Chronic pain is the most common reason for medical cannabis certification. Data regarding alcohol use and risky drinking among medical cannabis patients with pain is largely unknown. Therefore, we ...examined the prevalence and correlates of alcohol use and risky drinking in this population.
Participants completed surveys regarding demographics, pain-related variables, anxiety, cannabis use, and past six-month alcohol consumption. Alcohol use groups were defined using the AUDIT-C i.e., non-drinkers, low-risk drinkers, and high-risk drinkers (≥4 for men and ≥3 for women) and compared on demographic characteristics, pain measures, anxiety, and cannabis use.
Overall, 42% (n=330/780) were non-drinkers, 32% (n=251/780) were low-risk drinkers, and 26% (n=199/780) were high-risk drinkers. Compared to non-drinkers, low- and high-risk drinkers were significantly younger whereas a larger proportion of low-risk drinkers reported being African-American compared to non- or high-risk drinkers. High-risk drinkers reported significantly lower pain severity/interference compared to the other groups; high-risk drinkers were also less likely to be on disability compared to other groups. A multinomial logistic regression showed that patients reporting lower pain severity and less disability had greater odds of being classified a high-risk drinker.
High-risk drinking appears common among medical cannabis patients. Future research should examine whether such use is concurrent or consecutive, and the relationship of such co-use patterns to consequences. Nevertheless, individuals treating patients reporting medical cannabis use for pain should consider alcohol consumption, with data needed regarding the efficacy of brief alcohol interventions among medical cannabis patients.
•Among chronic pain patients using medical cannabis, 26% were high-risk drinkers•Those with less pain severity/disability had greater odds of being a high-risk drinker.•Providers should assess alcohol consumption among patients using medical cannabis.•Future studies should examine the efficacy of alcohol interventions in this population.
Objective To assess mental health symptoms, suicidal ideation/behaviors, and treatment among a nationally representative probability sample of student veterans. Participants: Student veterans ...enrolled in post-secondary educational institutions and matched comparison students. Methods: Sampled participants completed an online survey (n = 1,838). Analyses accounted for the complex sample design and non-response. Results: Substantial percentages of student veterans screened positive for: depression (36.9%, 95% CI: 31.1-42.7), PTSD (35.7%, 95% CI 29.9-41.5), anxiety (29.5%, 95% CI 26.8-32.2), and suicidal ideation (14.6%, 95% CI 12.1-17.1), with student veterans having odds ratios between 1.7 to 2.4 for positive screens compared to non-veteran students. Only 41.5% (95% CI 33.0-50.0) of student veterans with positive screens received treatment, although they had 50% higher odds of receiving treatment than non-veteran students. Conclusions: Student veterans have high rates of mental health symptoms and low rates of treatment. However, they are more likely to receive treatment than comparison students.
The VA has mandated that evidence-based psychotherapies (EBPs) be offered to patients with PTSD, but only a small minority of the psychotherapy delivered to VA patients with PTSD is a documented EBP. ...It is unknown what factors are associated with receiving a documented EBP.
Patients who received an EBP in FY2015 that was documented using a templated progress note (N = 21,808) were compared with patients who received psychotherapy for PTSD that was not documented using a template (N = 251,886).
Among psychotherapy recipients, VA patients with markers of clinical complexity such as service connection for PTSD, comorbid bipolar or psychotic disorder, longer duration of PTSD diagnosis, and a benzodiazepine prescription for PTSD had lower odds of receiving a documented EBP.
Recipients of documented EBPs differed from those who did not receive documented EBPs on several sociodemographic characteristics and indicators of treatment need. A limitation of our study is that some individuals in the group without EBP documentation may still have received an EBP, but did not receive EBP documentation in the electronic health record. Nevertheless, our results suggest that high-need or complex VA patients with PTSD may be less likely to receive documented EBPs.
Posttraumatic stress disorder (PTSD) disproportionately affects low-income individuals and is untreated in 70% of those affected. One third of low-income Americans are treated in Federally Qualified ...Health Centers (FQHCs), which do not have the capacity to provide all patients with first-line treatments such as Prolonged Exposure (PE). To address this problem, FQHCs could use low-intensity interventions (e.g., Clinician-Supported PTSD Coach: CS PTSD Coach) and medium-intensity interventions (e.g., PE for Primary Care: PE-PC) to treat PTSD with fewer resources. However, some patients will still require high-intensity treatments (e.g., full-length PE) for sustained clinical benefit. Thus, there is a critical need to develop stepped-care models for PTSD in FQHCs.
We are conducting a Sequential, Multiple Assignment, Randomized Trial (SMART) with 430 adults with PTSD in FQHCs. Participants are initially randomized to CS PTSD Coach or PE-PC. After four sessions, early responders step down to lower frequency interaction within their assigned initial treatment strategy. Slow responders are re-randomized to either continue their initial treatment strategy or step up to Full PE for an additional eight weeks. The specific aims are to test the effectiveness of initiating treatment with PE-PC versus CS PTSD Coach in reducing PTSD symptoms and to test the effectiveness of second-stage strategies (continue versus step-up to Full PE) for slow responders.
This project will provide critical evidence to inform the development of an effective stepped-care model for PTSD. Testing scalable, sustainable sequences of PTSD treatments delivered in low-resource community health centers will improve clinical practice for PTSD.
Objective: To compare mental health symptoms and service utilization among returning student and nonstudent service members/veterans (SM/Vs). Participants: SM/Vs (N = 1,439) were predominately white ...(83%) men (92%), half were over age 30 (48%), and 24% were students. Methods: SM/Vs completed surveys 6 months post deployment (October 2011-July 2013). Results: Students and nonstudent SM/Vs did not differ in positive screens for depression, anxiety, hazardous drinking, or posttraumatic stress disorder. Students (n = 81) and nonstudents (n = 265) with mental health symptoms had low levels of mental health service use (eg, Department of Veterans Affairs VA, civilian, or military facilities), at 47% and 57%. respectively. Fewer students used VA mental health services. Common barriers to treatment seeking included not wanting treatment on military records and embarrassment. Conclusions: Like other returning SM/Vs, student SM/Vs have unmet mental health needs. The discrepancy between potential need and treatment seeking suggests that colleges might be helpful in further facilitating mental health service use for student SM/Vs.
Abstract Background Risk factors of violence perpetration in veterans include substance use and posttraumatic stress disorder (PTSD); however, it is unknown whether these factors are associated with ...greater risk for partner or non-partner violence. This study investigated the associations between probable PTSD, heavy drinking, marijuana use, cocaine use, and partner and non-partner violence perpetration. Methods Self-report questionnaires assessing past-year partner and non-partner aggression (CTS2) as well as past-month substance use (SAOM) , probable PTSD (PCL C) , and probable depression (PHQ-9) were administered to 810 substance using veterans entering VA mental health treatment. Results In bivariate analyses, probable PTSD in substance using veterans was associated with violence perpetration (partner physical, χ2 = 11.46, p = 0.001, φ = 0.12; non-partner physical, χ2 = 50.64, p < 0.001, φ = 0.25; partner injury, χ2 = 6.41, p = 0.011, φ = 0.09; non-partner injury, χ2 = 42.71, p < 0.001, φ = 0.23). In multiple logistic regression analyses that adjusted for sociodemographic characteristics , probable PTSD was independently associated with non-partner physical (odds ratio OR , 2.82; 95% confidence interval CI, 1.97–4.05) and injury aggression ( OR , 3.96; CI, 2.56–6.13). Cocaine and heavy drinking were independently associated with non-partner physical and injury aggression and non-partner injury aggression respectively. Conclusions The results provide evidence that probable PTSD, heavy drinking, and cocaine use are associated with increased risk of non-partner violence perpetration in substance using veterans. These results underscore the importance of screening for PTSD symptoms and violence perpetration towards non-partners in substance using veterans presenting for treatment.
Response to Aubin et al. (2017) Bohnert, Kipling M.; Ilgen, Mark A.; McCarthy, John F.
Addiction (Abingdon, England),
November 2017, 2017-11-00, 20171101, Letnik:
112, Številka:
11
Journal Article
•Approximately 20–30% of veterans with PTSD have a comorbid SUD, and up to 75% of veterans with a SUD also have PTSD.•In this study, only 13.41% of veterans received an adequate dose of PTSD or SUD ...treatment.•Older age, service-connected disability, and psychiatric comorbidities were associated with decreased odds of treatment.•Specific types of SUDs, including alcohol, cocaine, and opioid use disorders, along with receipt of diagnosis in a PTSD or SUD clinic, were associated with increased odds of treatment.
Veterans with comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) have complex needs and often do not receive adequate mental health treatment. The purpose of this study was to examine rates and predictors of PTSD-only, SUD-only, or PTSD and SUD psychotherapy receipt among newly diagnosed Veterans with PTSD and SUD.
An administrative dataset including Veterans Health Administration (VHA) users.
The sample comprised 32,779 United States Veterans with a new PTSD and a new SUD diagnosis in fiscal year 2015.
Multinomial logistic regression was used to identify predictors of receipt of any and adequate psychotherapy for PTSD, SUD, or PTSD and SUD across settings. Binomial logistic regression was used to identify predictors of PTSD psychotherapy among those who received any psychotherapy.
A total of 13,824 (42.17%) Veterans in this sample received any PTSD- or SUD-related therapy in the year following diagnosis. Low rates of veterans received an adequate dose of PTSD-related psychotherapy (6.58%), SUD-related psychotherapy (7.72%), or both PTSD and SUD-related psychotherapy (<1%) In adjusted models, older age, service-connected disability, and psychiatric comorbidities were associated with decreased odds of treatment. Specific types of SUDs, including alcohol, cocaine, and opioid use disorders, along with receipt of diagnosis in a PTSD or SUD clinic, were associated with increased odds of treatment.
Low rates of PTSD and SUD related psychotherapy highlight a need to better engage and retain Veterans with these disorders in care. Predictors of decreased treatment utilization, such as older age, service connection, and bipolar and major depressive disorders, may inform efforts by the VHA to further target and engage Veterans with indicated treatments.
Abstract Objective For patients with an initial primary care (PC) encounter in the Veterans Health Administration (VHA) that included a mental health diagnosis, we evaluate whether same-day receipt ...of Primary Care–Mental Health Integration (PC-MHI) services is associated with the likelihood of receiving a subsequent mental-health-related encounter in the following 90 days. Method Using VHA administrative data, we identified 9046 patients who received VHA care for the first time in fiscal year 2009, received a PC encounter that included a mental health diagnosis on the first day of their VHA services and initiated care at a VHA facility that provided PC-MHI services. Using multivariable generalized estimating equations logistic regression, we examined whether receipt of same-day PC-MHI was associated with receipt of a subsequent encounter with a mental health diagnosis within 90 days. Analyses adjusted for Operation Enduring Freedom/Operation Iraqi Freedom Veteran status, demographic characteristics, service-connected disability, psychiatric and non-psychiatric diagnoses, and psychotropic medication initiation on the index day of service use. Results Receipt of same-day PC-MHI services was positively associated with having a mental-health-related encounter in the following 90 days (adjusted odds ratio=2.05; 95% confidence interval=1.66–2.54). Conclusions PC-MHI services may enhance mental health continuation of care among PC patients with mental health conditions who initiate VHA services.
Although the U.S. Department of Veterans Affairs (VA) has prioritized care for posttraumatic stress disorder (PTSD), many patients with PTSD remain symptomatic. Patterns of PTSD symptom change are ...not well understood. Thus, the current study was designed to categorize and investigate potential predictors of symptom trajectories in patients with PTSD. The sample comprised 2,237 VA patients who were diagnosed with PTSD in 2013 and completed at least 4 PTSD Checklist (PCL) assessments over 12 weeks. Latent trajectory analysis was used to identify latent classes of patients based on PCL scores. Based on model fit indices, 3 trajectories were identified. Compared to patients in the mild‐improving trajectory (21.9%), those in the severe‐stable trajectory (34.3%) were more likely to be male, relative risk ratio (RRR) = 1.48, 95% CI 1.08, 2.02; non‐White, RRR = 1.77, 95% CI 1.33, 2.35; Hispanic, RRR = 2.07, 95% CI 1.40, 3.04; and have comorbid depression, RRR = 1.58, 95% CI 1.25, 1.99. Compared to patients in the moderate‐improving trajectory (43.8%), those in the severe‐stable trajectory were more likely to have sleep disorders, RRR = 1.25, 95% CI 1.01, 1.55. Our findings suggest that male veterans, minority veterans, and veterans with certain comorbid conditions may be less likely to achieve improved PTSD symptoms. Targeted efforts are needed to improve outcomes for PTSD patients on nonremitting trajectories and to improve the consistency of PTSD assessment across the VA health care system.
Resumen
Spanish s by the Asociación Chilena de Estrés Traumático (ACET)
A pesar que el departamento de asuntos para veteranos (AV) ha priorizado la atención del trastorno por estrés postraumático (TEPT), muchos pacientes con TEPT permanecen sintomáticos. Los patrones de cambio de los síntomas de TEPT no se conocen bien. De este modo, el presente estudio fue formulado para categorizar e investigar los potenciales predictores de las trayectorias de síntomas en pacientes con TEPT. La muestra comprendía a 2.237 pacientes AV que fueron diagnosticados con TEPT en el 2013 y completaron al menos 4 evaluaciones de listas de chequeo de TEPT (PCL) a lo largo de 12 semanas. Se utilizó el análisis de trayectoria latente para identificar clases latentes de pacientes basados en los puntajes de PCL. Basado en los índices de ajuste del modelo, 3 trayectorias fueron identificadas. En comparación con los pacientes en la trayectoria de mejoría leve (21,9%),los de la trayectoria severa estable (34,3%) fueron más propensos a ser hombres (Radio de Riesgo Relativo RRR = 1.48, 95% CI 1.08, 2.02), de color (RRR = 1.77, 95% CI 1.33, 2.35), Hispánicos (RRR = 2.07, 95% CI 1.40, 3.04), y con depresión comorbida (RRR = 1.58, 95% CI 1.25, 1.99).En comparación con los pacientes en la trayectoria de mejoría moderada (43,8%) aquellos en la trayectoria severa estable tenían más probabilidades de tener trastornos del sueño (RRR = 1.25, 95% CI 1.01, 1.55). Nuestros hallazgos sugieren que veteranos hombres, de grupos minoritarios, y con ciertas condiciones de comorbilidad pueden tener menos probabilidad de conseguir una mejoría en los síntomas de TEPT. Es necesario dirigir los esfuerzos en mejorar las consecuencias del TEPT para pacientes en las trayectorias sin remisión y para mejorar la consistencia de la evaluación del TEPT en toda la AV.
摘要
Traditional and Simplified Chinese s by AsianSTSS
標題: 退伍軍人事務部門診患者中PTSD症狀變化的預測變量
撮要: 雖然退伍軍人事務部(VA)會優先治療創傷後壓力症(PTSD)患者, 但仍有很多PTSD患者還未康復。目前我們還未了解PTSD症狀變化的模式。因此, 本研究透過PTSD患者, 分類並探查症狀軌跡的潛在預測變量。樣本為2,237名於2013年在VA被確診患PTSD的患者, 他們在12星期裡進行了至少4次的PTSD檢查表(PCL)評估。我們利用潛在軌跡分析, 基於PCL分數得出患者的潛在類別。
我們基於模型吻合指數, 找出3種軌跡。跟「輕微與正在改善」軌跡的患者(21.9%)相比, 在「嚴重與穩定」軌跡的患者(34.3%)有更大可能是男性 (相對風險率 RRR = 1.48, 95% CI 1.08, 2.02)、非白人 (RRR = 1.77, 95% CI 1.33, 2.35)、西班牙裔 (RRR = 2.07, 95% CI 1.40, 3.04), 並有共病抑鬱症 (RRR = 1.58, 95% CI 1.25, 1.99)。跟「中度與正在改善」軌跡的患者(43.8%)相比, 在「嚴重與穩定」軌跡的患者更大可能有睡眠失常(RRR = 1.25, 95% CI 1.01, 1.55)。結果反映, 男性、少數族裔退役軍人, 和有某些共病狀況的退役軍人, PTSD症狀改善的可能性較小。對於在無改善軌跡的患者, 我們需加以提供針對性治療, 並提升VA普遍評估PTSD的一致性。
标题: 退伍军人事务部门诊患者中PTSD症状变化的预测变量
撮要: 虽然退伍军人事务部(VA)会优先治疗创伤后压力症(PTSD)患者, 但仍有很多PTSD患者还未康复。目前我们还未了解PTSD症状变化的模式。因此, 本研究透过PTSD患者, 分类并探查症状轨迹的潜在预测变量。样本为2,237名于2013年在VA被确诊患PTSD的患者, 他们在12星期里进行了至少4次的PTSD检查表(PCL)评估。我们利用潜在轨迹分析, 基于PCL分数得出患者的潜在类别。
我们基于模型吻合指数, 找出3种轨迹。跟「轻微与正在改善」轨迹的患者(21.9%)相比, 在「严重与稳定」轨迹的患者(34.3%)有更大可能是男性 (相对风险率 RRR = 1.48, 95% CI 1.08, 2.02)、非白人 (RRR = 1.77, 95% CI 1.33, 2.35)、西班牙裔 (RRR = 2.07, 95% CI 1.40, 3.04), 并有共病抑郁症 (RRR = 1.58, 95% CI 1.25, 1.99)。跟「中度与正在改善」轨迹的患者(43.8%)相比, 在「严重与稳定」轨迹的患者更大可能有睡眠失常(RRR = 1.25, 95% CI 1.01, 1.55)。结果反映, 男性、少数族裔退役军人, 和有某些共病状况的退役军人, PTSD症状改善的可能性较小。对于在无改善轨迹的患者, 我们需加以提供针对性治疗, 并提升VA普遍评估PTSD的一致性。
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