Developing an individualized treatment rule for Veterans with major depressive disorder using electronic health records.

Efforts to develop an individualized treatment rule (ITR) to optimize major depressive disorder (MDD) treatment with antidepressant medication (ADM), psychotherapy, or combined ADM-psychotherapy have been hampered by small samples, small predictor sets, and suboptimal analysis methods. Analyses of large administrative databases designed to approximate experiments followed iteratively by pragmatic trials hold promise for resolving these problems. The current report presents a proof-of-concept study using electronic health records (EHR) of n = 43,470 outpatients beginning MDD treatment in Veterans Health Administration Primary Care Mental Health Integration (PC-MHI) clinics, which offer access not only to ADMs but also psychotherapy and combined ADM-psychotherapy.

Development of a model to predict antidepressant treatment response for depression among Veterans.

Background: Only a limited number of patients with major depressive disorder (MDD) respond to a first course of antidepressant medication (ADM). We investigated the feasibility of creating a baseline model to determine which of these would be among patients beginning ADM treatment in the US Veterans Health Administration (VHA).

Methods: A 2018-2020 national sample of = 660 VHA patients receiving ADM treatment for MDD completed an extensive baseline self-report assessment near the beginning of treatment and a 3-month self-report follow-up assessment.

A two-phase, prescriptive comparative effectiveness study to optimize the treatment of co-occurring insomnia and depression with digital interventions.

Background: Insomnia and depression frequently co-occur. Significant barriers preclude a majority of patients from receiving first line treatments for both disorders in a sequential treatment episode. Although digital versions of cognitive behavioral therapy for insomnia (CBTI) and for depression (CBTD) hold some promise to meet demand, especially when paired with human support, it is unknown whether heterogeneity of treatment effects exist, such that some patients would be optimally treated with single or sequential interventions.

Development of a model to predict combined antidepressant medication and psychotherapy treatment response for depression among veterans.

Background: Although research shows that more depressed patients respond to combined antidepressants (ADM) and psychotherapy than either alone, many patients do not respond even to combined treatment. A reliable prediction model for this could help treatment decision-making. We attempted to create such a model using machine learning methods among patients in the US Veterans Health Administration (VHA).

The Appalachia Mind Health Initiative (AMHI): a pragmatic randomized clinical trial of adjunctive internet-based cognitive behavior therapy for treating major depressive disorder among primary care patients.

Background: Major depressive disorder (MDD) is a leading cause of disease morbidity. Combined treatment with antidepressant medication (ADM) plus psychotherapy yields a much higher MDD remission rate than ADM only. But 77% of US MDD patients are nonetheless treated with ADM only despite strong patient preferences for psychotherapy.

Designing mental health promotion campaigns: segmenting U.S. Veteran audiences to address public stigma.

Background: Public stigma is a significant deterrent to mental health service use for U.S. veterans.

Development of a model to predict psychotherapy response for depression among Veterans.

Background: Fewer than half of patients with major depressive disorder (MDD) respond to psychotherapy. Pre-emptively informing patients of their likelihood of responding could be useful as part of a patient-centered treatment decision-support plan.

Methods: This prospective observational study examined a national sample of 807 patients beginning psychotherapy for MDD at the Veterans Health Administration.

Trends in comorbid opioid and stimulant use disorders among Veterans receiving care from the Veterans Health Administration, 2005-2019.

Background: Identifying solutions to the continued rise in overdose deaths is a public health priority. However, there is evidence of change in recent substance type associated with morbidity and mortality. To better understand the continued rise in overdose deaths, in particular those attributed to opioid and stimulant use disorders, increased knowledge of patterns of use is needed.

Are Veterans Getting Their Preferred Depression Treatment? A National Observational Study in the Veterans Health Administration.

Background: Physician responsiveness to patient preferences for depression treatment may improve treatment adherence and clinical outcomes.

Objective: To examine associations of patient treatment preferences with types of depression treatment received and treatment adherence among Veterans initiating depression treatment.

Design: Patient self-report surveys at treatment initiation linked to medical records.

The association of pre-war medical conditions to Gulf War Illness.

Aims: Gulf War Illness (GWI) remains a significant health concern for many veterans. The relation of pre-war health conditions and symptoms to GWI could aid in developing a more accurate case definition of GWI. The objective of this study was to investigate pre-war predictors of GWI in a population-based sample of Gulf War veterans using two definitions of GWI.

Comorbid mental disorders, depression symptom severity, and role impairment among Veterans initiating depression treatment through the Veterans Health Administration.

Background: Psychiatric comorbidities may complicate depression treatment by being associated with increased role impairments. However, depression symptom severity might account for these associations. Understanding the independent associations of depression severity and comorbidity with impairments could help in treatment planning.

Treatment Differences in Primary and Specialty Settings in Veterans with Major Depression.

Introduction: The Veterans Health Administration (VHA) supports the nation's largest primary care-mental health integration (PC-MHI) collaborative care model to increase treatment of mild to moderate common mental disorders in primary care (PC) and refer more severe-complex cases to specialty mental health (SMH) settings. It is unclear how this treatment assignment works in practice.

Methods: Patients (n = 2610) who sought incident episode VHA treatment for depression completed a baseline self-report questionnaire about depression severity-complexity.

Depression and anxiety in patients with heart disease and/or cancer based on the National Health Interview Survey.

Depression and anxiety in patients with heart disease and/or cancer have been shown to affect quality of life, adherence with medical management, and prognosis. We investigated the association of the diagnoses of cancer, heart disease, or both with self-reported symptoms consistent with serious mental illness (SMI). We used the K6 score to identify self-reported symptoms consistent with SMI from patients' responses to the 2017 National Health Interview Survey.

Causes of death among U.S. Veterans with a prior nonfatal opioid overdose.

Background: For over a decade, there has been a surge in opioid-related morbidity and mortality among Veterans. To better understand the impact of the growing epidemic, it is important to identify the cause-specific mortality rates among Veterans with a prior nonfatal opioid overdose.

Methods: We followed 8370 Veterans who received medical care for a nonfatal opioid overdose between 2011 through 2015.

Mortality Among Male U.S. Army Soldiers Within 18 Months of Separation.

Introduction: Understanding how soldiers die after separation from military service, particularly those who die shortly after separating from service, may help to identify opportunities to ease transitions to civilian life.

Materials And Methods: Mortality data were analyzed for male U.S.

The next wave? Mental health comorbidities and patients with substance use disorders in under-resourced and rural areas.

The rapid spread of the coronavirus disease (COVID-19) has impacted the lives of millions around the globe. The COVID-19 pandemic has caused increasing concern among treatment professionals about mental health and risky substance use, especially among those who are struggling with a substance use disorder (SUD). The pandemic's impact on those with an SUD may be heightened in vulnerable communities, such as those living in under-resourced and rural areas.