- Email: [email protected]
Perceptions of mental health care and willingness to seek treatment among military medical personnel
E4
Abstracts / Comprehensive Psychiatry 52 (2011) E1–E18
higher levels of HAB (β = .06, P b .01) and NER (β = .13, P b .001) both predicted increased aggression. Finally, childhood trauma moderated the relationship between NER and adult aggression (β = .05, P b .01). Specifically, the relationship between NER and aggression was stronger among participants with higher levels of childhood trauma. In addition, NER did not predict aggression for participants with low levels of childhood trauma (ie, whose childhood trauma score was 1.26 standard deviation less than the sample mean). Conclusion: Findings from the current study suggest that childhood trauma may intensify the effects of maladaptive social information processing on adult aggression. Limitations of the current study include that data on childhood trauma, social information processing, and aggression were collected at the same point of time. In addition, the retrospective nature of the childhood trauma assessment may be subject to recall bias. Future longitudinal studies that span from childhood to adulthood are needed to more thoroughly examine moderating effects of childhood trauma on associations between social information processing and adult aggression. Funding Source: This study was funded by a grant from the National Institute of Mental Health (R01 MH063262, E Coccaro, PI). Drs Chen and Jacobson were partially supported by an NIH Director's New Innovator Award (DP2 OD003021) to Dr. Jacobson. doi:10.1016/j.comppsych.2011.04.015 Mental health and combat, peacekeeping, or relief work: results from the National Comorbidity Survey Replication E. Connorton , M. Miller, M.J. Perry , D. Hemenway Harvard School of Public Health Introduction: Peacekeepers, relief workers, and military members are exposed to multiple traumas—believed to increase risk for psychiatric distress. Using a sample of men from the National Comorbidity Survey Replication (NCS-R), we examined whether exposure to combat and/or peacekeeping or relief work was associated with subsequent mental illness and whether mental illness was associated with exposure to combat, peacekeeping, or relief work. Methods: Onset of diagnoses was compared with onset of exposure to combat or peacekeeping/relief work. Multivariate logistic regression estimated the association between exposure and lifetime mental illness according to the Diagnostic and Statistical Manual, Fourth Edition (DSMIV) compared with US men. Results: Twenty-eight percent of diagnoses occurred before exposure. Odds ratios for PTSD were highest among those exposed to combat, including combat with peacekeeping/relief work (OR = 11.2, CI 2.9-43.2) and combat only (OR = 7.26, CI 3.3-15.8). Drug abuse/dependence was significant for both combat-exposed groups: combat and peacekeeping/relief work (OR = 3.76, CI 1.3-10.3) and combat only (OR = 3.74, CI 1.9-7.2). Alcohol abuse/ dependence was significant for the combat-only group (OR = 1.65, CI 1.02.7). Subjects diagnosed before combat also had higher rates of diagnoses, but only PTSD was significant. Conclusion: Combat alone or combined with peacekeeping or relief work appears to be a risk factor for later PTSD and substance abuse, and those with prior PTSD appear to be drawn to combat or combat and peacekeeping/ relief work. Peacekeeping/relief work without combat does not appear to be associated with mental illness. Relevance to Public Health: There has been an increased focus on trauma related to combat and conflict, and subsequent mental illness and substance use. With complex emergencies and use of military, peacekeeping, and relief work increasing, exposure to these risks is also rising—with an anticipated increase in related mental illness and substance use. Funding Source: This dissertation research was made possible by a National Institute of Occupational Safety and Health, US Centers for Disease Control and Prevention (NIOSH/CDC) Occupational Injury Training Grant and support from the Harvard Injury Control Research Center (HICRC). doi:10.1016/j.comppsych.2011.04.016
Perceptions of mental health care and willingness to seek treatment among military medical personnel B.D. Dickstein a,b, L.H. Krantz b, A. Fang a, M.T. Baker c, D.P. Tansley d, A. Peterson c,e, B.T. Litz b,f,g a Boston University Department of Psychology, Boston, MA b Boston Veterans Affairs Healthcare System, Boston, MA c Wilford Hall Medical Center, San Antonio, TX d RAF Upwood, England e University of Texas Health Science Center at San Antonio, TX f Boston University School of Medicine, Boston, MA g Massachusetts Veterans Epidemiological Research and Information Center, Boston, MA Introduction: The stigma faced by service members with psychiatric disorders has been well acknowledged (eg, Hoge et al, 2004) and has led to efforts aimed at redressing this problem and promoting mental health service utilization. Recent findings suggest that perceptions of mental health care have improved among service members since the beginning of Operation Iraqi Freedom (Warner, Appenzeller, Mullen, Warner, & Griger, 2008); however, it remains unclear whether service members are becoming more willing to seek mental health treatment. Accordingly, we examined trends in service members' willingness to seek care. Methods: Self-report data were collected from 378 Air Force medical personnel as part of an ongoing longitudinal study. Assessments were completed approximately 1 month after participants returned from Iraq. Measures included 2 face valid questionnaires, created specifically for this study, assessing willingness to seek treatment and alcohol consumption. In addition, participants completed the PHQ-9 Depression Scale and the PTSD Checklist (PCL). Internal consistency for each of these scales was found to be adequate (Cronbach α was not calculated for alcohol consumption, as this measure merely asks about the number of drinks consumed in the past month). The effect of time on service members' willingness to seek treatment was examined by comparing participants assessed between 2005 and 2006 to those assessed between 2007 and 2009. To rule out possible confounds, cohorts were compared on demographic variables, PTSD and depression symptomatology, and alcohol use. Results: The sample was split about evenly with regard to sex and was varied with regard to rank, time in the military, age, education, and race. The χ2 analysis revealed that participants in the second cohort (2007-2009) reported greater willingness to seek care. No differences were found between cohorts on demographic variables, alcohol use, PTSD, or depression. Conclusion: It appears that efforts to reduce stigma are working; however, a salient minority of participants did not report a willingness to seek treatment. Thus, continued work is needed to address stigma among service members. Public Health Relevance: Our results have high public health relevance. They suggest that efforts to redress stigma in the military are working and that service members are becoming more willing to seek mental health treatment. Funding Source: This study was funded by the US Air Force Surgeon General's Operational Medicine Research Program (FA7014-07-C-0036; PI: Peterson). doi:10.1016/j.comppsych.2011.04.017 Prospective longitudinal studies of posttraumatic stress disorder: a systematic review of the literature J. DiGangi a, K. Koenen b, L. Jason a, C. Keys a a DePaul University b Harvard University In the 30 years since PTSD's diagnostic debut, its precise etiology and nosology remain unclear (Koenen, Moffitt, Caspi, Gregory, & Harrington, 2008). Although a traumatic event continues to be the most necessary diagnostic element, it is insufficient. Findings from cross-sectional studies suggest that a host of other factors appears to play a critical role in the etiology of PTSD (Rosen & Lilienfeld, 2008). Although virtually all PTSD research relies on cross-sectional, retrospective designs, there are
Abstracts / Comprehensive Psychiatry 52 (2011) E1–E18
higher levels of HAB (β = .06, P b .01) and NER (β = .13, P b .001) both predicted increased aggression. Finally, childhood trauma moderated the relationship between NER and adult aggression (β = .05, P b .01). Specifically, the relationship between NER and aggression was stronger among participants with higher levels of childhood trauma. In addition, NER did not predict aggression for participants with low levels of childhood trauma (ie, whose childhood trauma score was 1.26 standard deviation less than the sample mean). Conclusion: Findings from the current study suggest that childhood trauma may intensify the effects of maladaptive social information processing on adult aggression. Limitations of the current study include that data on childhood trauma, social information processing, and aggression were collected at the same point of time. In addition, the retrospective nature of the childhood trauma assessment may be subject to recall bias. Future longitudinal studies that span from childhood to adulthood are needed to more thoroughly examine moderating effects of childhood trauma on associations between social information processing and adult aggression. Funding Source: This study was funded by a grant from the National Institute of Mental Health (R01 MH063262, E Coccaro, PI). Drs Chen and Jacobson were partially supported by an NIH Director's New Innovator Award (DP2 OD003021) to Dr. Jacobson. doi:10.1016/j.comppsych.2011.04.015 Mental health and combat, peacekeeping, or relief work: results from the National Comorbidity Survey Replication E. Connorton , M. Miller, M.J. Perry , D. Hemenway Harvard School of Public Health Introduction: Peacekeepers, relief workers, and military members are exposed to multiple traumas—believed to increase risk for psychiatric distress. Using a sample of men from the National Comorbidity Survey Replication (NCS-R), we examined whether exposure to combat and/or peacekeeping or relief work was associated with subsequent mental illness and whether mental illness was associated with exposure to combat, peacekeeping, or relief work. Methods: Onset of diagnoses was compared with onset of exposure to combat or peacekeeping/relief work. Multivariate logistic regression estimated the association between exposure and lifetime mental illness according to the Diagnostic and Statistical Manual, Fourth Edition (DSMIV) compared with US men. Results: Twenty-eight percent of diagnoses occurred before exposure. Odds ratios for PTSD were highest among those exposed to combat, including combat with peacekeeping/relief work (OR = 11.2, CI 2.9-43.2) and combat only (OR = 7.26, CI 3.3-15.8). Drug abuse/dependence was significant for both combat-exposed groups: combat and peacekeeping/relief work (OR = 3.76, CI 1.3-10.3) and combat only (OR = 3.74, CI 1.9-7.2). Alcohol abuse/ dependence was significant for the combat-only group (OR = 1.65, CI 1.02.7). Subjects diagnosed before combat also had higher rates of diagnoses, but only PTSD was significant. Conclusion: Combat alone or combined with peacekeeping or relief work appears to be a risk factor for later PTSD and substance abuse, and those with prior PTSD appear to be drawn to combat or combat and peacekeeping/ relief work. Peacekeeping/relief work without combat does not appear to be associated with mental illness. Relevance to Public Health: There has been an increased focus on trauma related to combat and conflict, and subsequent mental illness and substance use. With complex emergencies and use of military, peacekeeping, and relief work increasing, exposure to these risks is also rising—with an anticipated increase in related mental illness and substance use. Funding Source: This dissertation research was made possible by a National Institute of Occupational Safety and Health, US Centers for Disease Control and Prevention (NIOSH/CDC) Occupational Injury Training Grant and support from the Harvard Injury Control Research Center (HICRC). doi:10.1016/j.comppsych.2011.04.016
Perceptions of mental health care and willingness to seek treatment among military medical personnel B.D. Dickstein a,b, L.H. Krantz b, A. Fang a, M.T. Baker c, D.P. Tansley d, A. Peterson c,e, B.T. Litz b,f,g a Boston University Department of Psychology, Boston, MA b Boston Veterans Affairs Healthcare System, Boston, MA c Wilford Hall Medical Center, San Antonio, TX d RAF Upwood, England e University of Texas Health Science Center at San Antonio, TX f Boston University School of Medicine, Boston, MA g Massachusetts Veterans Epidemiological Research and Information Center, Boston, MA Introduction: The stigma faced by service members with psychiatric disorders has been well acknowledged (eg, Hoge et al, 2004) and has led to efforts aimed at redressing this problem and promoting mental health service utilization. Recent findings suggest that perceptions of mental health care have improved among service members since the beginning of Operation Iraqi Freedom (Warner, Appenzeller, Mullen, Warner, & Griger, 2008); however, it remains unclear whether service members are becoming more willing to seek mental health treatment. Accordingly, we examined trends in service members' willingness to seek care. Methods: Self-report data were collected from 378 Air Force medical personnel as part of an ongoing longitudinal study. Assessments were completed approximately 1 month after participants returned from Iraq. Measures included 2 face valid questionnaires, created specifically for this study, assessing willingness to seek treatment and alcohol consumption. In addition, participants completed the PHQ-9 Depression Scale and the PTSD Checklist (PCL). Internal consistency for each of these scales was found to be adequate (Cronbach α was not calculated for alcohol consumption, as this measure merely asks about the number of drinks consumed in the past month). The effect of time on service members' willingness to seek treatment was examined by comparing participants assessed between 2005 and 2006 to those assessed between 2007 and 2009. To rule out possible confounds, cohorts were compared on demographic variables, PTSD and depression symptomatology, and alcohol use. Results: The sample was split about evenly with regard to sex and was varied with regard to rank, time in the military, age, education, and race. The χ2 analysis revealed that participants in the second cohort (2007-2009) reported greater willingness to seek care. No differences were found between cohorts on demographic variables, alcohol use, PTSD, or depression. Conclusion: It appears that efforts to reduce stigma are working; however, a salient minority of participants did not report a willingness to seek treatment. Thus, continued work is needed to address stigma among service members. Public Health Relevance: Our results have high public health relevance. They suggest that efforts to redress stigma in the military are working and that service members are becoming more willing to seek mental health treatment. Funding Source: This study was funded by the US Air Force Surgeon General's Operational Medicine Research Program (FA7014-07-C-0036; PI: Peterson). doi:10.1016/j.comppsych.2011.04.017 Prospective longitudinal studies of posttraumatic stress disorder: a systematic review of the literature J. DiGangi a, K. Koenen b, L. Jason a, C. Keys a a DePaul University b Harvard University In the 30 years since PTSD's diagnostic debut, its precise etiology and nosology remain unclear (Koenen, Moffitt, Caspi, Gregory, & Harrington, 2008). Although a traumatic event continues to be the most necessary diagnostic element, it is insufficient. Findings from cross-sectional studies suggest that a host of other factors appears to play a critical role in the etiology of PTSD (Rosen & Lilienfeld, 2008). Although virtually all PTSD research relies on cross-sectional, retrospective designs, there are