Veterans PTSD

The National Veteran Sleep Disorder Study: Descriptive Epidemiology and Secular Trends, 2000-2010.

April 27, 2016 05:11

The National Veteran Sleep Disorder Study: Descriptive Epidemiology and Secular Trends, 2000-2010.

The National Veteran Sleep Disorder Study: Descriptive Epidemiology and Secular Trends, 2000-2010.

Sleep. 2016 Apr 12;

Authors: Alexander M, Ray MA, Hébert JR, Youngstedt SD, Zhang H, Steck SE, Bogan RK, Burch JB

Abstract

STUDY OBJECTIVES: A large proportion of individuals affected by sleep disorders are untreated and susceptible to accidents, injuries, long-term sequelae (e.g., risk of cardiovascular disease, cancer, psychiatric disorders), and increased mortality risk. Few studies have examined the scope and magnitude of sleep disorder diagnoses in the United States (US) or factors influencing them. Veterans are particularly vulnerable to factors that elicit or exacerbate sleep disorders.

METHODS: This serial cross-sectional study characterized secular trends in diagnosed sleep disorders among veterans seeking care in US Veterans Health Administration facilities over an eleven-year span (FY2000-2010, N = 9,798,034). Electronic medical records from the national Veterans Administration Informatics and Computing Infrastructure database were accessed. Cases were defined using diagnostic codes specified by the American Academy of Sleep Medicine. Age-adjusted annual prevalence was summarized by sex, race, combat exposure, body mass index, and comorbid diagnoses (cardiovascular disease, cancer, mental disorders).

RESULTS: Sleep apnea (47%) and insomnia (26%) were the most common diagnoses among patients with any sleep disorder. There was a six-fold relative increase in total sleep disorder prevalence over the study period. Post-traumatic stress disorder, which tripled over the same time period, was associated with the highest prevalence of sleep disorders (16%) among the comorbid conditions evaluated.

CONCLUSIONS: The results indicate a growing need for integration of sleep disorder management with patient care and health care planning among US veterans.

PMID: 27091538 [PubMed – as supplied by publisher]

The relationships of posttraumatic stress disorder and depression symptoms with health-related quality of life and the role of social support among Veterans.

April 27, 2016 05:11

The relationships of posttraumatic stress disorder and depression symptoms with health-related quality of life and the role of social support among Veterans.

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The relationships of posttraumatic stress disorder and depression symptoms with health-related quality of life and the role of social support among Veterans.

Qual Life Res. 2016 Apr 16;

Authors: Painter JM, Gray K, McGinn MM, Mostoufi S, Hoerster KD

Abstract

PURPOSE: The presence of posttraumatic stress disorder (PTSD) or depression symptoms is associated with poor quality of life. Social support buffers against developing symptoms of PTSD and depression and is associated with greater quality of life. We examined the relationships between PTSD and depression symptom severity with physical (PCS) and mental (MCS) health-related quality of life (HRQoL), and whether social support moderated these relationships.

METHODS: Randomly selected Veterans with at least one Primary Care or PTSD Clinical Team visit received a mailed survey including self-report measures of health and wellness. Among the 717 respondents, we examined the association between symptom severity and HRQoL using linear regression. We included interaction terms between symptom severity and social support to examine whether social support moderated these associations.

RESULTS: Social support did not moderate the association between symptom severity and mental HRQoL. Higher PTSD and depression symptom severity were associated with lower MCS scores, whereas higher social support was associated with higher MCS scores. When examining physical HRQoL, social support moderated the association with PTSD and depression symptom severity. Among individuals with high social support, there was a negative association between symptom severity and PCS scores, whereas there was no association among those with low social support.

CONCLUSIONS: Although there are contexts in which social support is helpful, in some cases it may interfere with HRQoL among those with mental health conditions. Thus, it is important to educate support providers about behaviors that enhance the benefits and minimize the costs of social support.

PMID: 27085339 [PubMed – as supplied by publisher]

Female veterans’ preferences for counseling related to intimate partner violence: Informing patient-centered interventions.

April 27, 2016 05:11

Female veterans’ preferences for counseling related to intimate partner violence: Informing patient-centered interventions.

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Female veterans’ preferences for counseling related to intimate partner violence: Informing patient-centered interventions.

Gen Hosp Psychiatry. 2016 Mar 18;

Authors: Iverson KM, Stirman SW, Street AE, Gerber MR, Carpenter SL, Dichter ME, Bair-Merritt M, Vogt D

Abstract

OBJECTIVE: Female veterans are at high risk for intimate partner violence (IPV). A critical issue in the provision of health care to women who experience IPV is the delivery of effective brief counseling interventions that address women’s unique needs. We aimed to identify female veterans’ priorities and preferences for healthcare-based IPV counseling.

METHOD: A 2014 Web-based survey was administered to a national sample of US female veterans. Among 411 respondents (75% participation rate), 55% (n=226) reported IPV during their lifetime. These women identified priorities for the content focus of IPV-related counseling and preferences for the delivery of these services.

RESULTS: Women prioritized counseling that focuses on physical safety and emotional health, with learning about community resources being a relatively lower priority. Participants preferred counseling to focus specifically on enhancing coping skills and managing mental health symptoms. In addition, women want counseling to be individualized and preferred the option to meet with a counselor immediately following disclosure. Affordable services and attention to privacy concerns were of paramount importance in the context of IPV-related counseling.

CONCLUSION: These findings can inform patient-centered brief counseling interventions for women who experience IPV, which may ultimately reduce health disparities and violence among this population.

PMID: 27083252 [PubMed – as supplied by publisher]

Prevalence of Central Nervous System Polypharmacy and Associations with Overdose and Suicide-Related Behaviors in Iraq and Afghanistan War Veterans in VA Care 2010-2011.

April 27, 2016 05:03

Prevalence of Central Nervous System Polypharmacy and Associations with Overdose and Suicide-Related Behaviors in Iraq and Afghanistan War Veterans in VA Care 2010-2011.

Prevalence of Central Nervous System Polypharmacy and Associations with Overdose and Suicide-Related Behaviors in Iraq and Afghanistan War Veterans in VA Care 2010-2011.

Drugs Real World Outcomes. 2016;3:45-52

Authors: Collett GA, Song K, Jaramillo CA, Potter JS, Finley EP, Pugh MJ

Abstract

BACKGROUND: The increase in the quantities of central nervous system (CNS)-acting medications prescribed has coincided with increases in overdose mortality, suicide-related behaviors, and unintentional deaths in military personnel deployed in support of the wars in Iraq and Afghanistan. Data on the extent and impact of prescribing multiple CNS drugs among Iraq and Afghanistan Veterans (IAVs) are sparse.

OBJECTIVES: We sought to identify the characteristics of IAVs with CNS polypharmacy and examine the association of CNS polypharmacy with drug overdose and suicide-related behaviors controlling for known risk factors.

METHODS: This cross-sectional cohort study examined national data of Iraq and Afghanistan Veterans (N = 311,400) who used the Veterans Health Administration (VHA) during the fiscal year 2011. CNS polypharmacy was defined as five or more CNS-acting medications; drug/alcohol overdose and suicide-related behaviors were identified using ICD-9-CM codes. Demographic and clinical characteristics associated with CNS polypharmacy were identified using a multivariable logistic regression model.

RESULTS: We found that 25,546 (8.4 %) of Iraq and Afghanistan Veterans had CNS polypharmacy. Those with only post-traumatic stress disorder (PTSD) (adjusted odds ratio (AOR) 6.50, 99 % confidence interval (CI) 5.96-7.10), only depression (AOR 6.42, 99 % CI 5.86-7.04), co-morbid PTSD and depression (AOR 12.98, 99 % CI 11.97-14.07), and co-morbid traumatic brain injury (TBI), PTSD, and depression (AOR 15.30, 99 % CI 14.00-16.73) had the highest odds of CNS polypharmacy. After controlling for these co-morbid conditions, CNS polypharmacy was significantly associated with drug/alcohol overdose and suicide-related behavior.

CONCLUSION: CNS polypharmacy was most strongly associated with PTSD, depression, and TBI, and independently associated with overdose and suicide-related behavior after controlling for known risk factors. These findings suggest that CNS polypharmacy may be used as an indicator of risk for adverse outcomes. Further research should evaluate whether CNS polypharmacy may be used as a trigger for evaluation of the current care provided to these individuals.

PMID: 27073756 [PubMed – as supplied by publisher]

Obese Veterans Enrolled in a Veterans Affairs Medical Center Outpatient Weight Loss Clinic Are Likely to Experience Disordered Sleep and Posttraumatic Stress.

April 27, 2016 05:03

Obese Veterans Enrolled in a Veterans Affairs Medical Center Outpatient Weight Loss Clinic Are Likely to Experience Disordered Sleep and Posttraumatic Stress.

Obese Veterans Enrolled in a Veterans Affairs Medical Center Outpatient Weight Loss Clinic Are Likely to Experience Disordered Sleep and Posttraumatic Stress.

J Clin Sleep Med. 2016 Mar 21;

Authors: Mayer SB, Levy JR, Farrell-Carnahan L, Nichols MG, Raman S

Abstract

STUDY OBJECTIVES: This cross-sectional study aimed to characterize sleep patterns, the quality and duration of sleep, and estimate the prevalence of common sleep disorders and posttraumatic stress disorder (PTSD) in a hospital-based Veterans Affairs MOVE! (Managing Overweight Veterans Everywhere) clinic.

METHODS: Participants completed five instruments: the Pittsburgh Sleep Quality Index (PSQI), Smith’s Measure of Morningness/ Eveningness, Restless Legs Syndrome Rating Scale, the STOP Questionnaire, and the Posttraumatic Stress Disorder (PTSD) Checklist – Civilian Version (PCL-C).

RESULTS: Enrolled Veterans (n = 96) were mostly male (78%), African American (49%), mean age 58 (SD 10.6) years, and mean body mass index (BMI) 38.4 kg/m2 (SD 8.4). By PSQI, 89% rated sleep quality as “poor” (M = 11.1, SD = 5.1), consistent with severely impaired sleep. Most were at high risk for sleep disorders including restless leg syndrome (53%), obstructive sleep apnea (66%), and circadian sleep disorders (72%). Forty-seven percent endorsed clinically significant symptoms of PTSD. Hypotheses-generating regression models suggest sleep latency (minutes before falling asleep) was associated with BMI (p = 0.018). Bedtime, getting up time, hours of sleep, waking up in the middle of the night or early morning, having to get up to use the bathroom, inability to breathe comfortably, cough or snore loudly, feeling too cold or too hot, having bad dreams, pain, and frequency of having trouble sleeping, were not significantly associated with BMI.

CONCLUSIONS: Our cross-sectional study suggests that sleep difficulties are common among Veterans referred to a weight loss program at a Veterans Affairs Hospital. Controlled studies are needed to investigate whether the results are generalizable and whether obesity among veterans is a risk factor for sleep disorders and PTSD.

PMID: 27070244 [PubMed – as supplied by publisher]

Association of Spirituality With Mental Health Conditions in Ohio National Guard Soldiers.

April 27, 2016 05:03

Association of Spirituality With Mental Health Conditions in Ohio National Guard Soldiers.

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Association of Spirituality With Mental Health Conditions in Ohio National Guard Soldiers.

J Nerv Ment Dis. 2016 Apr 8;

Authors: Ganocy SJ, Goto T, Chan PK, Cohen GH, Sampson L, Galea S, Liberzon I, Fine T, Shirley E, Sizemore J, Calabrese JR, Tamburrino MB

Abstract

Research exploring spirituality in military populations is a relatively new field with limited published reports. This study used the Spiritual Well-Being Scale to examine the association of spiritual well-being with suicidal ideation/behavior, posttraumatic stress disorder (PTSD), and depression and alcohol use disorders in a randomized sample of Ohio Army National Guard soldiers. The participants were 418 soldiers, mostly white and male, with nearly three-quarters indicating that they had been deployed at least once during their careers. Higher spirituality, especially in the existential well-being subscale, was associated with significantly less lifetime PTSD, depression, and alcohol use disorders and with less suicidal ideation over the past year. Future research in this area may benefit from a longitudinal design that can assess spirituality and mental health behaviors in addition to diagnoses at different time points, to begin to explore spirituality in a larger context.

PMID: 27065107 [PubMed – as supplied by publisher]

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.

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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]