Actuarial prediction of psychotherapy retention among Iraq-Afghanistan veterans with posttraumatic stress disorder.

The present study aimed to identify predictors of treatment retention in a sample of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans with posttraumatic stress disorder (PTSD) who were referred for PTSD-focused treatment through completion of a Veterans Affairs (VA) specialty clinic introductory information session. A total of 124 returning veterans (89% male, 53% Caucasian, 40% African American, 2% Latino; average age = 37 years) participated in an introductory session intended to facilitate informed decision making about treatment selection for PTSD. To evaluate patient, therapist, and system characteristics that were associated with risk of prematurely dropping out of psychotherapy for PTSD, we used recursive partitioning or "classification tree" methods commonly used to derive actuarial models of risk for high or low scores on a particular outcome when the set of independent or predictor variables is large.

An Investigation of Treatment Engagement Among Returning Veterans With Problematic Anger.

Anger is a commonly reported problem among returning veterans, yet little attention has been devoted to studying treatment engagement among veterans who report anger problems but do not have posttraumatic stress disorder (PTSD). This study compares Iraq-Afghanistan veterans with anger/no PTSD (n = 159) to others reporting significant PTSD symptoms (n = 285) and those reporting neither anger nor PTSD (n = 716) on rates of treatment utilization, perceived barriers to treatment, and preferences for care. Relative to the PTSD group, the anger/no-PTSD group was significantly less likely to have received mental health treatment in the last year, despite endorsing barriers to treatment at a lower rate.

An RCT of Effects of Telephone Care Management on Treatment Adherence and Clinical Outcomes Among Veterans With PTSD.

Objective: This study assessed whether adding telephone care management to usual outpatient mental health care improved treatment attendance, medication compliance, and clinical outcomes of veterans with posttraumatic stress disorder (PTSD).

Methods: In a multisite randomized controlled trial, 358 veterans were assigned to either usual outpatient mental health treatment (N=165) or usual care plus twice-a-month telephone care management (TCM) and support in the first three months of treatment (N=193). Treatment utilization and medication refills were determined from U.

Patient, Therapist, and System Factors Influencing the Effectiveness of Prolonged Exposure for Veterans With Comorbid Posttraumatic Stress Disorder and Traumatic Brain Injury.

In contrast to concerns that cognitive limitations and neurobehavioral symptoms (NBS) associated with traumatic brain injury (TBI) may inhibit treatment effectiveness, a recent study found prolonged exposure (PE) led to large reductions in posttraumatic stress disorder (PTSD) symptoms among Iraq-Afghanistan veterans with a range of TBI severity (article by Wolf, Kretzmer, Crawford, Thors, Wagner, Strom, Eftekhari, Klenk, Hayward, and Vanderploeg [J Trauma Stress 28:339-347, 2015]). We further examined this sample of 69 veterans to determine whether system, veteran, and therapist factors predicted clinically significant responses. Results of hierarchical, logistic regressions revealed that therapist training in PE and lower service connection were associated with increased odds of large decreases in PTSD symptoms after adjusting for the robust effect of PE sessions completed.

Nature and Treatment of Comorbid Alcohol Problems and Post Traumatic Stress Disorder Among American Military Personnel and Veterans.

Many service members and veterans seeking treatment for alcohol problems also have post-traumatic stress disorder (PTSD). This article considers the effectiveness of treating alcohol problems and PTSD simultaneously. The authors begin by summarizing the extent of excessive alcohol use among military service members and veterans.

Mental Health Among Military Personnel and Veterans.

This commentary describes the prevalence of mental health problems affecting military service members and veterans in North Carolina and the rest of the nation, with a special emphasis on those who served in the recent wars in Iraq and Afghanistan. Approximately 1.9 million of these veterans have become eligible for Veterans Affairs health care since 2002, and an estimated 1.

Veterans' Preferences for Receiving Information About VA Services: Is Getting the Information You Want Related to Increased Health Care Utilization?

Although the current cohort of returning veterans has engaged more fully with care from the Department of Veterans Affairs (VA) than have veterans from previous eras, concern remains regarding low engagement with VA services, particularly for specialty services for diagnoses that can most negatively impact quality of life. This study used the framework of the Andersen Model to examine factors related to VA health care use in Operation Enduring Freedom/Operation Iraqi Freedom veterans. Match between veterans' preferences for source of information about VA programs and veterans' actual sources of information about VA services was examined as an additional predictor of help seeking.

Surveying treatment preferences in U.S. Iraq-Afghanistan Veterans with PTSD symptoms: a step toward veteran-centered care.

This study examined health care barriers and preferences among a self-selected sample of returning U.S. veterans drawn from a representative, randomly selected frame surveyed about posttraumatic stress disorder (PTSD) symptomatology and mental health utilization in the prior year.

Diagnostic efficiency of the AUDIT-C in U.S. veterans with military service since September 11, 2001.

Background: Alcohol screening with the 3-item alcohol use disorders identification test (AUDIT-C) has been implemented throughout the U.S. Veterans Health Administration.

Diagnostic efficiency of the personality assessment inventory LOGIT function for posttraumatic stress disorder in women.

In this study, we examined the diagnostic efficiency of the Personality Assessment Inventory (PAI; Morey, 1991) for the assessment of posttraumatic stress disorder (PTSD) in a community-based sample of women (n = 128). Receiver operating characteristic curves (ROC) were generated to examine the efficiency of the PAI PTSD LOGIT function as a tool for diagnosing PTSD. Using the Clinician Administered PTSD Scale as the reference standard, the PTSD LOGIT function performed well (area under the curve [AUC] = .

Predicting mortality in veterans with posttraumatic stress disorder thirty years after Vietnam.

Previous research has demonstrated elevated mortality rates among Vietnam-era veterans with posttraumatic stress disorder, especially deaths resulting from nonmedical causes. However, information on the relative contribution of particular risk factors to increased mortality is limited. We used receiver operating characteristics methodology to identify patient-level characteristics that predicted 7-year mortality in 79,551 middle-aged, male, posttraumatic stress disorder-diagnosed outpatients seeking mental health treatment within the Veterans Affairs Health Care System between April 1, 1998 and September 30, 1998.

The association of posttraumatic stress disorder and metabolic syndrome: a study of increased health risk in veterans.

Background: There is accumulating evidence for a link between trauma exposure, posttraumatic stress disorder (PTSD) and diminished health status. To assess PTSD-related biological burden, we measured biological factors that comprise metabolic syndrome, an important established predictor of morbidity and mortality, as a correlate of long-term health risk in PTSD.

Methods: We analyzed clinical data from 253 male and female veterans, corresponding to five factors linked to metabolic syndrome (systolic and diastolic blood pressure, waist-to-hip ratio and fasting measures of high-density lipoprotein (HDL) cholesterol, serum triglycerides and plasma glucose concentration).

An evaluation of the psychometric properties of the traumatic events questionnaire in primary care patients.

This study examined the reliability of reports of traumatic experiences across the Traumatic Events Questionnaire (TEQ; S. Vrana & D. Lauterbach, 1994) and the Composite International Diagnostic Interview (CIDI; World Health Organization, 1998), and evaluated other psychometric properties of the TEQ in 154 primary care patients.

Validity of the Personality Assessment Inventory Aggression scales and Violence Potential index in veterans with PTSD.

In this study, we examined the validity of the Personality Assessment Inventory (PAI; Morey, 1991) Aggression (AGG) scales and Violence Potential index (VPI) in 399 male combat veterans presenting for formal evaluation of posttraumatic stress disorder (PTSD). The AGG scales exhibited convergence with other measures of hostility and violence and demonstrated discriminant validity with alternative constructs. When we examined reports of interpersonal violence in the past year, the AGG composite scale displayed substantial incremental validity over the effects of PTSD severity, demographics, a simple dichotomous question regarding violence in the past 30 days, and MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) scales measuring aggression.

MMPI-2 assessment of malingered emotional distress related to a workplace injury: a mixed group validation.

In this study, we examined the capacity of MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 2001) validity indexes to identify malingered depression associated with a workplace injury. We compared 27 graduate students simulating depression with archival records of 33 inpatients diagnosed with major depressive disorder. We employed a mixed-group validation design to generate true positive rates (TPR) and false positive rates (FPR) for the various MMPI-2 validity scales [F, FB, F(p), FBS, F - K, Ds2] while we accounted for base rates of malingering in each sample.