Effectiveness of evidence-based psychotherapy (EBP) for PTSD can vary based on gender and trauma type, with poorer outcomes for men and sexual traumas. Among veterans receiving EBPs for PTSD, the ...effects of the interaction between gender and military sexual trauma (MST) on treatment outcome are unclear. This study examined how gender and MST impact PTSD symptoms following cognitive processing therapy (CPT) and prolonged exposure (PE).
We conducted a national, retrospective cohort study of all post 9/11 veterans who had a PTSD diagnosis from 10/2001-9/2017 at VHA facilities and >1 psychotherapy visit. Inclusion criteria included completion of ≥8 CPT/PE sessions and pre- and post-treatment PCL (N = 9711). Mixed-effects linear regression models were conducted, separately by treatment, to examine associations between changes in PTSD symptoms and gender, MST, and their interactions with time.
For both treatments, there were no significant differences in pre-treatment PCL by gender or MST, and PCL decreased significantly over time. In adjusted models, only the gender by time interaction on pre-to-post-CPT change was significant (p < .001); the decrease in women's PCL was 2.67 points greater, compared to men.
Women veterans demonstrated greater reductions in PTSD symptoms from CPT. There were no differences by gender for PE, suggesting men and women veterans benefit similarly. Results suggest outcomes may be impacted by gender socialization when utilizing certain cognitive behavioral techniques. MST, regardless of gender, did not impact PTSD outcomes for either treatment. Both CPT and PE may thus be effective for veterans irrespective of MST history.
•Women had larger PTSD reductions from Cognitive Processing Therapy than men.•No gender differences in PTSD outcomes from Prolonged Exposure.•No differences in PTSD outcomes based on MST history for either treatment.•Gender differences in treatment effectiveness do not vary by MST history.
In management, decisions are expected to be based on rational analytics rather than intuition. But intuition, as a human evolutionary achievement, offers wisdom that, despite all the advances in ...rational analytics and AI, should be used constructively when recruiting and winning personnel. Integrating these inner experiential competencies with rational-analytical procedures leads to smart recruiting decisions.
Half the world's people currently live in rural and remote areas. The problem is that most health workers live and work in cities. This imbalance is common to almost all countries and poses a major ...challenge to the nationwide provision of health services. Its impact, however, is most severe in low income countries. There are two reasons for this. One is that many of these countries already suffer from acute shortages of health workers - in all areas. The other is that the proportion of the population living in rural regions tends to be greater in poorer countries than in rich ones. The World Health Organization (WHO) has therefore drawn up a comprehensive set of strategies to help countries encourage health workers to live and work in remote and rural areas. These include refining the ways students are selected and educated, as well as creating better working and living conditions. The first step has been to establish what works, through a year-long process that has involved a wide range of experts from all regions of the world. The second is to share the results with those who need them, via the guidelines contained in this document. The third will be to implement them, and to monitor and evaluate progress, and - critically - to act on the findings of that monitoring and evaluation. The guidelines are a practical tool that all countries can use. As such, they complement the WHO Global Code of Practice on the International Recruitment of Health Personnel, adopted by the Sixty-third World Health Assembly in May 2010. The Code offers a framework to manage international migration over the medium to longer term. The guidelines are a tool that can be used straight away to address one of the first triggers to internal and international migration - dissatisfaction with living and working conditions in rural areas. Together, the code of practice and
these new guidelines provide countries with instruments to improve workforce distribution and enhance health services. Doing so will address a long-standing problem, contribute to more equitable access to health care, and boost prospects for improving maternal and child health and combating diseases such as AIDS, tuberculosis and malaria.
Although much has been written about tank losses during the fighting near Prokhorovka as part of the battle for the Kursk salient in July 1943, little has been written about losses in personnel. This ...research note addresses the issue of Soviet personnel losses during the battle.
In the article, from the standpoint of theory and methodology, a competent approach to the evaluation of company personnel is described. The models for assessing the company's personnel from ...different approaches are presented. The methods used by modern companies for the personnel assessment procedure are highlighted. The meaning of the competence concept and approaches to understanding the essence of the competence concept are given. The concept of competency model is formulated and a variant of this competence model is presented. Deficient moments in the formation of competence models for the evaluation of company personnel were identified.
Objective To describe new onset and persistence of self reported post-traumatic stress disorder symptoms in a large population based military cohort, many of whom were deployed in support of the wars ...in Iraq and Afghanistan.Design Prospective cohort analysis.Setting and participants Survey enrolment data from the millennium cohort (July 2001 to June 2003) obtained before the wars in Iraq and Afghanistan. Follow-up (June 2004 to February 2006) data on health outcomes collected from 50 184 participants.Main outcome measures Self reported post-traumatic stress disorder as measured by the posttraumatic stress disorder checklist—civilian version using Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria.Results More than 40% of the cohort were deployed between 2001 and 2006; between baseline and follow-up, 24% deployed for the first time in support of the wars in Iraq and Afghanistan. New incidence rates of 10-13 cases of post-traumatic stress disorder per 1000 person years occurred in the millennium cohort. New onset self reported post-traumatic stress disorder symptoms or diagnosis were identified in 7.6-8.7% of deployers who reported combat exposures, 1.4-2.1% of deployers who did not report combat exposures, and 2.3-3.0% of non-deployers. Among those with self reported symptoms of post-traumatic stress disorder at baseline, deployment did not affect persistence of symptoms.Conclusions After adjustment for baseline characteristics, these prospective data indicate a threefold increase in new onset self reported post-traumatic stress disorder symptoms or diagnosis among deployed military personnel who reported combat exposures. The findings define the importance of post-traumatic stress disorder in this population and emphasise that specific combat exposures, rather than deployment itself, significantly affect the onset of symptoms of post-traumatic stress disorder after deployment.
Objective
This study aimed to examine the effectiveness of cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) when administered on a daily basis during a 2‐week period of ...time.
Method
In an open‐label, prospective cohort pilot trial, 20 U.S. military personnel and veterans diagnosed with PTSD or subthreshold PTSD participated in 12 daily sessions of CPT. Primary outcomes included Clinician Administered PTSD Scale for DSM‐5 and PTSD Checklist for DSM‐5 scores. Secondary outcomes included Patient Health Questionnaire‐8 and Beck Scale for Suicide Ideation (BSSI) scores. Interviews and self‐report scales were completed at pretreatment, posttreatment, and 6 months after the treatment.
Results
Relative to baseline, PTSD symptom severity and rates of PTSD diagnosis were significantly reduced at posttreatment and 6‐month follow‐up. Depression symptom severity did not significantly improve, but suicide ideation significantly decreased at 6‐month follow‐up.
Conclusions
Daily administration of CPT is associated with significant reductions in PTSD and suicide ideation.
The US military has conducted population-level screening for mental health problems among all service members returning from deployment to Afghanistan, Iraq, and other locations. To date, no ...systematic analysis of this program has been conducted, and studies have not assessed the impact of these deployments on mental health care utilization after deployment.
To determine the relationship between combat deployment and mental health care use during the first year after return and to assess the lessons learned from the postdeployment mental health screening effort, particularly the correlation between the screening results, actual use of mental health services, and attrition from military service.
Population-based descriptive study of all Army soldiers and Marines who completed the routine postdeployment health assessment between May 1, 2003, and April 30, 2004, on return from deployment to Operation Enduring Freedom in Afghanistan (n = 16,318), Operation Iraqi Freedom (n = 222,620), and other locations (n = 64,967). Health care utilization and occupational outcomes were measured for 1 year after deployment or until leaving the service if this occurred sooner.
Screening positive for posttraumatic stress disorder, major depression, or other mental health problems; referral for a mental health reason; use of mental health care services after returning from deployment; and attrition from military service.
The prevalence of reporting a mental health problem was 19.1% among service members returning from Iraq compared with 11.3% after returning from Afghanistan and 8.5% after returning from other locations (P<.001). Mental health problems reported on the postdeployment assessment were significantly associated with combat experiences, mental health care referral and utilization, and attrition from military service. Thirty-five percent of Iraq war veterans accessed mental health services in the year after returning home; 12% per year were diagnosed with a mental health problem. More than 50% of those referred for a mental health reason were documented to receive follow-up care although less than 10% of all service members who received mental health treatment were referred through the screening program.
Combat duty in Iraq was associated with high utilization of mental health services and attrition from military service after deployment. The deployment mental health screening program provided another indicator of the mental health impact of deployment on a population level but had limited utility in predicting the level of mental health services that were needed after deployment. The high rate of using mental health services among Operation Iraqi Freedom veterans after deployment highlights challenges in ensuring that there are adequate resources to meet the mental health needs of returning veterans.
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