Archives for April 2016

Consistency of Reporting for Stressful Life Events Among Nondeployed Soldiers.

April 27, 2016 05:03

Consistency of Reporting for Stressful Life Events Among Nondeployed Soldiers.

http:--media.wiley.com-assets-7315-19-Wi

Consistency of Reporting for Stressful Life Events Among Nondeployed Soldiers.

J Clin Psychol. 2016 Apr 8;

Authors: Pless Kaiser A, Proctor SP, Vasterling JJ

Abstract

OBJECTIVES: Measurement of stress exposure is central to understanding military mental health outcomes. Although temporal stability of combat event reporting has been examined, less is known about the stability of reporting for noncombat events in military samples. Objectives are to examine consistency in reporting stressful life events in nondeployed U.S. Army soldiers and its association with posttraumatic stress disorder (PTSD) symptomatology.

METHOD: Examined reporting consistency over approximately 8 months among 466 soldiers. Regression models examined factors associated with decreased, increased, and stable reporting.

RESULTS: Stability of the number of events endorsed over time was high. However, item-level agreement was slight to moderate (kappas: .13-.54), with inconsistencies due primarily to decreased reporting. After adjusting for covariates and initial PTSD, second assessment PTSD was associated with increased and stable reporting.

CONCLUSIONS: Inconsistent reporting extends beyond combat events to other stressful life events in military personnel and is associated with PTSD.

PMID: 27062505 [PubMed – as supplied by publisher]

The burden of alcohol use disorders in U.S. Military veterans: results from the national health and resilience in veterans study.

April 27, 2016 05:02

The burden of alcohol use disorders in U.S. Military veterans: results from the national health and resilience in veterans study.

The burden of alcohol use disorders in U.S. Military veterans: results from the national health and resilience in veterans study.

Addiction. 2016 Apr 9;

Authors: Fuehrlein BS, Mota N, Arias AJ, Trevisan LA, Kachadourian LK, Krystal JH, Southwick SM, Pietrzak RH

Abstract

AIMS: To analyze data from a large, contemporary, nationally representative sample of U.S. veterans to evaluate: (1) the prevalence of lifetime alcohol use disorder (AUD), and past-year AUD; (2) common psychiatric comorbidities associated with lifetime AUD; and (3) correlates of lifetime and past-year probable AUD.

DESIGN: Data were analyzed from the National Health and Resilience in Veterans Study (NHRVS), a web-based survey of a random probability sample of a contemporary, nationally representative sample of U.S. military veterans.

SETTING: USA.

PARTICIPANTS: Nationally representative sample of 3,157 U.S. veterans aged 21 years and older.

MEASUREMENTS: Lifetime alcohol abuse and dependence were assessed according to DSM-IV diagnostic criteria using the Mini International Neuropsychiatric Interview, and combined into a single variable: AUD. Past-year probable AUD was assessed using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Correlates of AUD, including psychiatric comorbidities, suicidality, and demographic characteristics, were also assessed.

FINDINGS: The prevalence of lifetime AUD and past-year probable AUD was 42.2% (95% confidence interval [CI] = 40.5%-43.9%), and 14.8% (95%CI = 13.6%-16.0%), respectively. Compared with veterans without AUD, those with lifetime AUD had substantially elevated rates of lifetime and current mood and anxiety disorders (odds ratios [ORs] = 2.6-4.1), drug use disorder (OR = 10.7), lifetime suicide attempt (OR = 4.1) and current suicidal ideation (OR = 2.1). Younger age, male sex, lower education, lower annual household income, and greater number of lifetime traumatic events were independently associated with lifetime AUD. Younger age, male sex, unpartnered marital status, and a lifetime diagnosis of major depressive disorder were independently associated with past-year probable AUD.

CONCLUSIONS: More than 40% of U.S. military veterans have a lifetime history of alcohol use disorder (AUD). Veterans with a lifetime history of AUD have substantial comorbid psychiatric burden, including elevated rates of suicidal ideation and attempts. Certain sociodemographic (e.g., younger age, male sex, lower education) and clinical (e.g., trauma burden, history of depression) characteristics are associated with increased risk of AUD.

PMID: 27061707 [PubMed – as supplied by publisher]

US media representation of post-traumatic stress disorder: a comparative study of regional newspapers and national newspapers.

April 27, 2016 05:02

US media representation of post-traumatic stress disorder: a comparative study of regional newspapers and national newspapers.

US media representation of post-traumatic stress disorder: a comparative study of regional newspapers and national newspapers.

J Ment Health. 2016 Apr 7;:1-7

Authors: Wu L

Abstract

BACKGROUND: News media play an important role in introducing and defining PTSD-related issues to the general public as well as framing their social importance and analyzing solutions for policymakers.

AIMS: Compare how coverage of PTSD by larger papers serving general audiences differed from smaller papers catering to communities likely to be affected by the issue.

METHOD: A content analysis of frames and subtopics about PTSD in all newspaper articles published by selected national newspapers and regional newspapers between the year of 2003 and 2014 (N = 426).

RESULTS: National newspapers engaged in higher-level policy discussion with greater frequency than regional newspapers, while regional newspapers were more likely to publish stories highlighting the impact of PTSD on individuals and local communities. Furthermore, coverage by regional newspapers used significantly more episodic frames than thematic frames.

CONCLUSION: Both national and regional newspapers increased the amount of coverage on PTSD significantly after the beginning of the Iraq War in 2003. National newspapers and regional newspapers shared similarities in recognizing dominant issues with PTSD but varied in the way of presenting the topics to the public.

PMID: 27053417 [PubMed – as supplied by publisher]

Prescription opioid use: Patient characteristics and misuse in community pharmacy.

April 27, 2016 03:19

Prescription opioid use: Patient characteristics and misuse in community pharmacy.

http:--linkinghub.elsevier.com-ihub-imag

Prescription opioid use: Patient characteristics and misuse in community pharmacy.

J Am Pharm Assoc (2003). 2016 Mar 24;

Authors: Cochran G, Bacci JL, Ylioja T, Hruschak V, Miller S, Seybert AL, Tarter R

Abstract

OBJECTIVES: Opioid pain medication misuse is a major concern for US public health. The purpose of this article is to: 1) describe the demographic and physical, behavioral, and mental health characteristics of patients who fill opioid medications in community pharmacy settings; and 2) describe the extent of opioid medication misuse behaviors among these patients.

DESIGN: We recruited and screened a convenience sample of patients with the use of a tablet computer-based assessment protocol that examined behavioral, mental, and physical health. Descriptive and inferential statistics were calculated to describe respondents and their opioid medication misuse and health characteristics.

SETTING: Patients were screened in two urban and two rural community pharmacies in southwestern Pennsylvania.

PARTICIPANTS: Survey participants were adult patients filling opioid pain medications who were not currently receiving treatment for a cancer diagnosis.

INTERVENTION: None.

MAIN OUTCOME MEASURES: Validated screening measures included the: Prescription Opioid Misuse Index, Alcohol Use Disorders Identification Test C, Short Form 12, Drug Abuse Screening Test 10, Primary Care Post-traumatic Stress Disorder (PTSD) screen, and the Patient Health Questionnaire 2.

RESULTS: A total of 333 patients were screened (71.2% response rate). Nearly the entire population reported pain above and general health below national norms. Hydrocodone (19.2%) and morphine (20.8%) were found to be the medications with the highest rates of misuse-with hydrocodone having more than four times higher odds of misuse compared with other medications (adjusted odds ratio [AOR] 4.48, 95% confidence interval [CI] 1.1-17.4). Patients with positive screens for illicit drug use (AOR 8.07, 95% CI 2.7-24.0), PTSD (AOR 5.88, 95% CI 2.3-14.7), and depression (AOR 2.44, 95% CI 1.0-5.9) also had significantly higher odds for misuse compared with those with negative screening results.

CONCLUSION: These findings provide important foundational data that suggest implementation of regular opioid misuse screening protocols within community pharmacies. Such screening activities could foster a culture of prevention and overall reduction for misuse among patients filling opioid medications in community pharmacies.

PMID: 27053277 [PubMed – as supplied by publisher]

Receptivity to Alcohol-Related Care among US Women Veterans with Alcohol Misuse.

April 27, 2016 02:36

Receptivity to Alcohol-Related Care among US Women Veterans with Alcohol Misuse.

Receptivity to Alcohol-Related Care among US Women Veterans with Alcohol Misuse.

J Addict Dis. 2016 Apr 6;:0

Authors: Lewis ET, Jamison AL, Ghaus S, Durazo EM, Frayne SM, Hoggatt KJ, Bean-Mayberry B, Timko C, Cucciare MA

Abstract

BACKGROUND: Previous research indicates women Veterans have a potentially large, unmet need for alcohol-related care but are under-represented in treatment settings.

OBJECTIVE: This study’s purpose was to identify factors associated with women Veterans’ receptivity to a recommendation for alcohol-related care when they present to Veterans Affairs (VA) primary care with alcohol misuse.

METHODS: Semi-structured interviews were conducted in 2012-2013 with 30 women Veterans at two VA facilities who screened positive for alcohol misuse during a primary care visit and discussed their alcohol use with their primary care provider. Qualitative analyses identified nine themes women used to describe what affected their receptivity to a recommendation for alcohol-related care (i.e., VA specialty substance use disorder services).

RESULTS: The most common themes positively associated with women’s receptivity included self-appraisal of their drinking behavior as more severe; the provider’s presentation of treatment options; availability of gender-specific services; and worse physical and mental health.

DISCUSSION: The themes identified here may have important implications for the clinical strategies providers can use to present alcohol-related care options to women Veterans to facilitate their use of care. These strategies include educating women about the health effects of alcohol misuse and increasing providers’ knowledge about available care options (within the care organization or the community), including the availability of gender-specific services.

PMID: 27049338 [PubMed – as supplied by publisher]

Late-life exacerbation of PTSD symptoms in US veterans: results from the National Health and Resilience in Veterans Study.

April 27, 2016 02:36

Late-life exacerbation of PTSD symptoms in US veterans: results from the National Health and Resilience in Veterans Study.

Late-life exacerbation of PTSD symptoms in US veterans: results from the National Health and Resilience in Veterans Study.

J Clin Psychiatry. 2016 Mar;77(3):348-54

Authors: Mota N, Tsai J, Kirwin PD, Harpaz-Rotem I, Krystal JH, Southwick SM, Pietrzak RH

Abstract

OBJECTIVE: More than 60% of US military veterans are 55 years or older. Although several case studies have suggested that older age is associated with a higher likelihood of reactivated or delayed-onset posttraumatic stress disorder (PTSD) symptoms in veterans, population-based data on the prevalence and determinants of this phenomenon are lacking.

METHOD: Using data from the National Health and Resilience in Veterans Study (NHRVS: Wave 1 = October 2011-December 2011; Wave 2 = September 2013), a nationally representative, cohort study of US veterans, we evaluated the prevalence and determinants of exacerbated PTSD symptoms in 1,441 veterans 55 years or older using a DSM-IV-based measure in 2011 and a DSM-5-based measure in 2013. Veterans whose worst trauma occurred at least 5 years prior to Wave 2 of the NHRVS (mean = 28.6 years) and who reported a clinically significant increase (ie, ≥ 0.5 standard deviation [SD]; mean = 1.27, SD = 0.78) in PTSD symptoms from Wave 1 (lifetime) to Wave 2 (past-month) were identified as having exacerbated PTSD symptoms.

RESULTS: Results revealed that 9.9% of older US veterans experienced exacerbated PTSD symptoms an average of nearly 3 decades after their worst trauma. A multivariable logistic regression model indicated that greater self-reported cognitive difficulties at Wave 1 independently predicted exacerbated PTSD symptoms at Wave 2. Post hoc analysis revealed that this association was driven by greater severity of executive dysfunction (adjusted odds ratio range, 1.27-3.22).

CONCLUSIONS: Approximately 1 in 10 older US veterans experiences a clinically significant exacerbation of PTSD symptoms in late life. Executive dysfunction may contribute to risk for exacerbated PTSD symptoms. These results suggest that exacerbated PTSD symptoms are prevalent in US veterans and highlight potential targets for identifying veterans at risk for this phenomenon.

PMID: 27046308 [PubMed – in process]

Comparison of Blast-Exposed OEF/OIF Veterans with and without a History of TBI Symptoms on a Brief Computerized Neuropsychological Battery.

April 27, 2016 02:36

Comparison of Blast-Exposed OEF/OIF Veterans with and without a History of TBI Symptoms on a Brief Computerized Neuropsychological Battery.

Comparison of Blast-Exposed OEF/OIF Veterans with and without a History of TBI Symptoms on a Brief Computerized Neuropsychological Battery.

Appl Neuropsychol Adult. 2016 Apr 4;:1-6

Authors: Kalkstein S, Scott JC, Biester R, Brownlow JA, Harpaz-Rotem I, Gur RC

Abstract

Mild traumatic brain injuries (mild TBIs) resulting from exposure to Improvised Explosive Devices (IEDs) are highly prevalent among veterans of the wars in Iraq and Afghanistan. This exploratory study compared the neurocognitive performance of blast-exposed veterans with (n = 19) and without (n = 15) reported symptoms of mild TBI. All subjects had diagnoses of posttraumatic stress disorder (PTSD). Neurocognitive testing was administered using a well-established computerized battery, the Penn Computerized Neuropsychological Battery (CNB), and groups were well matched on age, race, education, and time since most recent blast exposure. Although differences were not observed on CNB accuracy scores, MANOVAs revealed slower processing speed in the mTBI group when answering correctly on tests of simple and sustained attention, with large effect sizes. Results suggest a potential speed-accuracy tradeoff in blast-related mild TBI, which should be further examined in larger samples.

PMID: 27045712 [PubMed – as supplied by publisher]

Influence of Mild Traumatic Brain Injury (TBI) and Posttraumatic Stress Disorder (PTSD) on Pain Intensity Levels in OEF/OIF/OND Veterans.

April 27, 2016 02:36

Influence of Mild Traumatic Brain Injury (TBI) and Posttraumatic Stress Disorder (PTSD) on Pain Intensity Levels in OEF/OIF/OND Veterans.

http:--highwire.stanford.edu-icons-exter

Influence of Mild Traumatic Brain Injury (TBI) and Posttraumatic Stress Disorder (PTSD) on Pain Intensity Levels in OEF/OIF/OND Veterans.

Pain Med. 2016 Apr 3;

Authors: Stojanovic MP, Fonda J, Fortier CB, Higgins DM, Rudolph JL, Milberg WP, McGlinchey RE

Abstract

OBJECTIVE: Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) are common among US veterans of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND). We postulated that these injuries may modulate pain processing in these individuals and affect their subjective pain levels.

DESIGN: Cross-sectional.

SUBJECTS: 310 deployed service members of OEF/OIF/OND without a lifetime history of moderate or severe TBI were included in this study.

METHODS: All participants completed a comprehensive evaluation for Blast Exposure, mTBI, PTSD, and Pain Levels. The Boston Assessment of TBI-Lifetime Version (BAT-L) was used to assess blast exposure and potential brain injury during military service. The Clinician-Administered PTSD Scale (CAPS) characterized presence and severity of PTSD. The Visual Analog Scale (VAS) was used to assess pain intensity over the previous month before the interview, with higher scores indicative of worse pain. Statistical analysis was performed by ANOVA and results were adjusted for co-morbidities, clinical characteristics and demographic data.

RESULTS: In comparison to control participants (veterans without mTBI or current PTSD), veterans with both current PTSD and mTBI reported the highest pain intensity levels, followed by veterans with PTSD only (P < 0.0001 andP = 0.0005, respectively). Pain levels in veterans with mTBI only were comparable to control participants.

CONCLUSIONS: Comorbid PTSD and mTBI is associated with increased self-reported pain intensity. mTBI alone was not associated with increased pain.

PMID: 27040665 [PubMed – as supplied by publisher]