Design and methods of the Longitudinal Eating Disorders Assessment Project research consortium for veterans.

INTRODUCTION: Military service members must maintain a certain body mass index and body fat percentage. Due to weight-loss pressures, some service members may resort to unhealthy behaviors that place them at risk for the development of an eating disorder (ED). OBJECTIVES: To understand the scope and impact of EDs in military service members and veterans, we formed the Longitudinal Eating Disorders Assessment Project (LEAP) Consortium. LEAP aims to develop novel screening, assessment, classification, and treatment tools for veterans and military members with a focus on EDs and internalizing psychopathology. METHODS: We recruited two independent nationally representative samples of post-9/11 veterans who were separated from service within the past year. Study 1 was a four-wave longitudinal survey and Study 2 was a mixed-methods study that included surveys, structured-clinical interviews, and qualitative interviews. RESULTS: Recruitment samples were representative of the full population of recently separated veterans. Sample weights were created to adjust for sources of non-response bias to the baseline survey. Attrition was low relative to past studies of this population, with only (younger) age predicting attrition at 1-week follow-up. CONCLUSIONS: We expect that the LEAP Consortium data will contribute to improved information about EDs in veterans, a serious and understudied problem.

Exercise to Reduce Posttraumatic Stress Disorder Symptoms in Veterans.

Background: Physical exercise offers benefits for treating psychological disorders, particularly depression. Exercise is associated with reduction of posttraumatic stress disorder (PTSD) symptoms in civilians. Given the comorbidities and unique trauma experiences of the veteran population, the current work aims to estimate the effect of exercise on PTSD symptoms in veteran samples. Observations: A systematic review identified 6 single-arm studies and 3 randomized controlled trials (RCTs) using exercise as an interventional treatment among veteran samples with full or subsyndromal PTSD. Most single-arm studies used yoga-based interventions, whereas RCTs showed more variety and included yoga, aerobic activity, and resistance exercises. Data synthesis of study results revealed a medium standardized mean difference for the single-arm trials (Hedges g, -0.60, P = .03) and a small-to-medium standardized mean difference for the RCTs (Hedges g, -0.40, P = .06). Single-arm studies were all rated at serious risk of bias. Only 1 RCT was rated at high risk of bias, although the remaining RCTs showed some concern of elevated bias. Conclusions: There is preliminary evidence that exercise may be a useful treatment option for PTSD symptom reduction in veterans. Our review also highlights the need for additional high-quality randomized trials to confirm the benefits of exercise for PTSD symptom reduction in veterans.

Comparison of A1c Reduction, Weight Loss, and Changes in Insulin Requirements With Addition of GLP-1 Agonists vs SGLT-2 Inhibitors in Patients Using Multiple Daily Insulin Injections.

Objective: To determine whether Glucagon-Like Peptide 1 (GLP-1) agonists or Sodium Glucose Transporter 2 (SGLT-2) inhibitors result in greater A1c reduction, weight loss, and reduction of insulin requirements in veterans using multiple daily doses of insulin. Methods: This retrospective, single-site, cohort study included patients of VA Eastern Kansas Health Care System with a diagnosis of Type II Diabetes utilizing multiple daily dose insulin and an SGLT-2 inhibitor or GLP-1 agonist. SAS Enterprise Guide was utilized to complete a multivariate analysis of variance to evaluate all outcomes. Key Findings: 150 patients met selection criteria. The GLP-1 group averaged a .65% reduction in A1c compared to a 1.05% reduction in the SGLT-2 group (P = .1397). The Basal insulin dose was reduced by 5.5 units in the GLP-1 group vs 2.45 units in the SGLT-2 group (P = .3132), and 7.12 units vs 8.14 units respectively for short-acting insulin (P = .8170). The resulting weight reduction was 4.1 Kg in the GLP-1 group compared to 3.6 Kg in the SGLT-2 group (P = .6993). Conclusion: The results suggest there is not a statistically significant difference in changes to A1c, insulin requirements, or weight after 1 year of treatment with an SGLT-2 vs GLP-1 in patients using multiple daily insulin injections.

Factor structure and measurement invariance of the Revised Brief Addiction Monitor.

There are currently 2 versions of the Brief Addiction Monitor (BAM) being widely used within Department of Veterans Affairs (VA) medical centers and other treatment settings: the BAM, which entails use of discrete response options for all items, and the revised version, the BAM-R, which consists of the same items but uses continuous response options for several of the items. There is also conflicting evidence about the factor structure of the original BAM, with a 4-factor structure proposed by 1 study that refutes a 3-factor structure proposed from the original study of the measure. The BAM-R is widely administered in substance use treatment settings across the country and is overtaking the discrete BAM as the preferred instrument, although little research has examined the factor structure or longitudinal performance of this version of the measure. The purpose of this study is to examine the factor structure and temporal stability of the BAM-R among a large national sample of veterans across multiple treatment settings (i.e., all VA veterans with at least 2 complete BAM-R administrations reflected in the medical record; N = 22,453). Findings suggest that the 4-factor structure is superior to the commonly used 3-factor structure for both model fit and stability over two occasions of measurement and should be the factor structure used for clinical and research purposes pending further measure revisions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Implementation of an integrative medicine treatment program at a Veterans Health Administration residential mental health facility.

A 4-week interdisciplinary integrative medicine program was recently added to the core treatment offerings for veterans participating in the Mental Health Residential Rehabilitation Program at the Dwight D. Eisenhower Veterans Affairs Medical Center. The new integrative medicine program teaches veterans about using meditative practices, nutrition, creative expression, tai chi, hatha yoga, sensory and breathing techniques, and lifestyle changes to enhance well-being. The groups are run by professionals from a variety of disciplines including recreation therapy, art therapy, occupational therapy, psychology, and nutrition. For the first 42 veterans to complete the program, the Short Form 12-item Health Survey was administered before and after participation in the integrative medicine program to assess the potential effectiveness of the program in enhancing physical and psychological well-being. In addition, a brief semistructured interview was used to assess veteran opinions about the program. Results suggest that the program was well received and that both physical and mental health scores improved from before to after treatment in this sample of veterans with complex behavioral health concerns. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Factor structure and measurement invariance of the Brief Addiction Monitor.

Substance use disorders (SUDs) are of great concern for health care providers working with military veteran populations. Systematic evaluation of progress and outcomes within the Veterans Affairs (VA) is a critical component of care provided for the veteran population. The Brief Addiction Monitor (BAM) is a 17-item instrument used within VA to assess substance use and related constructs among veterans participating in SUD care. Initial evaluations, using a version containing continuous items, suggested that the items form three factors reflecting substance use, risk factors, and protective factors. Subsequent work, using the BAM version containing Likert-style items collected from a single VA Medical Center sample, did not support the proposed 3-factor solution. The current study used a nationwide sample of 4955 veterans to evaluate the factor structure of the BAM and its usefulness over time. Exploratory factor analyses conducted did not provide evidence of the originally proposed BAM factor structure but instead supported a 4-factor model (reflecting alcohol use, stress, risk, and stability) formed from 13 of the items. Further analyses conducted within a structural equation modeling framework showed that the four-factor model exhibited invariance across occasions of measurement, although internal consistency was found to be low for most subscales. Results provide caution against using BAM subscale scores to track treatment outcomes over time.

A meta-analytic review of mood-congruent implicit memory in depressed mood.

In studies of explicit memory, researchers have reliably demonstrated that mood-congruent, depressive information is especially likely to be recalled by individuals exhibiting depressed mood. Results from studies of implicit mood-congruent memory in depressed mood, however, have been largely discrepant. The current research reviews 20 studies of implicit mood-congruent memory for emotionally valenced words in the context of dysphoria and clinical depression. Meta-analytic techniques were used to summarize this research. Results indicated that depressive groups exhibited preferential implicit recall of negative information and nondepressed groups exhibited preferential implicit recall of positive information. Also, depressive implicit mood-congruent memory for negative information was associated with recall and encoding tasks that matched with regard to the perceptual versus conceptual processes required. Furthermore, self-relevance emerged as an important moderator for implicit recall in analyses that compared clinically depressed groups to nondepressed groups. These results provide partial support both for the transfer appropriate processing framework of memory and cognitive theories of depression that emphasize self-relevant information. Finally, certain participant characteristics, particularly age and severity of depressive symptoms, emerged as important moderators of the effect of group status on depressive implicit recall biases.