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

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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]

Neurology in the Vietnam War.

Neurology in the Vietnam War.

Front Neurol Neurosci. 2016 Apr 1;38:201-213

Authors: Gunderson CH, Daroff RB

Abstract

Between December 1965 and December 1971, the United States maintained armed forces in Vietnam never less than 180,000 men and women in support of the war. At one time, this commitment exceeded half a million soldiers, sailors, and airmen from both the United States and its allies. Such forces required an extensive medical presence, including 19 neurologists. All but two of the neurologists had been drafted for a 2-year tour of duty after deferment for residency training. They were assigned to Vietnam for one of those 2 years in two Army Medical Units and one Air Force facility providing neurological care for American and allied forces, as well as many civilians. Their practice included exposure to unfamiliar disorders including cerebral malaria, Japanese B encephalitis, sleep deprivation seizures, and toxic encephalitis caused by injection or inhalation of C-4 explosive. They and neurologists at facilities in the United States published studies on all of these entities both during and after the war. These publications spawned the Defense and Veterans Head Injury Study, which was conceived during the Korean War and continues today as the Defense and Veterans Head Injury Center. It initially focused on post-traumatic epilepsy and later on all effects of brain injury. The Agent Orange controversy arose after the war; during the war, it was not perceived as a threat by medical personnel. Although soldiers in previous wars had developed serious psychological impairments, post-traumatic stress disorder was formally recognized in the servicemen returning from Vietnam.

PMID: 27035455 [PubMed – as supplied by publisher]

Validity testing and neuropsychology practice in the VA healthcare system: results from recent practitioner survey.

Validity testing and neuropsychology practice in the VA healthcare system: results from recent practitioner survey.

Clin Neuropsychol. 2016 Apr 1;:1-18

Authors: Young JC, Roper BL, Arentsen TJ

Abstract

OBJECTIVE: A survey of neuropsychologists in the Veterans Health Administration examined symptom/performance validity test (SPVT) practices and estimated base rates for patient response bias.

METHOD: Invitations were emailed to 387 psychologists employed within the Veterans Affairs (VA), identified as likely practicing neuropsychologists, resulting in 172 respondents (44.4% response rate). Practice areas varied, with 72% at least partially practicing in general neuropsychology clinics and 43% conducting VA disability exams.

RESULTS: Mean estimated failure rates were 23.0% for clinical outpatient, 12.9% for inpatient, and 39.4% for disability exams. Failure rates were the highest for mTBI and PTSD referrals. Failure rates were positively correlated with the number of cases seen and frequency and number of SPVT use. Respondents disagreed regarding whether one (45%) or two (47%) failures are required to establish patient response bias, with those administering more measures employing the more stringent criterion. Frequency of the use of specific SPVTs is reported.

CONCLUSIONS: Base rate estimates for SPVT failure in VA disability exams are comparable to those in other medicolegal settings. However, failure in routine clinical exams is much higher in the VA than in other settings, possibly reflecting the hybrid nature of the VA’s role in both healthcare and disability determination. Generally speaking, VA neuropsychologists use SPVTs frequently and eschew pejorative terms to describe their failure. Practitioners who require only one SPVT failure to establish response bias may overclassify patients. Those who use few or no SPVTs may fail to identify response bias. Additional clinical and theoretical implications are discussed.

PMID: 27032437 [PubMed – as supplied by publisher]