Success of treatment for hip or knee osteoarthritis (OA) should be evaluated relative to patients' personal activity goals. : We sought to ascertain important principles for collecting such goals and developed a survey informed by those principles to facilitate better shared decision-making. : From a series of 100 patient interviews inquiring about specific activity goals, we identified 6 principles for goal collection that are important to patients and physicians and could practically facilitate better shared decision-making (phase 1).
View Article and Find Full Text PDFAlthough 40 years have passed since the Vietnam War, demand for treatment of posttraumatic stress disorder (PTSD) among veterans from this conflict has increased steadily. This study investigates the extent to which two factors, delayed onset or awareness of PTSD symptoms, may influence this demand. Using data from two studies of Vietnam Veterans in outpatient (n = 353) and inpatient (n = 721) PTSD treatment, this analysis examines retrospective perceptions of the time of symptom onset and awareness of the connection between symptoms and war-zone stress.
View Article and Find Full Text PDFMost of the attention to the treatment of patients who have comorbid Substance Use/Dependence Disorder (SUD) and Posttraumatic Stress Disorder (PTSD) has focused on SUD outcomes. This study focuses on the PTSD outcomes of comorbid patients as compared to those with PTSD only. Altogether 8599 Veterans admitted to VA specialized inpatient/residential PTSD programs were assessed for PTSD and SUD symptoms at admission and four months following discharge.
View Article and Find Full Text PDFObjective: This study proposed to evaluate Veterans Health Administration (VHA) specialty mental health care workload for treating posttraumatic stress disorder (PTSD) and other mental disorders between 2005 and 2010 in comparison with results from 1997 to 2005. The 2005-2010 time frame represents a period of increased utilization of services by recently returning veterans and of program expansion within VHA.
Methods: VHA administrative databases were queried for all veterans receiving specialty mental health treatment annually between 2005 and 2010.
J Nerv Ment Dis
October 2010
Patients with mental illness often return for further treatment after an initial episode of care. Two processes that may contribute to the return for further treatment are the severity of patients' initial social and clinical status; and/or deterioration in their status over time, regardless of their initial status. This study examined these processes in an administrative database of war zone veterans who had received outpatient treatment from a Veterans Affairs specialized posttraumatic stress disorder program.
View Article and Find Full Text PDFBackground: Differences in the characteristics and mental health needs of female veterans of the Iraq/Afghanistan war compared with those of veterans of other wars may have useful implications for VA program and treatment planning.
Methods: Female veterans reporting service in the Iraq/Afghanistan war were compared with women reporting service in the Persian Gulf and Vietnam wars and to men reporting service in the Iraq/Afghanistan war. Subjects were drawn from VA administrative data on veterans who sought outpatient treatment from specialized posttraumatic stress disorder (PTSD) treatment programs.
Introduction: Despite the strong association between smoking and posttraumatic stress disorder (PTSD), mechanisms influencing smoking in this population remain unclear. Previous smoking research has largely examined PTSD as a homogenous syndrome despite the fact that PTSD is composed of four distinct symptom clusters (i.e.
View Article and Find Full Text PDFThe objective of this investigation was to assess the inter-examiner reliability of PTSD symptomatology by 12 clinical examiners who evaluated independently a single-case Vietnam-Era veteran, using videotaped clinician interviews with The Clinician Administered PTSD Scale-1 (CAPS-1). A second patient was utilized for cross-validation purposes. Data were analyzed using a specially designed Kappa statistic.
View Article and Find Full Text PDFDifferences in the characteristics and mental health needs of veterans of the Iraq/Afghanistan war when compared with those of veterans who served in the Persian Gulf war and in the Vietnam war may have important implications for Veterans Affairs (VA) program and treatment planning. Subjects were drawn from administrative data bases of veterans who sought treatment from specialized VA programs for treatment of posttraumatic stress disorder (PTSD). Current Iraq/Afghanistan veterans were compared with 4 samples of outpatient and inpatient Persian Gulf and Vietnam veterans whose admission to treatment was either contemporaneous or noncontemporaneous with their admission.
View Article and Find Full Text PDFHealth Aff (Millwood)
February 2008
Treating post-traumatic stress disorder (PTSD) among returning Iraq/Afghanistan veterans is a high priority for the U.S. Department of Veterans Affairs (VA).
View Article and Find Full Text PDFThis study investigated the hypotheses that the general disposition to be satisfied is more influential than the nature of service delivery in determining satisfaction with treatment, and that there is a specificity to satisfaction with the delivery of care and with clinical outcome of care that makes their ratings distinct. Data were obtained by questionnaire at intake into treatment and 4 months later from 154 male veterans. There were statistically significant relationships between the general disposition to be satisfied and satisfaction with treatment, but they had only a trivial effect on the relationships between treatment satisfaction and other variables.
View Article and Find Full Text PDFThis study examines the role of women's comfort in coming for treatment of posttraumatic stress disorder in a predominantly male environment. Consecutive admissions (N = 224) to the Department of Veterans Affairs (VA)'s Women's Stress Disorder Treatment Teams were enrolled in an outcome study from July 1998 through June 2000. Women reported that they were somewhat comfortable in coming to the VA for their mental health care.
View Article and Find Full Text PDFClinical observation and theory suggest that people who have difficulty coping with their exposure to traumatic events often experience a loss of meaning to their lives. This article examines the contribution of loss of meaning to seeking help from clergy and/or mental health providers. Results support the hypotheses that veterans who have suffered a greater loss of meaning are more likely to seek help from clergy and from VA mental health professionals.
View Article and Find Full Text PDFObjective: The recovery movement is having a growing impact on policy for people with severe mental illness. The empirical literature on the recovery orientation, however, is scant, and no empirical conceptualization of recovery has been published.
Method: We identified items reflecting recovery themes and measuring aspects of subjective experience, and used principle components and confirmatory factor analyses to develop an empirical conceptualization of the recovery orientation, using data from a large, systematic study of schizophrenia.
J Nerv Ment Dis
March 2005
Historically, successful reintegration of war veterans into civilized society has been an enduring concern of nations. Data from the National Vietnam Veterans Readjustment Study were used to develop and evaluate an etiological model of postwar antisocial behavior. Two initial models specified causal paths among five sets of variables, ordered according to their historical occurrence: (a) premilitary risk factors, (b) military traumas and disciplinary actions, (c) the homecoming reception, (d) postmilitary PTSD and substance abuse, and (e) postmilitary antisocial behavior.
View Article and Find Full Text PDFOne of the most pervasive effects of traumatic exposure is the challenge that people experience to their existential beliefs concerning the meaning and purpose of life. Particularly at risk is the strength of their religious faith and the comfort that they derive from it. The purpose of this study is to examine a model of the interrelationships among veterans' traumatic exposure, posttraumatic stress disorder (PTSD), guilt, social functioning, change in religious faith, and continued use of mental health services.
View Article and Find Full Text PDFContinuity of care (COC) is often used as an indicator of treatment quality for patients with severe psychiatric or addictive disorders. However, few studies have examined the relationship between measures of COC and treatment outcomes. This study used standard regression models to examine the strength of the association between continuity of care measures and health outcomes for a sample of female veterans newly entering outpatient treatment for PTSD.
View Article and Find Full Text PDFThis study examined whether Rasch analysis could provide more information than true score theory (TST) in determining the usefulness of reverse-scored items in the Mississippi Scale for Posttraumatic Stress Disorder (M-PTSD). Subjects were 803 individuals in inpatient PTSD units at 10 VA sites. TST indicated that the M-PTSD performed well and could be improved slightly by deleting one item.
View Article and Find Full Text PDFThis study is a 6-year longitudinal study of 51 treatment-seeking male veterans with combat-related posttraumatic stress disorder. Measures of PTSD and psychiatric symptomatology, social functioning, and program impact were assessed at admission to an inpatient treatment program, at 18 months, and 6 years later. Previous studies had shown that the treatment program's impact on course of illness had been negligible.
View Article and Find Full Text PDFObjective: Evidence has been found of significant psychological distress after the terrorist attacks of September 11, 2001, even in communities that were not directly affected. Persons with preexisting posttraumatic stress disorder (PTSD) may be especially vulnerable to such distress. The authors examined clinical data on veterans who had a diagnosis of PTSD to determine whether the attacks exacerbated their symptoms.
View Article and Find Full Text PDFAm J Psychiatry
September 2003
Objective: Community surveys have demonstrated significant psychological distress since the terrorist attacks of Sept. 11, 2001. Since people with posttraumatic stress disorder (PTSD) and other mental illnesses are especially vulnerable to stressful events, the authors examined the use of PTSD treatment services and other mental health services at Department of Veterans Affairs (VA) medical centers in New York City and elsewhere after the attacks.
View Article and Find Full Text PDFThis article examines the ways in which changes in the treatment environment and in measurement perspectives can affect the evaluation of cost-effectiveness of new medications. In three studies we reexamined data from a clinical trial of haloperidol and clozapine conducted from 1993 to 1996. The results of the studies are as follows: Study 1 found that clozapine treatment was associated with significantly reduced inpatient costs, and increased outpatient costs, suggesting that as systems use less inpatient care and more outpatient care, more effective medications may increase, rather than decrease, costs in sicker patients.
View Article and Find Full Text PDFEvaluation of the quality of outpatient treatment for patients with severe psychiatric or addictive disorders has often focused on the assessment of continuity of care (COC) as measured with administrative data. However, there has been little empirical evaluation of the relationship of measures of COC and treatment outcomes. This study used hierarchical linear modeling to examine the relationship between 6 indicators of COC and 6 outcome measures in a multisite monitoring effort for veterans with war-related posttraumatic stress disorder.
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