Medicine and Health Sciences Commons^™

Preliminary Evidence For The Impact Of Combat Experiences On Gray Matter Volume Of The Posterior Insula, Ashley N. Clausen, Sandra A. Billinger, Jason-Flor V. Sisante, Hideo Suzuki, Robin L. Aupperle

Department of Educational Psychology: Faculty Publications

Background: Combat-exposed veteran populations are at an increased risk for developing cardiovascular disease. The anterior cingulate cortex (ACC) and insula have been implicated in both autonomic arousal to emotional stressors and homeostatic processes, which may contribute to cardiovascular dysfunction in combat veteran populations. The aim of the present study was to explore the intersecting relationships of combat experiences, rostral ACC and posterior insula volume, and cardiovascular health in a sample of combat veterans.

Method: Twenty-four male combat veterans completed clinical assessment of combat experiences and posttraumatic stress symptoms. Subjects completed a magnetic resonance imaging scan and autosegmentation using FreeSurfer was …

Confidentiality And Mental Health/Chaplaincy Collaboration, Denise Bulling, Mark Dekraai, Tarik Abdel-Monem, Jason A. Nieuwsma, William C. Cantrell, Keith Ethridge, Keith Meador

University of Nebraska Public Policy Center: Publications

Confidentiality can both facilitate and inhibit working relationships of chaplains and mental health professionals addressing the needs of service members and veterans in the United States. Researchers conducted this study to examine opportunities for improving integration of care within the Department of Defense (DoD) and Department of Veterans Affairs (VA). Interviews were conducted with 198 chaplains and 201 mental health professionals in 33 DoD and VA facilities. Using a blended qualitative research approach, researchers identified several themes from the interviews, including recognition that integration can improve services; chaplaincy confidentiality can facilitate help seeking behavior; and mental health and chaplain confidentiality …

The Structure Of Posttraumatic Psychopathology In Veterans Attending Primary Care, David Forbes, Jon D. Elhai, Emma Lockwood, Mark Creamer, B. Christopher Frueh, Kathryn M. Magruder

Public Health Resources

This study attempted to extend research indicating that posttraumatic stress disorder (PTSD) factors of Re-experiencing, Avoidance and Hyperarousal are more related to Fear/phobic disorders, while PTSD Dysphoria is more related to Anxious-Misery disorders. Trauma exposure, PTSD and comorbidity data for 668 veteran patients were analysed using confirmatory factor analyses and relative strengths of the relationships between PTSD factors and the Fear and Anxious-Misery factors were assessed. Combining Simms, Watson, and Doebbeling’s (2002) model of PTSD symptoms and Krueger’s (1999) Fear/Anxious Misery model of mood and anxiety disorders fit the data well. Contrary to previous research, PTSD Reexperiencing, Avoidance and Hyperarousal …

Women At War: Understanding How Women Veterans Cope With Combat And Military Sexual Trauma, Kristin M. Mattocks, Sally G. Haskell, Erin E. Krebs, Amy C. Justice, Elizabeth M. Yano, Cynthia Brandt

Public Health Resources

The wars in Iraq (Operation Iraqi Freedom, OIF) and Afghanistan (Operation Enduring Freedom, OEF) have engendered a growing population of US female veterans, with women now comprising 15% of active US duty military personnel. Women serving in the military come under direct fire and experience combatrelated injuries and trauma, and are also often subject to in-service sexual assaults and sexual harassment. However, little is known regarding howwomen veterans cope with these combat and military sexual trauma experiences once they return from deployment. To better understand their experiences, we conducted semi-structured interviews with nineteen OEF/OIF women veterans between JanuaryeNovember 2009. Women …

Factors Associated With Screening Or Treatment Initiation Among Male United States Veterans At Risk For Osteoporosis Fracture, Richard E. Nelson, Jonathan R. Nebeker, Brian C. Sauer, Joanne Lafleur

Public Health Resources

Male osteoporosis continues to be under-recognized and undertreated in men. An understanding of which factors cue clinicians about osteoporosis risk in men, and which do not, is needed to identify areas for improvement. This study sought to measure the association of a provider's recognition of osteoporosis with patient information constructs that are available at the time of each encounter. Using clinical and administrative data from the Veterans Health Administration system, we used a stepwise procedure to construct prognostic models for a combined outcome of osteoporosis diagnosis, treatment, or a bone mineral density (BMD) test order using time-varying covariates and Cox …

Long Term Depleted Uranium Exposure In Gulf War I Veterans Does Not Cause Elevated Numbers Of Micronuclei In Peripheral Blood Lymphocytes, M. V. Bakhmutskya, M. S. Oliver, M. A. Mcdiarmid, K. S. Squibb, J. D. Tucker

Public Health Resources

Depleted uranium (DU) is a high density heavy metal that has been used in military munitions since the 1991 Gulf War. DU is weakly radioactive and chemically toxic. Long term exposure can cause adverse health effects. This study assessed genotoxic effects in DU exposed Gulf War I veterans as a function of uranium (U) body burden. Levels of urine U were used to categorize the cohort into low and high exposure groups. Exposure to DU occurred during friendly fire incidents in 1991 involving DU munitions resulting in inhalation and ingestion exposure to small particles of DU and soft tissue DU …

Factors Associated With Suicidal Ideation In Oef/Oif Veterans, Chad M. Lemaire, David P. Graham

Public Health Resources

Background: The purpose of this projectwas to examine factors associated with suicidal ideation in returning Iraq and Afghanistan war veterans.

Methods: A cross-sectional review of 1740 veterans' initial mental health screening evaluations. One-hundred and thirteen (6.5%) OEF/OIF veterans reported active suicidal ideation at the time of the interview.

Results: Prior exposures of physical or sexual abuse and having a history of a prior suicide attempt(s) were associated with the presence of current suicidal ideation, as were having a diagnosis of a psychotic disorder, a depressive disorder, or posttraumatic stress disorder (PTSD). Deployment concerns related to training (protective), …

Imagery Rescripting And Exposure Group Treatment Of Posttraumatic Nightmares In Veterans With Ptsd, Mary E. Long, Mary E. Hammons, Joanne L. Davis, B. Christopher Frueh, Myrna M. Khan, Jon D. Elhai, Ellen J. Teng

Public Health Resources

This study details results of an open trial of a group psychological treatment for Veterans with posttraumatic stress disorder (PTSD) and chronic posttraumatic nightmares called “Imagery Rescripting and Exposure Therapy” (IRET). IRET is a variant of a successful imagery rescripting treatment for civilian trauma-related nightmares that was modified to address the needs of the Veteran population. Thirtyseven male U.S. Veterans with PTSD and nightmares attended 6 multicomponent group sessions. Findings indicated that the intervention significantly reduced frequency of nightmares and PTSD severity, as well as increased hours of sleep. Unlike the few open trials examining treatment of nightmares in Veterans, …

The Impact Of Endorsing Spitzer’S Proposed Criteria For Ptsd In The Forthcoming Dsm-V On Male And Female Veterans, Lyndsey N. Miller, Kathleen M. Chard, Jeremiah A. Schumm, Carol O’Brien

Public Health Resources

This study explored differences between Spitzer’s proposed model of posttraumatic stress disorder (PTSD) and the current DSM-IV diagnostic classification scheme in 353 Veterans. The majority of Veterans (89%) diagnosed with PTSD as specified in the DSM-IV also met Spitzer’s proposed criteria. Veterans who met both DSM-IV and Spitzer’s proposed criteria had significantly higher Clinician Administered PTSD Scale severity scores than Veterans only meeting DSM-IV criteria. Logistic regression indicated that being African American and having no comorbid diagnosis of major depressive disorder or history of a substance use disorder were found to predict those Veterans who met current, but not proposed …

Cerebrocerebellar Hypometabolism Associated With Repetitive Blast Exposure Mild Traumatic Brain Injury In 12 Iraq War Veterans With Persistent Post-Concussive Symptoms, Elaine R. Peskind, Eric C. Petrie, Donna J. Cross, Kathleen Pagulayan, Kathleen Mccraw, David Hoff, Kim Hart, Chang-En Yu, Murray A. Raskind, David G. Cook, Satoshi Minoshima

Public Health Resources

Disagreement exists regarding the extent to which persistent post-concussive symptoms (PCS) reported by Iraq combat Veterans with repeated episodes of mild traumatic brain injury (mTBI) from explosive blasts represent structural or functional brain damage or an epiphenomenon of comorbid depression or posttraumatic stress disorder (PTSD). Objective assessment of brain function in this population may clarify the issue. To this end, twelve Iraq war Veterans (32.0±8.5 [mean±standard deviation (SD)] years of age) reporting one or more blast exposures meeting American Congress of Rehabilitation Medicine criteria for mTBI and persistent PCS and 12 cognitively normal community volunteers (53.0±4.6 years of age) without …

Electroconvulsive Therapy For Major Depression Within The Veterans Health Administration, Paul N. Pfeiffer, Marcia Valenstein, Katherine J. Hoggatt, Dara Ganoczy, Dan Maixner, Erin M. Miller, Kara Zivin

Public Health Resources

Objectives: Electroconvulsive therapy (ECT) is the most effective treatment for severe or treatment resistant depression; however, the lack of widely accepted methods for determining when ECT is indicated may contribute to disparities and variation in use. We examined receipt of ECT among depressed patients in the largest coordinated health system in the US, the Veterans Health Administration.

Methods: Using administrative data, we conducted a multivariable logistic regression to identify individual clinical and sociodemographic predictors of receiving ECT, including variables of geographic accessibility to ECT, among patients diagnosed with major depressive disorder between 1999 and 2004.

Results: 307 (0.16%) …

Substance Use Disorders In Iraq And Afghanistan Veterans In Va Healthcare, 2001–2010: Implications For Screening, Diagnosis And Treatment, Karen H. Seal, Greg Cohen, Angela Waldrop, Beth E. Cohen, Shira Maguen, Li Ren

Public Health Resources

Background: The prevalence and correlates of alcohol use disorder (AUD) and drug use disorder (DUD) diagnoses in Iraq and Afghanistan veterans who are new users of Department of Veterans Affairs (VA) healthcare nationwide has not been evaluated.

Methods: VA administrative data were used in retrospective cross-sectional descriptive and multivariable analyses to determine the prevalence and independent correlates of AUD and DUD in 456,502 Iraq and Afghanistan veterans who were first-time users of VA healthcare between October 15, 2001 and September 30, 2009 and followed through January 1, 2010.

Results: Over 11% received substance use disorder diagnoses: AUD, …

Insomnia Characteristics And Clinical Correlates In Operation Enduring Freedom/Operation Iraqi Freedom Veterans With Post-Traumatic Stress Disorder And Mild Traumatic Brain Injury: An Exploratory Study, D. M. Wallace, S. Shafazand, A.R. Ramos, D.Z. Carvalho, H. Gardener, D. Lorenzo, W.K. Wohlgemuth

Public Health Resources

Background: There is limited data on chronic insomnia in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans, in whom post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) often co-exist. Our aim was to compare sleep characteristics of three groups of OEF/OIF veterans: (1) healthy sleepers (HS), (2) those with insomnia associated with PTSD and mTBI (PTSD–mTBI), and (3) those with insomnia associated with PTSD alone.

Methods: Consecutive veterans with insomnia complaints (>6 months) were recruited over 6 months from the Miami VA Post Deployment clinic. Participants completed a sleep disorders clinical interview, medical history, and questionnaires …

Mortality Patterns Of Army Chemical Corps Veterans Who Were Occupationally Exposed To Herbicides In Vietnam, Yasmin Cypel, Han Kang

Public Health Resources

PURPOSE: This research examined the risk of disease-related mortality of the Army Chemical Corps (ACC) veterans who handled/sprayed herbicides in Vietnam in comparison with their non-Vietnam veteran peers or U.S. men.

METHODS: Vital status was determined through December 31, 2005. All-cause mortality and cause-specific mortality were compared for individuals who served in Vietnam (n Z 2872) versus those who did not (n Z 2737). Similar analyses were completed on a subset of the original Vietnam cohort that consisted of individuals who either reported spraying herbicide (n Z 662) or not (n Z 811). The observed deaths for each …

Patterns Of Drug Use And Abuse Among Aging Adults With And Without Hiv: A Latent Class Analysis Of A Us Veteran Cohort, Traci C. Green, Trace Kershaw, Haiqun Lin, Robert Heimer, Joseph L. Goulet, Kevin L. Kraemer, Adam J. Gordon, Steve A. Maisto, Nancy L. Day, Kendall Bryant, David A. Fiellin, Amy C. Justice

Public Health Resources

This study characterized the extent and patterns of self-reported drug use among aging adults with and without HIV, assessed differences in patterns by HIV status, and examined pattern correlates. Data derived from 6351 HIV-infected and uninfected adults enrolled in an eight-site matched cohort, the Veterans Aging Cohort Study (VACS). Using clinical variables from electronic medical records and sociodemographics, drug use consequences, and frequency of drug use from baseline surveys, we performed latent class analyses (LCA) stratified by HIV status and adjusted for clinical and socio-demographic covariates. Participants were, on average, age 50 (range 22–86), primarily male (95%) and African-American (64%). …

An Examination Of The Construct Validity Of Posttraumatic Stress Disorder With Veterans Using A Revised Criterion Set, Anouk L. Grubaugh, Mary E. Long, Jon D. Elhai, B. Christopher Frueh, Kathryn M. Magruder

Public Health Resources

Ongoing concerns exist in the literature regarding the construct of posttraumatic stress disorder (PTSD) and how to best conceptualize and measure this disorder. We compared the traditional DSM-IV PTSD symptom criteria (i.e., symptoms from clusters B, C, and D) to a revised criterion set that omits overlapping mood and other anxiety symptoms on PTSD prevalence, PTSD diagnostic caseness, associated psychiatric comorbidity, functional status, and structural validity using a cross-sectional, multi-site primary care sample of 747 veterans. After removing items theorized to overlap with mood and other anxiety disorders, PTSD prevalence was identical using both criterion sets (i.e., 12%). Overall, there …

Investigating The Risk Of Cancer In 1990–1991 Us Gulf War Veterans With The Use Of State Cancer Registry Data, Heather A. Young, Jessica D. Maillard, Paul H. Levine, Samuel J. Simmens, Clare M. Mahan, Han K. Kang

Public Health Resources

PURPOSE: The purpose of this study was to determine whether proportional cancer incidence is greater among Gulf War veterans compared with non-Gulf War veterans.

METHODS: Files obtained from the Defense Manpower Data Center included data for 621,902 veterans who were deployed to the Persian Gulf during the 1990 to 1991 Gulf War (August 2, 1990, to March 1, 1991) and 746,248 non-Gulf War veteran controls. Identification of veterans who received a cancer diagnosis between 1991 and 2006 was accomplished through record linkage of the Defense Manpower Data Center dataset with files from 28 state cancer registries and the Department of …