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Post-Traumatic Stress Disorders: HELP
Articles by Patrick S. Calhoun
Based on 75 articles published since 2010
(Why 75 articles?)
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Between 2010 and 2020, Patrick S. Calhoun wrote the following 75 articles about Stress Disorders, Post-Traumatic.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Review A systematic review of the PTSD Checklist's diagnostic accuracy studies using QUADAS. 2015

McDonald, Scott D / Brown, Whitney L / Benesek, John P / Calhoun, Patrick S. ·Mental Health Service, Hunter Holmes McGuire Richmond VA Medical Center. · VA Mid-Atlantic Mental Illness, Education, & Clinical Center (MIRECC), Durham VA Medical Center. ·Psychol Trauma · Pubmed #26323052.

ABSTRACT: Despite the popularity of the PTSD Checklist (PCL) as a clinical screening test, there has been no comprehensive quality review of studies evaluating its diagnostic accuracy. A systematic quality assessment of 22 diagnostic accuracy studies of the English-language PCL using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) assessment tool was conducted to examine (a) the quality of diagnostic accuracy studies of the PCL, and (b) whether quality has improved since the 2003 STAndards for the Reporting of Diagnostic accuracy studies (STARD) initiative regarding reporting guidelines for diagnostic accuracy studies. Three raters independently applied the QUADAS tool to each study, and a consensus among the 4 authors is reported. Findings indicated that although studies generally met standards in several quality areas, there is still room for improvement. Areas for improvement include establishing representativeness, adequately describing clinical and demographic characteristics of the sample, and presenting better descriptions of important aspects of test and reference standard execution. Only 2 studies met each of the 14 quality criteria. In addition, study quality has not appreciably improved since the publication of the STARD Statement in 2003. Recommendations for the improvement of diagnostic accuracy studies of the PCL are discussed.

2 Review The prevalence of posttraumatic stress disorder in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans: a meta-analysis. 2015

Fulton, Jessica J / Calhoun, Patrick S / Wagner, H Ryan / Schry, Amie R / Hair, Lauren P / Feeling, Nicole / Elbogen, Eric / Beckham, Jean C. ·Durham VA Medical Center, Durham, NC 27705, United States; VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States. Electronic address: jessica.j.fulton@gmail.com. · Durham VA Medical Center, Durham, NC 27705, United States; VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States. · Durham VA Medical Center, Durham, NC 27705, United States. · Durham VA Medical Center, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States. · Durham VA Medical Center, Durham, NC 27705, United States; VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Durham, NC 27705, United States; Department of Psychiatry, UNC-Chapel Hill, Chapel Hill, NC 27516, United States. ·J Anxiety Disord · Pubmed #25768399.

ABSTRACT: Literature on posttraumatic stress disorder (PTSD) prevalence among Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) veterans report estimates ranging from 1.4% to 60%. A more precise estimate is necessary for projecting healthcare needs and informing public policy. This meta-analysis examined 33 studies published between 2007 and 2013 involving 4,945,897 OEF/OIF veterans, and PTSD prevalence was estimated at 23%. Publication year and percentage of Caucasian participants and formerly active duty participants explained significant variability in prevalence across studies. PTSD remains a concern for a substantial percentage of OEF/OIF veterans. To date, most studies have estimated prevalence among OEF/OIF veterans using VA medical chart review. Thus, results generalize primarily to the prevalence of PTSD in medical records of OEF/OIF veterans who use VA services. Additional research is needed with randomly selected, representative samples administered diagnostic interviews. Significant financial and mental health resources are needed to promote recovery from PTSD.

3 Review The diagnostic accuracy of the PTSD checklist: a critical review. 2010

McDonald, Scott D / Calhoun, Patrick S. ·Defense and Veterans Brain Injury Center, Richmond VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA 23249, USA. Scott.McDonald@va.gov ·Clin Psychol Rev · Pubmed #20705376.

ABSTRACT: The PTSD Checklist (PCL) is the most frequently used self-report measure of PTSD symptoms. Although the PCL has been in use for nearly 20 years and over a dozen validation studies have been conducted, this paper provides the first comprehensive review of its diagnostic utility. Eighteen diagnostic accuracy studies of the PCL are presented, followed by an examination of the potential roles of spectrum effects, bias, and prevalence in understanding the variation in sensitivity, specificity, and other operating characteristics across these studies. Two related issues as to the interchangeability of the PCL's three versions (civilian, military, and specific) and various scoring methods are also discussed. Findings indicate that the PCL has several strengths as a PTSD screening test and suggest that it can be a useful tool when followed by a second-tier diagnostic test such as a standardized interview. However, the PCL's operating characteristics demonstrate significant variation across populations, settings, and research methods and few studies have examined such factors that may moderate the PCL's utility. Recommendations and cautions regarding the use of the PCL as a clinical screening test, a diagnostic tool in research, and as an estimator of PTSD population prevalence are provided.

4 Review Posttraumatic stress disorder, cardiovascular, and metabolic disease: a review of the evidence. 2010

Dedert, Eric A / Calhoun, Patrick S / Watkins, Lana L / Sherwood, Andrew / Beckham, Jean C. ·VA Research Service, Department of Psychiatry and Behavioral Sciences, Durham Veterans Affairs and Duke University Medical Centers, Durham, NC, USA. eric.dedert@duke.edu ·Ann Behav Med · Pubmed #20174903.

ABSTRACT: BACKGROUND: Posttraumatic stress disorder (PTSD) is a significant risk factor for cardiovascular and metabolic disease. PURPOSE: The purpose of the current review is to evaluate the evidence suggesting that PTSD increases cardiovascular and metabolic risk factors, and to identify possible biomarkers and psychosocial characteristics and behavioral variables that are associated with these outcomes. METHODS: A systematic literature search in the period of 2002-2009 for PTSD, cardiovascular disease, and metabolic disease was conducted. RESULTS: The literature search yielded 78 studies on PTSD and cardiovascular/metabolic disease and biomarkers. CONCLUSIONS: Although the available literature suggests an association of PTSD with cardiovascular disease and biomarkers, further research must consider potential confounds, incorporate longitudinal designs, and conduct careful PTSD assessments in diverse samples to address gaps in the research literature. Research on metabolic disease and biomarkers suggests an association with PTSD, but has not progressed as far as the cardiovascular research.

5 Article Examining the relationship between negative affect and posttraumatic stress disorder symptoms among smokers using ecological momentary assessment. 2019

Erwin, Meredith C / Dennis, Paul A / Coughlin, Lara N / Calhoun, Patrick S / Beckham, Jean C. ·Durham VA Health Care System, Durham, NC, USA; University of Toledo, Department of Psychology, Toledo, OH, USA. · Durham VA Health Care System, Durham, NC, USA; Research and Development Service, Durham Veterans Affairs Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA. Electronic address: paul.dennis@duke.edu. · Durham VA Health Care System, Durham, NC, USA; Addiction Recovery Research Center, Virginia Tech Carilion Research Institute, Roanoke, VA, USA. · Durham VA Health Care System, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; VA Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Health Science Research and Development Service, Durham Veterans Affairs Medical Center, Durham, NC, USA. · Durham VA Health Care System, Durham, NC, USA; Research and Development Service, Durham Veterans Affairs Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; VA Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, USA. ·J Affect Disord · Pubmed #31077971.

ABSTRACT: BACKGROUND: Posttraumatic stress disorder (PTSD) and negative affect (e.g., anger, depression, anxiety), are highly co-occurring. It remains unclear whether changes in PTSD symptoms subsequently impact negative affect, or vice versa. This study assessed associations between moment-to-moment PTSD symptoms and negative affect in a sample of smokers with PTSD to determine directionality of this relationship. METHODS: Participants (N = 125) enrolled in two smoking cessation studies with co-occurring PTSD and cigarette use completed measures of PTSD and negative affect. Ecological momentary assessment (EMA) methodology was used to record symptoms during a one-week baseline period, during which participants smoked ad lib. Cross-lagged path analyses assessed PTSD symptoms and negative affect for directionality of their relationship, controlling for whether an EMA reading was smoking or non-smoking. Path analyses examined the lagged associations between PTSD symptoms and negative affect. RESULTS: Results found PTSD symptom severity at T-1 was significantly related to negative affect levels at time T, but negative affect at time T-1 was not associated with PTSD symptom severity at time T. Results indicated the model retaining the cross-lagged effect of PTSD symptom severity on negative affect provided better fit to the data than other models. LIMITATIONS: Limitations included use of self-report data, brief measures of symptoms, participants already had PTSD and/or MDD, participants were recruited from a specific clinical population, and use of DSM-IV data. CONCLUSIONS: Results suggest PTSD symptoms drive day-to-day fluctuations in negative affect, and highlight the importance of evaluating negative affect in the treatment of PTSD.

6 Article The Personality Assessment Inventory Alcohol Scale in Veterans With PTSD: Convergent and Discriminant Relations With the Alcohol Use Disorders Identification Test. 2019

Blalock, Dan V / Wilson, Sarah M / Dedert, Eric A / Clancy, Carolina P / Hertzberg, Michael A / Beckham, Jean C / Calhoun, Patrick S. ·1 Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA. · 2 Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, USA. · 3 VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Washington, DC, USA. · 4 Durham VA Medical Center, Durham, NC, USA. ·Assessment · Pubmed #30674200.

ABSTRACT: In this study, we examined the validity of the Personality Assessment Inventory Alcohol (ALC) scale in 736 male veterans presenting for formal evaluation of posttraumatic stress disorder (PTSD). The ALC scale exhibited convergence with other measures of alcohol problems, and this convergence was similar for veterans with and without formal PTSD diagnosis. When predicting alcohol consumption via the Alcohol Use Disorders Identification Test (AUDIT), the ALC scale also displayed substantial incremental validity over the effects of demographics and MMPI-2 MacAndrew Alcohol Scale. Using a standard alcohol consumption cut score on the AUDIT, the ALC scale displayed good specificity and (generally) good sensitivity across three common cut scores. PTSD severity did not significantly affect the association between the ALC composite and alcohol consumption via the AUDIT. Taken together, results suggested that the ALC can provide valid assessment of alcohol use among treatment seeking veterans.

7 Article Why do trauma survivors become depressed? Testing the behavioral model of depression in a nationally representative sample. 2019

Blakey, Shannon M / Yi, Jennifer Y / Calhoun, Patrick S / Beckham, Jean C / Elbogen, Eric B. ·Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Davie Hall (CB # 3270), Chapel Hill, NC 27599-3270, USA. Electronic address: sblakey@unc.edu. · Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Davie Hall (CB # 3270), Chapel Hill, NC 27599-3270, USA. · Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC 27705, USA; Durham Veterans Affairs Medical Center, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA. ·Psychiatry Res · Pubmed #30616128.

ABSTRACT: Despite accumulated evidence linking trauma exposure to major depressive disorder (MDD), there is limited understanding as to why some trauma survivors subsequently develop MDD. The behavioral model of depression points to a negative reinforcement cycle of trauma-related avoidance and depressed mood, but no study has evaluated this framework in trauma survivors. This study tested the hypothesis that traumatic stress symptom-related interference with daily activities and with relationships and self-medicating traumatic stress symptoms with alcohol and with drugs would predict MDD onset in a nationally representative sample after controlling for established risk factors. Data were drawn from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) using two samples: adults reporting lifetime trauma exposure but no history of MDD at Wave 1 (n = 8301) and a subset of those participants who met criteria for lifetime PTSD prior to Wave 1 (n = 1055). Younger age, female gender, a greater number of different trauma types, traumatic stress-related interference with daily activities, and self-medicating traumatic stress symptoms with alcohol significantly predicted MDD onset in both groups. Findings underscore the role of traumatic stress-related interference and self-medication in the development of MDD.

8 Article Shame as a mediator between posttraumatic stress disorder symptoms and suicidal ideation among veterans. 2019

Cunningham, Katherine C / LoSavio, Stefanie T / Dennis, Paul A / Farmer, Chloe / Clancy, Carolina P / Hertzberg, Michael A / Kimbrel, Nathan A / Calhoun, Patrick S / Beckham, Jean C. ·Durham Veterans Affairs Medical Center, Durham, NC, United States; The VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center,Durham, NC, United States. Electronic address: katherine-cunningham@utulsa.edu. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States. · NeuroCog Trials, Durham, NC, United States. · Durham Veterans Affairs Medical Center, Durham, NC, United States. · Durham Veterans Affairs Medical Center, Durham, NC, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States. · Durham Veterans Affairs Medical Center, Durham, NC, United States; The VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center,Durham, NC, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States. ·J Affect Disord · Pubmed #30248631.

ABSTRACT: BACKGROUND: Suicidal ideation is a problem that disproportionately affects veterans. Moreover, veterans with posttraumatic stress disorder (PTSD) appear to be at particularly high risk for suicide. OBJECTIVE: The purpose of the present research was to examine whether shame mediates the association between PTSD and suicidal ideation. METHODS: Secondary analyses were conducted in a sample of 201 veterans with PTSD seeking care through an outpatient Veterans Affairs specialty PTSD clinic. RESULTS: Path analysis revealed that shame fully accounted for the effects of PTSD on suicidal ideation, suggesting that shame may represent a key link between PTSD and suicidal ideation among veterans. LIMITATIONS: Although the reverse mediation effect was also examined, the present sample was cross-sectional and predominantly male. CONCLUSIONS: The present findings suggest that shame may be an effective point of treatment intervention to reduce suicidal ideation among veterans with PTSD; however, additional prospective research is still needed to delineate the precise nature of these associations over time.

9 Article Barriers to the use of Veterans Affairs health care services among female veterans who served in Iraq and Afghanistan. 2019

Newins, Amie R / Wilson, Sarah M / Hopkins, Tiffany A / Straits-Troster, Kristy / Kudler, Harold / Calhoun, Patrick S. ·Durham Veterans Affairs Medical Center. · Mid-Atlantic Mental Illness Research, Education, and Clinical Center. ·Psychol Serv · Pubmed #29419309.

ABSTRACT: The study investigated barriers to the utilization of Veterans Affairs (VA) health care services among female veterans who served in served in Iraq and Afghanistan, including reasons for not choosing VA health care, reasons for not seeking mental health treatment, and types of desired VA services. Female respondents to a survey assessing Operation Enduring Freedom/Operation Iraqi Freedom veterans' needs and health (N = 186) completed measures of military history, posttraumatic stress disorder, depression, barriers to VA health care, and preferences for services. Barriers to use of VA health care endorsed by female veterans included receiving care elsewhere and logistical issues. Barriers to utilization of mental health services among female veterans who screened positive for depression or posttraumatic stress disorder included negative treatment biases and concerns about stigma, privacy, and cost. Female veterans endorsed preferences for services related to eligibility education, nonprimary care physical health services, vocational assistance, and a few behavioral/mental health services. Findings highlight the need for ongoing outreach and education regarding eligibility and types of resources for physical and mental health problems experienced by female veterans who served in Iraq and Afghanistan, as well as inform types of VA programming and services desired by female veterans. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

10 Article The Association Between Alcohol Consumption, Lifetime Alcohol Use Disorder, and Psychiatric Distress Among Male and Female Veterans. 2018

Wilson, Sarah M / Burroughs, Thomas K / Newins, Amie R / Dedert, Eric A / Medenblik, Alyssa M / McDonald, Scott D / Beckham, Jean C / Anonymous2901115 / Calhoun, Patrick S. ·Center for Health Services Research in Primary Care, Durham VA Health Care System, Durham, North Carolina. · VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina. · Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina. · VA Portland Health Care System, Portland, Oregon. · Department of Psychology, University of Central Florida, Orlando, Florida. · Durham VA Health Care System, Durham, North Carolina. · Hunter Holmes McGuire VA Medical Center, Richmond, Virginia. ·J Stud Alcohol Drugs · Pubmed #30079875.

ABSTRACT: OBJECTIVE: This study aimed to examine among veterans (a) whether alcohol consumption patterns are associated with probability of psychiatric symptoms and (b) whether an alcohol use disorder (AUD) history explains psychiatric symptoms among nondrinkers. METHOD: Data were collected from 3,003 veterans (20.5% women). Gender-stratified logistic models examined the association between alcohol consumption pattern and the odds of symptoms of posttraumatic stress disorder (PTSD), depression, and suicidality. Two types of models were tested: four-group models comparing moderate drinkers to nondrinkers, light, and heavy drinkers; and five-group models separating nondrinkers by AUD history. RESULTS: In four-group models for both genders, compared with moderate drinkers, hazardous drinkers were more likely to have psychiatric symptoms. Among men, nondrinkers were more likely to have symptoms of depression and suicidality but not PTSD. Among women, nondrinkers and light drinkers were more likely to have PTSD symptoms. In the five-group model for men, odds of symptoms were higher for nondrinkers with an AUD history and hazardous drinkers. Compared to nondrinkers without an AUD history and light drinkers, male nondrinkers with an AUD history had higher odds of psychiatric symptoms. In the five-group model for women, the odds of symptoms were higher for hazardous drinkers. Female nondrinkers with an AUD history had higher odds of a positive depression screen. Odds of a positive PTSD screen were higher for female nondrinkers (with and without an AUD history) and light drinkers. CONCLUSIONS: For male veterans, there was a protective effect of moderate drinking (compared with abstinence) that disappeared when nondrinkers without an AUD history were separated. However, results for women showed a protective effect of moderate drinking with regard to PTSD that persisted even when an AUD history was taken into account.

11 Article A Randomized Clinical Trial of Nicotine Preloading for Smoking Cessation in People with Posttraumatic Stress Disorder. 2018

Dedert, Eric A / Dennis, Paul A / Calhoun, Patrick S / Dennis, Michelle F / Beckham, Jean C. ·a Department of Veterans Affairs, Durham Veterans Affairs Health Care System , Durham , North Carolina , USA. · b Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , North Carolina , USA. · c Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center , Durham , North Carolina , USA. ·J Dual Diagn · Pubmed #29693495.

ABSTRACT: OBJECTIVE: The aim of this research was to determine whether augmenting standard smoking cessation treatment by wearing an active nicotine patch before the smoking quit date improves rates of smoking cessation in individuals with posttraumatic stress disorder (PTSD) and to explore mechanisms of treatment response such as decreased cigarette craving and symptom relief from smoking. METHODS: This was a double-blind parallel randomized controlled trial in 81 people with PTSD who smoked cigarettes. Participants were recruited from Veterans Affairs outpatient clinics and flyers in the community. Participants provided ecological momentary assessments (EMAs) of PTSD symptoms, smoking withdrawal symptoms, and cravings before and after smoking a cigarette during one week of ad lib smoking and then three weeks of either a nicotine patch (n = 37) or placebo patch (n = 44) preceding the quit date. All participants received standard pharmacotherapy and behavioral treatment for smoking cessation after the quit date. To test the efficacy of nicotine patch preloading for engaging proposed treatment targets during the pre-quit phases, we used multilevel models to compare post-smoking changes in symptoms and cravings during the preloading phases to post-smoking changes reported during the ad lib smoking phase. RESULTS: There was no significant difference in quit rates across the two conditions on the primary outcome of seven-day point prevalence smoking abstinence bioverified with breath carbon monoxide at six weeks post-quit date. In a multivariable multilevel model pre- to post-cigarette changes in PTSD symptom clusters, smoking withdrawal symptoms, and cravings, there was a significant interaction between treatment phase and condition. Relative to participants in the placebo condition, participants in the nicotine patch condition experienced diminished relief from PTSD reexperiencing symptoms, smoking withdrawal symptoms, and cigarette craving after smoking a cigarette. CONCLUSIONS: Relative to placebo patch preloading, nicotine patch preloading diminished the reinforcing effects of smoking cigarettes. However, the low quit rates in both conditions suggest that nicotine patch preloading is not a sufficiently intensive treatment for achieving smoking cessation in people with PTSD. TRIAL REGISTRATION: clinicaltrials.gov: NCT00625131.

12 Article Examination of the indirect effects of combat exposure on suicidal behavior in veterans. 2018

Dillon, Kirsten H / Cunningham, Katherine C / Neal, Julia M / Wilson, Sarah M / Dedert, Eric A / Elbogen, Eric B / Calhoun, Patrick S / Beckham, Jean C / Anonymous2270944 / Kimbrel, Nathan A. ·Duke University Medical Center, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Durham Veterans Affairs Medical Center, Durham, NC, USA. · VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Durham Veterans Affairs Medical Center, Durham, NC, USA. · Duke University Medical Center, Durham, NC, USA; Durham Veterans Affairs Medical Center, Durham, NC, USA. · Duke University Medical Center, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Durham Veterans Affairs Medical Center, Durham, NC, USA; VA Center for Health Services Research in Primary Care, Durham, NC, USA. · VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA. · Duke University Medical Center, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Durham Veterans Affairs Medical Center, Durham, NC, USA. Electronic address: nathan.kimbrel@va.gov. ·J Affect Disord · Pubmed #29677605.

ABSTRACT: BACKGROUND: Researchers have theorized that increased rates of suicide in the military are associated with combat exposure; however, this hypothesis has received inconsistent support in the literature, potentially because combat exposure may be indirectly related to suicide risk through its influence on posttraumatic stress disorder (PTSD) and depressive symptoms. The current study tested the hypothesis that combat exposure has a significant indirect effect on suicidal behavior among Iraq/Afghanistan-era veterans through its effects on PTSD-depressive symptomatology. METHODS: Iraq/Afghanistan-era veterans (N = 3,238) participated in a cross-sectional, multi-site study of post-deployment mental health consisting of clinical interviews and self-report questionnaires. Structural equation modeling (SEM) was used to examine direct and indirect relationships between three latent variables: combat exposure, PTSD-depression, and suicidal behavior (past attempts and current ideation, intent, and preparation). RESULTS: A partial mediation model was the best-fitting model for the data. Combat exposure was significantly associated with PTSD-depression (β = 0.50, p < .001), which was in turn associated with suicidal behavior (β = 0.62, p < .001). As expected, the indirect effect between combat exposure and suicidal behavior was statistically significant, β = 0.31, p < .001. LIMITATIONS: Data were cross-sectional, and suicidal behavior was measured via self-report. CONCLUSIONS: Results indicated that combat exposure was indirectly related to suicidal behavior via PTSD-depressive symptomatology. Findings lend support for a higher-order combined PTSD-depression latent factor and suggest that Iraq/Afghanistan-era veterans with high levels of PTSD-depressive symptoms are at increased risk for suicidal behavior.

13 Article Association of posttraumatic stress disorder and traumatic brain injury with aggressive driving in Iraq and Afghanistan combat veterans. 2018

Van Voorhees, Elizabeth E / Moore, Daniel A / Kimbrel, Nathan A / Dedert, Eric A / Dillon, Kirsten H / Elbogen, Eric B / Calhoun, Patrick S. ·Durham Veterans Affairs Medical Center. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center. ·Rehabil Psychol · Pubmed #29553791.

ABSTRACT: PURPOSE: Aggressive driving contributes to the high rates of postdeployment motor vehicle-related injury and death observed among veterans, and veterans cite problems with anger, aggressive driving, and road rage as being among their most pressing driving-related concerns. Both posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) have been associated with driving-related deficits in treatment-seeking samples of veterans, but the relative contribution of each of these conditions to problems with aggressive driving in the broader population of combat veterans is unclear. METHOD: χ2 and logistic regression analyses were used to examine the relative association of PTSD, TBI, and co-occurring PTSD and TBI to self-reported problems with road rage in a sample of 1,102 veterans living in the mid-Atlantic region of the United States who had served in Afghanistan or Iraq. RESULTS: Results indicate that controlling for relevant demographic variables, PTSD without TBI (odds ratio = 3.44, p < .001), and PTSD with co-occurring TBI (odds ratio = 4.71, p < .001) were associated with an increased risk of road rage, but TBI without PTSD was not. CONCLUSIONS: Our findings suggest that PTSD, with or without comorbid TBI, may be associated with an increased risk of aggressive driving in veterans. Clinical implications for treating problems with road rage are discussed, including use of interventions targeting hostile interpretation bias and training in emotional and physiological arousal regulation skills. (PsycINFO Database Record

14 Article Characterizing anger-related affect in individuals with posttraumatic stress disorder using ecological momentary assessment. 2018

Van Voorhees, Elizabeth E / Dennis, Paul A / Elbogen, Eric B / Fuemmeler, Bernard / Neal, Lydia C / Calhoun, Patrick S / Beckham, Jean C. ·Durham Veterans Affairs Medical Center, United States; VISN 6, Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States. Electronic address: e.vanv@duke.edu. · Durham Veterans Affairs Medical Center, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States. · Durham Veterans Affairs Medical Center, United States; VISN 6, Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States. · Department of Health Behavior and Policy School of Medicine, Virginia Commonwealth University, Richmond, VA, United States. ·Psychiatry Res · Pubmed #29329048.

ABSTRACT: This study employed secondary analyses of existing ecological momentary assessment (EMA) data to characterize hostile and irritable affect in the day-to-day experience of 52 smokers with, and 65 smokers without, posttraumatic stress disorder (PTSD). EMA monitoring occurred over a mean of 8.2 days, and participants responded to an average of 2.8 random prompts/day. Analyses included Wilcoxon rank sum tests of group differences, and path analyses of cross-lagged multilevel models. Participants with PTSD endorsed a significantly higher proportion of total EMA entries indicating hostile affect and irritable affect than did individuals without PTSD. Cross-lagged analyses indicated that over a period of hours, PTSD symptoms significantly predicted subsequent hostile and irritable affect, but hostile and irritable affect did not predict subsequent PTSD symptoms. Findings suggest that day-to-day exposure to PTSD-related trauma cues may contribute to chronically elevated levels of anger-related affect. Such heightened affective arousal may, in turn, underlie an increased risk for verbal or physical aggression, as well as other health and quality-of-life related impairments associated with PTSD. Clinical implications include conceptualizing anger treatment in the broader context of trauma history and symptoms, and specifically targeting physiological arousal and maladaptive hostile cognitions triggered by trauma reminders in patients with PTSD.

15 Article The association of alcohol consumption patterns with self-rated physical health and psychiatric distress among Afghanistan- and Iraq-era U.S. veterans. 2018

Calhoun, Patrick S / Wilson, Sarah M / Dedert, Eric A / Cunningham, Katherine C / Burroughs, Thomas K / Hicks, Terrell A / Beckham, Jean C / Kudler, Harold S / Straits-Troster, Kristy. ·Durham Veterans Affairs Medical Center, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA; Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC 27705, USA. Electronic address: Patrick.calhoun2@va.gov. · Durham Veterans Affairs Medical Center, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA. · Durham Veterans Affairs Medical Center, Durham, NC 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA. · Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA; Hunter Holmes McGuire VA Medical Center, Richmond, VA 23249, USA. · Durham Veterans Affairs Medical Center, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA. · Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA; Phoenix VA Healthcare System, Phoenix, AZ 85012, USA. ·Psychiatry Res · Pubmed #29045920.

ABSTRACT: Alcohol misuse is associated with negative mental and physical health outcomes, which presents a public health concern in veterans. However, less is known regarding outcomes among veterans with low to moderate alcohol consumption. This study included veterans with military service in Iraq and/or Afghanistan (N = 1083) who resided in the VA Mid-Atlantic region catchment area (North Carolina, Virginia, and parts of West Virginia). Participants completed a mailed survey that inquired about demographics, past-year alcohol consumption, self-rated physical health, and psychiatric symptoms. Logistic regression was used to evaluate associations between alcohol consumption and posttraumatic stress disorder (PTSD), depression, and self-rated physical health. In both bivariate results and adjusted models, non-drinkers and hazardous drinkers were more likely to endorse clinically significant PTSD and depression symptoms than moderate drinkers. Moderate drinkers were also less likely to report fair/poor health, after adjusting for demographics and psychiatric symptoms. Results overall showed a U-shaped curve, such that moderate alcohol use was associated with lower rates of mental health problems and fair/poor health. While the VA routinely screens for alcohol misuse, current results suggest that non-drinkers are also at risk for poor mental and physical health.

16 Article Wall/Object Punching: An Important but Under-Recognized Form of Nonsuicidal Self-Injury. 2018

Kimbrel, Nathan A / Thomas, Shaun P / Hicks, Terrell A / Hertzberg, Michael A / Clancy, Carolina P / Elbogen, Eric B / Meyer, Eric C / DeBeer, Bryann B / Gross, Georgina M / Silvia, Paul J / Morissette, Sandra B / Gratz, Kim L / Calhoun, Patrick S / Beckham, Jean C. ·Durham Veterans Affairs Medical Center, Durham, NC, USA. · VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA. · Duke University Medical Center, Durham, NC, USA. · VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA. · Central Texas Veterans Health Care System, Temple, TX, USA. · Texas A&M University Health Science Center, College Station, TX, USA. · University of North Carolina at Greensboro, Greensboro, NC, USA. · The University of Texas at San Antonio, San Antonio, TX, USA. · University of Toledo, Toledo, OH, USA. · VA Center for Health Services Research in Primary Care, Durham, NC, USA. ·Suicide Life Threat Behav · Pubmed #28925016.

ABSTRACT: The present research investigated wall/object punching as a form of nonsuicidal self-injury (NSSI) among 1,143 veterans seeking treatment for posttraumatic stress disorder (PTSD). Wall/object punching was remarkably common in this sample (43%), and its inclusion in the definition of NSSI increased estimated prevalence of recent NSSI by 14%. As expected, wall/object punching was strongly associated with other traditional forms of NSSI, post-NSSI relief, and suicide ideation. Male veterans and veterans with PTSD were significantly more likely to engage in wall/object punching than female veterans and veterans without PTSD. More research on this important but under-recognized form of NSSI is needed.

17 Article The Association Between Military Sexual Trauma and Use of VA and Non-VA Health Care Services Among Female Veterans With Military Service in Iraq or Afghanistan. 2018

Calhoun, Patrick S / Schry, Amie R / Dennis, Paul A / Wagner, H Ryan / Kimbrel, Nathan A / Bastian, Lori A / Beckham, Jean C / Kudler, Harold / Straits-Tröster, Kristy. ·1 VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA. · 2 Durham VA Medical Center, NC, USA. · 3 Duke University School of Medicine, Durham, NC, USA. · 4 VA Center of Excellence for Health Services Research in Primary Care, Durham, NC, USA. · 5 University of Connecticut Health Center, Farmington, CT, USA. · 6 VA Connecticut Healthcare System, West Haven, CT, USA. · 7 Phoenix VA Healthcare System, AZ, USA. ·J Interpers Violence · Pubmed #26802046.

ABSTRACT: Military sexual trauma (MST) has been linked with increased rates of mental health disorders among veterans. Few studies have addressed how MST is related to use of VA and non-VA health care. The purpose of the current study was to (a) examine the association between MST, combat experiences, and mental health outcomes (i.e., posttraumatic stress disorder [PTSD] and depression) and (b) examine the association of MST and use of VA and non-VA health care services among female veterans who served in Iraq and Afghanistan. Female respondents to a survey assessing Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) veterans' needs and health ( N = 185) completed measures of demographic variables, military history, combat exposure, MST, PTSD, and depression symptoms, and use of VA and non-VA health care. Overall, 70% of the sample experienced one or more combat-related experiences and 15.7% endorsed MST during deployment to Iraq or Afghanistan. MST and combat exposure were both positively associated with PTSD and depression symptoms even after controlling for the effects of demographic and military history variables. MST was associated with increased use of VA mental health services in bivariate results but was not independently related to VA service utilization after accounting for PTSD and depression symptoms. Approximately half of the women who reported MST had not used VA health care. Continued outreach and education initiatives may be needed to ensure veterans understand the resources available to address MST-related mental and physical health problems through the VA.

18 Article A model comparison approach to trauma-related guilt as a mediator of the relationship between PTSD symptoms and suicidal ideation among veterans. 2017

Cunningham, Katherine C / Farmer, Chloe / LoSavio, Stefanie T / Dennis, Paul A / Clancy, Carolina P / Hertzberg, Michael A / Collie, Claire F / Calhoun, Patrick S / Beckham, Jean C. ·Durham Veterans Affairs Medical Center, Durham, NC, USA; The VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA. Electronic address: katherine-cunningham@utulsa.ed. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA. · Durham Veterans Affairs Medical Center, Durham, NC, USA. · Durham Veterans Affairs Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA. ·J Affect Disord · Pubmed #28654847.

ABSTRACT: BACKGROUND: Suicidal ideation (SI) is a serious issue affecting U.S. veterans, and those with posttraumatic stress disorder (PTSD) are at an especially high risk of SI. Guilt has been associated with both PTSD and SI and may therefore be an important link between these constructs. METHODS: The present study compared models of trauma-related guilt and used path analysis to examine the direct and indirect effects of PTSD and trauma-related guilt on SI among a sample of 988 veterans receiving outpatient PTSD treatment at a Veterans Affairs (VA) specialty clinic. RESULTS: Results showed that a model of trauma-related guilt including guilt-cognitions and global guilt (but not distress) provided the best model fit for the data. PTSD and trauma-related guilt had direct effects on SI, and PTSD exhibited indirect effects on SI via trauma-related guilt. LIMITATIONS: The use of cross-sectional data limits the ability to make causal inferences. A treatment-seeking sample composed primarily of Vietnam veterans limits generalizability to other populations. CONCLUSIONS: Trauma-related guilt, particularly guilt cognitions, may be an effective point of intervention to help reduce SI among veterans with PTSD. This is an important area of inquiry, and suggestions for future research are discussed.

19 Article Trauma and Autonomic Dysregulation: Episodic-Versus Systemic-Negative Affect Underlying Cardiovascular Risk in Posttraumatic Stress Disorder. 2017

Dennis, Paul A / Kimbrel, Nathan A / Sherwood, Andrew / Calhoun, Patrick S / Watkins, Lana L / Dennis, Michelle F / Beckham, Jean C. ·From the Durham Veterans Affairs Medical Center (P.A. Dennis, Kimbrel, Calhoun, M.F. Dennis, Beckham), Durham, NC · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center (P.A. Dennis, Kimbrel, Sherwood, Calhoun, Watkins, Beckham), Durham, NC · Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham (Kimbrel, Calhoun, Beckham), NC · and Durham Veterans Affairs Center for Health Services Research in Primary Care (Calhoun), Durham, NC. ·Psychosom Med · Pubmed #28570433.

ABSTRACT: OBJECTIVE: Posttraumatic stress disorder (PTSD) has been linked to elevated heart rate (HR) and reduced heart rate variability (HRV) in cross-sectional research. Recent evidence suggests that this link may be driven by individual differences in autonomic arousal associated with momentary negative affect (NA). Using ecological momentary assessment (EMA) of NA and minute-to-minute HR/HRV monitoring, we examined whether NA-related HR/HRV mediated the association of PTSD symptom severity with 24-hour HRV and endothelial functioning. METHODS: One hundred ninety-seven young adults (18-39 years), 93 with PTSD, underwent 1 day of Holter monitoring while concurrently reporting NA levels via EMA. Two noninvasive measures of endothelial functioning-flow-mediated dilation and hyperemic flow-were also collected. Multilevel modeling was used to assess the associations of momentary NA with HR and low- and high-frequency HRV during the 5-minute intervals after each EMA reading. Latent variable modeling was then used to determine whether individual differences in these associations mediated the association of PTSD symptom severity with 24-hour HRV, flow-mediated dilation, and hyperemic flow. RESULTS: PTSD symptom severity was positively associated with NA-related autonomic arousal (β = .21, p < .001), which significantly mediated the association of PTSD symptom severity with 24-hour HRV and hyperemic flow, accounting for 62% and 34% of their associations, respectively, while overshadowing the influence of smoking, lifetime alcohol dependence, sleep duration, mean NA, and episodes of acute NA. CONCLUSIONS: Results suggest that NA-related autonomic arousal is both a primary factor driving cardiovascular risk in PTSD and a potential point of intervention.

20 Article ADHD and nonsuicidal self-injury in male veterans with and without PTSD. 2017

Kimbrel, Nathan A / Wilson, Laura C / Mitchell, John T / Meyer, Eric C / DeBeer, Bryann B / Silvia, Paul J / Gratz, Kim L / Calhoun, Patrick S / Beckham, Jean C / Morissette, Sandra B. ·VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Durham Veterans Affairs Medical Center, Durham, NC, USA; Duke University Medical Center, Durham, NC, USA. Electronic address: Nathan.Kimbrel@va.gov. · University of Mary Washington, Fredericksburg, Virginia, USA. · Duke University Medical Center, Durham, NC, USA. · VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; Central Texas Veterans Health Care System, Temple, TX, USA; Texas A&M University Health Science Center, College Station, TX, USA. · University of North Carolina at Greensboro, Greensboro, NC, USA. · University of Toledo, Toledo, OH, USA. · VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Durham Veterans Affairs Medical Center, Durham, NC, USA; Duke University Medical Center, Durham, NC, USA; VA Center for Health Services Research in Primary Care, Durham, NC, USA. · VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Durham Veterans Affairs Medical Center, Durham, NC, USA; Duke University Medical Center, Durham, NC, USA. · The University of Texas at San Antonio, San Antonio, TX, USA. ·Psychiatry Res · Pubmed #28279896.

ABSTRACT: The objective of the present research was to examine the association between ADHD symptoms and nonsuicidal self-injury (NSSI) in male Iraq/Afghanistan-era veterans with and without PTSD. Approximately 25% of veterans screened positive for clinically-significant levels of ADHD. Male veterans with PTSD were significantly more likely to report ADHD symptoms than male veterans without PTSD. In addition, as expected, ADHD was strongly associated with NSSI, even after accounting for the effects of demographic variables, PTSD, depression, and alcohol use disorder. Future work aimed at replicating and extending these findings in longitudinal studies of veterans is needed.

21 Article Cannabis use disorder and suicide attempts in Iraq/Afghanistan-era veterans. 2017

Kimbrel, Nathan A / Newins, Amie R / Dedert, Eric A / Van Voorhees, Elizabeth E / Elbogen, Eric B / Naylor, Jennifer C / Ryan Wagner, H / Brancu, Mira / Anonymous6870894 / Beckham, Jean C / Calhoun, Patrick S. ·Durham Veterans Affairs Medical Center, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Duke University Medical Center, Durham, NC, USA. Electronic address: Nathan.Kimbrel@va.gov. · University of Central Florida, Orlando, FL, USA. · Durham Veterans Affairs Medical Center, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Duke University Medical Center, Durham, NC, USA. · VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA. · Durham Veterans Affairs Medical Center, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Duke University Medical Center, Durham, NC, USA; VA Center for Health Services Research in Primary Care, Durham, NC, USA. ·J Psychiatr Res · Pubmed #28129565.

ABSTRACT: The objective of the present research was to examine the association between lifetime cannabis use disorder (CUD), current suicidal ideation, and lifetime history of suicide attempts in a large and diverse sample of Iraq/Afghanistan-era veterans (N = 3233) using a battery of well-validated instruments. As expected, CUD was associated with both current suicidal ideation (OR = 1.683, p = 0.008) and lifetime suicide attempts (OR = 2.306, p < 0.0001), even after accounting for the effects of sex, posttraumatic stress disorder, depression, alcohol use disorder, non-cannabis drug use disorder, history of childhood sexual abuse, and combat exposure. Thus, the findings from the present study suggest that CUD may be a unique predictor of suicide attempts among Iraq/Afghanistan-era veterans; however, a significant limitation of the present study was its cross-sectional design. Prospective research aimed at understanding the complex relationship between CUD, mental health problems, and suicidal behavior among veterans is clearly needed at the present time.

22 Article An Investigation of Treatment Engagement Among Returning Veterans With Problematic Anger. 2017

Dillon, Kirsten H / Crawford, Eric F / Kudler, Harold / Straits-Troster, Kristy A / Elbogen, Eric B / Calhoun, Patrick S. ·*Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC; †Sheridan VA Medical Center, Sheridan, WY; ‡VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center; §Phoenix VA Healthcare System, Phoenix, AZ; and ∥Department of Psychiatry, University of North Carolina, Chapel Hill, NC. ·J Nerv Ment Dis · Pubmed #28098580.

ABSTRACT: Anger is a commonly reported problem among returning veterans, yet little attention has been devoted to studying treatment engagement among veterans who report anger problems but do not have posttraumatic stress disorder (PTSD). This study compares Iraq-Afghanistan veterans with anger/no PTSD (n = 159) to others reporting significant PTSD symptoms (n = 285) and those reporting neither anger nor PTSD (n = 716) on rates of treatment utilization, perceived barriers to treatment, and preferences for care. Relative to the PTSD group, the anger/no-PTSD group was significantly less likely to have received mental health treatment in the last year, despite endorsing barriers to treatment at a lower rate. Furthermore, the anger/no-PTSD group endorsed fewer preferences than the PTSD group. Results suggest that the anger/no-PTSD group is a unique subgroup that may be less likely to identify a need for treatment. Implications are discussed.

23 Article Nonsuicidal self-injury and interpersonal violence in U.S. veterans seeking help for posttraumatic stress disorder. 2017

Calhoun, Patrick S / Van Voorhees, Elizabeth E / Elbogen, Eric B / Dedert, Eric A / Clancy, Carolina P / Hair, Lauren P / Hertzberg, Michael / Beckham, Jean C / Kimbrel, Nathan A. ·VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Center for Health Services Research in Primary Care, Durham VA Medical Center, NC, USA. Electronic address: patrick.calhoun2@va.gov. · Durham VA Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA. · Durham VA Medical Center, Durham, NC, USA. · VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Center for Health Services Research in Primary Care, Durham VA Medical Center, NC, USA. · VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA. ·Psychiatry Res · Pubmed #27930966.

ABSTRACT: Nonsuicidal self-injury (NSSI) has been defined as deliberately damaging one's body tissue without conscious suicidal intent. NSSI is a robust predictor of suicidal ideation and attempts in adults. While NSSI has been associated with other-directed violence in adolescent populations, the link between NSSI and interpersonal violence in adults is less clear. The current study examined the cross-sectional relationship between NSSI and past-year interpersonal violence among 729 help-seeking veterans with posttraumatic stress disorder (PTSD). Veterans who reported a recent history of engaging in cutting, hitting, or burning themselves were significantly more likely to report making violent threats and engaging in violent acts, including the use of a knife or gun, in the past year than veterans without NSSI. NSSI was uniquely associated with interpersonal violence after controlling for a variety of dispositional, historical, contextual, and clinical risk factors for violence, including age, race, socio-economic status, marital status, employment status, combat exposure, alcohol misuse, depression, PTSD symptom severity, and reported difficulty controlling violence. These findings suggest that clinicians working with veterans with PTSD should review NSSI history when conducting a risk assessment of violence.

24 Article A Preliminary Investigation of a Relapse Prevention Mobile Application to Maintain Smoking Abstinence Among Individuals With Posttraumatic Stress Disorder. 2017

Hicks, Terrell A / Thomas, Shaun P / Wilson, Sarah M / Calhoun, Patrick S / Kuhn, Eric R / Beckham, Jean C. ·a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , North Carolina , USA. · b Durham Veterans Affairs (VA) Medical Center , Durham , North Carolina , USA. · c VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center , Durham , North Carolina , USA. · d Center for Health Services Research in Primary Care, Durham VA Medical Center , Durham , North Carolina , USA. · e VA National Center for PTSD , Menlo Park , California , USA. · f Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA. ·J Dual Diagn · Pubmed #27918881.

ABSTRACT: OBJECTIVES: Smokers with posttraumatic stress disorder (PTSD) have increased difficulty achieving and maintaining abstinence. Contingency management approaches to smoking cessation interventions have demonstrated short-term efficacy but are limited by high rates of relapse. The goal of this pilot study was to evaluate the usability and feasibility of a smartphone-based smoking cessation application (Stay Quit Coach) designed to prevent relapse among individuals with PTSD. METHODS: Smokers (N = 11) were randomized to (1) QUIT4EVER, an intervention combining mobile contingency management smoking cessation counseling and medications, and Stay Quit Coach or (2) a contact control condition that was identical to QUIT4EVER except Stay Quit Coach was not included. The primary outcome was prolonged smoking abstinence. RESULTS: Among those queried during the follow-up periods, average Stay Quit Coach helpfulness ratings were high and ranged from 7.25 to 10 on a 10-point Likert scale (with higher scores corresponding to greater helpfulness). The Stay Quit Coach was rated by participants as being most effective at helping to quit smoking, helping to remain quit, and providing support and relevant information about quitting. Among the three quitters in the QUIT4EVER group, all reported abstinence at 3 and 6 months; however, abstinence was only bioverified for one quitter at 6 months. Among the four quitters in the contact control condition group, three reported abstinence at 3 and 6 months, but abstinence was not confirmed by bioverification. CONCLUSIONS: Smokers with PTSD express interest in and helpfulness of Stay Quit Coach for remaining abstinent after a quit attempt. Combined use of mobile contingency management and Stay Quit Coach is a feasible and acceptable adjunctive smoking cessation treatment for reducing smoking among smokers with PTSD. Adequately powered clinical trials are needed to demonstrate the long-term efficacy of this combined approach to smoking cessation. This study [Use of Technological Advances to Prevent Smoking Relapse among Smokers with PTSD (QUIT4EVER)] was registered on www.clinicaltrials.gov . clinicaltrials.gov identifier: NCT01990079.

25 Article Moral transgression during the Vietnam War: a path analysis of the psychological impact of veterans' involvement in wartime atrocities. 2017

Dennis, Paul A / Dennis, Nora M / Van Voorhees, Elizabeth E / Calhoun, Patrick S / Dennis, Michelle F / Beckham, Jean C. ·a Durham Veterans Affairs Medical Center , Durham , NC , USA. · b Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , NC , USA. · c Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center , Durham , NC , USA. · d Veterans Affairs Center for Health Services Research in Primary Care , Durham , NC , USA. ·Anxiety Stress Coping · Pubmed #27580161.

ABSTRACT: BACKGROUND AND OBJECTIVES: Involvement in wartime combat often conveys a number of deleterious outcomes, including posttraumatic stress disorder (PTSD), depression, hostility, aggression, and suicidal ideation. Less studied is the effect of engagement in wartime atrocities, including witnessing and perpetrating abusive violence. DESIGN AND METHODS: This study employed path analysis to examine the direct effects of involvement in wartime atrocities on hostility, aggression, depression, and suicidal ideation independent of combat exposure, as well as the indirect effects via guilt and PTSD symptom severity among 603 help-seeking male Vietnam War veterans. RESULTS: Involvement in wartime atrocities was predictive of increased guilt, PTSD severity, hostility, aggression, depressive symptoms, and suicidal ideation after controlling for overall combat exposure. Combat-related guilt played a minor role in mediating the effect of atrocity involvement on depression and suicidal ideation. PTSD severity had a larger mediational effect. However, it still accounted for less than half of the total effect of involvement in wartime atrocities on hostility, aggression, and suicidal ideation. CONCLUSIONS: These findings highlight the heightened risk conveyed by involvement in wartime atrocities and suggest that the psychological sequelae experienced following atrocity involvement may extend well beyond guilt and PTSD.

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