Symptom severity and lifetime and prospective health service use among military veterans evaluated for PTSD

We used structural equation modeling with 174 treatment-seeking military trauma survivors evaluated for posttraumatic stress disorder (PTSD) at a VA Medical Center PTSD clinic to examine relationships among lifetime mental health service use, PTSD symptom severity and medical problems (from self-report), as well as prospective (1-year) mental health and medical care use visit counts extracted from medical records. We discovered an adequate statistical fit to a hypothesized model of previous and prospective health service use, and current PTSD severity and health-related problems. Previous inpatient mental health treatment was significantly related to PTSD severity and prospective outpatient mental health use. However, PTSD severity was unrelated to prospective use of mental health or medical services. Health problems were related to prospective medical service use. Clinical and administrative implications in predicting health care use among trauma survivors are discussed.     

Impact of Multi-Agency Employment Services on Employment Rates

Adults with severe and persistent mental illness who received employment services through mental health and/or vocational rehabilitation programs had higher employment rates than individuals who did not receive any employment services. Individuals who received services from both programs had significantly higher employment rates than individuals who received services from only one program. Results indicate that employment services had a greater relative effect on older clients and clients with a schizophrenia diagnosis than on other individuals. This state-wide study relied exclusively on analysis of administrative/operational databases that provide the employment rates for both recipients of vocational services and other clients.     

Unrecognized trauma and PTSD among public mental health consumers with chronic and severe mental illness

Lifetime prevalence of traumatic events and current PTSD was assessed among 142 mental health consumers with serious mental illness served by a psychosocial rehabilitation day program. Lifetime exposure to trauma was high (87%). The rate of PTSD based on the PTSD Checklist (PCL) was also high (19–30% depending on different scoring criteria). Overall, the PCL had strong internal reliability for this sample. Documentation of trauma and PTSD was exceptionally low in medical records. Results suggest that trauma and PTSD are significantly overlooked in the public mental health system. Improved recognition of trauma and PTSD are needed in order to provide meaningful services to this highly vulnerable population.1Karen J. Cusack is affiliated with the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC2Anouk L. Grubaugh and Rebecca G. Knapp are affiliated with the Medical University of South Carolina2,3B. Christopher Frueh is affiliated with the Medical University of South Carolina and the Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SCKaren J. Cusack, Ph.D., Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, CB 7590, 725 Martin Luther King, Chapel Hill, NC 27599-7590 Telephone: 919.966.6725, Fax: 919.966.1384, kcusack@schsr.unc.edu <mailto:kcusack@schsr.unc.edu>     

Recovery from PTSD following Hurricane Katrina

Background: We examined patterns and correlates of speed of recovery of estimated posttraumatic stress disorder (PTSD) among people who developed PTSD in the wake of Hurricane Katrina. Method: A probability sample of prehurricane residents of areas affected by Hurricane Katrina was administered a telephone survey 7–19 months following the hurricane and again 24–27 months posthurricane. The baseline survey assessed PTSD using a validated screening scale and assessed a number of hypothesized predictors of PTSD recovery that included sociodemographics, prehurricane history of psychopathology, hurricane‐related stressors, social support, and social competence. Exposure to posthurricane stressors and course of estimated PTSD were assessed in a follow‐up interview. Results: An estimated 17.1% of respondents had a history of estimated hurricane‐related PTSD at baseline and 29.2% by the follow‐up survey. Of the respondents who developed estimated hurricane‐related PTSD, 39.0% recovered by the time of the follow‐up survey with a mean duration of 16.5 months. Predictors of slow recovery included exposure to a life‐threatening situation, hurricane‐related housing adversity, and high income. Other sociodemographics, history of psychopathology, social support, social competence, and posthurricane stressors were unrelated to recovery from estimated PTSD. Conclusions: The majority of adults who developed estimated PTSD after Hurricane Katrina did not recover within 18–27 months. Delayed onset was common. Findings document the importance of initial trauma exposure severity in predicting course of illness and suggest that pre‐ and posttrauma factors typically associated with course of estimated PTSD did not influence recovery following Hurricane Katrina. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

The impact of PTSD symptoms on physical and mental health functioning in returning veterans

This study aimed to determine the unique impact of PTSD symptoms, beyond other frequently examined factors on physical and mental health functioning in a sample of returning veterans. Assessments of 168 returning OEF/OIF veterans conducted an average of six months following return from deployment included measures of emotional disorders and the Short Form (36) Health Survey. Hierarchical multiple regressions revealed significant, unique contribution of Clinician-Administered PTSD Scale (CAPS) score above all other predictors in the model (demographics, severity of trauma exposure, physical injury, substance abuse and depressive symptoms), for both the physical (8%) and mental (6%) health aggregate scores, along with significant prediction of physical health (4–10%) and mental health (3–7%) subscale scores. The only other significant predictors were age for physical health scores, and depressive symptoms for mental health scores. PTSD criterion B (re-experiencing) symptoms uniquely predicted reduced physical health functioning and higher experience of bodily pain, while criterion D (hyperarousal) symptoms uniquely predicted lower feelings of energy/vitality and poorer perceptions of emotional health.     

Mental health economic studies from developing countries reviewed in the context of those from developed countries

Objective : Mental health economic studies from developing countries were reviewed in the context of such studies from developed countries. Method : Mental health economic studies were ascertained through a systematic Medline search, chasing references at the end of papers acquired from the initial medline search and details of studies furnished by members of the WHO collaborating centre. Results : Only a small number of mental health economic studies from developing countries were identified. They were mainly cost‐of‐illness and cost‐effectiveness studies. Conclusion : Psychiatric disorders impose a significant burden in developing countries. It is not always possible to extrapolate findings from developed countries to developing countries. Potential avenues for future research and development are discussed.     

Well-being, physical functioning, and use of health services in the elderly with PTSD and subthreshold PTSD

OBJECTIVE: To measure the impact of PTSD and subthreshold PTSD on daily life functioning, well-being and health care use in a community based-sample of the elderly population in the Netherlands. METHODS: Consequences of PTSD were investigated in an elderly community-based population (LASA study) by comparing three groups: subjects with PTSD, with subthreshold PTSD, and a reference group. Indicators of well-being (loneliness, self-perceived health and satisfaction with life), disability (days spent in bed and disability days) and use of health care (general practitioners, medical specialists, psychiatrists, mental health care, social workers and professional home care) were investigated. RESULTS: In comparison to the reference group, subjects with PTSD or subthreshold PTSD spent more days in bed due to illness and had more disability days, even when corrected for concurring other diseases or functional limitations. They were less satisfied with life in general, used health care for predominantly somatic care and evaluated the care they received to be inadequate. Psychotropic drugs, if prescribed, were predominantly benzodiazepines and seldom antidepressants. CONCLUSIONS: The findings strongly suggest that elderly with either PTSD or subthreshold PTSD suffer grave impairments in daily life, are less satisfied with life and do not receive optimum treatment. Especially elderly with PTSD frequently visit medical specialists but are rarely treated by psychiatrists or other mental health professionals, nor do they receive antidepressant treatment from their GP. Lack of adequate treatment may be the cause of dissatisfaction with the care they receive.     

The TAPS Project 42: the last to leave hospital — a profile of residual long-stay populations and plans for their resettlement

This study aims to assess the service needs of residual hospital populations and the adequacy of the alternative facilities provided for them following the closure of psychiatric hospitals. The remaining 368 long-stay patients in four representative English hospitals scheduled for closure within 1 year were assessed by means of a standardized schedule devised to rate problem behaviours. The residual populations consisted predominantly of elderly, male and very long-stay patients. The most frequent problem behaviours were hostility, physical aggression and incontinence. The one hospital which allowed new admissions to continue indefinitely had the highest proportion of problematic patients. Alternative care facilities were provided by a diverse range of agencies. Large residential homes were the predominant type of provision for most patients, and private nursing homes often accommodated mixed groups of elderly people. NHS trusts catered for most of the ‘difficult to place’ patients within specialized facilities, based in the community. There were some indications that compromises led to insufficient and understaffed specialist facilities. In view of the increasing demand for long-term intensively staffed facilities, this policy might put an extra burden on the local health services.     

The need for trauma assessment and related clinical services in a state-funded mental health system

Previous data show that trauma is highly prevalent in public sector consumers and is associated with severe mental illness and high service use costs. Despite this, evidence suggests that trauma victims tend to go unrecognized and to receive inadequate mental health services. We surveyed all facilities (6 inpatient, 17 outpatient) within the South Carolina Department of Mental Health about their current services for trauma victims. Results indicate that most public mental health facilities do not routinely evaluate trauma history in an adequate manner or provide specialized trauma-related services. Implications and future directions are addressed, including the current trauma initiatives of many state-funded systems.     

Prevalence and Correlates of Mental Health Problems in Canadian Forces Personnel Who Deployed in Support of the Mission in Afghanistan: Findings From Postdeployment Screenings, 2009–2012

Objective:

An important minority of military personnel will experience mental health problems after overseas deployments. Our study sought to describe the prevalence and correlates of postdeployment mental health problems in Canadian Forces personnel.

Method:

Subjects were 16 193 personnel who completed postdeployment screening after return from deployment in support of the mission in Afghanistan. Screening involved a detailed questionnaire and a 40-minute, semi-structured interview with a mental health clinician. Mental health problems were assessed using the Patient Health Questionnaire and the Posttraumatic Stress Disorder Checklist—Civilian Version. Logistic regression was used to explore independent risk factors for 1 or more of 6 postdeployment mental health problems.

Results:

Symptoms of 1 or more of 6 mental health problems were seen in 10.2% of people screened; the most prevalent symptoms were those of major depressive disorder (3.2%), minor depression (3.3%), and posttraumatic stress disorder (2.8%). The strongest risk factors for postdeployment mental health problems were past mental health care (adjusted odds ratio [AOR] 2.89) and heavy combat exposure (AOR 2.57 for third tertile, compared with first tertile). These risk groups might be targeted in prevention and control efforts. In contrast to findings from elsewhere, Reservist status, deployment duration, and number of previous deployments had no relation with mental health problems.

Conclusions:

An important minority of personnel will disclose symptoms of mental health problems during postdeployment screening. Differences in risk factors seen in different nations highlight the need for caution in applying the results of research in one population to another.     

Inpatient Hospitalizations and Emergency Service Visits Among Participants in an Individual Placement and Support (IPS) Model Program

Supported employment (SE) is considered an "evidence-based" practice for people with serious mental illness. We examined inpatient hospitalizations and emergency service visits among clients in a SE program based on the Individual Placement and Support (IPS) model in comparison to a propensity score matched group of clients who did not participate in IPS. A significant interaction showed that only IPS/SE clients who were also high in regular mental health services had fewer hospitalizations and emergency service visits than matched controls. The interaction effect was moderate, even when we controlled for client functioning. These findings provide support for the integration of mental health and vocational rehabilitation services, a key feature of evidence-based SE services.