After Combat Deployment: Low Utilization of Mental Health Care and Reasons for Dropout
Charles W. Hoge
, M.D.,
Sasha H. Grossman
, B.A.,
Jennifer L. Auchterlonie
, M.S.,
Lyndon A. Riviere
, Ph.D.,
Charles S. Milliken
, M.D., and
Joshua E. Wilk
, Ph.D.
Published Online:1 Aug 2014https://doi-org.ezp.waldenulibrary.org/10.1176/appi.ps.201300307
Abstract
Objective
Limited data exist on the adequacy of treatment for posttraumatic stress disorder (PTSD) after combat deployment. This study assessed the percentage of soldiers in need of PTSD treatment, the percentage receiving minimally adequate care, and reasons for dropping out of care.
Methods
Data came from two sources: a population-based cohort of 45,462 soldiers who completed the Post-Deployment Health Assessment and a cross-sectional survey of 2,420 infantry soldiers after returning from Afghanistan (75% response rate).
Results
Of 4,674 cohort soldiers referred to mental health care at a military treatment facility, 75% followed up with this referral. However, of 2,230 soldiers who received a PTSD diagnosis within 90 days of return from Afghanistan, 22% had only one mental health care visit and 41% received minimally adequate care (eight or more encounters in 12 months). Of 229 surveyed soldiers who screened positive for PTSD (PTSD Checklist score ≥50), 48% reported receiving mental health treatment in the prior six months at any health care facility. Of those receiving treatment, the median number of visits in six months was four; 22% had only one visit, 52% received minimally adequate care (four or more visits in six months), and 24% dropped out of care. Reported reasons for dropout included soldiers feeling they could handle problems on their own, work interference, insufficient time with the mental health professional, stigma, treatment ineffectiveness, confidentiality concerns, or discomfort with how the professional interacted.
Conclusions
Treatment reach for PTSD after deployment remains low to moderate, with a high percentage of soldiers not accessing care or not receiving adequate treatment. This study represents a call to action to validate interventions to improve treatment engagement and retention.
Over two million service members have deployed to Iraq or Afghanistan since 2001, and these deployments have been strongly associated with an increased risk of mental health problems (1–4). A meta-analysis of studies found that the average post deployment prevalence of posttraumatic stress disorder (PTSD) was 13.2% for personnel assigned to operational infantry units and 5.5% for representative samples of total deployed forces (including support personnel) (3). These and other studies indicate that there will be a significant ongoing need for mental health care in this population.
Although a relatively high percentage of military personnel and veterans access mental health services (for example, one analysis of Army personnel showed that 21% had one or more clinical encounters during a ...
REVIEW ARTICLEExploring positive pathways to care for memb.docxronak56
REVIEW ARTICLE
Exploring positive pathways to care for members of
the UK Armed Forces receiving treatment for PTSD:
a qualitative study
Dominic Murphy1*, Elizabeth Hunt1, Olga Luzon2 and Neil Greenberg1
1King’s Centre for Military Health Research, King’s College London, London, UK; 2Department of
Clinical Psychology, Royal Holloway University, London, UK
Objective: To examine the factors which facilitate UK military personnel with post-traumatic stress disorder
(PTSD) to engage in help-seeking behaviours.
Methods: The study recruited active service personnel who were attending mental health services, employed a
qualitative design, used semi-structured interview schedules to collect data, and explored these data using
interpretative phenomenological analysis (IPA).
Results: Five themes emerged about how participants were able to access help; having to reach a crisis point
before accepting the need for help, overcoming feelings of shame, the importance of having an internal locus
of control, finding a psychological explanation for their symptoms and having strong social support.
Conclusions: This study reported that for military personnel who accessed mental health services, there were a
number of factors that supported them to do so. In particular, factors that combated internal stigma, such as
being supported to develop an internal locus of control, appeared to be critical in supporting military
personnel to engage in help-seeking behaviour.
Keywords: Military health; PTSD; depression; pathways; stigma; barriers
*Correspondence to: Dominic Murphy, KCMHR, Weston Education Centre, Cutcombe Road, SE5 9PR
London, UK, Email: [email protected]
For the abstract or full text in other languages, please see Supplementary files under Article Tools online
Received: 17 June 2013; Revised: 4 October 2013; Accepted: 20 November 2013; Published: 17 February 2014
S
ince 2002, the UK and US military’s have con-
ducted highly challenging operations in Afghanistan
and Iraq. These military operations have been
the focus of a number of large-scale epidemiological re-
search studies, which have investigated the psychological
health of US and UK service personnel. Studies in the
United States have observed rates of post-traumatic stress
disorder (PTSD) in deployed personnel to be between
8 and 18% (Hoge et al., 2004; Smith et al., 2008). Further,
13% of participants met criteria for alcohol problems
and 18% for symptoms of anxiety and depression, with a
very high co-morbidity rate between these disorders and
PTSD (Riddle et al., 2007; Smith et al., 2008). This
increase in the rate of PTSD following deployment has
been replicated prospectively (Vasterling et al., 2006).
However, in the UK, the effects of the conflict upon the
mental health of service personnel have been quite
different.
The most extensive UK epidemiological studies of
service personnel since 2003 have been carried out at
King’s College London. This study is based o ...
PSYCHIATRIC SERVICES ps.psychiatryonline.org September 201.docxpotmanandrea
PSYCHIATRIC SERVICES � ps.psychiatryonline.org � September 2012 Vol. 63 No. 9 885555
Soldiers returning from combatoften face a postdeployment pe-riod in which there is an in-
creased risk of readjustment stres-
sors, such as problems with family,
marriage, or employment. This peri-
od can also be marked by the onset of
posttraumatic stress disorder (PTSD).
Coping with the additional burden of
PTSD likely complicates soldiers’
ability to cope during the readjust-
ment period. Accordingly, research
has documented a relationship be-
tween PTSD and greater readjust-
ment stress among soldiers serving in
recent conflicts (1) or in previous
ones (2,3).
Many soldiers with a mental health
need do not seek care within the first
year of their readjustment period. An
estimated 23%–44% of returning sol-
diers with PTSD or other mental
health problems receive treatment
within the first year (4,5). Linking re-
turning soldiers who have PTSD with
treatment is a national priority be-
cause effective treatments for PTSD
are available (6,7) and PTSD suffer-
ers who seek treatment experience
symptom relief more quickly than
those who do not (8). Therefore, re-
search is needed to better understand
the process by which returning sol-
diers with PTSD seek treatment.
Readjustment stressors may be a
key motivator for treatment seeking.
Veterans returning from Operation
Enduring Freedom or Operation Iraqi
Freedom (OIF) often seek help for fi-
nancial, occupational, and other read-
justment concerns. A qualitative
study suggested that returning sol-
diers are most likely to seek mental
health treatment when problems
emerge within family and occupa-
tional roles (9). Accordingly, one
study showed that combat veterans
seeking care from the U.S. Depart-
ment of Veterans Affairs (VA) ex-
pressed most interest for services re-
lated to veterans’ benefits (83%) and
schooling, employment, or job train-
ing (80%) (1). Also, at least one study
Readjustment Stressors and Early Mental
Health Treatment Seeking by Returning
National Guard Soldiers With PTSD
AAlleejjaannddrroo IInntteerriiaann,, PPhh..DD..
AAnnnnaa KKlliinnee,, PPhh..DD..
LLaannoorraa CCaallllaahhaann,, MM..SS..
MMiikkllooss LLoossoonncczzyy,, MM..DD..,, PPhh..DD..
Dr. Interian, Dr. Kline, and Dr. Losonczy are affiliated with the Department of Psychia-
try, UMDNJ–Robert Wood Johnson Medical School, 671 Hoes Lane, D306, Piscataway,
NJ 08854-5635 (e-mail: [email protected]). They are also with the Veterans Af-
fairs New Jersey Healthcare System, Mental Health and Behavioral Sciences, Lyons, New
Jersey. Ms. Callahan is with the Bloustein Center for Survey Research, Rutgers Univer-
sity, Piscataway.
Objectives: Readjustment stressors are commonly encountered by vet-
erans returning from combat operations and may help motivate treat-
ment seeking for posttraumatic stress disorder (PTSD). The study ex-
amined rates of readjustment stressors (marital, family, and employ-
ment) and their relationshi ...
Longitudinal Military Health System data were analyzed from redeployed active duty Army service members (n=15,544) who were assigned to Warrior Transition Units (WTUs), FY2008-2015, to identify factors predicting OUD treatment.
Rates and Predictors of Suicidal Ideation During the FirstYe.docxaudeleypearl
Rates and Predictors of Suicidal Ideation During the First
Year After Traumatic Brain Injury
Jessica L. Mackelprang, PhD, Charles H. Bombardier, PhD, Jesse R. Fann, MD, MPH, Nancy R. Temkin, PhD,
Jason K. Barber, MS, and Sureyya S. Dikmen, PhD
Suicide is a major public health problem among
the 1.7 million people who sustain traumatic
brain injury (TBI) each year in the United
States.1 People with a history of TBI in both
civilian and military populations are 1.55 to
4.05 times more likely to die by suicide than
the general population.2---5 In a study of
Australian outpatients with a history of TBI,
the majority of whom had no preinjury history
of suicide attempts, suicide attempts were
reported by 17.4% (30 of 172) of the sample
over a 5-year period.6 Nearly half of the
individuals who attempted suicide had made
multiple attempts.6,7 The Centers for Disease
Control and Prevention recently called for
investigations of individual-level risk and
protective factors for self-directed violence
among people with TBI as an important com-
ponent of improving long-term outcomes.8
Rates of suicidal ideation (SI) after TBI
have been found to exceed 20% in some
studies6,9---14; however, in a recent systematic
review of SI and behavior after TBI, Bahraini
et al. highlighted the paucity of research in
this area.15 They concluded that additional
research is needed to determine the prevalence
of SI and behavior after brain injury, as well as
to ascertain patient-level factors that may be
associated with increased suicide risk. Studies
examining whether injury severity predicts
post-TBI suicidality have yielded inconclusive
findings.6,13,16,17 In perhaps the most thorough
study on this topic to date, Tsaousides et al.12
surveyed 356 community-dwelling adults with
a self-reported history of TBI and found that
preinjury substance abuse was the only corre-
late of current SI. Risk factors for SI after TBI
have been underinvestigated. Research in this
area has been limited by reliance on retro-
spective reporting and self-reported history of
TBI,12,18---20 with only a few studies including
objective indicators of TBI severity.6 Most
studies have involved cross-sectional designs
and have included participants whose time
since injury varied from several months to
many years.12,21 Finally, because most existing
studies have included relatively small, poten-
tially biased samples21 recruited from outpa-
tient clinics or TBI survivor programs,6,7,12 they
may not be representative of the population of
people who sustain TBI.
Given these gaps in the existing literature,
our objectives were (1) to investigate rates of SI
during the first year after complicated mild to
severe TBI in a representative sample of adults
who had been admitted to a level I trauma
center and (2) to investigate whether demo-
graphic characteristics, preinjury psychiatric
history, or injury-related factors predicted SI.
METHODS
This study was part of the recruitment phase
of a clinical trial ...
Running head COMPREHENSIVE QUALITY CARE1COMPREHENSIVE QUALIT.docxjoellemurphey
Running head: COMPREHENSIVE QUALITY CARE 1
COMPREHENSIVE QUALITY CARE 10
Improving the Quality of Comprehensive Care for the OEF and OIF Veterans with Posttraumatic Stress Disorder (PTSD)
Ashlie Burnett
Capella University
2/15/15
Research Questions
1. How efficiently can quality of Comprehensive care be improved to ensure quality care to the OEF and OIF with posttraumatic stress disorder?
2. To what extent are the problems faced by the OEF and OIF with posttraumatic disorder matched by the available ways of serving them?
Research Objectives
1. The general objective of this research was to determine how efficiently quality of comprehensive care be improved to ensure quality care to the OEF and OIF with posttraumatic stress disorder.
2. The paper also sought to determine the extent to which the problems faced by the OEF and OIF with posttraumatic disorder matched by the available ways of serving them.
Sub-related questions
1. What are the most common problems facing the war veteran’s over the world?
2. What are the medical covers available for the victims of posttraumatic disorders?
3. What are the inefficiencies in the health care provision of the PSTD veterans?
Relevance of the Sub-related questions
The sub-related questions form the basis of finding the needed results for the general objectives of this paper. To find an effective measure of improving quality of health care for the victims of post traumatic disorder, the first question will help find the main problem to be addressed in order to avoid cases of mismatch of services and problems experienced. The second sub-related question on the will helps the available medical cover for the victims of posttraumatic disorder in order to help make any further recommendations on where and how to improve the services. Finally, the last sub-related question will assist in pointing the inefficiencies in the health care services offered to the PSTD veterans. Knowing these inefficiencies will help the researcher to make educated recommendations as per what measures can be taken to address them.
Important Information about the Issue and Types of Data to be collected
To understand the issue of quality of comprehensive care for the OEF and OIF veterans with posttraumatic stress disorder, the research must understand the kind of challenges these veterans go through in the battlefields. Also of importance is information on the available medical care options at the disposal of these veterans plus the number qualified personnel in this area. The data to be collected, on the other hand, will mostly be experiences and awareness of the victims. The research will also collect records of relevant institution that will be analyzed qualitatively.
Action Plan
The paper desired for a future in which medical programs offer the best possible financial and technical support to those who had sacrificed their comfort to help the OIF/OEF veterans. The policies must be able to authorize veterans to provide ...
REVIEW ARTICLEExploring positive pathways to care for memb.docxronak56
REVIEW ARTICLE
Exploring positive pathways to care for members of
the UK Armed Forces receiving treatment for PTSD:
a qualitative study
Dominic Murphy1*, Elizabeth Hunt1, Olga Luzon2 and Neil Greenberg1
1King’s Centre for Military Health Research, King’s College London, London, UK; 2Department of
Clinical Psychology, Royal Holloway University, London, UK
Objective: To examine the factors which facilitate UK military personnel with post-traumatic stress disorder
(PTSD) to engage in help-seeking behaviours.
Methods: The study recruited active service personnel who were attending mental health services, employed a
qualitative design, used semi-structured interview schedules to collect data, and explored these data using
interpretative phenomenological analysis (IPA).
Results: Five themes emerged about how participants were able to access help; having to reach a crisis point
before accepting the need for help, overcoming feelings of shame, the importance of having an internal locus
of control, finding a psychological explanation for their symptoms and having strong social support.
Conclusions: This study reported that for military personnel who accessed mental health services, there were a
number of factors that supported them to do so. In particular, factors that combated internal stigma, such as
being supported to develop an internal locus of control, appeared to be critical in supporting military
personnel to engage in help-seeking behaviour.
Keywords: Military health; PTSD; depression; pathways; stigma; barriers
*Correspondence to: Dominic Murphy, KCMHR, Weston Education Centre, Cutcombe Road, SE5 9PR
London, UK, Email: [email protected]
For the abstract or full text in other languages, please see Supplementary files under Article Tools online
Received: 17 June 2013; Revised: 4 October 2013; Accepted: 20 November 2013; Published: 17 February 2014
S
ince 2002, the UK and US military’s have con-
ducted highly challenging operations in Afghanistan
and Iraq. These military operations have been
the focus of a number of large-scale epidemiological re-
search studies, which have investigated the psychological
health of US and UK service personnel. Studies in the
United States have observed rates of post-traumatic stress
disorder (PTSD) in deployed personnel to be between
8 and 18% (Hoge et al., 2004; Smith et al., 2008). Further,
13% of participants met criteria for alcohol problems
and 18% for symptoms of anxiety and depression, with a
very high co-morbidity rate between these disorders and
PTSD (Riddle et al., 2007; Smith et al., 2008). This
increase in the rate of PTSD following deployment has
been replicated prospectively (Vasterling et al., 2006).
However, in the UK, the effects of the conflict upon the
mental health of service personnel have been quite
different.
The most extensive UK epidemiological studies of
service personnel since 2003 have been carried out at
King’s College London. This study is based o ...
PSYCHIATRIC SERVICES ps.psychiatryonline.org September 201.docxpotmanandrea
PSYCHIATRIC SERVICES � ps.psychiatryonline.org � September 2012 Vol. 63 No. 9 885555
Soldiers returning from combatoften face a postdeployment pe-riod in which there is an in-
creased risk of readjustment stres-
sors, such as problems with family,
marriage, or employment. This peri-
od can also be marked by the onset of
posttraumatic stress disorder (PTSD).
Coping with the additional burden of
PTSD likely complicates soldiers’
ability to cope during the readjust-
ment period. Accordingly, research
has documented a relationship be-
tween PTSD and greater readjust-
ment stress among soldiers serving in
recent conflicts (1) or in previous
ones (2,3).
Many soldiers with a mental health
need do not seek care within the first
year of their readjustment period. An
estimated 23%–44% of returning sol-
diers with PTSD or other mental
health problems receive treatment
within the first year (4,5). Linking re-
turning soldiers who have PTSD with
treatment is a national priority be-
cause effective treatments for PTSD
are available (6,7) and PTSD suffer-
ers who seek treatment experience
symptom relief more quickly than
those who do not (8). Therefore, re-
search is needed to better understand
the process by which returning sol-
diers with PTSD seek treatment.
Readjustment stressors may be a
key motivator for treatment seeking.
Veterans returning from Operation
Enduring Freedom or Operation Iraqi
Freedom (OIF) often seek help for fi-
nancial, occupational, and other read-
justment concerns. A qualitative
study suggested that returning sol-
diers are most likely to seek mental
health treatment when problems
emerge within family and occupa-
tional roles (9). Accordingly, one
study showed that combat veterans
seeking care from the U.S. Depart-
ment of Veterans Affairs (VA) ex-
pressed most interest for services re-
lated to veterans’ benefits (83%) and
schooling, employment, or job train-
ing (80%) (1). Also, at least one study
Readjustment Stressors and Early Mental
Health Treatment Seeking by Returning
National Guard Soldiers With PTSD
AAlleejjaannddrroo IInntteerriiaann,, PPhh..DD..
AAnnnnaa KKlliinnee,, PPhh..DD..
LLaannoorraa CCaallllaahhaann,, MM..SS..
MMiikkllooss LLoossoonncczzyy,, MM..DD..,, PPhh..DD..
Dr. Interian, Dr. Kline, and Dr. Losonczy are affiliated with the Department of Psychia-
try, UMDNJ–Robert Wood Johnson Medical School, 671 Hoes Lane, D306, Piscataway,
NJ 08854-5635 (e-mail: [email protected]). They are also with the Veterans Af-
fairs New Jersey Healthcare System, Mental Health and Behavioral Sciences, Lyons, New
Jersey. Ms. Callahan is with the Bloustein Center for Survey Research, Rutgers Univer-
sity, Piscataway.
Objectives: Readjustment stressors are commonly encountered by vet-
erans returning from combat operations and may help motivate treat-
ment seeking for posttraumatic stress disorder (PTSD). The study ex-
amined rates of readjustment stressors (marital, family, and employ-
ment) and their relationshi ...
Longitudinal Military Health System data were analyzed from redeployed active duty Army service members (n=15,544) who were assigned to Warrior Transition Units (WTUs), FY2008-2015, to identify factors predicting OUD treatment.
Rates and Predictors of Suicidal Ideation During the FirstYe.docxaudeleypearl
Rates and Predictors of Suicidal Ideation During the First
Year After Traumatic Brain Injury
Jessica L. Mackelprang, PhD, Charles H. Bombardier, PhD, Jesse R. Fann, MD, MPH, Nancy R. Temkin, PhD,
Jason K. Barber, MS, and Sureyya S. Dikmen, PhD
Suicide is a major public health problem among
the 1.7 million people who sustain traumatic
brain injury (TBI) each year in the United
States.1 People with a history of TBI in both
civilian and military populations are 1.55 to
4.05 times more likely to die by suicide than
the general population.2---5 In a study of
Australian outpatients with a history of TBI,
the majority of whom had no preinjury history
of suicide attempts, suicide attempts were
reported by 17.4% (30 of 172) of the sample
over a 5-year period.6 Nearly half of the
individuals who attempted suicide had made
multiple attempts.6,7 The Centers for Disease
Control and Prevention recently called for
investigations of individual-level risk and
protective factors for self-directed violence
among people with TBI as an important com-
ponent of improving long-term outcomes.8
Rates of suicidal ideation (SI) after TBI
have been found to exceed 20% in some
studies6,9---14; however, in a recent systematic
review of SI and behavior after TBI, Bahraini
et al. highlighted the paucity of research in
this area.15 They concluded that additional
research is needed to determine the prevalence
of SI and behavior after brain injury, as well as
to ascertain patient-level factors that may be
associated with increased suicide risk. Studies
examining whether injury severity predicts
post-TBI suicidality have yielded inconclusive
findings.6,13,16,17 In perhaps the most thorough
study on this topic to date, Tsaousides et al.12
surveyed 356 community-dwelling adults with
a self-reported history of TBI and found that
preinjury substance abuse was the only corre-
late of current SI. Risk factors for SI after TBI
have been underinvestigated. Research in this
area has been limited by reliance on retro-
spective reporting and self-reported history of
TBI,12,18---20 with only a few studies including
objective indicators of TBI severity.6 Most
studies have involved cross-sectional designs
and have included participants whose time
since injury varied from several months to
many years.12,21 Finally, because most existing
studies have included relatively small, poten-
tially biased samples21 recruited from outpa-
tient clinics or TBI survivor programs,6,7,12 they
may not be representative of the population of
people who sustain TBI.
Given these gaps in the existing literature,
our objectives were (1) to investigate rates of SI
during the first year after complicated mild to
severe TBI in a representative sample of adults
who had been admitted to a level I trauma
center and (2) to investigate whether demo-
graphic characteristics, preinjury psychiatric
history, or injury-related factors predicted SI.
METHODS
This study was part of the recruitment phase
of a clinical trial ...
Running head COMPREHENSIVE QUALITY CARE1COMPREHENSIVE QUALIT.docxjoellemurphey
Running head: COMPREHENSIVE QUALITY CARE 1
COMPREHENSIVE QUALITY CARE 10
Improving the Quality of Comprehensive Care for the OEF and OIF Veterans with Posttraumatic Stress Disorder (PTSD)
Ashlie Burnett
Capella University
2/15/15
Research Questions
1. How efficiently can quality of Comprehensive care be improved to ensure quality care to the OEF and OIF with posttraumatic stress disorder?
2. To what extent are the problems faced by the OEF and OIF with posttraumatic disorder matched by the available ways of serving them?
Research Objectives
1. The general objective of this research was to determine how efficiently quality of comprehensive care be improved to ensure quality care to the OEF and OIF with posttraumatic stress disorder.
2. The paper also sought to determine the extent to which the problems faced by the OEF and OIF with posttraumatic disorder matched by the available ways of serving them.
Sub-related questions
1. What are the most common problems facing the war veteran’s over the world?
2. What are the medical covers available for the victims of posttraumatic disorders?
3. What are the inefficiencies in the health care provision of the PSTD veterans?
Relevance of the Sub-related questions
The sub-related questions form the basis of finding the needed results for the general objectives of this paper. To find an effective measure of improving quality of health care for the victims of post traumatic disorder, the first question will help find the main problem to be addressed in order to avoid cases of mismatch of services and problems experienced. The second sub-related question on the will helps the available medical cover for the victims of posttraumatic disorder in order to help make any further recommendations on where and how to improve the services. Finally, the last sub-related question will assist in pointing the inefficiencies in the health care services offered to the PSTD veterans. Knowing these inefficiencies will help the researcher to make educated recommendations as per what measures can be taken to address them.
Important Information about the Issue and Types of Data to be collected
To understand the issue of quality of comprehensive care for the OEF and OIF veterans with posttraumatic stress disorder, the research must understand the kind of challenges these veterans go through in the battlefields. Also of importance is information on the available medical care options at the disposal of these veterans plus the number qualified personnel in this area. The data to be collected, on the other hand, will mostly be experiences and awareness of the victims. The research will also collect records of relevant institution that will be analyzed qualitatively.
Action Plan
The paper desired for a future in which medical programs offer the best possible financial and technical support to those who had sacrificed their comfort to help the OIF/OEF veterans. The policies must be able to authorize veterans to provide ...
Hospital Care for Mental Health and Substance Abuse ConditionsLizbethQuinonez813
Hospital Care for Mental Health and Substance Abuse Conditions in
Parkinson’s Disease
Allison. W. Willis, MD, MSCI,1,2,3,4* Dylan P. Thibault, MS,1 Peter N. Schmidt, PhD,5 E. Ray Dorsey, MD, MBA,6 and
Daniel Weintraub, MD1,7,8
1Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
2
Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
3
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
4
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
5
National Parkinson’s Foundation, Miami, Florida, USA
6Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
7
Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
8
Parkinson’s Disease and Mental Illness Research, Education and Clinical Centers, Philadelphia Veterans Affairs Medical Center, Philadelphia,
Pennsylvania, USA
A B S T R A C T : O b j e c t i v e : The objective of this
study was to examine mental health conditions among
hospitalized individuals with Parkinson’s disease in the
United States.
M e t h o d s : This was a serial cross-sectional study of
hospitalizations of individuals aged �60 identified in the
Nationwide Inpatient Sample dataset from 2000 to
2010. We identified all hospitalizations with a diagnosis
of PD, alcohol abuse, anxiety, bipolar disorder, depres-
sion, impulse control disorders, mania, psychosis, sub-
stance abuse, and attempted suicide/suicidal ideation.
National estimates of each mental health condition
were compared between hospitalized individuals with
and without PD. Hierarchical logistic regression models
determined which inpatient mental health diagnoses
were associated with PD, adjusting for demographic,
payer, geographic, and hospital characteristics.
R e s u l t s : We identified 3,918,703 mental health and sub-
stance abuse hospitalizations. Of these, 2.8% (n 5 104,
437) involved a person also diagnosed with PD. The major-
ity of mental health and substance abuse patients were
white (86.9% of PD vs 83.3% of non-PD). Women were
more common than men in both groups (male:female
prevalence ratio, PD: 0.78, 0.78-0.79, non-PD: 0.58, 0.57-
0.58). Depression (adjusted odds ratio 1.32, 1.31-1.34),
psychosis (adjusted odds ratio 1.25, 1.15-1.33), bipolar
disorder (adjusted odds ratio 2.74, 2.69-2.79), impulse
control disorders (adjusted odds ratio 1.51, 1.31-1.75),
and mania (adjusted odds ratio 1.43, 1.18-1.74) were more
likely among PD patients, alcohol abuse was less likely
(adjusted odds ratio 0.26, 0.25-0.27). We found no PD-
associated difference in suicide-related care.
C o n c l u s i o n s : PD patients have unique patterns of
acute care for mental health and substance abuse.
Research is needed to guide PD treatment in individuals
with ...
Running head PSYCHOLOGY1PSYCHOLOGY5Empirical res.docxSUBHI7
Running head: PSYCHOLOGY
1
PSYCHOLOGY
5
Empirical research on the prevalence of PTSD on servicemen and veterans from combat
Developments in combat zone medicine infer more aggrieved servicemen and veterans are surviving their injuries; though, numerous injuries are not as noticeable such as missing appendages and other bodily wounds, explicitly distressing cognitive damages and post-traumatic stress writhed by both soldiers and citizens in the way of relatives and friends. The frequency of these injuries can be, and still are, not clear-cut. Moreover, the categorizations of these injuries have transformed over the course of time, touching on the way in which the sum of the aggrieved is tallied over and above the interventions presented (Angkaw et.al, 2015). An editorial in The Economist on March 2013 centered on the upsurge in the figure of war veterans pursuing medical assistance as a result of post-traumatic stress symptoms. The rise was realized amongst the newly repatriated officers, albeit similarly among elderly veterans of prior wars, and had resulted to a surge in America`s disabled former soldiers count by nearly 45% from the year 2000. A lot of empirical research reinforces the assertion made in the Economist piece, and investigation correspondingly demonstrates the long-term overheads will be a reality for many nations involved in the cross-border wars (Beckham et.al, 2014). Internationally, a rise in number of war veterans looking for assistance for psychological signs that are every so often well-matched with PTSD disorder explicate that the number of troupers affected with PTSD in the year 2013 will grow to over 300,000 persons in the United States. A similar predisposition is noticed in other nation state, and a recent research from Europe (particularly United Kingdom) pronounces late onset indications among servicemen. Our test hypothesis will appraise the prevalence and frequency of PTSD in servicemen and veteran from the warzone. From the prevalence then apt interventions can be devised to help assist all those who served and are affected with disorder.
How is PTSD perceived in a health perspective?
PTSD is a mental disorder, which is described and defined in the ensuing two classifications; the International Classification of Diseases (ICD-10) established by the World Health Organization (WHO), together with the Diagnostic and Statistical Manual of Mental Disorders (DMMD) instigated by the American Psychiatric Association (DSM-5). The analytical measures in the two classifications are articulated somewhat differently, but overall they are seen as alike. The analytical criteria consist of the following: experiencing a traumatic situation or event, short or long lasting, in which the person is exposed to fears of loss of life, grim harm or sexual abuse. The exposure is a due to circumstances with unswervingly involves the distressing event or observes the traumatic happening personally (Angkaw et.al, 2015). The social-b ...
Military Health System (MHS) data were analyzed to estimate the prevalence of demographic, military, deployment, physical, mental health, and substance use characteristics of the AWTU cohort (N=31,094) compared to an Army cohort (N=851,997) who returned from OEF/OIF/OND deployments between FY2008-FY2015 and received BH care in the MHS, but were not referred to an AWTU during post-deployment. This study aimed to: (1) compare military and deployment characteristics of Army service members (SMs) who returned from Iraq and Afghanistan deployments from FY2008-FY2015 and were referred to Warrior Transition Units (WTUs) to those who were not referred to WTUs and (2) estimate the prevalence of physical injuries and behavioral health diagnoses of Army service members referred to WTUs from FY2008-FY2015 within 90 days of WTU referral.
Respond to posts of two peers in this discussion. As part of your.docxlanagore871
Respond to posts of two peers in this discussion. As part of your reply, comment on the ways in which your peer's annotated entries were effective in summarizing the studies for you, and ways in which the annotated entries could be more effective.. You need to respond about each peers posting which contains two articles.
Laurie Leitch, M., Vanslyke, J., & Allen, M. (2009). Somatic experiencing treatment with social service workers following hurricanes katrina and rita. Social Work, 54(1), 9-18.
Laurie Leitch, PhD, is the research director for the Foundation of Human Enrinchment and a coufounder of the Trauma Research Institute. Jan Vanslyke, PhD, and Marisa Allen, ABD, are senior evaluation specialists at Reid and Associates. The purpose of this study was to determine if the Somatic Experiencing Trauma Resiliency Model (SE/TRM) could "reduce the post disaster symptoms of social service workers“ who deliver services to individuals and communities after a disaster.
The researchers conducted a quantitative study of 142 social service workers who provided service after huricanes Katrina and Rita in New Orleans. The study was conducted on a nonrandom sample of 142 social service workers. 91 participants received SE/TRM and they were compared with 51 workers who did not receive SE/TRM and were matched via propensity score matching. They hypothesis was that the use of SE/TRM could reduce the symptoms of disaster relief workers post disaster. Data analysis showed that there was a significant difference between the two groups in relation to post disaster relief. The group that received SE/TRM showed significantly lower PTSD symptoms and psychological distress and higher levels of resiliency. The authors noted that all of the participants in this study were employed, which sets them apart from many disaster survivors as well as the study was not a „randomized control study“. Further research is needed to further study the effectiveness of SE/TRM in the field of disaster treatment.
Metcalf, O., Varker, T., Forbes, D., Phelps, A., Dell, L., DiBattista, A., Ralph, N., & O’Donnell, M. (2016). Efficacy of Fifteen Emerging Interventions for the Treatment of Posttraumatic Stress Disorder: A Systematic Review. Journal of Traumatic Stress, 29, 88-92.
The purpose of this study was to evaluate the effectiveness of 15 "new or novel interventions“ that are being utilizef for the treatment of PTSD. This work was funded by the Department of Veterans‘ Affaris and National Health and Medical Research Council Programs. The study eliminated appraoches that did not offer "moderate quality evidence from randomized controlled trials“ by a team of 5 Trauma Experts. To be included, studies also required adults over 18 years of age, 70% of the sample majority were diagnosed with PTSD and outcome data were reported for severity of symptoms and diagnosis. The approaches that fulfilled this critera are emotional freedom technique, yoga, mantra-based meditation and ac.
Running head VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEM.docxjenkinsmandie
Running head: VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEMS 1
VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEMS 3
Veterans PTSD Causes, Treatments, and Support systems
Veterans PTSD Causes, Treatments, and Support systems
Evaluations on Post Traumatic Stress Disorder (PTSD) among veterans is imperative for a positive health outcome. The evaluations and analysis of the results ensure that barriers to treatment are addressed and have access to the available support systems. Studies carried out have depicted the successes of the treatments and support programs in the health systems to veterans. Modifications on the systems have also been recommended to combat and control PTSD. Alternative approaches such as computerized systems, natural treatment methods, and home-based systems are also essential in providing a holistic approach in PTSD treatments. Treatment methods success ensures that veterans do not fall victim to depression, which can result in chronic diseases. This can be as a result of negative health behaviors and lifestyles. Understanding the consequences of PTSD among veterans will ensure that approaches utilized offer not only treatment methods but also offer support systems for general wellbeing.
The first source focuses on the treatment and success of three-week outpatient program by “evaluating patterns and predictors of symptom change during a three-week intensive outpatient treatment for veterans with PTSD.” The study is evidence-based on statistics drawn from the program and modifications for optimal success rates. 191 veterans were the participants in the research comprising of a daily group and individual Cognitive Processing Therapy (Zalta et al., 2018). The data was analyzed from the sample cohorts in accordance with military and demographic characteristics. Measures in the study involved treatment engagement as well as comparison of pre-treatment and post-treatment changes (Zalta et al., 2018). The results showed progress in the evaluation of predictors and patterns in treatment changes. Procedures utilized involved group sessions with daily activities for the development of the treatment program. Self-report metrics were also applied in the procedures as control groups were challenging in the study. Modified and intensive outpatient (IOP) treatment to veterans showed high success levels in the program (Zalta et al., 2018).
The second source examines a new treatment in exploring the feasibility of computerized, placebo-controlled, and home-based executive function training (EFT) on psychological and neuropsychological functions. The source titled “Computer-based executive function training for combat veterans with PTSD” shows trials in assessing feasibility and predictors output. The study shows how the functions can be useful in brain activation combating PTSD in veterans. Symptoms experienced after treatment on PTSD cases are stimulated through neural and cognition reactivity, which can be contr.
Journal Review: Rates of Treatment-Resistant Schizophrenia from First-Episode...Robert Ferris
Review of British Journal of Psychiatry publication by Siskind et. al. in 2022 entitled 'Rates of Treatment-Resistant Schizophrenia from First-Episode Cohorts: Systematic Review and Meta-Analysis', presented by Dr. Robert Ferris and Dr. Daere Akobo.
Note: uploading to SlideShare causes disruption of slide layout, creating text overlap. Original layout visible on download.
Sources for all imagery and resources listed in references section. I do not claim ownership of any images or graphics. Slides for educational purposes only, and should not replace clinical judgement. No monetary gain was made for this work.
Background: Behavioral health conditions are prevalent among patients in inpatient medical settings and when not adequately treated contribute to diminished treatment outcomes and quality of life. Substantial evidence has demonstrated the effectiveness of psychological interventions in addressing behavioral health conditions in a range of settings but, to a lesser extent with psychologically-based interventions delivered in inpatient medical settings. Purpose: The purpose of this paper is to increase attention on psychological interventions being delivered to patients across a broad spectrum of medical specialties in inpatient medical settings to support the implementation of interventions to address increasing patient needs. Methods: This selected, brief review of the literature sought to describe published psychologically-based interventions delivered in inpatient medical settings. A search for studies catalogued on PubMed from 2007 to 2016 was examined and studies were included in the review if they were delivered within inpatient medical settings. Two reviewers independently assessed relevant studies for criteria. Results: A total of ten articles met the inclusion criteria with interventions targeting outcomes across four primary domains: 1) pain and fatigue; 2) cognition; 3) affective/emotional and; 4) self-harm. Several articles support interventions grounded in Cognitive-Behavioral Therapy and brief psychological interventions. Most studies reported favorable outcomes for the interventions relative to controls. Conclusions: Psychologically-based interventions, especially those that integrate components of cognitive-behavioral therapy and a multidisciplinary approach, can be implemented in inpatient medical settings and may promote improved patient outcomes. However, the quality of this evidence requires formal assessment, requiring more comprehensive reviews are needed to replicate findings and clarify effectiveness of interventions.
An Internet questionnaire to identify Drug seeking behavior in a patient in t...Nelson Hendler
Drug seeking behavior in patients with little or no real pain, has led to the opioid crisis. Until now, there was no reliable method for detecting drug seeking behavior. The Pain Validity Test from www.MarylandClinicalDiagnostics.com can predict with 95% accuracy who will have medical test abnormalities, i.e. who has a valid complaint of pain, and predicts with 85%-100% accuracy who will not have any medical test abnormalities, i.e. who is faking and drug seeking. The Pain Validity Test has been admitted as evidence in over 30 legal cases in 8 states.
Pain Validity Test to detect drug seeking behaviorNelson Hendler
The Pain Validity Test predicts which patient will have medical test abnormalities with 95% accuracy, thereby validating their complaint of pain. The Pain Validity Test also predicts with 85%-100% accuracy who will not have medical test abnormalities, thereby detecting drug seeking behavior, faking and malingering.
Pain Validity Test identifies drug seeking behavior. Stop opioid abuse. Prote...Nelson Hendler
Physician prescribing practices are under constant scrutiny. An Internet questionnaire will predict if a patient will have a medical test abnormality with 95% accuracy, and 100% if the patient will not. This Pain Validity Test can be used to detect drug seeking behavior in patients, at a far high level of accuracy than tests currently in use (34.4%-48.2% accuracy).. The Pain Validity test has been admitted as evidence in 30 cases in 9 states.
THE UNIVERSITY OF MEMPHIS POST TRAUMATIC STRESS DISORDER.docxchristalgrieg
THE UNIVERSITY OF MEMPHIS
POST TRAUMATIC STRESS
DISORDER
EARLY INTERVENTION FOR OUR SOLDIERS
LESLIE JAYROE
4/25/2011
HPRO 7720
Post Traumatic Stress Disorder and Our Soldiers- Providing Earlier Intervention
History
There is a significant amount of information out there on post traumatic stress disorder and the
military, and this is mostly due to the fact that our combat soldiers were the ones observed over
time to determine the effects war has had on them. Post traumatic stress disorder (PTSD) can
be thought of as a "young" diagnosis. PTSD has been around for centuries, but it was n~t until
1980 that it was made an official disorder. However, throughout history, people have
recognized that exposure to combat situations can have an intensely negative impact on the
people who are involved in these situations. (Mathew Tull, 2009) PTSD has previously been
described ia-410J e ~s "combat fatigue," "shell shock," or "war neurosis," and is defined by the
American Psychiatric Association as an anxiety (emotional) disorder which stems from a
particular incident evoking significant stress. (Bentley, 2005) PTSD is not limited to combat
soldiers but can also be found among survivors of the Holocaust, of car accidents, of sexual
assaults, and of other traumatic experiences. War has always had a severe psychological effect
on people, and with the war our country is currently in, more and more of our soldiers are
suffering from PTSD. After a traumatic experience, the mind and the body are in shock, but as
the victim makes sense of what happened and processes his/her emotions, healing takes place
leading toward normal function once again. With PTSD, one remains in psychological shock.
The memory of what happened and their feelings about it are disconnected. In order to move
on, it's important to face and feel those memories and emotions. One effective approach is
through counseling. (Mathew Tull, 2009)
The symptoms of PTSD can occur all of a sudden, progressively, come and go over time, or
appear out of nowhere. Sometimes, symptoms are triggered by something that reminds a
31 Page
person of the original traumatic event, such as a noise, an image, certain words, or a smell.
While everyone experiences PTSD differently, there are three main types of symptoms:
(Bentley, 2005)
1. Re-experiencing the traumatic event
2. Avoiding reminders of the trauma
3. Increased anxiety and emotional arousal
According to the Graffiti of War Project, in 2007, the number of diagnosed cases in the military
jumped 50%. One in every five military personnel returning from Iraq and Afghanistan has
PTSD, and 20% of the soldiers who've been deployed since 2001 have PTSD which is over
300,000. More troops are serving their second, third or fourth tours of duty, which dramatically
increases stress according to medical heath experts. Also, extended tour lengths from 12
months to 15 months were done to prov ...
Determine the Patients' Satisfaction Concerning In-hospital Information Progr...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care.
Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice
Variables in a Research Study and Data CollectionIn this assignmen.docxdaniahendric
Variables in a Research Study and Data Collection
In this assignment, you will explore the variables involved in a research study.
Complete the following tasks:
Read the following articles from the Cumulative Index to Nursing and Allied Health Literature (CINAHL) Database in the South University Online Library.
Lee, A., Craft-Rosenberg, M. (2010). Ineffective family participation in
professional care: A concept analysis of a proposed nursing
diagnosis.
Nurs Diagn
. 2002 Jan-Mar;
13
(1), 5–14.
Witt, C. M., Lüdtke, R., Willich, S. N. (2010). Homeopathic treatment
of patients with migraine: A prospective observational study with
a 2-year follow-up period.
J Altern Complement Med
. 2010 Apr;
16
(4), 347–55. doi: 10.1089/acm.2009.0376.
Read the process for data collection employed in both these studies. Compare the method used in each of them.
Provide a bulleted list of the five tasks performed as part of data collection in each of them. Click
here
to enter your responses in the organizer.
.
Variation exists in virtually all parts of our lives. We often see v.docxdaniahendric
Variation exists in virtually all parts of our lives. We often see variation in results in what we spend (utility costs each month, food costs, business supplies, etc.). Consider the measures and data you use (in either your personal or job activities). When are differences (between one time period and another, between different production lines, etc.) between average or actual results important? How can you or your department decide whether or not the observed differences over time are important? How could using a mean difference test help?
.
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Hospital Care for Mental Health and Substance Abuse ConditionsLizbethQuinonez813
Hospital Care for Mental Health and Substance Abuse Conditions in
Parkinson’s Disease
Allison. W. Willis, MD, MSCI,1,2,3,4* Dylan P. Thibault, MS,1 Peter N. Schmidt, PhD,5 E. Ray Dorsey, MD, MBA,6 and
Daniel Weintraub, MD1,7,8
1Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
2
Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
3
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
4
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
5
National Parkinson’s Foundation, Miami, Florida, USA
6Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
7
Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
8
Parkinson’s Disease and Mental Illness Research, Education and Clinical Centers, Philadelphia Veterans Affairs Medical Center, Philadelphia,
Pennsylvania, USA
A B S T R A C T : O b j e c t i v e : The objective of this
study was to examine mental health conditions among
hospitalized individuals with Parkinson’s disease in the
United States.
M e t h o d s : This was a serial cross-sectional study of
hospitalizations of individuals aged �60 identified in the
Nationwide Inpatient Sample dataset from 2000 to
2010. We identified all hospitalizations with a diagnosis
of PD, alcohol abuse, anxiety, bipolar disorder, depres-
sion, impulse control disorders, mania, psychosis, sub-
stance abuse, and attempted suicide/suicidal ideation.
National estimates of each mental health condition
were compared between hospitalized individuals with
and without PD. Hierarchical logistic regression models
determined which inpatient mental health diagnoses
were associated with PD, adjusting for demographic,
payer, geographic, and hospital characteristics.
R e s u l t s : We identified 3,918,703 mental health and sub-
stance abuse hospitalizations. Of these, 2.8% (n 5 104,
437) involved a person also diagnosed with PD. The major-
ity of mental health and substance abuse patients were
white (86.9% of PD vs 83.3% of non-PD). Women were
more common than men in both groups (male:female
prevalence ratio, PD: 0.78, 0.78-0.79, non-PD: 0.58, 0.57-
0.58). Depression (adjusted odds ratio 1.32, 1.31-1.34),
psychosis (adjusted odds ratio 1.25, 1.15-1.33), bipolar
disorder (adjusted odds ratio 2.74, 2.69-2.79), impulse
control disorders (adjusted odds ratio 1.51, 1.31-1.75),
and mania (adjusted odds ratio 1.43, 1.18-1.74) were more
likely among PD patients, alcohol abuse was less likely
(adjusted odds ratio 0.26, 0.25-0.27). We found no PD-
associated difference in suicide-related care.
C o n c l u s i o n s : PD patients have unique patterns of
acute care for mental health and substance abuse.
Research is needed to guide PD treatment in individuals
with ...
Running head PSYCHOLOGY1PSYCHOLOGY5Empirical res.docxSUBHI7
Running head: PSYCHOLOGY
1
PSYCHOLOGY
5
Empirical research on the prevalence of PTSD on servicemen and veterans from combat
Developments in combat zone medicine infer more aggrieved servicemen and veterans are surviving their injuries; though, numerous injuries are not as noticeable such as missing appendages and other bodily wounds, explicitly distressing cognitive damages and post-traumatic stress writhed by both soldiers and citizens in the way of relatives and friends. The frequency of these injuries can be, and still are, not clear-cut. Moreover, the categorizations of these injuries have transformed over the course of time, touching on the way in which the sum of the aggrieved is tallied over and above the interventions presented (Angkaw et.al, 2015). An editorial in The Economist on March 2013 centered on the upsurge in the figure of war veterans pursuing medical assistance as a result of post-traumatic stress symptoms. The rise was realized amongst the newly repatriated officers, albeit similarly among elderly veterans of prior wars, and had resulted to a surge in America`s disabled former soldiers count by nearly 45% from the year 2000. A lot of empirical research reinforces the assertion made in the Economist piece, and investigation correspondingly demonstrates the long-term overheads will be a reality for many nations involved in the cross-border wars (Beckham et.al, 2014). Internationally, a rise in number of war veterans looking for assistance for psychological signs that are every so often well-matched with PTSD disorder explicate that the number of troupers affected with PTSD in the year 2013 will grow to over 300,000 persons in the United States. A similar predisposition is noticed in other nation state, and a recent research from Europe (particularly United Kingdom) pronounces late onset indications among servicemen. Our test hypothesis will appraise the prevalence and frequency of PTSD in servicemen and veteran from the warzone. From the prevalence then apt interventions can be devised to help assist all those who served and are affected with disorder.
How is PTSD perceived in a health perspective?
PTSD is a mental disorder, which is described and defined in the ensuing two classifications; the International Classification of Diseases (ICD-10) established by the World Health Organization (WHO), together with the Diagnostic and Statistical Manual of Mental Disorders (DMMD) instigated by the American Psychiatric Association (DSM-5). The analytical measures in the two classifications are articulated somewhat differently, but overall they are seen as alike. The analytical criteria consist of the following: experiencing a traumatic situation or event, short or long lasting, in which the person is exposed to fears of loss of life, grim harm or sexual abuse. The exposure is a due to circumstances with unswervingly involves the distressing event or observes the traumatic happening personally (Angkaw et.al, 2015). The social-b ...
Military Health System (MHS) data were analyzed to estimate the prevalence of demographic, military, deployment, physical, mental health, and substance use characteristics of the AWTU cohort (N=31,094) compared to an Army cohort (N=851,997) who returned from OEF/OIF/OND deployments between FY2008-FY2015 and received BH care in the MHS, but were not referred to an AWTU during post-deployment. This study aimed to: (1) compare military and deployment characteristics of Army service members (SMs) who returned from Iraq and Afghanistan deployments from FY2008-FY2015 and were referred to Warrior Transition Units (WTUs) to those who were not referred to WTUs and (2) estimate the prevalence of physical injuries and behavioral health diagnoses of Army service members referred to WTUs from FY2008-FY2015 within 90 days of WTU referral.
Respond to posts of two peers in this discussion. As part of your.docxlanagore871
Respond to posts of two peers in this discussion. As part of your reply, comment on the ways in which your peer's annotated entries were effective in summarizing the studies for you, and ways in which the annotated entries could be more effective.. You need to respond about each peers posting which contains two articles.
Laurie Leitch, M., Vanslyke, J., & Allen, M. (2009). Somatic experiencing treatment with social service workers following hurricanes katrina and rita. Social Work, 54(1), 9-18.
Laurie Leitch, PhD, is the research director for the Foundation of Human Enrinchment and a coufounder of the Trauma Research Institute. Jan Vanslyke, PhD, and Marisa Allen, ABD, are senior evaluation specialists at Reid and Associates. The purpose of this study was to determine if the Somatic Experiencing Trauma Resiliency Model (SE/TRM) could "reduce the post disaster symptoms of social service workers“ who deliver services to individuals and communities after a disaster.
The researchers conducted a quantitative study of 142 social service workers who provided service after huricanes Katrina and Rita in New Orleans. The study was conducted on a nonrandom sample of 142 social service workers. 91 participants received SE/TRM and they were compared with 51 workers who did not receive SE/TRM and were matched via propensity score matching. They hypothesis was that the use of SE/TRM could reduce the symptoms of disaster relief workers post disaster. Data analysis showed that there was a significant difference between the two groups in relation to post disaster relief. The group that received SE/TRM showed significantly lower PTSD symptoms and psychological distress and higher levels of resiliency. The authors noted that all of the participants in this study were employed, which sets them apart from many disaster survivors as well as the study was not a „randomized control study“. Further research is needed to further study the effectiveness of SE/TRM in the field of disaster treatment.
Metcalf, O., Varker, T., Forbes, D., Phelps, A., Dell, L., DiBattista, A., Ralph, N., & O’Donnell, M. (2016). Efficacy of Fifteen Emerging Interventions for the Treatment of Posttraumatic Stress Disorder: A Systematic Review. Journal of Traumatic Stress, 29, 88-92.
The purpose of this study was to evaluate the effectiveness of 15 "new or novel interventions“ that are being utilizef for the treatment of PTSD. This work was funded by the Department of Veterans‘ Affaris and National Health and Medical Research Council Programs. The study eliminated appraoches that did not offer "moderate quality evidence from randomized controlled trials“ by a team of 5 Trauma Experts. To be included, studies also required adults over 18 years of age, 70% of the sample majority were diagnosed with PTSD and outcome data were reported for severity of symptoms and diagnosis. The approaches that fulfilled this critera are emotional freedom technique, yoga, mantra-based meditation and ac.
Running head VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEM.docxjenkinsmandie
Running head: VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEMS 1
VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEMS 3
Veterans PTSD Causes, Treatments, and Support systems
Veterans PTSD Causes, Treatments, and Support systems
Evaluations on Post Traumatic Stress Disorder (PTSD) among veterans is imperative for a positive health outcome. The evaluations and analysis of the results ensure that barriers to treatment are addressed and have access to the available support systems. Studies carried out have depicted the successes of the treatments and support programs in the health systems to veterans. Modifications on the systems have also been recommended to combat and control PTSD. Alternative approaches such as computerized systems, natural treatment methods, and home-based systems are also essential in providing a holistic approach in PTSD treatments. Treatment methods success ensures that veterans do not fall victim to depression, which can result in chronic diseases. This can be as a result of negative health behaviors and lifestyles. Understanding the consequences of PTSD among veterans will ensure that approaches utilized offer not only treatment methods but also offer support systems for general wellbeing.
The first source focuses on the treatment and success of three-week outpatient program by “evaluating patterns and predictors of symptom change during a three-week intensive outpatient treatment for veterans with PTSD.” The study is evidence-based on statistics drawn from the program and modifications for optimal success rates. 191 veterans were the participants in the research comprising of a daily group and individual Cognitive Processing Therapy (Zalta et al., 2018). The data was analyzed from the sample cohorts in accordance with military and demographic characteristics. Measures in the study involved treatment engagement as well as comparison of pre-treatment and post-treatment changes (Zalta et al., 2018). The results showed progress in the evaluation of predictors and patterns in treatment changes. Procedures utilized involved group sessions with daily activities for the development of the treatment program. Self-report metrics were also applied in the procedures as control groups were challenging in the study. Modified and intensive outpatient (IOP) treatment to veterans showed high success levels in the program (Zalta et al., 2018).
The second source examines a new treatment in exploring the feasibility of computerized, placebo-controlled, and home-based executive function training (EFT) on psychological and neuropsychological functions. The source titled “Computer-based executive function training for combat veterans with PTSD” shows trials in assessing feasibility and predictors output. The study shows how the functions can be useful in brain activation combating PTSD in veterans. Symptoms experienced after treatment on PTSD cases are stimulated through neural and cognition reactivity, which can be contr.
Journal Review: Rates of Treatment-Resistant Schizophrenia from First-Episode...Robert Ferris
Review of British Journal of Psychiatry publication by Siskind et. al. in 2022 entitled 'Rates of Treatment-Resistant Schizophrenia from First-Episode Cohorts: Systematic Review and Meta-Analysis', presented by Dr. Robert Ferris and Dr. Daere Akobo.
Note: uploading to SlideShare causes disruption of slide layout, creating text overlap. Original layout visible on download.
Sources for all imagery and resources listed in references section. I do not claim ownership of any images or graphics. Slides for educational purposes only, and should not replace clinical judgement. No monetary gain was made for this work.
Background: Behavioral health conditions are prevalent among patients in inpatient medical settings and when not adequately treated contribute to diminished treatment outcomes and quality of life. Substantial evidence has demonstrated the effectiveness of psychological interventions in addressing behavioral health conditions in a range of settings but, to a lesser extent with psychologically-based interventions delivered in inpatient medical settings. Purpose: The purpose of this paper is to increase attention on psychological interventions being delivered to patients across a broad spectrum of medical specialties in inpatient medical settings to support the implementation of interventions to address increasing patient needs. Methods: This selected, brief review of the literature sought to describe published psychologically-based interventions delivered in inpatient medical settings. A search for studies catalogued on PubMed from 2007 to 2016 was examined and studies were included in the review if they were delivered within inpatient medical settings. Two reviewers independently assessed relevant studies for criteria. Results: A total of ten articles met the inclusion criteria with interventions targeting outcomes across four primary domains: 1) pain and fatigue; 2) cognition; 3) affective/emotional and; 4) self-harm. Several articles support interventions grounded in Cognitive-Behavioral Therapy and brief psychological interventions. Most studies reported favorable outcomes for the interventions relative to controls. Conclusions: Psychologically-based interventions, especially those that integrate components of cognitive-behavioral therapy and a multidisciplinary approach, can be implemented in inpatient medical settings and may promote improved patient outcomes. However, the quality of this evidence requires formal assessment, requiring more comprehensive reviews are needed to replicate findings and clarify effectiveness of interventions.
An Internet questionnaire to identify Drug seeking behavior in a patient in t...Nelson Hendler
Drug seeking behavior in patients with little or no real pain, has led to the opioid crisis. Until now, there was no reliable method for detecting drug seeking behavior. The Pain Validity Test from www.MarylandClinicalDiagnostics.com can predict with 95% accuracy who will have medical test abnormalities, i.e. who has a valid complaint of pain, and predicts with 85%-100% accuracy who will not have any medical test abnormalities, i.e. who is faking and drug seeking. The Pain Validity Test has been admitted as evidence in over 30 legal cases in 8 states.
Pain Validity Test to detect drug seeking behaviorNelson Hendler
The Pain Validity Test predicts which patient will have medical test abnormalities with 95% accuracy, thereby validating their complaint of pain. The Pain Validity Test also predicts with 85%-100% accuracy who will not have medical test abnormalities, thereby detecting drug seeking behavior, faking and malingering.
Pain Validity Test identifies drug seeking behavior. Stop opioid abuse. Prote...Nelson Hendler
Physician prescribing practices are under constant scrutiny. An Internet questionnaire will predict if a patient will have a medical test abnormality with 95% accuracy, and 100% if the patient will not. This Pain Validity Test can be used to detect drug seeking behavior in patients, at a far high level of accuracy than tests currently in use (34.4%-48.2% accuracy).. The Pain Validity test has been admitted as evidence in 30 cases in 9 states.
THE UNIVERSITY OF MEMPHIS POST TRAUMATIC STRESS DISORDER.docxchristalgrieg
THE UNIVERSITY OF MEMPHIS
POST TRAUMATIC STRESS
DISORDER
EARLY INTERVENTION FOR OUR SOLDIERS
LESLIE JAYROE
4/25/2011
HPRO 7720
Post Traumatic Stress Disorder and Our Soldiers- Providing Earlier Intervention
History
There is a significant amount of information out there on post traumatic stress disorder and the
military, and this is mostly due to the fact that our combat soldiers were the ones observed over
time to determine the effects war has had on them. Post traumatic stress disorder (PTSD) can
be thought of as a "young" diagnosis. PTSD has been around for centuries, but it was n~t until
1980 that it was made an official disorder. However, throughout history, people have
recognized that exposure to combat situations can have an intensely negative impact on the
people who are involved in these situations. (Mathew Tull, 2009) PTSD has previously been
described ia-410J e ~s "combat fatigue," "shell shock," or "war neurosis," and is defined by the
American Psychiatric Association as an anxiety (emotional) disorder which stems from a
particular incident evoking significant stress. (Bentley, 2005) PTSD is not limited to combat
soldiers but can also be found among survivors of the Holocaust, of car accidents, of sexual
assaults, and of other traumatic experiences. War has always had a severe psychological effect
on people, and with the war our country is currently in, more and more of our soldiers are
suffering from PTSD. After a traumatic experience, the mind and the body are in shock, but as
the victim makes sense of what happened and processes his/her emotions, healing takes place
leading toward normal function once again. With PTSD, one remains in psychological shock.
The memory of what happened and their feelings about it are disconnected. In order to move
on, it's important to face and feel those memories and emotions. One effective approach is
through counseling. (Mathew Tull, 2009)
The symptoms of PTSD can occur all of a sudden, progressively, come and go over time, or
appear out of nowhere. Sometimes, symptoms are triggered by something that reminds a
31 Page
person of the original traumatic event, such as a noise, an image, certain words, or a smell.
While everyone experiences PTSD differently, there are three main types of symptoms:
(Bentley, 2005)
1. Re-experiencing the traumatic event
2. Avoiding reminders of the trauma
3. Increased anxiety and emotional arousal
According to the Graffiti of War Project, in 2007, the number of diagnosed cases in the military
jumped 50%. One in every five military personnel returning from Iraq and Afghanistan has
PTSD, and 20% of the soldiers who've been deployed since 2001 have PTSD which is over
300,000. More troops are serving their second, third or fourth tours of duty, which dramatically
increases stress according to medical heath experts. Also, extended tour lengths from 12
months to 15 months were done to prov ...
Determine the Patients' Satisfaction Concerning In-hospital Information Progr...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care.
Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice
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After Combat Deployment Low Utilization of Mental Health Care and.docx
1. After Combat Deployment: Low Utilization of Mental Health
Care and Reasons for Dropout
Charles W. Hoge
, M.D.,
Sasha H. Grossman
, B.A.,
Jennifer L. Auchterlonie
, M.S.,
Lyndon A. Riviere
, Ph.D.,
Charles S. Milliken
, M.D., and
Joshua E. Wilk
, Ph.D.
Published Online:1 Aug 2014https://doi-
org.ezp.waldenulibrary.org/10.1176/appi.ps.201300307
Abstract
Objective
Limited data exist on the adequacy of treatment for
posttraumatic stress disorder (PTSD) after combat deployment.
This study assessed the percentage of soldiers in need of PTSD
treatment, the percentage receiving minimally adequate care,
and reasons for dropping out of care.
Methods
Data came from two sources: a population-based cohort of
45,462 soldiers who completed the Post-Deployment Health
Assessment and a cross-sectional survey of 2,420 infantry
soldiers after returning from Afghanistan (75% response rate).
Results
Of 4,674 cohort soldiers referred to mental health care at a
military treatment facility, 75% followed up with this referral.
However, of 2,230 soldiers who received a PTSD diagnosis
within 90 days of return from Afghanistan, 22% had only one
2. mental health care visit and 41% received minimally adequate
care (eight or more encounters in 12 months). Of 229 surveyed
soldiers who screened positive for PTSD (PTSD Checklist score
≥50), 48% reported receiving mental health treatment in the
prior six months at any health care facility. Of those receiving
treatment, the median number of visits in six months was four;
22% had only one visit, 52% received minimally adequate care
(four or more visits in six months), and 24% dropped out of
care. Reported reasons for dropout included soldiers feeling
they could handle problems on their own, work interference,
insufficient time with the mental health professional, stigma,
treatment ineffectiveness, confidentiality concerns, or
discomfort with how the professional interacted.
Conclusions
Treatment reach for PTSD after deployment remains low to
moderate, with a high percentage of soldiers not accessing care
or not receiving adequate treatment. This study represents a call
to action to validate interventions to improve treatment
engagement and retention.
Over two million service members have deployed to Iraq or
Afghanistan since 2001, and these deployments have been
strongly associated with an increased risk of mental health
problems (1–4). A meta-analysis of studies found that the
average post deployment prevalence of posttraumatic stress
disorder (PTSD) was 13.2% for personnel assigned to
operational infantry units and 5.5% for representative samples
of total deployed forces (including support personnel) (3).
These and other studies indicate that there will be a significant
ongoing need for mental health care in this population.
Although a relatively high percentage of military personnel and
veterans access mental health services (for example, one
analysis of Army personnel showed that 21% had one or more
clinical encounters during a year) (5), underutilization for those
most in need remains an ongoing concern. Studies have shown
that only 13%−53% of U.S. and Canadian veterans who meet
criteria for a mental health problem after deployment receive
3. care (6–8).
An additional problem is that veterans who enter mental health
treatment often do not receive adequate care. At least three
studies have found that only a third of Iraq and Afghanistan
veterans treated for PTSD received minimally adequate care (8–
10), broadly defined by the number of treatment sessions
received. Similar studies involving active duty service members
close to returning from deployment have not been conducted.
A number of explanations have been proposed for
underutilization of services, including stigma (1,6,7), lack of
appointment accessibility and availability (1,6,11), perceptions
of self-reliance (12), and distrust or negative perceptions of
care (6,13–16). Several recent studies among U.S. and Canadian
veterans have suggested that negative attitudes toward mental
health care may be more important in initially seeking treatment
than stigma and other traditional barriers (13–16).
With this descriptive study, we offer new findings on the
adequacy of PTSD treatment received by active duty service
members after returning from combat deployment. The principal
study aims were to determine the percentage of soldiers in need
of PTSD treatment after returning from deployment and the
percentage receiving an adequate number of treatment sessions
according to a standard definition of minimally adequate care.
A secondary aim was to explore reasons for dropping out of
care, including negative attitudes toward mental health
treatment.
Methods
Study groups
Data came from two very different but complementary sources:
a population-based Army cohort and a cross-sectional unit-
based survey. The cohort involved all Army active-component
service members returning from Afghanistan between January 1,
2010, and December 31, 2010, who completed the mandatory
Post-Deployment Health Assessment (PDHA) (N=45,462). This
study focused on service members returning from Afghanistan,
rather than Iraq, because the Afghanistan war zone had the most
4. significant combat engagements during the study time frame.
The PDHA is conducted just before leaving the combat theater
or just after service members return home. The PDHA involves
a brief self-assessment using standardized screening tools
(including PTSD screening) followed by a health care encounter
with a primary care clinician who determines the need for
further referral (17). Analysis focused on soldiers who received
a clinician diagnosis of PTSD within 90 days of completing the
PDHA. All subsequent health care utilization within the military
medical system documented in these soldiers’ electronic
medical records was measured for one year after return from
deployment. A principal purpose of analysis of this cohort was
to determine the proportion of soldiers who received a
minimally adequate number of treatment encounters after PTSD
diagnosis. Analysis was conducted under a protocol approved
by the Walter Reed Army Institute of Research.
The second study group included soldiers from an infantry
brigade surveyed confidentially in July 2011, four to five
months after returning from an Afghanistan combat deployment.
Soldiers were recruited by coordinating with unit commanders,
who made soldiers available in their work areas for group
recruitment briefings during which they could voluntarily
consent to participate. The brigade census showed a total of
3,832 soldiers on duty at the time of recruitment, and 2,876
(75.1%) consented to participate. Of the 2,876 soldiers, 2,420
had deployed with the brigade to Afghanistan and were included
in this study (the rest were new brigade members or transfers,
who were excluded). The analysis of the survey data focused on
characterizing health care utilization overall, and for soldiers
who screened positive for PTSD. The principal purpose of the
analysis was to identify how many high-risk infantry soldiers
reported receiving mental health services, how many visits
occurred, and, for those who reported dropping out of care, the
key reasons for dropout. Informed consent was obtained under a
protocol approved by the institutional review board of the
Walter Reed Army Institute of Research.
5. Outcome measures
For the population cohort, all health care utilization during the
year after the PDHA was measured with the electronic military
Defense Medical Surveillance System, which includes records
of all health care visits and associated ICD-9-CM diagnoses at
all military health care facilities within or outside the
continental United States (2,17). The cohort with PTSD was
defined as all soldiers who received ICD-9-CM code 309.81
(any diagnostic position) from any health care encounter within
90 days of the PDHA. One encounter with this diagnosis was
considered diagnostic for this descriptive study because of
research showing that requiring two or more encounters
produces minimal gains in predictive value but major reductions
in sample size (18,19). In addition, the highest dropout rates
tend to occur after the first visit (17), and there are unique
diagnostic considerations in the military health care system
(stemming from efforts to reduce stigma and high clinical focus
on PTSD) that add to the likelihood that one ICD-9-CM PTSD
code is sufficiently accurate (2). Minimally adequate care for
PTSD was defined per previous research as receiving eight or
more health care encounters involving this diagnosis in the 12-
month follow-up period (8–10).
For the infantry survey group, PTSD symptoms were measured
with the 17-item PTSD checklist (20,21). To meet PTSD
screening criteria of DSM-IV-TR, soldiers had to report at least
one intrusion, three avoidance, and two hyperarousal symptoms
at the moderate or higher level and have a total score of ≥50 on
a scale of 17–85. This well-established stringent cutoff is used
widely in the military and found optimal for population studies
(1,3,21).
Health care utilization for the infantry sample was measured
with a series of questions that asked soldiers whether they had
received mental health services for a stress, emotional, alcohol,
or family problem in the past six months from a mental health,
primary care, or military OneSource provider at any military,
civilian, or Veterans Affairs (VA) health facility or vet center.
6. Soldiers were also asked how many total visits they had with a
mental health professional in the past six months and whether
they were currently in mental health treatment. The six-month
period was selected to include the four to five months since
return from deployment as well as the final one to two months
of deployment, when medical screenings, including the PDHA,
are first initiated in preparation for returning home. Extensive
mental health services are available in the combat theater and
are used in conjunction with the PDHA to ensure coordinated
care during transition from deployment to home. A minimally
adequate number of mental health visits was defined as four or
more visits in the past six months (8–10). Participants were also
asked whether they had stopped treatment or dropped out before
completing treatment. Those who reported dropping out of care
were asked a series of additional yes-no questions concerning
their reasons. These questions were informed by clinical
experience and built on previous research on stigma, treatment
barriers, and negative perceptions of mental health care (1,7,12–
16).
Surveys were scanned with ScanTools (National Computer
Systems), and quality control processes verified error rates
below .25%. Analysis, which was largely descriptive, was
conducted with SPSS version 12.0 for the surveys and with SAS
version 9.1 for the cohort.
Results
Overall, the two study groups had comparable demographic
characteristics, with the largest proportion being young, male,
and junior enlisted rank (Table 1). The demographic
characteristics closely matched those of other studies of
deployed active duty personnel (1–4), and PTSD prevalence was
also consistent with previous reports (3,4).
Mental health outcomes of the PDHA population cohort
Of the 45,462 soldiers completing the PDHA on return from
Afghanistan, 4,674 (10.3%) were referred for further evaluation
7. or treatment for any mental health problem (of whom 3,514, or
75%, followed up with this referral within 90 days), 15,094
(33.2%) had one or more mental health encounters through
another referral mechanism (including primary care, self-
referrals, and command-directed referrals) within 90 days, and
2,230 (5.0%) (from all referral sources) received a PTSD
diagnosis from a clinician. Of the 2,230 soldiers who received a
PTSD diagnosis within 90 days of their PDHA, 1,962 (88.0%)
were able to be followed for a complete 12-month period with
measurement of the total number of mental health or primary
care encounters in which PTSD was listed as a diagnosis (the
other 12% left military service before 12 months had lapsed).
Table 2 shows the distribution of the total number of visits in
which the PTSD diagnosis was recorded; 22% of soldiers
received only one visit, 59% received four or more, and 41%
received eight or more encounters over 12 months.
Mental health outcomes of the infantry survey group
Table 3 shows self-reports of mental health care utilization for
all 2,420 soldiers as well as the 229 who met strict screening
criteria for PTSD. Overall, 21% of soldiers reported receiving
mental health services for any stress, emotional, alcohol, or
family problem through any type of provider; 6% reported
receiving a psychiatric medication, most commonly an
antidepressant; and 17% received at least one visit with a
mental health professional in the past six months (median of
two visits). Of soldiers who accessed care through a mental
health professional, 42% had only one visit. Of the 229 soldiers
who met strict criteria for PTSD, 48% reported receiving any
mental health services in the past six months, and 42% received
care from a mental health professional in the past six months;
22% had only one visit, and 52% had four or more visits in the
past six months (median of four visits). Soldiers with PTSD
who reported being prescribed a psychiatric medication had a
significantly greater number of mental health care visits than
soldiers with PTSD who were not prescribed medication
8. (median of six visits, interquartile range [IQR]=3–12, versus
median of three visits, IQR=1–5; p<.001). Overall satisfaction
with care was moderate and was somewhat higher for all
soldiers in current treatment compared with those who screened
positive for PTSD, with 79% versus 67%, respectively,
responding that they were somewhat or very satisfied.
Of the 507 total soldiers and the 106 with PTSD who reported
receiving any mental health services, 53 (11%) and 25 (24%),
respectively, answered yes to the question, “Did you start
receiving mental health treatment anytime in the past six
months, but stopped or dropped out before completing the
treatment?” Of these soldiers, 50 and 23, respectively, endorsed
one or more reasons for dropping out (Table 4). A majority of
these soldiers reported multiple reasons (median=4.5,
IQR=2.75–8.00, for the 50 total soldiers and median=7, IQR=4–
10, for the 23 soldiers who screened positive for PTSD). The
distribution of responses for each of these 23 soldiers is shown
in Table 5. The most common individual reasons included
perceptions of self-sufficiency, not having sufficient time with
the professional, lack of appointment availability, being too
busy with work, and concerns about stigma. However, negative
perceptions of the interaction with the clinician were also
common; of the 23 soldiers, 15 (65%) endorsed one or more of
five concerns related to how the professional communicated or
interacted with them.
Discussion
Fostering engagement and willingness to remain in mental
health treatment is critical to ensure the provision of evidence-
based treatment to service members and veterans. This study
9. provided important new findings, based on both cohort and
cross-sectional methods, on the willingness of active duty
soldiers to engage in and continue with needed treatment after
combat deployment and provides additional qualitative data on
reasons for dropping out of care. Despite the very different data
collection methods, the two study groups had similar
demographic characteristics (Table 1) and provided remarkably
complementary findings on health care utilization and adequacy
of treatment.
Among the large cohort of soldiers who completed the clinical
PDHA process, 10% were referred for further mental health
evaluation, and 75% of these had documentation in their
electronic health records of following up with this referral. This
75% rate is significantly higher than has been reported
previously (42% was reported in 2007 [17]), suggesting that
efforts to improve postdeployment screening have been
successful. However, despite this finding, the overall treatment
reach for those most in need is estimated to remain low. Of
2,230 soldiers who received a PTSD diagnosis within 90 days of
the PDHA, most did not have an adequate opportunity for
evidence-based care; 22% had only one mental health visit (the
one in which the diagnosis was made), and 41% received
minimally adequate care, defined as eight or more visits
involving this diagnosis within the ensuing year. Furthermore,
previous research has documented that many soldiers returning
from deployment are not willing to disclose concerns during the
initial clinical PDHA process (22).
Data from the cross-sectional infantry sample complemented the
cohort findings. Among the 229 soldiers who screened positive
for PTSD under strict case criteria, only 106 (48%) reported
receiving any mental health care, and 25 (24%) soldiers
reported dropping out of care. Overall satisfaction with care
was moderate, with nearly a third reporting dissatisfaction.
Among the 95 infantry soldiers who met criteria for PTSD and
accessed care with a mental health professional, the total
number of visits reported was strikingly similar to the much
10. larger PDHA cohort; 22% of these soldiers reported receiving
only one visit, which was identical to the percentage in the
cohort based on documented encounters; 52% met the study
definition for minimally adequate care, compared with 41% in
the cohort. The overall reach of treatment was very low. Of all
229 infantry soldiers who screened positive for PTSD, only 49
(17%) received treatment that would be considered adequate,
with the remainder either not receiving any care or receiving an
insufficient number of sessions.
The definition of minimally adequate mental health treatment
used in this study was a composite of definitions from the
literature, which have included the criterion of four or more
pharmacotherapy encounters in any clinic over either a six-
month (10) or 12-month (8,23) period, eight or more
psychotherapy encounters over six (10) or 12 (8,23) months, or
nine or more encounters (either psychotherapy or
pharmacotherapy) in a PTSD-specific Veterans Health
Administration (VHA) clinic over 12 months (9). However, all
of these definitions have to do with only a minimally acceptable
dose of care, not treatment adequacy, especially with the
chronicity and comorbidities associated with PTSD and
changing standards of clinical practice (24). These definitions
are crude estimates of what should be considered a minimal
number of sessions necessary for provision of evidence-based
care. Nevertheless, they have produced comparable results in
veteran studies, with estimates ranging from 30% to 33% (8–
10).
PTSD psychotherapy modalities typically involve weekly
treatment sessions spanning 12 weeks. Pharmacotherapy
treatment usually involves a number of sessions in the initial
higher risk period (for example, four to six visits over the first
12 weeks) to ensure appropriate titration of medication dose and
monitoring for suicidal ideation (due to FDA black-box
warnings); thereafter, follow-ups typically occur every one to
three months. Contrary to assumptions used in some definitions
of “minimally adequate treatment,” we found that individuals
11. with PTSD who were prescribed medications reported a
significantly greater number of encounters than those not
prescribed medications; this may reflect greater disease severity
or more intensive follow-up for medication management
according to revised standards. Recovery from PTSD in both
psychotherapy and pharmacotherapy randomized clinical trials
can reach 70%−80% among individuals who complete treatment
(which usually involves at least eight visits, even for
pharmacotherapy trials). However, dropout plagues virtually
every treatment trial, leading to average recovery rates in
intent-to-treat analyses of only around 40% (24,25).
Furthermore, the total number of encounters alone says nothing
about the provision of evidence-based strategies, the quality of
treatment, or whether the focus of visits was even related to the
index diagnosis instead of other comorbid conditions. Thus it is
unlikely that either four sessions in six months or eight in 12
months truly reflects an adequate opportunity to receive
evidence-based care with either psychotherapy or
pharmacotherapy. The actual percentage of patients who receive
adequate evidence-based care is therefore unknown but is likely
to be lower than the 30%−33% estimate in previous veteran
studies or the 41%−52% estimate in this study of active duty
personnel.
To add to the above concerns of low treatment reach, this study
provides new data on the specific reasons soldiers report for
dropping out of mental health care. It is possible that the survey
did not identify all who dropped out of treatment. Soldiers who
missed follow-up appointments but intended to eventually
return to treatment may not have endorsed the question on
dropping out of care. However, despite this limitation, the 24%
dropout rate among soldiers who met criteria for PTSD was
comparable to rates found in clinical trials and civilian studies
(24,26,27). The wide range and high number of responses
endorsed by each participant was impressive, spanning a variety
of domains.
Concerns most commonly reported by soldiers included feeling
12. like they could take care of problems on their own, not having
sufficient time with the professional, work interference, stigma,
confidentiality concerns, and the belief that care was
ineffective. Two-thirds of soldiers also expressed discomfort
with the interpersonal interaction with the mental health
professional, including the perception that the professional was
not suitably caring, communicative, or competent; soldiers
sometimes felt judged or misunderstood. These data add to
studies of the predictors of initial treatment access that have
shown that negative attitudes may be more important than
stigma perceptions (13–16), including civilian data showing that
an important predictor of dropping out of treatment is the belief
that treatment will not be effective (26).
Limitations of this study include the reliance on administrative
data for the cohort and self-report data for the cross-sectional
survey. However, the large sizes of both study groups, high
survey response rate, and especially the consistency in findings
between the cross-sectional surveys and longitudinal clinical
records strongly support the methodology and conclusions. The
study provides a unique integration of findings from different
sources related to mental health care utilization, adequacy, and
satisfaction, as well as soldiers’ perceptions of care. Although
there are some unique aspects of treatment immediately after
exposure to traumatic events in the war zone, by the time
service members return home, access care, and receive a
diagnosis of PTSD, the standard of treatment remains eight or
more encounters (24). This study did not address potential
benefits of brief or stepped-care interventions, which are being
studied in primary care settings and which leverage strategies,
such as motivational interviewing, behavioral activation, care
management, phone follow-up, initiation of antidepressants, and
treatment of comorbid sleep disturbance (28).
This study represents a call to action to develop and test
interventions to improve perceptions of mental health care and
treatment engagement and retention in military, VHA, and
civilian treatment settings. Dropping out of care is clearly the
13. most important predictor of treatment failure; therefore the most
promising strategies to improve efficacy of evidence-based
treatments will be those that address engagement, therapeutic
rapport, and retention. Particular attention is needed to better
understand the modifiable organizational, patient, and clinician
factors and specific actions that clinicians and health care
systems can take. Interventions related to organizational
barriers include ensuring adequate appointment availability and
duration at convenient times and locations, as well as peer-to-
peer outreach. Strategies to address patients’ beliefs about
treatment should consider perceptions of self-reliance (for
example through motivational interviewing techniques) (29–31).
Policies concerning confidentiality, especially for treatment of
comorbid substance use disorders, remain an ongoing issue in
the military (32). Clinician factors that warrant close
examination concern the skills and training needed to optimally
foster patient-centered care.
In a comprehensive review, Swift and colleagues (27) suggested
six strategies to minimize client dropout in civilian
psychotherapy settings. These strategies include providing
information to clients about therapy duration and expected
patterns of change, educating clients about the roles and
behaviors of the therapist and client, incorporating the client’s
preferences for treatment, strengthening the client’s early hopes
for therapy, fostering the therapeutic alliance and sustaining
rapport, and assessing and discussing treatment progress at
intervals. Many of these principles are inherent in patient-
centered care. Factors likely to be particularly important in
military and veteran populations include the ability of the
clinician to communicate in way that is sensitive to the military
occupational context and providing as wide a range of treatment
options as possible (24,25,33). Establishing ongoing simple
measures of patient feedback is likely to be helpful (34).
Military health care systems should reevaluate how mental
health treatment programs are structured and marketed.
Embedding mental health treatment within primary care settings
14. and coordinating care between primary and specialty care are
also important strategies (35). It is particularly important to
consider integrated stepped approaches that enhance
engagement through brief low-intensity treatments in primary
care settings before stepping up to a specialty setting
(28,36,37).
Conclusions
This research showed that the overall reach of mental health
services for deployment-related PTSD remains low to moderate,
despite the availability of extensive screening and treatment
services, as well as measurable increases in mental health care
utilization since the beginning of the conflicts in Iraq and
Afghanistan. The study highlights important priorities for
clinical interventions research. Improving perceptions of mental
health care and fostering therapeutic rapport, engagement, and
retention offer the greatest potential for improving overall
treatment effectiveness.
The authors are with the Center for Psychiatry and
Neuroscience, Walter Reed Army Institute of Research, Silver
Spring, Maryland (e-mail: [email protected]).
Acknowledgments and disclosures
Funding was received from the U.S. Army Military Operational
Research Program. The authors thank the Land Combat Study
team. The views contained here are those of the authors and are
not considered to be an official position of the U.S. Department
of the Army or the Department of Defense.
The authors report no competing interests.
References
1 Hoge CW, Castro CA, Messer SC, et al.: Combat duty in Iraq
and Afghanistan, mental health problems, and barriers to care.
New England Journal of Medicine 351:13–22, 2004Crossref,
Medline, Google Scholar
2 Hoge CW, Auchterlonie JL, Milliken CS: Mental health
problems, use of mental health services, and attrition from
military service after returning from deployment to Iraq or
Afghanistan. JAMA 295:1023–1032, 2006Crossref,
15. Medline, Google Scholar
3 Kok BC, Herrell RK, Thomas JL, et al.: Posttraumatic stress
disorder associated with combat service in Iraq or Afghanistan:
reconciling prevalence differences between studies. Journal of
Nervous and Mental Disease 200:444–450, 2012Crossref,
Medline, Google Scholar
4 Thomas JL, Wilk JE, Riviere LA, et al.: Prevalence of mental
health problems and functional impairment among active
component and National Guard soldiers 3 and 12 months
following combat in Iraq. Archives of General Psychiatry
67:614–623, 2010Crossref, Medline, Google Scholar
5 McKibben JBA, Fullerton CS, Gray CL, et al.: Mental health
service utilization in the US Army. Psychiatric Services
64:347–353, 2013Link, Google Scholar
6 Sareen J, Cox BJ, Afifi TO, et al.: Combat and peacekeeping
operations in relation to prevalence of mental disorders and
perceived need for mental health care: findings from a large
representative sample of military personnel. Archives of
General Psychiatry 64:843–852, 2007Crossref, Medline, Google
Scholar
7 Kim PY, Thomas JL, Wilk JE, et al.: Stigma, barriers to care,
and use of mental health services among active duty and
National Guard soldiers after combat. Psychiatric Services
61:582–588, 2010Link, Google Scholar
8 Schell TL, Marshall GN: Survey of individuals previously
deployed for OEF/OIF; in Invisible Wounds of War:
Psychological and Cognitive Injuries, Their Consequences, and
Services to Assist Recovery. Edited by Tanielian TJaycox LH.
Santa Monica, Calif, RAND, 2008Google Scholar
9 Lu MW, Duckart JP, O’Malley JP, et al.: Correlates of
utilization of PTSD specialty treatment among recently
diagnosed veterans at the VA. Psychiatric Services 62:943–949,
2011Link, Google Scholar
10 Spoont MR, Murdoch M, Hodges J, et al.: Treatment receipt
by veterans after a PTSD diagnosis in PTSD, mental health, or
general medical clinics. Psychiatric Services 61:58–63,
16. 2010Link, Google Scholar
11 Harpaz-Rotem I, Rosenheck RA: Serving those who served:
retention of newly returning veterans from Iraq and Afghanistan
in mental health treatment. Psychiatric Services 62:22–27,
2011Link, Google Scholar
12 Stecker T, Fortney JC, Hamilton F, et al.: An assessment of
beliefs about mental health care among veterans who served in
Iraq. Psychiatric Services 58:1358–1361, 2007Link, Google
Scholar
13 Kim PY, Britt TW, Klocko RP, et al.: Stigma, negative
attitudes about treatment, and utilization of mental health care
among soldiers. Military Psychology 23:65–81,
2011Crossref, Google Scholar
14 Brown MC, Creel AH, Engel CC, et al.: Factors associated
with interest in receiving help for mental health problems in
combat veterans returning from deployment to Iraq. Journal of
Nervous and Mental Disease 199:797–801, 2011Crossref,
Medline, Google Scholar
15 Pietrzak RH, Johnson DC, Goldstein MB, et al.: Perceived
stigma and barriers to mental health care utilization among
OEF-OIF veterans. Psychiatric Services 60:1118–1122,
2009Link, Google Scholar
16 Sudom K, Zamorski M, Garber B: Stigma and barriers to
mental health care in deployed Canadian Forces personnel.
Military Psychology 24:414–431, 2012Crossref, Google Scholar
17 Milliken CS, Auchterlonie JL, Hoge CW: Longitudinal
assessment of mental health problems among active and reserve
component soldiers returning from the Iraq war. JAMA
298:2141–2148, 2007Crossref, Medline, Google Scholar
18 Gravely AA, Cutting A, Nugent S, et al.: Validity of PTSD
diagnoses in VA administrative data: comparison of VA
administrative PTSD diagnoses to self-reported PTSD Checklist
scores. Journal of Rehabilitation Research and Development
48:21–30, 2011Crossref, Medline, Google Scholar
19 Frayne SM, Miller DR, Sharkansky EJ, et al.: Using
administrative data to identify mental illness: what approach is
17. best? American Journal of Medical Quality 25:42–50,
2010Crossref, Medline, Google Scholar
20 Blanchard EB, Jones-Alexander J, Buckley TC, et al.:
Psychometric properties of the PTSD Checklist (PCL).
Behaviour Research and Therapy 34:669–673, 1996Crossref,
Medline, Google Scholar
21 Terhakopian A, Sinaii N, Engel CC, et al.: Estimating
population prevalence of posttraumatic stress disorder: an
example using the PTSD Checklist. Journal of Traumatic Stress
21:290–300, 2008Crossref, Medline, Google Scholar
22 Warner CH, Appenzeller GN, Grieger TA, et al.: Importance
of anonymity to encourage honest reporting in mental health
screening after combat deployment. Archives of General
Psychiatry 68:1065–1071, 2011Crossref, Medline, Google
Scholar
23 Wang PS, Lane M, Olfson M, et al.: Twelve-month use of
mental health services in the United States: results from the
National Comorbidity Survey Replication. Archives of General
Psychiatry 62:629–640, 2005Crossref, Medline, Google Scholar
24 Clinical Practice Guideline for Management of Post-
Traumatic Stress, Version 2.0. Washington, DC, US Department
of Veteran Affairs, US Department of Defense, 2010Google
Scholar
25 Hoge CW: Interventions for war-related posttraumatic stress
disorder: meeting veterans where they are. JAMA 306:549–551,
2011Crossref, Medline, Google Scholar
26 Edlund MJ, Wang PS, Berglund PA, et al.: Dropping out of
mental health treatment: patterns and predictors among
epidemiological survey respondents in the United States and
Ontario. American Journal of Psychiatry 159:845–851,
2002Link, Google Scholar
27 Swift JK, Greenberg RP, Whipple JL, et al.: Practice
recommendations for reducing premature termination in
therapy. Professional Psychology: Research and Practice
43:379–387, 2012Crossref, Google Scholar
28 Trusz SG, Wagner AW, Russo J, et al.: Assessing barriers to
18. care and readiness for cognitive behavioral therapy in early
acute care PTSD interventions. Psychiatry 74:207–223,
2011Crossref, Medline, Google Scholar
29 Arkowitz HWestra HAMiller WH, et al. (eds): Motivational
Interviewing in the Treatment of Psychological Problems. New
York, Guilford, 2008Google Scholar
30 Slagle DM, Gray MJ: The utility of motivational
interviewing as an adjunct to exposure therapy in the treatment
of anxiety disorders. Professional Psychology: Research and
Practice 38:329–337, 2007Crossref, Google Scholar
31 Murphy RT, Thompson KE, Murray M, et al.: Effect of a
motivation enhancement intervention on veterans’ engagement
in PTSD treatment. Psychological Services 6:264–278,
2009Crossref, Google Scholar
32 Institute of Medicine: Substance Use Disorders in the US
Armed Forces. Washington, DC, National Academies Press,
2012Google Scholar
33 Hoge CW: Once a Warrior Always a Warrior: Navigating the
Transition From Combat to Home, Including Combat Stress,
PTSD, and mTBI. Guilford, Conn, Globe Pequot Press,
2010Google Scholar
34 Miller SD, Duncan BL, Brown J, et al.: Using formal client
feedback to improve retention and outcome: making ongoing,
real-time assessment feasible. Journal of Brief Therapy 5:5–22,
2006Google Scholar
35 Warner CH, Appenzeller GN, Parker JR, et al.: Effectiveness
of mental health screening and coordination of in-theater care
prior to deployment to Iraq: a cohort study. American Journal of
Psychiatry 168:378–385, 2011Link, Google Scholar
36 Koepsell TD, Zatzick DF, Rivara FP: Estimating the
population impact of preventive interventions from randomized
trials. American Journal of Preventive Medicine 40:191–198,
2011Crossref, Medline, Google Scholar
37 Zatzick DF, Galea S: An epidemiologic approach to the
development of early trauma focused intervention. Journal of
Traumatic Stress 20:401–412, 2007Crossref, Medline, Google