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1.
J Trauma Stress ; 34(4): 808-818, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33524199

RESUMO

High treatment dropout rates reported in recent literature have brought into question the effectiveness of trauma-focused posttraumatic stress disorder (PTSD) treatments among military populations. The aim of the current systematic review was to evaluate PTSD treatment dropout rates among military populations by treatment type and other study-level variables. We searched four databases as well as gray literature for randomized controlled trials that evaluated evidence-based PTSD treatments in samples of active duty personnel and/or veterans. In total, 26 studies were included in this review, with a total of 2,984 participants. We analyzed dropout rates across treatment types using multivariate meta-analysis. Across all forms of treatment, the aggregated dropout rate was 24.2%. Dropout percentages based on treatment type were 27.1% for trauma-focused treatments, 16.1% for non-trauma-focused treatments, and 6.8% for waitlist groups. We found substantial heterogeneity between studies that was not explained by military status or other study-level covariates. Summary risk ratios (RRs) comparing relative dropout between treatment groups indicated that trauma-focused treatment groups had a higher risk of dropout compared to non-trauma-focused treatments, RR = 1.60. The statistical heterogeneity of within-treatment dropout risk ratios was negligible. Dropout rates among military patients receiving trauma-focused therapies were only slightly higher than those reported in the literature among civilian populations and were not explained by study-level covariates.


Assuntos
Militares , Transtornos de Estresse Pós-Traumáticos , Veteranos , Humanos , Pacientes Desistentes do Tratamento , Psicoterapia , Transtornos de Estresse Pós-Traumáticos/terapia
2.
Community Ment Health J ; 53(4): 452-459, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28070775

RESUMO

This pilot study examined the usability, acceptability, and effectiveness of a free Provider Resilience (PR) mobile application (app) designed by the National Center for Telehealth and Technology to reduce provider burnout. Outpatient mental health providers (N = 30) used the PR app for 1 month. Participants rated the PR app on the System Usability Scale with an overall score of 79.7, which is in the top quartile for usability. Results of paired sample t tests on the Professional Quality of Life Scale indicated significant decreases on the Burnout (t = 3.65, p < .001) and Compassion Fatigue (t = 4.54, p < .001) subscales. The Provider Resilience app shows promise in reducing burnout and compassion fatigue in mental health care providers.


Assuntos
Esgotamento Profissional/prevenção & controle , Pessoal de Saúde/psicologia , Aplicativos Móveis , Resiliência Psicológica , Adulto , Esgotamento Profissional/psicologia , Feminino , Humanos , Masculino , Inquéritos e Questionários
3.
Telemed J E Health ; 21(4): 245-58, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25615027

RESUMO

OBJECTIVE: Although personal electronic devices, such as mobile phones, computers, and tablets, increasingly are being leveraged as vehicles for health in the civilian world, almost nothing is known about personal technology use in the U.S. military. In 2012 we conducted a unique survey of personal technologies used by U.S. military service members. However, with the rapidly growing sophistication of personal technology and changes in consumer habits, that knowledge must be continuously updated to be useful. Accordingly, we recently surveyed new samples of active duty service members, National Guard and Reserve, and veterans. MATERIALS AND METHODS: We collected data by online surveys in 2013 from 239 active, inactive, and former service members. Online surveys were completed in-person via laptop computers at a large military installation and remotely via Web-based surveys posted on the Army Knowledge Online Web site and on a Defense Center Facebook social media channel. RESULTS AND CONCLUSIONS: We measured high rates of personal technology use by service members at home across popular electronic media. The most dramatic change since our earlier survey was the tremendous increase in mobile phone use at home for a wide variety of purposes. Participants also reported moderate non-work uses of computers and tablets while on recent deployment to Iraq and Afghanistan, but almost no mobile phone use, ostensibly because of military restrictions in the war zone. These latest results will enable researchers and technology developers target their efforts on the most promising and popular technologies for psychological health in the military.


Assuntos
Microcomputadores/estatística & dados numéricos , Medicina Militar/métodos , Militares/estatística & dados numéricos , Telecomunicações/instrumentação , Veteranos/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Estudos Transversais , Bases de Dados Factuais , Feminino , Previsões , Humanos , Masculino , Satisfação Pessoal , Fatores Sexuais , Tecnologia , Telecomunicações/tendências , Adulto Jovem
4.
J Nerv Ment Dis ; 201(11): 991-5, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24177488

RESUMO

The smartphone is an increasingly widespread technological vehicle for general health and psychological health promotion, evaluation, education, and sometimes intervention. However, the psychometric performance of behavioral health screening measures has not been commonly evaluated for the new, small-format, touch-screen medium. Before mobile-based applications for behavioral health screening can be disseminated confidently, the reliability and the validity of measures administered by the smartphone must be evaluated. We compared psychometric properties (i.e., internal consistency and test-retest reliability) of seven behavioral health measures completed on paper, a computer, and an iPhone by 45 army soldiers. The results showed the internal consistencies of the smartphone-delivered measures to be equivalent and very high across all three modalities and the test-retest reliability of the iPhone measures also to be very high. Furthermore, completion of the behavioral screening measures by the iPhone was highly preferred over the other modalities and was reported to be easy and convenient. Our findings help corroborate the use of smartphones and other small mobile devices for behavioral health screening.


Assuntos
Telefone Celular , Computadores de Mão , Comportamento do Consumidor , Promoção da Saúde/métodos , Saúde Mental , Psicometria/métodos , Comportamento Social , Telefone Celular/normas , Computadores de Mão/normas , Estudos Transversais , Feminino , Promoção da Saúde/normas , Humanos , Masculino , Psicometria/normas , Reprodutibilidade dos Testes
5.
Psychol Serv ; 20(1): 74-83, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35420858

RESUMO

Caring Contacts (CC), a low-cost intervention originally designed and tested by Jerome Motto in 1976, remains one of the few strategies to demonstrate efficacy in the prevention of suicide deaths. Interest in CC has increased steadily over the last several years in tandem with rising U.S. suicide rates and the acceleration of suicide prevention initiatives. There have been several efforts to design interventions modeled after Motto's strategy, and the recent publication of additional large-scale randomized controlled trials (RCTs) in alignment with the intent of Motto's original model afford an opportunity to systematically review efficacy findings. The current systematic review provides an updated and focused analysis of the evidence supporting the efficacy of CC. A systematic literature search of MEDLINE, EMBASE, PsycINFO, Cochrane Library, and ClinicalTrials.gov was conducted, and PRISMA, Cochrane, and GRADE guidelines were followed. Of 2,746 abstracts reviewed, 13 publications, comprising six randomized controlled trials (RCTs) met inclusion criteria. The studies encompassed 6,218 participants across four countries and military, veteran, and civilian health care systems. The primary outcome was suicide mortality; secondary outcomes were suicide attempts and emergency department (ED) presentations/hospitalizations. The DerSimonian-Laird random-effects univariate meta-analysis was used to estimate summary effect sizes and evaluate statistical heterogeneity. Summary risk ratio estimates ranged from 0.57 to 1.29 across outcomes and time points; most estimates indicated a protective effect. For suicide deaths and ED presentations/hospitalization, interval estimates at 1-year postrandomization were consistent with either an increase or a decrease in risk. A protective effect was observed for suicide attempts at 1-year postrandomization. Implications and methodological recommendations for future work in this area reviewed and discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Assuntos
Militares , Veteranos , Humanos , Tentativa de Suicídio/prevenção & controle , Prevenção do Suicídio
6.
Am J Public Health ; 102 Suppl 1: S24-8, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22390595

RESUMO

The US National Strategy for Suicide Prevention (National Strategy) described 11 goals across multiple areas, including suicide surveillance. Consistent with these goals, the Department of Defense (DoD) has engaged aggressively in the area of suicide surveillance. The DoD's population-based surveillance system, the DoD Suicide Event Report (DoDSER) collects information on suicides and suicide attempts for all branches of the military. Data collected includes suicide event details, treatment history, military and psychosocial history, and psychosocial stressors at the time of the event. Lessons learned from the DoDSER program are shared to assist other public health professionals working to address the National Strategy objectives.


Assuntos
Órgãos Governamentais/organização & administração , Militares/psicologia , Vigilância da População , Prevenção do Suicídio , Coleta de Dados , Humanos , Objetivos Organizacionais , Saúde Pública , Suicídio/psicologia , Suicídio/estatística & dados numéricos , Estados Unidos/epidemiologia
7.
Telemed J E Health ; 18(4): 253-63, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22400971

RESUMO

OBJECTIVE: Personal technologies such as smartphones, computers, and gaming devices, are ubiquitous in the civilian world. Consequently they represent ideal vehicles for disseminating psychological and other health resources and interventions. However, almost nothing is known about personal technology use in the U.S. military. We conducted the most comprehensive survey to date of the use, availability, and need for personal technologies by U.S. military service members. Our survey asked detailed questions about computers and the Internet, phones and smartphones, other mobile or portable technologies, gaming devices, and TV and video media used during deployment and at permanent duty station or home. MATERIALS AND METHODS: We collected data by paper-and-pencil survey in 2010 and 2011 from 331 active Army service members at a processing and registration center in a large military installation in the western United States. Two cohorts were surveyed: Soldiers who had previously been deployed to a warzone and soldiers who had never been deployed. RESULTS AND CONCLUSION: We measured high rates of personal technology use by service members at home across all popular electronic media. Soldiers at home essentially resembled civilian consumers in their use of popular technologies. Some technologies, including the Internet, gaming, and TV, were widespread on deployment. Others, most notably cellphones, were more restricted by availability, connectivity, opportunity, and military regulation in the warzone. Results will enable researchers and technology developers target their efforts on the most promising and popular technologies for psychological health in the military.


Assuntos
Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Medicina Militar , Militares , Psiquiatria/organização & administração , Telemedicina/organização & administração , Adolescente , Adulto , Estudos de Coortes , Estudos Transversais , Feminino , Pesquisas sobre Atenção à Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Psiquiatria/instrumentação , Estados Unidos , Adulto Jovem
8.
J Clin Psychol ; 68(9): 1036-47, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22826136

RESUMO

OBJECTIVE: This research developed and tested the Military Stigma Scale (MSS), a 26-item scale, designed to measure public and self-stigma, two theorized core components of mental health stigma. METHOD: The sample comprised 1,038 active duty soldiers recruited from a large Army installation. Soldiers' mean age was 26.7 (standard deviation = 5.9) years, and 93.6% were male. The sample was randomly split into a scale development group (n = 520) and a confirmatory group (n = 518). RESULTS: Factor analysis conducted with the scale development group resulted in the adoption of two factors, named public and self-stigma, accounting for 52.1% of the variance. Confirmatory factor analysis conducted with the confirmatory group indicated good fit for the two-factor model. Both factors were components of a higher order stigma factor. The public and self-stigma scales for the exploratory and confirmatory groups demonstrated good internal consistency (α = .94 and .89; α = .95 and .87, respectively). Demographic differences in stigma were consistent with theory and previous empirical research: Soldiers who had seen a mental health provider scored lower in self-stigma than those who had not. CONCLUSIONS: The MSS comprises two internally consistent dimensions that appear to capture the constructs of public and self-stigma. The overall results indicate that public and self-stigma are dimensions of stigma that are relevant to active duty soldiers and suggest the need to assess these dimensions in future military stigma research.


Assuntos
Serviços de Saúde Mental/estatística & dados numéricos , Militares/psicologia , Psicometria/instrumentação , Autoimagem , Estigma Social , Inquéritos e Questionários/normas , Adulto , Análise Fatorial , Feminino , Humanos , Masculino , Estados Unidos
9.
Psychol Serv ; 19(2): 283-293, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-33507770

RESUMO

Adjustment disorders are among the most commonly diagnosed mental health disorders in both civilian and military clinical settings. Despite their high prevalence, adjustment disorders have received little research attention. The many gaps in our understanding of this group of disorders hinder the development of adequate, evidence-based treatment protocols. This study utilizes a systematic methodology to identify and prioritize research gaps in adjustment disorders. We used authoritative source reports to identify gaps in research domains from foundational science to services research. Subject-matter experts conducted literature searches to substantiate and refine research gaps, and stakeholders assessed the importance and impact of this work for researchers and policy-makers. We identified 254 possible research-needs statements, which were ultimately reduced to 11 final, prioritized research gaps. Two gaps addressed prevention and screening and three addressed treatment and services research. Six gaps addressed foundational science, epidemiology, and etiology research domains, highlighting the need for basic research. Until some of the basic science questions are resolved (e.g., diagnostic clarity, valid screening, and assessment measures) about adjustment disorders, we may not be able to develop adequate evidence-based interventions for the disorders, and it will be difficult to understand the trajectory of these disorders throughout treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Assuntos
Transtornos de Adaptação , Transtornos de Adaptação/diagnóstico , Transtornos de Adaptação/epidemiologia , Transtornos de Adaptação/terapia , Humanos
10.
Mil Med ; 176(11): 1215-22, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22165648

RESUMO

An upward trend of suicides has emerged in the U.S. military, and record high suicide rates have been reported. There is abundant evidence of the negative consequences of trauma, especially posttraumatic stress disorder, as risk factors for suicide. However, stressful events and trauma sometimes can have positive psychological consequences, commonly labeled posttraumatic growth (PTG). Little formal research has examined the role of PTG in moderating suicide in the military. We examined the relationship between PTG and suicidal ideation in data reported by 5302 service members with war zone or combat experience completing the Army's Automated Behavioral Health Clinic electronic screening. Controlling for other known risk factors for suicide, we found that the more PTG service members reported, the less suicidal ideation they subsequently espoused. Our results suggest the need for further research to determine the potential clinical value of PTG as a therapeutic component of suicide prevention.


Assuntos
Militares/psicologia , Ideação Suicida , Adolescente , Adulto , Campanha Afegã de 2001- , Feminino , Humanos , Guerra do Iraque 2003-2011 , Masculino , Fatores de Risco , Estresse Psicológico , Suicídio/estatística & dados numéricos , Estados Unidos , Adulto Jovem , Prevenção do Suicídio
11.
Suicide Life Threat Behav ; 51(4): 767-774, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34254693

RESUMO

OBJECTIVE: This study identified and prioritized research gaps for suicide prevention in the Department of Defense to inform future research investments. METHODS: The 2019 VA/DoD Clinical Practice Guideline for the Assessment and Management of Patients at Risk for Suicide was the primary source document for research gaps, supplemented by an updated literature search. Institutional stakeholders rated the identified research gaps and ranked the gap categories. We used Q factor analysis to derive a list of the prioritized research gaps and category rankings. RESULTS: Thirty-five research gaps were identified and prioritized. The highest rated research gap topic was lethal means safety interventions and their effectiveness in increasing safety behaviors and/or reducing suicide-related outcomes. Research on the effectiveness of crisis response planning and several other non-pharmacological interventions (e.g., implementation of cognitive-behavioral therapy, technology-based behavioral interventions, and applications of dialectical behavior therapy to non-Borderline patients) were also rated highly by stakeholders. CONCLUSIONS: This work generated a list of priorities for future suicide research as evaluated by Departments of Defense and Veterans Affairs stakeholders. Our findings can help guide the efforts of suicide researchers and inform decisions about future research funding for suicide prevention.


Assuntos
Terapia Cognitivo-Comportamental , Prevenção do Suicídio , Humanos
12.
Clin Neuropsychol ; 34(6): 1124-1133, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31985330

RESUMO

OBJECTIVE: Prior research indicates that there is an additive association between traumatic brain injury and mental health diagnoses on health-care utilization. This assumed additivity has not been formally assessed. The objective of this study was to estimate additive and multiplicative interactions associated with mild traumatic brain injury (mTBI) and pre-existing health conditions. METHOD: Active-duty military patient records over a nine-year period were sampled within four exposure groups (N = 4500 per group) defined jointly by incident mTBI and pre-existing mental health diagnoses. Outpatient and inpatient health encounters were compared between the four exposure groups using generalized linear models for count and proportion outcomes. Additive interactions were estimated using the interaction contrast ratio. Multiplicative interactions were estimated as a product term in the generalized linear models. RESULTS: The joint association of mTBI and pre-existing mental health diagnoses with health-care utilization, overall, was less than multiplicative and greater than additive. Patients with both exposures experienced more health-care utilization than expected under the assumed additivity (independence) of the two exposures. PTSD and anxiety diagnoses were the MH diagnoses associated with the largest interaction contrast values specific to total outpatient encounters. CONCLUSIONS: Studies of the interaction of two diagnoses on subsequent health-care utilization should examine both additive and multiplicative interactions. The greater-than-additive findings in this study indicate that there may be synergy, for at least some patients, between mTBI injury and mental health that complicates the treatment course.


Assuntos
Concussão Encefálica/diagnóstico , Militares/psicologia , Testes Neuropsicológicos/normas , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adolescente , Adulto , Concussão Encefálica/psicologia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
13.
Psychol Serv ; 16(2): 188-195, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30407057

RESUMO

In this brief state of the science review, we provide a synopsis of the literature on psychological health mobile applications (apps) and discuss the impact of mobile technology on psychological health practice. We describe the variety of psychological health app uses from self-management, skills training, and supportive care to symptom tracking and data collection; and we summarize the current evidence for the efficacy and effectiveness of psychological health apps. Finally, we offer some pragmatic suggestions for evaluating psychological health apps for quality and clinical utility. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos Mentais/terapia , Serviços de Saúde Mental , Aplicativos Móveis , Smartphone , Telemedicina , Humanos , Serviços de Saúde Mental/normas , Aplicativos Móveis/normas , Telemedicina/instrumentação , Telemedicina/métodos , Telemedicina/normas
14.
Mil Med ; 184(Suppl 1): 432-437, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30423136

RESUMO

This paper presents data from the United States Department of Defense Suicide Event Report System for years 2012-2015 to detail descriptive, longitudinal rate data and risk factor profiles associated with military suicide. The annual findings were aggregated from all U.S. military suicide deaths and suicide attempts. Data elements included the most common method of suicide (firearms), most common behavioral health diagnoses (substance abuse/dependence), common life stressors (failed intimate-partner relationships), and an individual's history of operational deployment. Age- and sex-adjusted rates for the Services were compared with rates for the U.S. adult population. Results showed that the current reporting period (2015) is similar to patterns that have been observed over the preceding years and to patterns reported in the overall U.S. adult population. Suicide rates remain elevated but stable for both the Active and Reserve Components of the Military Services compared to historical levels observed prior to 2003. Finally, we discuss common errors and misinterpretations that can occur when analyzing surveillance data.


Assuntos
Militares/estatística & dados numéricos , Suicídio/tendências , Adulto , Feminino , Humanos , Masculino , Medicina Militar/métodos , Medicina Militar/tendências , Militares/psicologia , Vigilância da População/métodos , Fatores de Risco , Gestão de Riscos , Suicídio/estatística & dados numéricos , Estados Unidos
15.
Arch Suicide Res ; 23(2): 234-246, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29624123

RESUMO

In this study, we examined the indirect effect of the Virtual Hope Box (VHB) smartphone application on suicidal ideation, mediated through coping self-efficacy. A total of 117 veterans with suicidal ideation completed measures on coping self-efficacy and suicidal ideation at baseline and weeks 3, 6, and 12. Participants were randomly assigned to either the VHB or enhanced treatment as usual (eTAU) condition. Parallel process growth curve modeling (-0.20 [95% CI = -0.44, 0.00]) and auto-regressive modeling (-0.12 [95% CI = -0.35, -0.01]) revealed that a higher rate of change in coping self-efficacy in the VHB group was associated with a decrease in suicidal ideation severity, as compared to the eTAU group. Findings suggest that coping self-efficacy may be one mechanism by which the VHB operates to help reduce suicidal ideation. More broadly, the role of coping self-efficacy in reducing suicidal ideation is worthy of future study.


Assuntos
Adaptação Psicológica , Aplicativos Móveis , Autoeficácia , Smartphone , Ideação Suicida , Veteranos/psicologia , Adulto , Feminino , Esperança , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença
16.
JAMA Psychiatry ; 76(6): 642-651, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30865249

RESUMO

Importance: Suicide prediction models have the potential to improve the identification of patients at heightened suicide risk by using predictive algorithms on large-scale data sources. Suicide prediction models are being developed for use across enterprise-level health care systems including the US Department of Defense, US Department of Veterans Affairs, and Kaiser Permanente. Objectives: To evaluate the diagnostic accuracy of suicide prediction models in predicting suicide and suicide attempts and to simulate the effects of implementing suicide prediction models using population-level estimates of suicide rates. Evidence Review: A systematic literature search was conducted in MEDLINE, PsycINFO, Embase, and the Cochrane Library to identify research evaluating the predictive accuracy of suicide prediction models in identifying patients at high risk for a suicide attempt or death by suicide. Each database was searched from inception to August 21, 2018. The search strategy included search terms for suicidal behavior, risk prediction, and predictive modeling. Reference lists of included studies were also screened. Two reviewers independently screened and evaluated eligible studies. Findings: From a total of 7306 abstracts reviewed, 17 cohort studies met the inclusion criteria, representing 64 unique prediction models across 5 countries with more than 14 million participants. The research quality of the included studies was generally high. Global classification accuracy was good (≥0.80 in most models), while the predictive validity associated with a positive result for suicide mortality was extremely low (≤0.01 in most models). Simulations of the results suggest very low positive predictive values across a variety of population assessment characteristics. Conclusions and Relevance: To date, suicide prediction models produce accurate overall classification models, but their accuracy of predicting a future event is near 0. Several critical concerns remain unaddressed, precluding their readiness for clinical applications across health systems.


Assuntos
Modelos Teóricos , Ideação Suicida , Tentativa de Suicídio , Suicídio , Algoritmos , Humanos
17.
J Telemed Telecare ; 24(4): 282-289, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28372513

RESUMO

Introduction Mild traumatic brain injury (mTBI) is an unfortunately common repercussion of military service in a combat zone. The CONTACT study tested an individualized telephone support intervention employing problem solving therapy (PST) for mTBI in soldiers recently returned from deployment. We sought to determine the cost effectiveness of this intervention from a military healthcare system perspective. Methods We conducted an intent-to-treat post-hoc analysis by building a decision analytic model that evaluated the choice between using PST or education only (EO). The model included cost-minimization and cost-effectiveness analyses. The incremental cost-effectiveness ratios (ICERs) were calculated as the differences in costs of PST versus EO relative to the differences in the outcomes of participants. Results The PST intervention resulted in an annual per-enrolee cost of $1027 (95% CI: $836 to $1248), while EO costs were $32 (95% CI: $25 to $39), resulting in a net incremental cost of $996 per enrolee (95% CI: $806 to $1,217). The ICERs were $68,658/QALY based on EQ-5D (95% CI: -$463,535 to $596,661) and $49,284/QALY based on SF-6D (95% CI: $26,971 to $159,309). Estimates of treatment costs in a real-world setting were accompanied by substantially lower ICERs that are within accepted thresholds for willingness-to-pay. Discussion Although the intervention had short-term benefits sufficient to yield acceptable ICERs, there was no long-term effect of PST over EO observed in the study. Consequently, we suggest that future studies examine the use of low-cost approaches, such as booster relapse-prevention calls, that may lead to a sustained treatment benefit for this population.


Assuntos
Concussão Encefálica/terapia , Militares , Resolução de Problemas , Telefone , Análise Custo-Benefício , Tomada de Decisões , Feminino , Humanos , Anos de Vida Ajustados por Qualidade de Vida , Exposição à Guerra
18.
Psychiatry Res ; 249: 125-131, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28092792

RESUMO

Curiosity, the tendency to engage in novel and challenging opportunities, may be an important source of resilience for those at risk for suicide. We hypothesized that curiosity would have a buffering effect against risk conferred by multiple sources of distress, whereby curiosity would be associated with reduced suicidal ideation and increased coping efficacy. As part of a larger intervention trial designed to improve coping skills and reduce suicidal ideation, 117 military veterans with suicidal ideation completed measures of curiosity and distress (perceived stress, depression, anxiety, and sleep disturbances) at baseline, and completed measures of suicidal ideation and coping efficacy (to stop negative thoughts, to enlist support from friends and family) at baseline and 3-, 6-, and 12-week follow up. Growth curve models showed that curiosity moderated the association between distress and suicidal ideation at baseline and that curiosity moderated the association between distress and increased coping efficacy to stop negative thoughts over time. Findings suggest that curiosity may buffer against the effect of heightened levels of distress on suicidal ideation and help facilitate stronger gains in coping efficacy over time. Additional work should further examine the role of curiosity as a protective factor for veterans with suicidal ideation.


Assuntos
Adaptação Psicológica , Comportamento Exploratório , Doenças Profissionais/psicologia , Estresse Psicológico/psicologia , Ideação Suicida , Veteranos/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
19.
Psychiatr Serv ; 68(4): 330-336, 2017 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-27842473

RESUMO

OBJECTIVE: The purpose of this study was to assess the impact of the Virtual Hope Box (VHB), a smartphone app to improve stress coping skills, suicidal ideation, and perceived reasons for living among patients at elevated risk of suicide and self-harm. METHODS: The authors conducted a parallel-group randomized controlled trial with two groups of U.S. service veterans in active mental health treatment who had recently expressed suicidal ideation. Between March 2014 and April 2015, 118 patients were enrolled in the study. Participants were assigned to use the VHB (N=58) or to a control group that received printed materials about coping with suicidality (N=60) to supplement treatment as usual over a 12-week period. Three measures-the Coping Self-Efficacy Scale, Beck Scale for Suicidal Ideation, and Brief Reasons for Living Inventory-were collected at baseline (before randomization) and three, six, and 12 weeks. Secondary measures-the Interpersonal Needs Questionnaire, Perceived Stress Scale, and Columbia-Suicide Severity Rating Scale-were collected at baseline and 12 weeks. RESULTS: VHB users reported significantly greater ability to cope with unpleasant emotions and thoughts (Coping Self-Efficacy Scale) at three (b=2.41, 95% confidence interval [CI]=.29-4.55) and 12 weeks (b=2.99, 95% CI=.08-5.90) compared with the control group. No significant advantage was found on other outcome measures for treatment augmented by the VHB. CONCLUSIONS: The VHB is a demonstrably useful accessory to treatment-an easily accessible tool that can increase stress coping skills. Because the app is easily disseminated across a large population, it is likely to have broad, positive utility in behavioral health care.


Assuntos
Adaptação Psicológica/fisiologia , Emoções/fisiologia , Aplicativos Móveis , Avaliação de Resultados em Cuidados de Saúde , Autoeficácia , Comportamento Autodestrutivo/prevenção & controle , Veteranos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Smartphone
20.
J Neurotrauma ; 34(2): 313-321, 2017 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-27579992

RESUMO

Mild traumatic brain injury (mTBI) is a common injury for service members in recent military conflicts. There is insufficient evidence of how best to treat the consequences of mTBI. In a randomized, clinical trial, we evaluated the efficacy of telephone-delivered problem-solving treatment (PST) on psychological and physical symptoms in 356 post-deployment active duty service members from Joint Base Lewis McChord, Washington, and Fort Bragg, North Carolina. Members with medically confirmed mTBI sustained during deployment to Iraq and Afghanistan within the previous 24 months received PST or education-only (EO) interventions. The PST group received up to 12 biweekly telephone calls from a counselor for subject-selected problems. Both groups received 12 educational brochures describing common mTBI and post-deployment problems, with follow-up for all at 6 months (end of PST), and at 12 months. At 6 months, the PST group significantly improved on a measure of psychological distress (Brief Symptom Inventory; BSI-18) compared to the EO group (p = 0.005), but not on post-concussion symptoms (Rivermead Post-Concussion Symptoms Questionnaire [RPQ]; p = 0.19), the two primary endpoints. However, these effects did not persist at 12-month follow-up (BSI, p = 0.54; RPQ, p = 0.45). The PST group also had significant short-term improvement on secondary endpoints, including sleep (p = 0.01), depression (p = 0.03), post-traumatic stress disorder (p = 0.04), and physical functioning (p = 0.03). Participants preferred PST over EO (p < 0.001). Telephone-delivered PST appears to be a well-accepted treatment that offers promise for reducing psychological distress after combat-related mTBI and could be a useful adjunct treatment post-mTBI. Further studies are required to determine how to sustain its effects. (Trial registration: ClinicalTrials.gov Identifier: NCT01387490 https://clinicaltrials.gov ).


Assuntos
Concussão Encefálica/psicologia , Concussão Encefálica/terapia , Militares/psicologia , Educação de Pacientes como Assunto/métodos , Resolução de Problemas , Telefone , Adulto , Campanha Afegã de 2001- , Concussão Encefálica/epidemiologia , Feminino , Seguimentos , Humanos , Guerra do Iraque 2003-2011 , Masculino , North Carolina/epidemiologia , Síndrome Pós-Concussão/epidemiologia , Síndrome Pós-Concussão/psicologia , Síndrome Pós-Concussão/terapia , Washington/epidemiologia , Adulto Jovem
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