino , Humanos , Masculino , Estimulação Luminosa/métodos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia
11.
Public Health ; 194: 232-237, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33962101

RESUMO

OBJECTIVES: The objective of this study was to offer an overview of literature relating to the topic of arts as activity within the context of military and veteran health and to consider the implications of current knowledge on future research with visually impaired veterans. STUDY DESIGN: A search for literature addressing the topic of visual art activities with visually impaired veterans was undertaken. No research addressing this topic was identified. A review of literature on the related topics of mental health and well-being in military veterans, visual impairment and mental health and well-being, and art therapy for veteran populations was carried out to offer an overview of current knowledge. RESULTS: While there is growing evidence of the benefits of arts engagement among both general and military populations, the role of the visual arts in the everyday lives of broader veteran samples, and the impact of these activities on holistic well-being, remains underexplored. The current article highlights the need for art as activity to be differentiated from art as therapy and argues that the former might offer a tool to positively impact the holistic well-being of visually impaired veterans. CONCLUSIONS: Future research relating to the use of visual art activities in the context of veteran health and well-being should endeavour to explore the potential impacts of engagement on holistic well-being. Research is needed to build on anecdotal evidence of the positive impact of arts engagement on visually impaired veterans by systematically exploring if, and how, holistic well-being in this population may be impacted by engagement with visual art activities.


Assuntos
Arte , Saúde Mental , Veteranos/psicologia , Pessoas com Deficiência Visual/psicologia , Humanos , Narração
12.
Nurs Clin North Am ; 56(2): 219-227, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34023117

RESUMO

Veterans are those who have served our country in one of the branches of armed forces or military reserves. The Veterans Health Administration is the largest integrated health system in the nation, providing health care services and latest research for veterans. Non-Veteran Health Administration primary care clinicians, who also take care of veterans, deserve to have an understanding of the unique challenges and conditions these individuals face and the resources that are available to improve sleep health and well-being of all veterans. This article guides these clinicians to manage sleep disorders, mental health disorders, and substance use among veterans.


Assuntos
Transtornos do Sono-Vigília/psicologia , Sono , Veteranos/psicologia , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Analgésicos Opioides/efeitos adversos , Humanos , Uso da Maconha/efeitos adversos , Uso da Maconha/epidemiologia , Uso da Maconha/psicologia , Programas de Rastreamento/métodos , Transtornos Mentais/complicações , Transtornos Mentais/psicologia , Transtornos do Sono-Vigília/complicações , Veteranos/estatística & dados numéricos
13.
J Psychiatr Pract ; 27(3): 203-211, 2021 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-33939375

RESUMO

Violence risk assessment is a requisite component of mental health treatment. Adhering to standards of care and ethical and legal requirements necessitates a cogent process for conducting, and then documenting, other-directed violence (ODV) risk screening, assessment, and management. In this 5-part series, we describe a model for achieving therapeutic risk management of the potentially violent patient, with essential elements involving: clinical interview augmented by structured screening or assessment tools; risk stratification in terms of temporality and severity; chain analysis to intervene on the functions of ODV ideation and behavior; and a personalized safety plan to mitigate/manage risk. In this fourth column of the series, we describe chain analysis as a critical tool for assessing and intervening on ODV ideation and behavior. We identify the pathways of reinforcement that can cause ODV to persist, and how to navigate potential barriers to completing ODV chains. Using a case example, we demonstrate how to apply chain analysis to ODV ideation and behavior and offer interventional strategies that can be used to disrupt the chain and ultimately reduce the risk for violence.


Assuntos
Medição de Risco , Violência/prevenção & controle , Violência/psicologia , Adulto , Humanos , Masculino , Psicoterapia , Reforço Psicológico , Veteranos/psicologia
14.
J Clin Psychiatry ; 82(2)2021 02 23.
Artigo em Inglês | MEDLINE | ID: mdl-33988923

RESUMO

OBJECTIVE: Risk for suicide is highest in the first 3 months (days 1-90) after discharge from acute psychiatric hospitalization yet remains elevated for the remainder of the year (days 91-365). The purpose of this study was to compare risk factors for suicide in the first 90 days to those over the remainder of the year to identify changes across time frames. METHODS: The study included 316,707 male veterans discharged from Veterans Health Administration acute psychiatric inpatient units from 2008 through 2013. Proportional hazard regression models were used to identify predictors of suicide death in the first 90 days and in days 91-365, defined via ICD-10 codes. Adjusted piecewise proportional hazard regression was used to compare risk across time frames. RESULTS: Among the 1,037 veterans (< 1%) who died by suicide, 471 (45%) died between days 1 and 90 and 566 (55%) died between days 91 and 365. There was little change regarding the strength of risk factors over time, with two exceptions: risk increased among those aged 18-29 years compared to those aged ≥ 65 years (days 1-90: hazard ratio [HR] = 0.83; 95% CI, 0.57-1.20 vs days 91-365: HR = 1.42; 95% CI, 1.03-1.97; P < .05), whereas, risk associated with suicidal ideation decreased (days 1-90: HR = 1.89; 95% CI, 1.57-2.28 vs days 91-365: HR = 1.40; 95% CI, 1.17-1.66, P < .05). CONCLUSIONS: The strength of association between common risk factors and suicide remains relatively stable during the year following psychiatric hospitalization. However, risk among veterans aged 19-29 years increased over time, whereas risk among those with suicidal ideation decreased.


Assuntos
Transtornos Mentais/psicologia , Alta do Paciente/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Veteranos/psicologia , Adolescente , Adulto , Fatores Etários , Idoso , Humanos , Masculino , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Fatores de Risco , Suicídio/psicologia , Fatores de Tempo , Estados Unidos/epidemiologia , Veteranos/estatística & dados numéricos , Adulto Jovem
15.
Exp Clin Psychopharmacol ; 29(2): 166-177, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34043400

RESUMO

Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are highly comorbid with complex and often unclear associations. Working memory deficits may represent a shared mechanism implicated in emotion regulation and control over impulsive alcohol use. Here we test whether PTSD symptoms and working memory correlated with performance on a behavioral economic assessment of alcohol demand. 113 veterans (mean age 51 years; 89% male) completed an Alcohol Purchase Task (APT) and were assessed for PTSD, alcohol use, and working memory. We examined the interaction of PTSD symptoms and working memory on four indices of alcohol demand measured from the APT; specifically, we used separate models to test whether associations between working memory and intensity (consumption at $0), Omax (maximum expenditure), Pmax (price at maximum expenditure), and elasticity (price sensitivity), differed as a function of PTSD symptoms. In a model controlling for hazardous drinking, average drinking levels, age, sex, marital status, occupation, and education, we observed a significant interaction between PTSD symptoms and working memory on elasticity, whereby greater working memory capacity was associated with greater elasticity for veterans with lower PTSD symptoms. Follow-up analyses regarding specific PTSD symptom domains indicated that this effect was strongest for avoidance symptoms. Taken together, working memory abilities correlated with subjective valuations of alcohol in a laboratory setting for veterans with less severe PTSD symptoms. This work highlights the conditions under which working memory may be a potential target for interventions geared toward reducing alcohol use in veterans with co-occurring PTSD and AUD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/psicologia , Memória de Curto Prazo , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Veteranos/psicologia
16.
Health Qual Life Outcomes ; 19(1): 137, 2021 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-33947411

RESUMO

BACKGROUND: The translated and culturally adapted German version of the Veterans Rand 36 Items Health Survey (VR-36), and its short form, the VR-12 counterpart, were validated in a German sample of orthopedic (n = 399) and psychosomatic (n = 292) inpatient rehabilitation patients. METHODS: The instruments were analyzed regarding their acceptance, distributional properties, validity, responsiveness and ability to discriminate between groups by age, sex and clinically specific groups. Eligible study participants completed the VR-36 (n = 169) and the VR-12 (n = 177). They also completed validated patient-reported outcome measures (PROs) including the Euroqol-5 Dimensions 5 Level (EQ-5D-5L); Depression, Anxiety and Stress Scale (DASS); Hannover Functional Abilities Questionnaire (HFAQ); and CDC Healthy Days. The VR-12 and the VR-36 were compared to the reference instruments MOS Short Form-12 Items Health Survey (SF-12) version 1.0 and MOS Short Form-36 Items Health Survey (SF-36) version 1.0, using percent of completed items, distributional properties, correlation patterns, distribution measures of known groups validity, and effect size measures. RESULTS: Item non-response varied between 1.8%/1.1% (SFVR-36/RESF-36) and 6.5%/8.6% (GHVR-36/GHSF-36). PCS was normally distributed (Kolmogorov-Smirnov tests: p > 0.05) with means, standard deviations and ranges very similar between SF-36 (37.5 ± 11.7 [13.8-66.1]) and VR-36 (38.5 ± 10.1 [11.7-67.8]), SF-12 (36.9 ± 10.9 [15.5-61.6]) and VR-12 (36.2 ± 11.5 [12.7-59.3]). MCS was not normally distributed with slightly differing means and ranges between the instruments (MCSVR-36: 36.2 ± 14.2 [12.9-66.6], MCSSF-36: 39.0 ± 15.6 [2.0-73.2], MCSVR-12: 37.2 ± 13.8 [8.4-70.2], MCSSF-12: 39.0 ± 12.3 [17.6-65.4]). Construct validity was established by comparing correlation patterns of the MCSVR and PCSVR with measures of physical and mental health. For both PCSVR and MCSVR there were moderate (≥ 0.3) to high (≥ 0.5) correlations with convergent (PCSVR: 0.55-0.76, MCSVR: 0.60-0.78) and small correlations (< 0.1) with divergent (PCSVR: < 0.12, MCSVR: < 0.16) self-report measures. Known-groups validity was demonstrated for both VR-12 and VR-36 (MCS and PCS) via comparisons of distribution parameters with significant higher mean PCS and MCS scores in both VR instruments found in younger patients with fewer sick days in the last year and a shorter duration of rehabilitation. CONCLUSIONS: The psychometric analysis confirmed that the German VR is a valid and reliable instrument for use in orthopedic and psychosomatic rehabilitation. Yet further research is needed to evaluate its usefulness in other populations.


Assuntos
Qualidade de Vida , Inquéritos e Questionários/normas , Veteranos/psicologia , Adulto , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Traduções
17.
Life Sci ; 284: 119656, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34043995

RESUMO

AIMS: Graphic elicitation is an emergent data gathering approach in qualitative research. An overview of the development and application of a collage based graphic elicitation method in gaining greater understanding about the experience of Gulf War Illness (GWI) is presented in this paper. The unique contributions of this method are also discussed. MAIN METHODS: Fourteen veterans with GWI were interviewed and then invited to represent their experiences in a visual format through a collage graphic elicitation task. Interviews and collage artworks were coded and compared to both verbal and art responses during the graphic elicitation process. KEY FINDINGS: Comparison of the content in the interview responses and collage artwork indicates that the graphic elicitation process resulted in three distinct responses: (1) Synthesis and confirmation of content articulated in the interviews, (2) focus on salient aspects of living with GWI, and (3) revealing previously unarticulated experiences. SIGNIFICANCE: This work demonstrates the unique contributions of collage graphic elicitation, including allowing for spontaneity, metaphorical thinking, enriching verbal explication, and uncovering lived experiences and new affective responses. The sample size was too small to make any generalizations, and more research is needed to further validate these initial findings.


Assuntos
Síndrome do Golfo Pérsico/psicologia , Veteranos/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
18.
Neuropsychology ; 35(3): 241-251, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33829824

RESUMO

OBJECTIVE: To evaluate the relationships among performance validity, symptom validity, symptom self-report, and objective cognitive testing. METHOD: Combat Veterans (N = 338) completed a neurocognitive assessment battery and several self-report symptom measures assessing depression, posttraumatic stress disorder (PTSD) symptoms, sleep quality, pain interference, and neurobehavioral complaints. All participants also completed two performance validity tests (PVTs) and one stand-alone symptom validity test (SVT) along with two embedded SVTs. RESULTS: Results of an exploratory factor analysis revealed a three-factor solution: performance validity, cognitive performance, and symptom report (SVTs loaded on the third factor). Results of t tests demonstrated that participants who failed PVTs displayed significantly more severe symptoms and significantly worse performance on most measures of neurocognitive functioning compared to those who passed. Participants who failed a stand-alone SVT also reported significantly more severe symptomatology on all symptom report measures, but the pattern of cognitive performance differed based on the selected SVT cutoff. Multiple linear regressions revealed that both SVT and PVT failure explained unique variance in symptom report, but only PVT failure significantly predicted cognitive performance. CONCLUSIONS: Performance and symptom validity tests measure distinct but related constructs. SVTs and PVTs are significantly related to both cognitive performance and symptom report; however, the relationship between symptom validity and symptom report is strongest. SVTs are also differentially related to cognitive performance and symptom report based on the utilized cutoff score. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Traumatismos por Explosões/psicologia , Lesões Encefálicas Traumáticas/psicologia , Simulação de Doença/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia , Adulto , Idoso , Traumatismos por Explosões/fisiopatologia , Lesões Encefálicas Traumáticas/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Reprodutibilidade dos Testes , Autorrelato , Adulto Jovem
19.
Arch Phys Med Rehabil ; 102(9): 1729-1734, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33811852

RESUMO

OBJECTIVE: To evaluate risk for suicide among veterans with a history of stroke, seeking care within the Veterans Health Administration (VHA), we analyzed existing clinical data. DESIGN: This retrospective cohort study was approved and performed in accordance with the local Institutional Review Board. Veterans were identified via the VHA's Corporate Data Warehouse. Initial eligibility criteria included confirmed veteran status and at least 90 days of VHA utilization between fiscal years 2001-2015. Cox proportional hazards models were used to assess the association between history of stroke and suicide. Among those veterans who died by suicide, the association between history of stroke and method of suicide was also investigated. SETTING: VHA. PARTICIPANTS: Veterans with at least 90 days of VHA utilization between fiscal years 2001-2015 (N=1,647,671). Data from these 1,647,671 veterans were analyzed (1,405,762 without stroke and 241,909 with stroke). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Suicide and method of suicide. RESULTS: The fully adjusted model, which controlled for age, sex, mental health diagnoses, mild traumatic brain injury, and modified Charlson/Deyo Index (stroke-related diagnoses excluded), demonstrated a hazard ratio of 1.13 (95% confidence interval, 1.02-1.25; P=.02). The majority of suicides in both cohorts was by firearm, and a significantly larger proportion of suicides occurred by firearm in the group with stroke than the cohort without (81.2% vs 76.6%). CONCLUSIONS: Findings suggest that veterans with a history of stroke are at increased risk for suicide, specifically by firearm, compared with veterans without a history of stroke. Increased efforts are needed to address the mental health needs and lethal means safety of veterans with a history of stroke, with the goal of improving function and decreasing negative psychiatric outcomes, such as suicide.


Assuntos
Reabilitação do Acidente Vascular Cerebral/psicologia , Suicídio/psicologia , Suicídio/estatística & dados numéricos , Serviços de Saúde para Veteranos Militares , Veteranos/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
20.
Med Care ; 59(6): 550-556, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33797509

RESUMO

BACKGROUND: The Veterans Health Administration (VHA) does not routinely collect and document sexual orientation and gender identity (SOGI) data despite research on health disparities among sexual and gender minority (SGM) veterans. Due to the legacy of previous Department of Defense policies that prohibited disclosure of sexual or gender minority identities among active-duty personnel, minority veterans may be reluctant to respond to SOGI questions on confidential VHA surveys and in discussions with their VHA providers. Veterans may generally find SOGI questions uncomfortable and may not appreciate their relevance to health care. OBJECTIVE: The purpose of this research was to examine veterans' comfort in reporting identity characteristics on confidential VHA surveys and in discussion with their VHA providers and whether comfort differed by sociodemographic characteristics. RESEARCH DESIGN: The project involves the secondary analysis of quantitative data from a quality improvement survey project. SUBJECTS: A total of 806 veterans were surveyed. RESULTS: Overall, 7.15% endorsed sexual or gender minority identity which is a higher rate than the 4.5% noted in the general US population. Cisgender and heterosexual veterans were more comfortable reporting identity characteristics both on VHA confidential surveys and in discussion with VHA providers compared with SGM veterans. CONCLUSIONS: These data suggest that the majority of veterans feel comfortable reporting their identities both on surveys and in the context of health care. Understanding these perceptions can assist VHA programs in implementing SOGI data collection and disclosure in clinical care, creating a welcoming environment of care for SGM veterans that does not make veterans from other backgrounds feel uncomfortable.


Assuntos
Revelação , Identidade de Gênero , Comportamento Sexual , Veteranos/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos , United States Department of Veterans Affairs
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