Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.845
Filtrar
1.
Psychol Trauma ; 15(1): 100-109, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36656744

RESUMO

OBJECTIVE: Although there is mounting evidence that massed treatment for PTSD is both feasible and effective, many questions remain about the optimal length of intensive treatment programs (ITPs), as well as the role of adjunctive services, such as psychoeducation, mindfulness, and yoga. Our setting recently transitioned from a three-week ITP to a two-week program. Adjunctive services were reduced, but the amount of individual CPT between programs remained similar. The present study examined the effectiveness of a two-week ITP based on twice daily individual CPT sessions and evaluated the program's noninferiority to an established three-week ITP using a Bayesian analytical approach. METHOD: Bayesian linear mixed regression models were used to explore PTSD and depression changes over time, as well as predictors of change. Noninferiority of the two-week ITP to a three-week ITP was also established using a Bayes factor approach. RESULTS: Results indicate that program participants change meaningfully in both PTSD and depression severity over the course of treatment, and that changes in posttraumatic cognitions predict subsequent changes in these outcomes. Further, the two-week ITP can be considered noninferior to the three-week ITP in both clinical outcomes and overall satisfaction. CONCLUSIONS: In the context of intensive PTSD treatment, the content of the ITP appears to matter more than its overall length. Shorter programs have the potential to increase access and treatment capacity. Our findings demonstrate the importance of continuous and rigorous program evaluation. Limitations as well as future directions for research, such as identifying the most effective treatment components, are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Assuntos
Terapia Cognitivo-Comportamental , Atenção Plena , Transtornos de Estresse Pós-Traumáticos , Veteranos , Humanos , Veteranos/psicologia , Teorema de Bayes , Transtornos de Estresse Pós-Traumáticos/terapia , Transtornos de Estresse Pós-Traumáticos/psicologia , Terapia Cognitivo-Comportamental/métodos , Resultado do Tratamento
2.
J Nerv Ment Dis ; 211(1): 65-73, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36596288

RESUMO

ABSTRACT: It has been suggested that religion and spirituality have a protective impact on suicide risk in populations living with posttraumatic stress disorder (PTSD). This review sought to examine the association between suicide risk among veterans and refugees with PTSD and religion or spirituality as a modifying factor. Two databases, PubMed and Embase, were searched and 10 publications were identified and included. Seven publications found that religion or spirituality was associated with lower suicide risk. The findings in this study suggest that religion and spirituality contain social as well as psychological domains, which should be considered in future interventions and in strategies of prevention of suicide in populations with PTSD. Further high-quality research with well-defined terms of religion and spirituality that investigates the connection to suicide risk of veterans and refugees with PTSD is recommended.


Assuntos
Refugiados , Transtornos de Estresse Pós-Traumáticos , Suicídio , Veteranos , Humanos , Espiritualidade , Veteranos/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Religião , Suicídio/psicologia
3.
Cogn Behav Ther ; 52(1): 1-17, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36562141

RESUMO

Access to mental health services, particularly for veterans residing in underserved communities, remain scarce. One approach to addressing availability barriers is through the use of group-based transdiagnostic or unified treatment protocols. One such protocol, Safety Aid Reduction Treatment (START), previously termed False Safety Behavior Elimination Treatment (FSET), has received increasing empirical support. However, prior research has only examined this treatment among civilians with a primary anxiety diagnosis. Thus, the purpose of the current study was to replicate and extend prior research by examining the acceptability, feasibility, and utility of START among veterans, particularly those living in underserved communities, and across a wider array of diagnoses. Veterans (n = 22) were assessed prior to, immediately after, and one month following the 8-week treatment. The majority of veterans found START useful and acceptable. Additionally, recruitment and retention rates suggest that the treatment was feasible. Notably, results revealed reductions in overall anxiety, depression, and safety aid usage, which were maintained throughout the brief follow-up period. These findings add to a growing body of literature highlighting the utility of transdiagnostic approaches in the amelioration of various anxiety and related disorders. Limitations include the small sample size and uncontrolled design.


Assuntos
Veteranos , Humanos , Veteranos/psicologia , Estudos de Viabilidade , Projetos Piloto , Ansiedade/psicologia , Terapia Comportamental/métodos
4.
J Affect Disord ; 323: 826-833, 2023 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-36529407

RESUMO

BACKGROUND: Acceptance and Commitment Therapy for depression (ACT-D) is a promising depression treatment which has not been evaluated on a large scale within VA. This study aimed to evaluate ACT-D's effectiveness in a national, treatment-seeking sample of Veterans. METHODS: The sample comprised 831 Veterans who received a primary depression diagnosis and received at least two sessions of ACT-D during fiscal years 2015-2020. We used GLM to measure predictors of symptom change, treatment response (50 % reduction in PHQ-9 and AAQ-II scores), subthreshold depression symptoms (PHQ-9 < 10; AAQ-II < 27), and treatment completion. RESULTS: Veterans experienced an average reduction of 3.39 points on the PHQ-9 (Cohen's d = 0.56) and 3.76 points on the AAQ-II (Cohen's d = 0.43). On the PHQ-9, 40 % achieved subthreshold depression symptoms. On the AAQ-II, 36 % of Veterans achieved subthreshold psychological inflexibility scores. Service-connected disability rating for depression and higher levels of medical comorbidity were both related to lower levels of overall depression symptom change and treatment response. Substance use disorder and bipolar/psychosis diagnoses were associated with greater reductions in psychological inflexibility. LIMITATIONS: This is an observational study without a control group, so we were unable to compare the effectiveness of ACT-D to other usual care for depression. We were also unable to assess variables that can influence treatment success, such as therapist fidelity and patient engagement. CONCLUSIONS: ACT-D achieved similar improvements in depression as reported in controlled trials. Adaptations to ACT-D may be needed to improve outcomes for Veterans with depression and comorbid PTSD.


Assuntos
Terapia de Aceitação e Compromisso , Transtornos de Estresse Pós-Traumáticos , Veteranos , Humanos , Depressão/terapia , Saúde dos Veteranos , Veteranos/psicologia , Resultado do Tratamento , Transtornos de Estresse Pós-Traumáticos/terapia , Transtornos de Estresse Pós-Traumáticos/complicações
5.
J Clin Psychiatry ; 84(1)2022 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-36576365

RESUMO

Objective: Individuals with posttraumatic stress disorder (PTSD) symptoms are often reluctant to engage in traditional mental health care but do seek primary care services. Alternative strategies are needed to develop emotional regulation skills among individuals with PTSD symptoms. This study examined the feasibility and effectiveness of Primary Care Brief Mindfulness Training (PCBMT) compared to a psychoeducational group for reducing PTSD symptoms.Methods: Primary care patients (n = 55) with DSM-5 PTSD symptoms but not engaged in PTSD psychotherapies were randomized to 4-week PCBMT or a PTSD psychoeducation group (EDU). Both groups were cofacilitated by mental health providers and veteran peer specialists. Between January 2019 and March 2020, assessments were completed at baseline, post-treatment, and 16- and 24-week follow-up.Results: PCBMT participants had significantly larger decreases in PTSD symptoms from pre- to post-treatment (d = 0.57) and depression from pre-treatment to 16- and 24-week follow-ups (d = 0.67, 0.60) compared to EDU. PCBMT participants also reported significantly greater improvements in health responsibility (d = 0.79), stress management (d = 0.99), and not feeling dominated by symptoms (d = 0.71). Both interventions resulted in the majority of participants "stepping up" to a higher level of PTSD care.Conclusions: Brief mindfulness training is effective for reducing psychiatric symptoms and improving broader recovery outcomes and health promoting behaviors. For individuals who are not yet willing to engage in trauma-focused PTSD treatment, PCBMT may be preferable and more effective than psychoeducational classes as preliminary treatments. Further research is needed to confirm the effectiveness of PCBMT in a larger sample and investigate factors that will support wider implementation in primary care settings.Clinical Trials Registration: ClinicalTrials.gov identifier: NCT03352011.


Assuntos
Atenção Plena , Transtornos de Estresse Pós-Traumáticos , Veteranos , Humanos , Transtornos de Estresse Pós-Traumáticos/terapia , Transtornos de Estresse Pós-Traumáticos/psicologia , Atenção Plena/métodos , Veteranos/psicologia , Saúde Mental , Atenção Primária à Saúde , Resultado do Tratamento
6.
Eur J Psychotraumatol ; 13(2): 2138059, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36340009

RESUMO

Background: Experiencing potentially morally injurious events (PMIEs) has been found to be significantly associated with poor mental health outcomes in military personnel/veterans. Currently, no manualised treatment for moral injury-related mental health difficulties for UK veterans exists. This article describes the design, methods and expected data collection of the Restore & Rebuild (R&R) protocol, which aims to develop procedures to treat moral injury related mental ill health informed by a codesign approach. Methods: The study consists of three main stages. First, a systematic review will be conducted to understand the best treatments for the symptoms central to moral injury-related mental ill health (stage 1). Then the R&R manual will be co-designed with the support of UK veteran participants with lived experience of PMIEs as well as key stakeholders who have experience of supporting moral injury affected individuals (stage 2). The final stage of this study is to conduct a pilot study to explore the feasibility and acceptability of the R&R manual (stage 3). Results: Qualitative data will be analysed using thematic analysis. Conclusions: This study was approved by the King's College London's Research Ethics Committee (HR-20/21-20850). The findings will be disseminated in several ways, including publication in academic journals, a free training event and presentation at conferences. By providing information on veteran, stakeholder and clinician experiences, we anticipate that the findings will not only inform the development of an acceptable evidence-based approach for treating moral injury-related mental health problems, but they may also help to inform broader approaches to providing care to trauma exposed military veterans.


Antecedentes: Se ha encontrado que experimentar eventos potencialmente dañinos para la moral (PMIE, por sus siglas en inglés) se asocia significativamente con malos resultados de salud mental en el personal militar/veteranos. Actualmente no existe un tratamiento manualizado para los problemas de salud mental relacionadas con daño moral para los veteranos del Reino Unido. Este artículo describe el diseño, los métodos y la recopilación de datos esperada del protocolo Restore & Rebuild (R&R), que tiene como objetivo desarrollar procedimientos para tratar la salud mental relacionada con el daño moral informado por un enfoque de codiseño.Métodos: El estudio consta de tres etapas principales. Primero, se realizará una revisión sistemática para comprender los mejores tratamientos para los síntomas centrales de la enfermedad mental relacionada con el daño moral (etapa 1). Luego, el manual de R&R se diseñará conjuntamente con el apoyo de participantes veteranos del Reino Unido con experiencia vivida de PMIE, así como con partes interesadas clave que tengan experiencia en el apoyo a las personas afectadas por daño moral (etapa 2). La etapa final de este estudio es realizar un estudio piloto para explorar la factibilidad y aceptabilidad del manual R&R (etapa 3).Resultados: Los datos cualitativos se analizarán mediante análisis temático.Conclusiones: Este estudio fue aprobado por el Comité de Ética en Investigación del King's College London (HR-20/21-20850). Los hallazgos se difundirán de varias maneras, incluida la publicación en revistas académicas, un evento de capacitación gratuito y presentaciones en conferencias. Al proporcionar información sobre las experiencias de veteranos, partes interesadas y médicos, anticipamos que los hallazgos no solo informarán el desarrollo de un enfoque basado en evidencia aceptable para tratar problemas de salud mental relacionados con daño moral, sino que también pueden ayudar a transmitir enfoques más amplios para proporcionar atención a veteranos militares expuestos a traumas.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Veteranos , Humanos , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos/psicologia , Saúde Mental , Projetos Piloto , Estudos de Viabilidade , Reino Unido , Revisões Sistemáticas como Assunto
7.
J Head Trauma Rehabil ; 37(6): E488-E495, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36345556

RESUMO

OBJECTIVE: To examine the relationship between neuropsychological functioning and performance-based functional capacity in veterans with a history of mild traumatic brain injury (mTBI), as well as the moderating effects of age and psychiatric symptoms on this relationship. SETTING: Three Veterans Affairs medical centers. PARTICIPANTS: One hundred nineteen Iraq/Afghanistan veterans with a history of mTBI and self-reported cognitive difficulties. DESIGN: Cross-sectional, secondary data analysis of baseline measures in a randomized controlled trial. MAIN MEASURES: The main outcome measure, functional capacity, was assessed using the objective and performance-based University of California San Diego Performance-based Skills Assessment-Brief. A global deficit score (GDS) was created as a composite score for performance on a battery of neuropsychological measures assessing domains of attention, processing speed, executive functioning, and verbal memory performance. Posttraumatic stress disorder (PTSD) symptom severity was assessed using the PTSD Checklist-Military Version, and depressive symptom severity was assessed using the Beck Depression Inventory, Second Edition. RESULTS: Bivariate analyses indicated that worse neuropsychological performance (ie, higher GDS) and greater PTSD symptom severity were associated with worse communication abilities and worse overall functional capacity. Multiple linear regressions demonstrated that GDS and PTSD symptom severity explained 9% of the variance in communication and 10% of the variance in overall functional capacity; however, GDS emerged as the only significant predictor in both regressions. Age, PTSD, and depressive symptom severity did not moderate the relationship between GDS and overall functional capacity. Performance in the verbal learning and memory domain emerged as the strongest neuropsychological predictor of communication and overall functional capacity. CONCLUSIONS: Worse neuropsychological functioning was moderately associated with worse performance-based functional capacity, even when accounting for PTSD symptom severity. Verbal learning and memory was the primary neuropsychological domain driving the relationship with functional capacity; improvement in verbal learning and memory may translate into improved functional capacity.


Assuntos
Concussão Encefálica , Transtornos de Estresse Pós-Traumáticos , Veteranos , Humanos , Veteranos/psicologia , Concussão Encefálica/complicações , Concussão Encefálica/diagnóstico , Guerra do Iraque 2003-2011 , Campanha Afegã de 2001- , Estudos Transversais , Transtornos de Estresse Pós-Traumáticos/complicações , Testes Neuropsicológicos
8.
Psychiatr Danub ; 34(3): 455-463, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36256983

RESUMO

BACKGROUND: Combat-related chronic post-traumatic stress disorder (PTSD) is a therapeutically resistant disorder of the fluctuating course. The success of a group psychotherapy is partial. The aim of this paper is to determine baseline characteristics of veterans for whom a group psychotherapy will be the effective psychotherapeutic treatment. SUBJECTS AND METHODS: We performed this prospective cohort study in two geographically distant institutions: Regional Psychotrauma Center at the Psychiatric Clinic Split, and the Daily Hospital of the Psychiatric Hospital "Sveti Ivan" Zagreb, Croatia. We selected a consecutive sample of 86 veterans with combat-related chronic PTSD admitted to the group psychotherapy during 2009-2012. The primary outcome was ≥5% improvement in PTSD symptoms severity measured by Mississippi Scale for Combat-Related PTSD and adjusted for the baseline Mississippi scale score. Predictors were participants' 17 baseline sociodemographic and clinical characteristics and psychological features like personality traits, stress-coping mechanisms, and depression. RESULTS: We identified two patients' segments with significantly higher likelihood for the favorable treatment outcome. The first one were patients with the low score (≤8) on the phobia scale and high score (≥7) on the hysterical personality scale. In this segment 100% of patients experienced a favorable treatment outcome. The second one were the patiens with a higher score (>8) on the phobia scale, the low score (≤12) on the free-floating anxiety scale and the high score ≥8) on the obsession scale. In this segment, 64% experienced the favorable treatment outcome. CONCLUSION: The favorable outcome of the group psychotherapy of PTSD symptoms severity in patients with combat-related chronic PTSD can be predicted before the start of the treatment. The favorable outcome should be expected in patients with the low phobia and pronounced hysteria personality traits, or in patients with higher phobia, but with low free-floating anxiety and low obsession.


Assuntos
Distúrbios de Guerra , Psicoterapia de Grupo , Transtornos de Estresse Pós-Traumáticos , Veteranos , Humanos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Estudos Prospectivos , Croácia , Veteranos/psicologia , Distúrbios de Guerra/psicologia , Psicoterapia
9.
Psychiatr Danub ; 34(3): 464-474, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36256984

RESUMO

BACKGROUND: As a extremely traumatic experience, captivity may cause other mental disorders in addition to posttraumatic stress disorder, which is highly prevalent among ex-prisoners of war, and which often occurs in comorbidity with at least one other mental disorder. This objective of this study is to identify the incidence of comorbid mental disorders in Homeland war veterans ex-prisoners of war affected by posttraumatic stress disorder, as well as to identify the factors that influenced psychiatric comorbidity. SUBJECTS AND METHODS: The study sample comprised 264 subjects, all of whom were Croatian Homeland War veterans with combat experience in the defence of the Republic of Croatia, and all of whom fulfilled clinical criteria for posttraumatic stress disorder at the time of the study. The subjects were divided into two groups: the experimental group was composed of ex-prisoners of war, and the control group of veterans who had never been prisoners of war. The methods of sociodemographic questionnaire, posttraumatic stress disorder self-report checklist and the Harvard Trauma Questionnaire were used in the study. Psychiatric comorbidity data were retrieved from the subjects' anamnesis and medical records. RESULTS: The results showed that ex-prisoners of war were exposed to a statistically much higher number of traumatic events, and had a significantly higher total number of psychiatric comorbidities (p<0.01) than the control group. The incidence of acute and transient psychotic disorders, generalized anxiety disorders and psychological and behavioural factors associated with disorders or diseases classified elsewhere was significantly higher among ex-prisoners of war. There was no statistically significant difference in overall posttraumatic stress disorder intensity between the two groups (p<0.05). CONCLUSIONS: The results of the study confirm our hypothesis that the incidence of psychiatric comorbidity is higher in ex-prisoners of war.


Assuntos
Prisioneiros de Guerra , Prisioneiros , Transtornos de Estresse Pós-Traumáticos , Veteranos , Humanos , Veteranos/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Prisioneiros de Guerra/psicologia , Estudos Transversais , Croácia/epidemiologia , Guerra , Prisioneiros/psicologia , Comorbidade
10.
J Anxiety Disord ; 92: 102612, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36252350

RESUMO

Few studies have examined the longitudinal courses of anxiety disorders in military members. This study examined the prevalence and predictors of courses of any anxiety disorder in members and veterans of the Canadian Armed Forces, including no lifetime, remitted, new onset, and persistent/recurrent anxiety disorder. The 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey is a 16-year follow-up of n = 2941 participants from the Canadian Community Health Survey: Canadian Forces Supplement in 2002. Diagnoses of any DSM-IV anxiety disorder (i.e., generalized anxiety, social anxiety, and/or panic disorder) in 2002 and 2018 were used to create four anxiety course groups. A large proportion of the sample (36.3 %; new onset = 24.6 %, remitting = 6.9 %, and persistent/recurrent = 4.8 %) met criteria for an anxiety disorder during one or both time points. Factors at baseline and/or between 2002 and 2018, including income, education, military rank, comorbidity of PTSD or depression, deployment history, and traumatic events, were positively associated with most anxiety courses relative to no anxiety in analyses. Targeted interventions are needed to help mitigate anxiety disorders among this population. Social support and active coping were protective factors for most anxiety courses and may need to be incorporated into targeted interventions.


Assuntos
Militares , Transtornos de Estresse Pós-Traumáticos , Veteranos , Humanos , Prevalência , Transtornos de Estresse Pós-Traumáticos/psicologia , Canadá/epidemiologia , Militares/psicologia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Veteranos/psicologia
11.
F1000Res ; 11: 944, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36203746

RESUMO

Social prescribing is a way of connecting individuals to a source of support within the community to help improve their health and well-being. Social prescribing programmes are being widely promoted within the United Kingdom (UK) and United States as non-pharmaceutical interventions for those living with addiction and substance misuse needs. These needs have been exasperated by the recent COVID-19 pandemic and global economic crisis, with emerging research indicating short-term and long-term detrimental effects on physical and mental health due to substance misuse and addictions. Psychosocial interventions utilize psychological or social factors rather than an overreliance on biological interventions to treat the health impacts of mental illnesses such as addictions and substance use disorder. In this paper, I will discuss the associated determinants of addictions and substance for the military veteran population, as well as how the social prescribing of psychosocial interventions could be used to reaffirm participant's identity and enhance their sense of belonging for military veterans, using a real-world example in Wales, UK.


Assuntos
COVID-19 , Transtornos Relacionados ao Uso de Substâncias , Veteranos , Humanos , Pandemias , Intervenção Psicossocial , Transtornos Relacionados ao Uso de Substâncias/terapia , Estados Unidos , Veteranos/psicologia
12.
J Subst Abuse Treat ; 143: 108893, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36215912

RESUMO

INTRODUCTION: The objective of this study was to inform clinical practice by identifying distinct subgroups of US veterans with criminal histories in residential mental health treatment. The study characterized veteran patients on their alcohol and drug use and criminogenic thinking. We also examined predictors and outcomes of subgroup membership. METHODS: Participants were 341 veterans with a criminal history in residential mental health care. A parallel latent growth trajectory model characterized participants' alcohol and drug use and criminogenic thinking at treatment entry and at 6- and 12-month follow-ups. RESULTS: The study identified four distinct classes: 53 % Normative Improvement, 27 % High Criminogenic Thinking, 11 % High Recurrence (of substance use), and 9 % High Drug Use. Compared to the Normative Improvement class, prior to treatment entry, patients in the High Recurrence class were less likely to be on parole or probation, and patients in the High Criminogenic Thinking class were more likely to be chronically homeless. Compared to the Normative Improvement class, at follow-ups, patients in the High Drug Use and High Criminogenic Thinking classes were more likely to recidivate, and patients in the High Drug Use class were more likely to report unstable housing. Depression scores were higher (nearly double) in the High Drug Use, High Recurrence, and High Criminogenic Thinking classes at follow-ups compared to the Normative Improvement class. CONCLUSIONS: That the Normative Improvement class entered mental health residential treatment with relatively low alcohol and drug use and criminogenic thinking, and sustained these low levels, suggests that treatment does not need to be broadened or intensified to improve these domains for these patients with criminal histories. In contrast, findings for the High Drug Use, High Recurrence, and High Criminogenic Thinking classes, which composed 47 % of the sample, suggest that more integrated and sustained treatment may be needed to reduce recidivism, depression, and homelessness among these patients.


Assuntos
Criminosos , Reincidência , Transtornos Relacionados ao Uso de Substâncias , Veteranos , Humanos , Veteranos/psicologia , Análise de Classes Latentes , Transtornos Relacionados ao Uso de Substâncias/terapia
13.
Law Hum Behav ; 46(5): 385-394, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36227321

RESUMO

OBJECTIVE: This study investigated individual-level and neighborhood-level predictors of criminal legal involvement of veterans during the critical transition period from military to civilian life. HYPOTHESES: We hypothesized that substance use, mental health, and personality disorders will increase the incidence of criminal legal involvement, which will be highest among veterans living in socioeconomically disadvantaged neighborhoods after military discharge. METHOD: We analyzed data from a longitudinal cohort study of 418,624 veterans who entered Department of Veterans Affairs (VA) health care after leaving the military. Department of Defense (DoD) data on clinical diagnoses, demographics, and military history were linked to VA data on neighborhood of residence and criminal legal involvement. RESULTS: Criminal legal involvement in the 2 years following military discharge was most strongly predicted by younger age, substance use disorder, and being male. Other predictors included the military branch in which veterans served, deployment history, traumatic brain injury, serious mental illness, personality disorder, having fewer physical health conditions, and living in socioeconomically disadvantaged neighborhoods. These factors combined in multivariable analysis yielded a very large effect size for predicting criminal legal involvement after military separation (area under the curve = .82). The incidence of criminal legal involvement was 10 times higher among veterans with co-occurring substance use disorder, serious mental illness, and personality disorder than among veterans with none of these diagnoses, and these rates were highest among veterans residing in more socioeconomically disadvantaged neighborhoods. CONCLUSIONS: To our knowledge, this is the largest longitudinal study of risk factors for criminal legal involvement in veterans following military discharge. The findings supported the hypothesis that veterans with co-occurring mental disorders living in socioeconomically disadvantaged neighborhoods were at higher risk of criminal legal involvement, underscoring the complex interplay of individual-level and neighborhood-level risk factors for criminal legal involvement after veterans leave the military. These results can inform policy and programs, such as the DoD Transition Assistance Program (TAP) and the VA Military to Civilian Readiness Pathway program (M2C Ready), to enhance community reintegration and prevent criminal legal involvement among veterans transitioning from military to civilian life. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Assuntos
Criminosos , Militares , Transtornos Relacionados ao Uso de Substâncias , Veteranos , Feminino , Humanos , Estudos Longitudinais , Masculino , Militares/psicologia , Estados Unidos , Veteranos/psicologia
14.
J Psychiatr Res ; 155: 559-566, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36201968

RESUMO

OBJECTIVE: Post-9/11 U.S. veterans and servicemembers are at increased risk for suicide, indicating an important need to identify and mitigate suicidal ideation and behaviors in this population. METHOD: Using data modeling techniques, we examined correlates of suicidal ideation and behavior at intake in 261 Post-9/11 veterans and servicemembers seeking mental health treatment. RESULTS: Our sample endorsed high rates of suicidal ideation and behavior. Approximately 40% of our sample scored in a range on the Suicide Behaviors Questionnaire-Revised (SBQ-R), indicating high clinical risk for suicide. Results from multivariate analyses indicate that greater state and/or trait depression severity, greater anger and anger expression, less impulse control, and lower rank were consistently associated with suicidal ideation and behavior across our models. Negative posttraumatic thoughts about the self, gender, and military branch of service were also significantly associated with suicidal ideation and behavior. CONCLUSIONS: Suicidal ideation and behaviors are common in veterans seeking mental health treatment. State and/or trait depression, anger and impulse control were predictors of increased risk for suicidal ideation and behavior across models. Consistencies and differences across models as well as limitations and practical implications for the findings are discussed.


Assuntos
Militares , Transtornos de Estresse Pós-Traumáticos , Veteranos , Humanos , Militares/psicologia , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Ideação Suicida , Veteranos/psicologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-36294023

RESUMO

The purpose of this qualitative study was to explore perspectives of Whole Health (WH) coaches at the Veterans Health Administration (VHA) on meeting the needs of rural Veterans during the COVID-19 pandemic. The evaluation design employed a qualitative description approach, employing focus groups and in-depth interviews with a convenience sample of WH coaches across the VHA system. Fourteen coaches who work with rural Veterans participated in either one of three focus groups, individual interviews, or both. The focus group data and in-depth interviews were analyzed separately using thematic analysis, and findings were then merged to compare themes across both datasets. Four primary themes were identified: bridging social risk factors for rural Veterans, leveraging technology to stay connected with Veterans at-a-distance, redirecting Veterans to alternate modes of self-care, and maintaining flexibility in coaching role during COVID-19. One overarching theme was also identified following a post-hoc analysis driven by interdisciplinary team discussion: increased concerns for Veteran mental health during COVID-19. Coaches reported using a variety of strategies to respond to the wide-ranging needs of rural Veterans during the pandemic. Implications of findings for future research and practice are discussed.


Assuntos
COVID-19 , Serviços de Saúde Mental , Veteranos , Estados Unidos/epidemiologia , Humanos , Veteranos/psicologia , United States Department of Veterans Affairs , COVID-19/epidemiologia , Pandemias , Pesquisa Qualitativa
16.
Subst Use Misuse ; 57(14): 2053-2062, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36305851

RESUMO

Background: Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are mental health conditions that often co-occur. The complexity of this comorbidity is well-documented, though the role of malleable cognitive-affective factors in PTSD/AUD warrants further study. Specifically, attaining a more comprehensive understanding of the role of malleable cognitive-affective factors in individuals with symptoms of PTSD/AUD may have important implications for future research, such as in treatment-seeking individuals. Extant examinations of cognitive-affective factors have demonstrated unique associations of cognitive reappraisal, expressive suppression, and rumination in PTSD symptom severity, though these effects had yet to be explored in subgroups of comorbid PTSD/AUD.Methods: In a sample of trauma-exposed individuals (n = 334) recruited to participate through an internet labor market, we first empirically examined latent subgroups of PTSD/AUD symptoms using latent profile analysis, then included expressive suppression, cognitive reappraisal, and four dimensions in the model to elucidate their role in specific profile patterns of PTSD/AUD symptom typologies.Results: Our results support a four-class model of PTSD/AUD symptoms, with unique predictive effects of expressive suppression, problem-focused thoughts, repetitive thoughts, and anticipatory thoughts on latent profile status.Conclusions: These findings may have important implications for future research focused on examining cognitive-affective patterns as they apply to intervention techniques in treatment-seeking individuals with symptoms of PTSD/AUD.


Assuntos
Alcoolismo , Transtornos de Estresse Pós-Traumáticos , Veteranos , Humanos , Transtornos de Estresse Pós-Traumáticos/psicologia , Consumo de Bebidas Alcoólicas , Alcoolismo/psicologia , Comorbidade , Cognição , Veteranos/psicologia
17.
Artigo em Inglês | MEDLINE | ID: mdl-36231518

RESUMO

Psychological distress may impact women's risk for future intimate partner violence (IPV). Yet, limited research has utilized longitudinal research designs and there is a scarcity of research looking at the three most commonly implicated mental health factors-posttraumatic stress disorder (PTSD), depression, and alcohol use-within the same study. Research is especially scarce for women veterans, who experience substantial risk for these mental health concerns and experiencing IPV. This study examined the role of PTSD symptoms, depression symptoms, and alcohol use in increasing risk for experiencing future IPV while simultaneously accounting for the impact of recent IPV experience on subsequent mental health. This study included a sample of 1921 women veterans (Mage = 36.5), who were asked to complete three mail surveys over the course of 8 months as part of a larger longitudinal survey study of US veterans' health and well-being. The survey assessed experiences of IPV, PTSD symptoms (PCL-5), depression symptoms (PHQ-9), and alcohol use (AUDIT-C) at each of the three time points. Results from separate path analysis models provided support for the role of PTSD symptoms and depression symptoms (but not alcohol use) in increasing risk for IPV experience over time. However, the path analysis models provided little support, with the exception of PTSD, for the impact of IPV experience on subsequent mental health symptoms. Findings point to the importance of better understanding the mechanisms by which PTSD and depression symptoms can increase risk for IPV to inform theory and prevention and treatment efforts. Detection and treatment of PTSD and depression symptoms among women may help reduce risk for future violence in intimate relationships.


Assuntos
Violência por Parceiro Íntimo , Transtornos de Estresse Pós-Traumáticos , Veteranos , Adulto , Depressão/psicologia , Feminino , Humanos , Violência por Parceiro Íntimo/psicologia , Saúde Mental , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia
18.
Artigo em Inglês | MEDLINE | ID: mdl-36231981

RESUMO

The social, health, and economic burden of mental health problems in the veteran community is heavy. Internationally, the array of services and support available to veterans and their families are extensive but vary in quality, are often disconnected, complex to navigate, and lack clear coordination. This paper describes a conceptual framework to guide the design and implementation of a system of services and supports to optimize the mental health and wellbeing of all veterans and their families. The framework recognizes the diversity of veterans across intersecting identities that uniquely shape experiences of posttraumatic mental health and wellbeing. It brings together several strands of research: the values and principles that should underpin the system; the needs of diverse veterans and their families; challenges in the current services and supports; evidence-based interventions; and principles of effective implementation. Central to the future system design is a next generation stepped model of care that organizes best and next practice interventions in a coherent system, matches service provision to level of need and addresses access and navigation. Practical guidance on implementation provides an aspirational and flexible structure for system evolution, and a template for all stakeholders-individuals, groups, agencies and organizations-to effect system change.


Assuntos
Veteranos , Reforma dos Serviços de Saúde , Humanos , Saúde Mental , Veteranos/psicologia
19.
J Psychiatr Res ; 155: 534-541, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36194991

RESUMO

BACKGROUND: Insomnia is associated with suicide risk in civilian and military populations. Thwarted belongingness is proposed as a mediator of this relationship under the Interpersonal Theory of Suicide (IPTS). The present study explored how insomnia relates to suicidal ideation in conjunction with thwarted belongingness among civilians, Service members, and Veterans. METHODS: Data from the Military Suicide Research Consortium for N = 6556 individuals (6316 with non-missing suicidal ideation status) were divided into 4 subgroups: civilians, never deployed Service members, previously deployed Service members, and Veterans. Robust Poisson models evaluated the associations between insomnia severity/subtype and current suicidal ideation, with bootstrap mediation models assessing thwarted belongingness as a mediator. RESULTS: A 5-point increase in insomnia severity was associated with a 38% increased risk for current suicidal ideation among civilians, a 56% greater risk among never deployed Service members, an 83% greater risk among previously deployed Service members, and a 37% greater risk among Veterans. Moreover, active Service members showed greater associations between difficulty falling asleep and staying asleep with suicidal ideation than civilians. These associations were independent of covariates and only mediated by thwarted belongingness among Veterans. CONCLUSIONS: The relationship between insomnia and suicide is not purely explained by thwarted belongingness except among Veterans. Future research should explore additional psychological and neurobiological mechanisms connecting insomnia and suicidality.


Assuntos
Distúrbios do Início e da Manutenção do Sono , Suicídio , Veteranos , Humanos , Relações Interpessoais , Teoria Psicológica , Fatores de Risco , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Ideação Suicida , Suicídio/psicologia , Veteranos/psicologia
20.
Depress Anxiety ; 39(12): 813-823, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36258655

RESUMO

BACKGROUND: The unified protocol (UP) is a promising transdisgnostic treatment for emotional disorders; limited data exists with trauma-exposed populations. This study compared effectiveness of the UP, presented centered therapy (PCT), and treatment as usual (TAU) in trauma-exposed veterans presenting to routine care. METHOD: Trauma-exposed veterans with one or more emotional disorder diagnoses participated in a pilot hybrid-1 effectiveness/preimplementation study. Thirty-seven male and female veterans were randomized to one of three conditions. RESULTS: Multilevel growth curve modeling demonstrated improvement over time across conditions with large effect sizes (range: -2.15 to -3.32), with the UP demonstrating the greatest change. The between group effect sizes for reductions in number of comorbid diagnoses were medium to small and statistically significant (TAU and UP, d = 0.49, p = .056; TAU and PCT d = 0.18, p = .166, UP and PCT d = 0.31, p = .229). Only the UP led to a decrease in the number of comorbid diagnoses (d = -0.71). Psychosocial functioning varied by group, with slight increases in impairment in PCT and TAU, and medium effect size reduction in the UP. Only the UP exhibited significant decreases in self-reported anxiety and depression. Between group differences for UP and PCT were medium to large and statistically significant for depression across two measures (d = -0.72 to d = -1.40). CONCLUSIONS: This represents the first trial examining effectiveness of the UP, PCT, and TAU in trauma-exposed veterans. Despite a small sample, large effect size differences demonstrated promising advantages for the UP. Trial Registration Number: NCT02944994.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Veteranos , Masculino , Feminino , Humanos , Veteranos/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Projetos Piloto , Ansiedade/psicologia , Comorbidade , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...