The Clinician-Administered PTSD Scale (CAPS) is an extensively validated and widely used structured diagnostic interview for posttraumatic stress disorder (PTSD). The CAPS was recently revised to ...correspond with PTSD criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). This article describes the development of the CAPS for DSM-5 (CAPS-5) and presents the results of an initial psychometric evaluation of CAPS-5 scores in 2 samples of military veterans (Ns = 165 and 207). CAPS-5 diagnosis demonstrated strong interrater reliability (к = .78 to 1.00, depending on the scoring rule) and test-retest reliability (к = .83), as well as strong correspondence with a diagnosis based on the CAPS for DSM-IV (CAPS-IV; к = .84 when optimally calibrated). CAPS-5 total severity score demonstrated high internal consistency (α = .88) and interrater reliability (ICC = .91) and good test-retest reliability (ICC = .78). It also demonstrated good convergent validity with total severity score on the CAPS-IV (r = .83) and PTSD Checklist for DSM-5 (r = .66) and good discriminant validity with measures of anxiety, depression, somatization, functional impairment, psychopathy, and alcohol abuse (rs = .02 to .54). Overall, these results indicate that the CAPS-5 is a psychometrically sound measure of DSM-5 PTSD diagnosis and symptom severity. Importantly, the CAPS-5 strongly corresponds with the CAPS-IV, which suggests that backward compatibility with the CAPS-IV was maintained and that the CAPS-5 provides continuity in evidence-based assessment of PTSD in the transition from DSM-IV to DSM-5 criteria.
Public Significance Statement
This study evaluated the DSM-5 version of the Clinician-Administered PTSD Scale (CAPS-5), a widely used structured interview for posttraumatic stress disorder, in 2 samples of military veterans. Results indicated that the CAPS-5 is psychometrically sound and corresponds closely with the previous DSM-IV version of the CAPS.
Background and Aims
Limited information is available regarding links between specific substance use disorders (SUDs) and suicide mortality; however, the preliminary evidence that is available ...suggests that suicide risk associated with SUDs may differ for men and women. This study aimed to estimate associations between SUDs and suicide for men and women receiving Veterans Health Administration (VHA) care.
Design
A cohort study using national administrative health records.
Setting
National VHA system, USA.
Participants
All VHA users in fiscal year (FY) 2005 who were alive at the beginning of FY 2006 (n = 4 863 086).
Measurements
The primary outcome of suicide mortality was assessed via FY 2006–2011 National Death Index (NDI) records. Current SUD diagnoses were the primary predictors of interest, and were assessed via FY 2004–2005 VHA National Patient Care Database (NPCD) records.
Findings
In unadjusted analyses, a diagnosis of any current SUD and the specific current diagnoses of alcohol, cocaine, cannabis, opioid, amphetamine and sedative use disorders were all associated significantly with increased risk of suicide for both males and females hazard ratios (HRs) ranging from 1.35 for cocaine use disorder to 4.74 for sedative use disorder for men, and 3.89 for cannabis use disorder to 11.36 for sedative use disorder for women. Further, the HR estimates for the relations between any SUD, alcohol, cocaine and opioid use disorders and suicide were significantly stronger for women than men (P < 0.05). After adjustment for other factors, most notably comorbid psychiatric diagnoses, associations linking SUDs with suicide were attenuated markedly and the greater suicide risk among females was observed for only any SUD and opioid use disorder (P < 0.05).
Conclusions
Current substance use disorders (SUDs) signal increased suicide risk, especially among women, and may be important markers to consider including in suicide risk assessment strategies. None the less, other co‐occurring psychiatric disorders may partially explain associations between SUDs and suicide, as well as the observed excess suicide risk associated with SUDs among women.
The Veterans Choice Program (VCP) of the Veterans Health Administration (VHA) allowed eligible veterans to use their benefits with participating providers outside the VHA. The authors aimed to ...identify characteristics of veterans with depression who used or did not use mental health care through the VCP.
In this cross-sectional study, the authors analyzed secondary data from the national VHA Corporate Data Warehouse. VHA administrative data were linked with VCP claims to examine characteristics of VCP-eligible veterans with depression. The study sample included 595,943 unique veterans who were enrolled in the VHA before 2013, were eligible for the VCP in 2016, were alive in 2018, and had an assessed Patient Health Questionnaire-9 (PHQ-9) score or depressive disorder diagnosis documented in the VHA between 2016 and 2018.
Veterans who used the VCP had lower medical comorbidity scores and lived in less socioeconomically disadvantaged counties, compared with veterans who received only VHA care. VCP veterans were also more likely to have a PHQ-9 score assessment and to have higher mean depression scores. Mean counts of annual mental health visits per 1,000 veterans were markedly higher for direct VHA care than for care provided via the VCP. As a percentage of the total counts of visits per 1,000 veterans across the VCP and VHA, residential programs and outpatient procedures were the services that were most frequently delivered through the VCP.
Between 2016 and 2018, the VCP was used primarily to augment mental health care provided by the VHA, rather than to fill a gap in care.
This study examined the psychometric properties of the posttraumatic stress disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5; Weathers, Litz, ...et al., 2013b) in 2 independent samples of veterans receiving care at a Veterans Affairs Medical Center (N = 468). A subsample of these participants (n = 140) was used to define a valid diagnostic cutoff score for the instrument using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; Weathers, Blake, et al., 2013) as the reference standard. The PCL-5 test scores demonstrated good internal consistency (α = .96), test-retest reliability (r = .84), and convergent and discriminant validity. Consistent with previous studies (Armour et al., 2015; Liu et al., 2014), confirmatory factor analysis revealed that the data were best explained by a 6-factor anhedonia model and a 7-factor hybrid model. Signal detection analyses using the CAPS-5 revealed that PCL-5 scores of 31 to 33 were optimally efficient for diagnosing PTSD (κ(.5) = .58). Overall, the findings suggest that the PCL-5 is a psychometrically sound instrument that can be used effectively with veterans. Further, by determining a valid cutoff score using the CAPS-5, the PCL-5 can now be used to identify veterans with probable PTSD. However, findings also suggest the need for research to evaluate cluster structure of DSM-5.
We sought to investigate longitudinal trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans.
We determined the prevalence and predictors of mental health diagnoses ...among 289,328 Iraq and Afghanistan veterans entering Veterans Affairs (VA) health care from 2002 to 2008 using national VA data.
Of 289,328 Iraq and Afghanistan veterans, 106,726 (36.9%) received mental health diagnoses; 62,929 (21.8%) were diagnosed with posttraumatic stress disorder (PTSD) and 50 432 (17.4%) with depression. Adjusted 2-year prevalence rates of PTSD increased 4 to 7 times after the invasion of Iraq. Active duty veterans younger than 25 years had higher rates of PTSD and alcohol and drug use disorder diagnoses compared with active duty veterans older than 40 years (adjusted relative risk = 2.0 and 4.9, respectively). Women were at higher risk for depression than were men, but men had over twice the risk for drug use disorders. Greater combat exposure was associated with higher risk for PTSD.
Mental health diagnoses increased substantially after the start of the Iraq War among specific subgroups of returned veterans entering VA health care. Early targeted interventions may prevent chronic mental illness.
From the author of The Veteran's Survival Guide, The Veteran's PTSD Handbook addresses the obstacles that veterans face when filing for benefits related to post-traumatic stress disorder (PTSD). One ...of the greatest obstacles, John Roche writes, is establishing a connection between a veteran's service and PTSD. Because both combat stressors and noncombat stressors can cause PTSD and because of the difficulties in diagnosing the condition, filing a successful claim for benefits based on PTSD is difficult. In the same accessible, self-help style used in The Veteran's Survival Guide, Roche offers detailed instructions on how to prepare a well-grounded claim for veterans' benefits relating to PTSD. He also discusses the four years he spent helping one veteran establish a service connection for his PTSD claim with Veterans Affairs. This book will be required reading for any veteran or veteran's dependent who wishes to obtain his or her well-earned benefits and for those officials of veterans' service organizations who assist veterans with their claims.
To help the U.S. Air Force gain greater insight into the well-being of its members who have sustained mental or physical injuries in combat or combat-related situations, this report gauges the ...current status of the Air Force’s wounded warriors, including their use of and satisfaction with Air Force programs designed to serve them. It presents the baseline findings from a longitudinal analysis of enrollees in the Air Force Wounded Warrior program who were receiving benefits or undergoing evaluation to receive benefits.
To investigate whether expanded access to Veterans Affairs (VA)-purchased care increased overall utilization or induced a shift from other payers to VA for emergency care among VA enrollees.
This ...study included all emergency department (ED) encounters in 2019 from hospitals in the state of New York.
We conducted a difference-in-differences analysis comparing VA enrollees to the general population before and after the implementation of the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act in June 2019.
We included all ED visits with individuals aged 30 or older at the time of the encounter. Individuals were considered eligible for the policy change if they were enrolled with VA at the beginning of 2019.
Of the 5,577,199 ED visits in the sample, 4.9% (n = 253,799) were made by VA enrollees. Of these, 44.9% of visits were paid by Medicare, 32.8% occurred in VA facilities, and 7% were paid by private health insurance. There was a 6.4% (2.91 percentage points; std. error = 0.18; p < 0.01) decrease in the proportion of ED visits paid by Medicare among VA enrollees relative to the general population after the implementation of the MISSION Act in June 2019. This decrease was larger for ED visits with a subsequent inpatient admission (-8.4%; 4.87 percentage points; std. error = 0.33; p < 0.01). There was no statistically significant change in the total volume of ED visits (0.06%; std. error = 0.08; p = 0.45).
Leveraging a novel dataset, we demonstrate that MISSION Act implementation coincided with a shift in the financing of non-VA ED visits from Medicare to VA without any increase in overall ED utilization. These findings have important implications for VA health care financing and delivery.
Hidden Heroes Ramchand, Rajeev; Tanielian, Terri; Fisher, Michael P ...
04/2014
eBook
Odprti dostop
Little has been reported about “military caregivers”—the population of those who care for wounded, ill, and injured military personnel and veterans. This report summarizes the results of a study ...designed to describe the magnitude of military caregiving in the United States today, as well as to identify gaps in the array of programs, policies, and initiatives designed to support military caregivers.
This intriguing exploration of the post-Civil War period through its fiction and nonfiction illuminates how the era spawned a new understanding of war veterans that lives on today. Scholars of the ...Civil War era have commonly assumed that veterans of the Union and Confederate armies effortlessly melted back into society and that they adjusted to the demands of peacetime with little or no difficulty. Yet the path these soldiers followed on the road to reintegration was far more tangled. New Men unravels the narrative of veteran reentry into civilian life and exposes the growing gap between how former soldiers saw themselves and the representations of them created by late-nineteenth century American society. In the early years following the Civil War, the concept of the "veteran" functioned as a marker for what was assumed by soldiers and civilians alike to be a temporary social status that ended definitively with army demobilization and the successful attainment of civilian employment. But in later postwar years this term was reconceptualized as a new identity that is still influential today. It came to be understood that former soldiers had crossed a threshold through their experience in the war, and they would never be the same: They had become new men. Uncovering the tension between veterans and civilians in the postwar era adds a new dimension to our understanding of the legacy of the Civil War. Reconstruction involved more than simply the road to reunion and its attendant conflicts over race relations in the United States. It also pointed toward the frustrating search for a proper metaphor to explain what soldiers had endured. A provocative engagement with literary history and historiography, New Men challenges the notion of the Civil War as "unwritten" and alters our conception of the classics of Civil War literature. Organized chronologically and thematically, New Men coherently blends an analysis of a wide variety of fictional and nonfictional narratives. Writings are discussed in revelatory pairings that illustrate various aspects of veteran reintegration, with a chapter dedicated to literature describing the reintegration experiences of African Americans in the Union Army. New Men is at once essential reading for anyone who wants to understand the origins of our concept of the "veteran" and a book for our times. It is an invitation to build on the rich lessons of the Civil War veterans' experiences, to develop scholarship in the area of veterans studies, and to realize the dream of full social integration for soldiers returning home.
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