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Combat Veteran

G Wilson, M Hill, M D Kiernan
Background: Loneliness and social isolation are being increasingly recognized as influencing both physical and mental health. There is limited research carried out with military veterans and, to date, there is no review of existing evidence. Aims: To synthesize and examine the evidence exploring aspects of social isolation and loneliness of military veterans, using a systematic narrative review strategy. Methods: A database search was carried out utilizing relevant search criterion...
December 14, 2018: Occupational Medicine
Lucija Tudor, Marcela Konjevod, Matea Nikolac Perkovic, Dubravka Svob Strac, Gordana Nedic Erjavec, Suzana Uzun, Oliver Kozumplik, Marina Sagud, Zrnka Kovacic Petrovic, Nela Pivac
Posttraumatic stress disorder (PTSD) is a trauma and stressor related disorder that may develop after exposure to an event that involved the actual or possible threat of death, violence or serious injury. Its molecular underpinning is still not clear. Brain-derived neurotrophic factor (BDNF) modulates neuronal processes such as the response to stress, but also weight control, energy and glucose homeostasis. Plasma BDNF levels and a functional BDNF Val66Met (rs6265) polymorphism were reported to be associated with PTSD, as well as with increased body mass index (BMI) and dyslipidaemia in healthy subjects and patients with cardio-metabolic diseases, but these results are controversial...
2018: Frontiers in Psychiatry
Sheila A M Rauch, H Myra Kim, Corey Powell, Peter W Tuerk, Naomi M Simon, Ron Acierno, Carolyn B Allard, Sonya B Norman, Margaret R Venners, Barbara O Rothbaum, Murray B Stein, Katherine Porter, Brian Martis, Anthony P King, Israel Liberzon, K Luan Phan, Charles W Hoge
Importance: Meta-analyses of treatments for posttraumatic stress disorder (PTSD) suggest that trauma-focused psychotherapies produce greater benefits than antidepressant medications alone. Objective: To determine the relative efficacy of prolonged exposure therapy plus placebo, prolonged exposure therapy plus sertraline hydrochloride, and sertraline plus enhanced medication management in the treatment of PTSD. Design, Setting, and Participants: The Prolonged Exposure and Sertraline Trial was a randomized, multisite, 24-week clinical trial conducted at the Veterans Affairs Ann Arbor Healthcare System, Veterans Affairs San Diego Healthcare System, Ralph H...
December 5, 2018: JAMA Psychiatry
Clark Ryan-Gonzalez, Nathan Kimbrel, Eric C Meyer, Evan M Gordon, Bryann B DeBeer, Suzy Bird Gulliver, Timothy R Elliott, Sandra Mosissette
The relationship between traumatic brain injury (TBI) and PTSD has been difficult to disentangle, in part due to the commonality of incidents that can cause both conditions, as well as high rates of comorbidity between the two conditions. Inconsistent findings may be related to different study characteristics and types of mTBI sustained (e.g., blast, non-blast). The objective of this study was to determine the association of blast-vs. non-blast related TBIs with long-term PTSD symptoms after controlling for demographic variables and trauma exposure...
December 4, 2018: Journal of Neurotrauma
Jennifer A Coleman, John R Lynch, Kathleen M Ingram, Christina M Sheerin, Lance M Rappaport, Stephen K Trapp
Posttraumatic stress disorder (PTSD) is one of the most prevalent mental health diagnoses for veterans. Group therapy can be an effective and efficient means of treating PTSD, yet the literature exploring treatment outcomes for racial minorities is mixed and limited. The present study was an evaluation across racial groups of the PTSD Recovery Program, a manualized group therapy implemented at a Veterans Affairs hospital. Data were collected from male veterans ( N = 450) who identified as non-Hispanic White or non-Hispanic African American and participated in a 10-week, combat-related, group therapy program between 2010 and 2014...
September 2018: Group Dynamics: Theory, Research, and Practice
Samantha N Hoffman, Matthew S Herbert, Laura D Crocker, Nicole E DeFord, Amber V Keller, Sarah M Jurick, Mark Sanderson-Cimino, Amy J Jak
OBJECTIVE: To determine the role of pain catastrophizing (PC) in neuropsychological functioning in veterans with a history of mild traumatic brain injury (TBI). PARTICIPANTS: Thirty-nine Iraq and Afghanistan combat veterans evaluated in the post-acute phase following mild TBI. METHODS: Participants underwent psychiatric and TBI clinical interviews, neuropsychological tests, and self-report assessments of PC, pain intensity, depression, and posttraumatic stress disorder symptoms...
November 28, 2018: Journal of Head Trauma Rehabilitation
Rollin McCulloch Gallagher, Friedhelm Sandbrink
War's burden on the health and well-being of combatants, civilians, and societies is well documented. Although the examination of soldiers' injuries in modern combat is both detailed and comprehensive, less is known about war-related injuries to civilians and refugees, including victims of torture. The societal burden of war-related disabilities persists for decades in war's aftermath. The complex injuries of combat survivors, including multiple pain conditions and neuropsychiatric comorbidities, challenge health care systems to reorganize care to meet these survivors' special needs...
November 29, 2018: American Journal of Public Health
Kyle Possemato, Emily M Johnson, J Bronte Emery, Michael Wade, Michelle C Acosta, Lisa A Marsch, Andrew Rosenblum, Stephen A Maisto
OBJECTIVE: Many combat veterans struggle with posttraumatic stress disorder (PTSD) and hazardous alcohol use and are hesitant to engage in behavioral health services. Combining peer support with an eHealth intervention may overcome many barriers to care. This pilot study investigated the feasibility of adding peer support to a web-based cognitive behavior therapy (CBT) targeting PTSD symptoms and hazardous drinking, called Thinking Forward. METHOD: Thirty primary care patients with PTSD and hazardous alcohol use were randomized to receive Thinking Forward with or without peer support...
November 29, 2018: Psychiatric Rehabilitation Journal
Amanda M Midboe, Steve Martino, Sarah L Krein, Joseph W Frank, Jacob T Painter, Michael Chandler, Allison Schroeder, Brenda T Fenton, Lara Troszak, Taryn Erhardt, Robert D Kerns, William C Becker
BACKGROUND: Dissemination of evidence-based practices that can reduce morbidity and mortality is important to combat the growing opioid overdose crisis in the USA. Research and expert consensus support reducing high-dose opioid therapy, avoiding risky opioid-benzodiazepine combination therapy, and promoting multi-modal, collaborative models of pain care. Collaborative care interventions that support primary care providers have been effective in medication tapering. We developed a patient-centered Primary Care-Integrated Pain Support (PIPS) collaborative care clinical program based on effective components of previous collaborative care interventions...
November 29, 2018: Implementation Science: IS
Bryan P Merritt, Tracy Kretzmer, Tamara L McKenzie-Hartman, Praveen Gootam
Since the inception of the Afghanistan and Iraq wars, an increasing number of veterans have sought treatment from the Department of Veterans Affairs for combat-related injuries. Many veterans experience postconcussive symptoms, traumatic stress, chronic pain, sensory deficits, and/or headaches. The goal of this article was to highlight some of the challenges treatment providers may face, while providing rehabilitation specialists with important evaluation and treatment considerations in working with this population to maximize outcomes for these veterans...
February 2019: Physical Medicine and Rehabilitation Clinics of North America
Michael Armstrong, Julie Champagne, Diane Schretzman Mortimer
Traumatic brain injury (TBI) is one of the signature injuries of Operation Iraqi Freedom and Operation Enduring Freedom. To ensure that rehabilitation care needs of veterans and active duty servicemembers with TBI and polytrauma injuries were met, the Department of Veterans Affairs (VA) established the Polytrauma System of Care (PSC) in 2005. The 5 VA Polytrauma Rehabilitation Centers provide tertiary, acute inpatient rehabilitation for the PSC. Interdisciplinary treatment teams of multiple rehabilitation disciplines provide the complex, patient-centered care to achieve maximum benefit...
February 2019: Physical Medicine and Rehabilitation Clinics of North America
Peter Charles Rhee
Wide-awake hand surgery is versatile and can be performed in a variety of settings for various pathologies. The benefits associated with wide-awake local anesthesia no tourniquet hand surgery can be extremely beneficial in the military health care system. Military medicine focuses on supporting soldiers in areas of combat, providing humanitarian care to local nationals, and to delivering health care to active duty soldiers and veterans in the domestic setting. The ability to perform hand surgery without general or sedating anesthesia conserves limited anesthetic resources and allows patients to maintain situational awareness perioperatively...
February 2019: Hand Clinics
Chi-Wai Lui, Michael Waller, Alison Bell, Jolieke C van der Pols
The use of dietary supplements is popular among military personnel. There is a lack of understanding about the changes in use during deployment and specific factors associated with such changes. This study retrospectively examined the changes in the pattern of supplement use among Australian veterans during their deployment to Iraq (n = 8,848) and Afghanistan (n = 6,507) between 2001 and 2009 and identified work-related circumstances that were associated with these changes. The frequency of use of supplements at present and during deployment was assessed...
November 23, 2018: Applied Physiology, Nutrition, and Metabolism, Physiologie Appliquée, Nutrition et Métabolisme
Daniel M Stout, Monte S Buchsbaum, Andrea D Spadoni, Victoria B Risbrough, Irina A Strigo, Scott C Matthews, Alan N Simmons
Trauma-related disorders of affect and cognition (TRACs) are associated with a high degree of diagnostic comorbidity, which may suggest that these disorders share a set of underlying neural mechanisms. TRACs are characterized by aberrations in functional and structural circuits subserving verbal memory and affective anticipation. Yet, it remains unknown how the neural circuitry underlying these multiple mechanisms contribute to TRACs. Here, in a sample of 47 combat Veterans, we measured affective anticipation using functional magnetic resonance imaging (fMRI), verbal memory with fluorodeoxyglucose positron emission tomography (FDG-PET), and grey matter volume with structural magnetic resonance imaging (sMRI)...
November 2018: Neurobiology of Stress
Sheila B Frankfurt, Bryann B DeBeer, Sandra B Morissette, Nathan A Kimbrel, Heidi La Bash, Eric C Meyer
Objective: Moral injury may result from perpetration-based and betrayal-based acts that violate deeply held norms; however, researchers and clinicians have little guidance about the moral injury syndrome's specific developmental pathways following morally injurious events. The present study's objective was to examine the direct and indirect pathways proposed in a frequently cited model of moral injury (1) in relation to two types of military-related traumas [experiencing military sexual trauma (MST) and combat exposure]...
2018: Frontiers in Psychiatry
Sinisa Colic, D J Richardson, P James Reilly, M Gary Hasey
Combat veterans; especially those with mental health conditions are an at risk group for suicidal ideation and behaviour. This study attempts to use machine learning algorithm to predict suicidal ideation (SI) in a treatment seeking veteran population. Questionnaire data from 738 patients consisting of veterans, still serving members of the Canadian Forces (CF) and Royal Canadian Mountain Police (RCMP) were examined to determine the likelihood of suicide ideation and to identify key variables for tracking the risk of suicide...
July 2018: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Galina A Portnoy, Mark R Relyea, Suzanne Decker, Andrea Shamaskin-Garroway, Mary Driscoll, Cynthia A Brandt, Sally G Haskell
A social-ecological framework for resilience underscores the importance of conceptualizing individuals embedded within their context when evaluating a person's vulnerability and adaptation to stress. Despite a high level of trauma exposure, most veterans exhibit psychological resilience following a traumatic event. Interpersonal trauma is associated with poorer psychological outcomes than noninterpersonal trauma and is experienced more frequently across the lifespan by women as compared to men. In the present study, we examined gender differences in trauma exposure, resilience, and protective factors among veterans...
November 15, 2018: Journal of Traumatic Stress
Carissa van den Berk Clark, Jennifer Chang, Jessica Servey, Jeffrey D Quinlan
Approximately 1.8 million American women are veterans of the Armed Services, and an additional 200,000 women are currently serving on active duty. With the increasing number of women in the military, there has been an increase in the number of women who have faced prolonged deployment in combat environments. This article discusses reproductive health concerns, family planning and contraceptive considerations, intimate partner violence and military sexual assault, posttraumatic stress disorder, and postdeployment health issues...
December 2018: Primary Care
Josine E Verhoeven, Ruoting Yang, Owen M Wolkowitz, Francesco S Bersani, Daniel Lindqvist, Synthia H Mellon, Rachel Yehuda, Janine D Flory, Jue Lin, Duna Abu-Amara, Iouri Makotkine, Charles Marmar, Marti Jett, Rasha Hammamieh
DNA methylation patterns change with age and can be used to derive an estimate of "epigenetic age," an indicator of biological age. Several studies have shown associations of posttraumatic stress disorder (PTSD) with worse somatic health and early mortality, raising the possibility of accelerated biological aging. This study examined associations between estimated epigenetic age and various variables in 160 male combat-exposed war veterans with ( n = 79) and without PTSD ( n = 81). DNA methylation was assessed in leukocyte genomic DNA using the Illumina 450K DNA methylation arrays...
October 2018: Molecular Neuropsychiatry
Christopher L Averill, Lynnette A Averill, Kristen M Wrocklage, J Cobb Scott, Teddy J Akiki, Brian Schweinsburg, Steven M Southwick, John H Krystal, Chadi G Abdallah
Purpose of the Study: Prior studies showed posttraumatic stress disorder (PTSD)-related alterations in white matter integrity, but most of these studies have used region-based approaches. We address this limitation by investigating the relationship between PTSD severity and fractional anisotropy (FA) using a tract-based approach. Procedures: Structural and diffusion magnetic resonance imaging were acquired from 67 combat-exposed US Veterans and processed using FSL/FreeSurfer TRActs Constrained by UnderLying Anatomy...
October 2018: Molecular Neuropsychiatry
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