Carissa van den Berk-Clark

Assessment of a postdeployment Yellow Ribbon Reintegration Program for National Guard members and supporters.

The Yellow Ribbon Reintegration Program (YRRP) was created to meet the needs of National Guard members and their families throughout the deployment cycle. This study examined the perceived utility of the YRRPs delivery of information and assistance during the postdeployment reintegration period by National Guard members and accompanying supporters who were mostly spouses. Over 22 months, from 10 YRRP events, 683 service members and 411 supporters completed questionnaires immediately after the YRRP. We analyzed questions on information and avenues for help, timeliness and concerns related to education, employment, legal, family, and health. Service members and supporters most often endorsed information delivery on education being met (76.8% and 78.2%, respectively) and were least likely to endorse legal information delivery (63.5% and 60%, respectively). Significantly more supporters than service members (p < 0.0001) reported that the YRRP was the first time they learned of available services across all domains. Service members were significantly more likely than supporters to report concerns about education, employment, and health, while supporters were significantly more likely to report concerns about family. Results suggest the YRRP fills gaps in supporter knowledge and provides needed information and resources to most National Guard families 2 to 4 months after a deployment.

Elderly Homeless Veterans in Los Angeles: Chronicity and Precipitants of Homelessness

OBJECTIVES We compared the characteristics of chronically homeless and acutely homeless elderly veterans to better understand precipitants of homelessness. METHODS We conducted interviews with 33 chronically and 26 acutely homeless veterans aged 65 years and older receiving transitional housing services in Los Angeles, California, between 2003 and 2005. We asked questions regarding their sociodemographic characteristics and other social status measures. Other precipitants of homelessness were acquired via observation and open-ended and structured questions. RESULTS Both veterans groups were more similar than different, with substantial levels of physical, psychiatric, and social impairment. They differed significantly in homelessness history, with chronically homeless veterans having more homelessness episodes and more total time homeless. They were also less educated and had smaller social networks. In response to open-ended questioning, elderly homeless veterans revealed how health and substance use issues interacted with loss of social support and eviction to exacerbate homelessness. CONCLUSIONS Assessment of a range of factors is needed to address risk factors and events leading to homelessness. Further research with larger samples is needed to confirm the characteristics and needs of the elderly homeless veteran population.

Male, But Not Female, Alcohol-Dependent African Americans Discount Delayed Gains More Steeply than Propensity-Score Matched Controls

RationaleAlcohol dependence is known to be associated with steep discounting of delayed rewards, but its relation to the discounting of delayed losses and probabilistic rewards is unclear. Moreover, patterns of alcohol consumption vary considerably between communities, but previous research has not examined the relation between discounting and alcohol dependence in low-income African Americans.ObjectivesThe goal of the present study was to determine whether low-income, alcohol-dependent African Americans differ from controls in the degree to which they discount delayed rewards, delayed losses, or probabilistic rewards.MethodsAfrican–American participants, both cases and controls, were recruited from the same low-income neighborhoods, and propensity-score matching was used to further control for demographic differences. Participants performed three tasks that assessed their discounting of hypothetical monetary outcomes: delayed rewards, delayed losses, and probabilistic rewards.ResultsAlcohol-dependent cases discounted delayed gains, but not delayed losses or probabilistic gains, more steeply than their matched controls. The difference in discounting of delayed gains was localized to the male cases, whose discounting was steeper than either the male controls or the female cases; no gender difference was observed between male and female controls.ConclusionsThe present results extend findings regarding discounting by substance abusers to a previously unstudied group, low-income African Americans, and suggest that in this group at least, alcohol dependence, particularly in males, may be more a reflection of choosing immediate rewards than of ignoring their delayed negative consequences.

Deconstructing Neoliberal Community Development Approaches and a Case for the Solidarity Economy

The solidarity economy movement is a burgeoning global justice movement that focuses on economic justice, sustainability, and democratic processes. Social workers care about alleviating poverty, but they generally adhere to neoliberal strategies and ignore transformative approaches to economic justice such as solidarity economics. Recent neoliberal community-development efforts center on approaches such as asset development, human capital building, and social capital enhancement. Solidarity economy seeks to boost economic and social development that promotes shared ownership, sustainable production/consumption, and fair distribution. In this article, we launch a critique of current approaches to community development and argue for a solidarity economy approach.

Provider-agency fit in substance abuse treatment organizations: implications for learning climate, morale, and evidence-based practice implementation

BackgroundSubstance abuse agencies have been slow to adopt and implement evidence-based practices (EBPs), due in part to poor provider morale and organizational climates that are not conducive to successful learning and integration of these practices. Person-organization fit theory suggests that alignment, or fit, between provider- and agency-level characteristics regarding the implementation of EBPs may influence provider morale and organizational learning climate and, thus, implementation success. The current study hypothesized that discrepancies, or lack of fit, between provider- and agency-level contextual factors would negatively predict provider morale and organizational learning climate, outcomes shown to be associated with successful EBP implementation.MethodsDirect service providers (n = 120) from four substance abuse treatment agencies responded to a survey involving provider morale, organizational learning climate, agency expectations for EBP use, agency resources for EBP use, and provider attitudes towards EBP use. Difference scores between combinations of provider- and agency-level factors were computed to model provider-agency fit. Quadratic regression analyses were conducted to more adequately and comprehensively model the level of the dependent variables across the entire “fit continuum”.ResultsDiscrepancies, or misfit, between agency expectations and provider attitudes and between agency resources and provider attitudes were associated with poorer provider morale and weaker organizational learning climate. For all hypotheses, the curvilinear model of provider-agency discrepancies significantly predicted provider morale and organizational learning climate, indicating that both directions of misfit (provider factors more favorable than agency factors, and vice-versa) were detrimental to morale and climate. However, outcomes were most negative when providers viewed EBPs favorably, but perceived that agency expectations and resources were less supportive of EBP use.ConclusionsThe current research benefits from a strong theoretical framework, consistent findings, and significant practical implications for substance abuse treatment agencies. Comprehensive attempts to strengthen outcomes related to EBP implementation must consider both provider- and agency-level characteristics regarding EBP use. Organizational efforts to more closely align provider attitudes and agency priorities will likely constitute a key strategy in fostering the implementation of EBPs in substance abuse treatment organizations.

Association between posttraumatic stress disorder and lack of exercise, poor diet, obesity, and co-occuring smoking: A systematic review and meta-analysis.

Objectives: Research has shown that posttraumatic stress disorder (PTSD) increases the risk of development of cardiometabolic disease (CMD) including cardiovascular disease and diabetes. Whether PTSD is also associated with behavioral risk factors (e.g., diet, exercise, smoking and obesity) for CMD, is less clear. Methods: PubMed, Web of Science, and Scopus databases were searched to obtain papers published between 1980–2016. Studies were reviewed for quality using the Quality of Cohort screen. Significance values, odds ratios (OR), 95% confidence intervals (CI), and tests of homogeneity of variance were calculated. Principal Findings: A total of 1,349 studies were identified from our search and 29 studies met all eligibility criteria. Individuals with PTSD were 5% less likely to have healthy diets (pooled adjusted OR = 0.95; 95% CI: 0.92, 0.98), 9% less likely to engage in physical activity (pooled adjusted OR = 0.91; 95% CI: 0.88, 0.93), 31% more likely to be obese (pooled adjusted OR = 1.31; 95% CI:1.25, 1.38), and about 22% more likely to be current smokers (pooled adjusted OR = 1.22; 95% CI: 1.19, 1.26), than individuals without PTSD. Conclusions: Evidence shows PTSD is associated with reduced healthy eating and physical activity, and increased obesity and smoking. The well-established association between PTSD and metabolic and cardiovascular disease may be partly due to poor diet, sedentary lifestyle, high prevalence of obesity, and co-occurring smoking in this population. The well-established association of PTSD with CMD is likely due in part to poor health behaviors in this patient population.

Differences in the Association between Depression and Opioid Misuse in Chronic Low Back Pain versus Chronic Pain at Other Locations

Patients with chronic pain and depression are more likely to develop opioid abuse compared to patients without depression. It is not known if this association differs by pain location. We compared the strength of association between depression and opioid misuse in patients with chronic low back pain (CLBP) vs. chronic pain of other location (CPOL). Chart abstracted data was obtained from 166 patients seeking care in a family medicine clinic. Depression was measured by the PHQ-9 and opioid misuse was measured using the Current Opioid Misuse Measure. Pain severity and interference questions came from the Brief Pain Inventory. Cross-tabulations were computed to measure the association between depression and opioid misuse stratified on pain location. Exploratory logistic regression modeled the association between depression and opioid misuse after adjusting for pain location and pain severity and interference. Depression was significantly associated with opioid misuse in CPOL but not in CLBP. Regression results indicate pain interference partly accounts for the depression–opioid misuse association. These preliminary results from a small patient sample suggest depression may co-occur with opioid misuse more often in CPOL than in CLBP. Further research is needed to compare this comorbidity in specific pain diagnoses such as arthritis, fibromyalgia and CLBP.

Trust in Health Care Providers: Factors Predicting Trust among Homeless Veterans over Time

We examined whether a combination of predisposing, enabling, need, and primary care experience variables would predict trust in medical health care providers for homeless veterans over 18 months. Linear mixed model analysis indicated that, among these variables, race, social support, service-connected disability status, and satisfaction and continuity with providers predicted trust in provider over time. Trust in providers improved during the initial stages of the relationship between patient and provider and then declined to slightly below baseline levels over time. Further research is needed to determine generalizability and effects of provider trust on patient health care status over longer periods of time.

The Role of Obesity in the Association Between Posttraumatic Stress Disorder and Incident Diabetes

Importance Posttraumatic stress disorder (PTSD) is associated with an increased risk of type 2 diabetes mellitus (T2DM). Existing literature has adjusted for obesity in combination with other confounders, which does not allow estimating the contribution of obesity alone on the association of PTSD with incident T2DM. Objective The current study was designed to determine if obesity accounted for the association between PTSD and incident T2DM. Design, Setting, and Participants This cohort study used data from Veterans Health Administration medical records collected from patients with PTSD and without PTSD from 2008 to 2015. Patients were eligible for study inclusion if they were free of prevalent PTSD and T2DM for 12 months prior to index date. To estimate whether the association of PTSD and incident T2DM remained independent of obesity, Cox proportional hazard models were computed before and after adding obesity to the model and then further expanded by adding psychiatric disorders, psychotropic medications, physical conditions, smoking status, and demographics. Additional Cox models were computed to compare the risk of incident T2DM in patients with PTSD with and without obesity. Data analysis was completed from February 2018 to May 2018. Exposures Two International Classification of Diseases, Ninth Revision (ICD-9) codes for PTSD in the same 12 months and obesity, defined by a body mass index of 30 or more or an ICD-9 code for obesity. Main Outcomes and Measures Incident T2DM, as defined by ICD-9 codes. Results Among 2204 patients without PTSD, the mean (SD) age was 47.7 (14.3) years; 1860 (84.4%) were men, 1426 (64.7%) were white, and 956 (43.4%) were married. Among 3450 patients with PTSD, the mean (SD) age was 42.8 (14.2) years; 2983 (86.5%) were men, 2238 (64.9%) were white, and 1525 (44.2%) were married. The age-adjusted association between PTSD and incident T2DM was significant (hazard ratio [HR], 1.33 [95% CI, 1.08-1.64]; P = .01), and after adding obesity to the model, this association was reduced and no longer significant (HR, 1.16 [95% CI, 0.94-1.43]; P = .18). Results of the full model, which included additional covariate adjustment, revealed no association between PTSD and incident T2DM (HR, 0.84 [95% CI, 0.64-1.10]; P = .19). Among patients with PTSD with obesity, the age-adjusted incidence of T2DM was 21.0 per 1000 person-years vs 5.8 per 1000 person-years in patients without obesity. In patients without PTSD, it was 21.2 per 1000 person-years for patients with obesity vs 6.4 per 1000 person-years in those without obesity. Conclusions and Relevance In this study of patients who use the Veterans Health Administration for health care, obesity moderated the association between PTSD and incident T2DM. The incidence of T2DM in patients with PTSD who are not obese is similar to the national incidence rate in the United States. These results suggest PTSD is not likely to have a causal association with incident T2DM. Future research is needed to determine if PTSD remission can lead to weight loss and reduced T2DM incidence.

Mental Health Help Seeking Among Traumatized Individuals: A Systematic Review of Studies Assessing the Role of Substance Use and Abuse.

Objective: Prior research has suggested that competing neurobehavioral decision-making processes might affect health outcomes among traumatized populations. Regulatory imbalances to impulsive and executive decision systems are affected by high levels of stress, including stress resulting from traumatic events. Such regulatory imbalances have been associated with addictive behaviors. However, it is not well known whether addictive behavior increases or decreases the likelihood of utilization of behavioral health services among traumatized populations. The aim of this study is to systematically review mental health utilization studies targeting traumatized populations to determine the direction of association between substance use and behavioral health utilization. Method: Databases of literature were searched in a systematic manner, and 37 relevant studies were recovered and analyzed. Findings: Of the 37 relevant studies that included addictive behaviors as a predictor of utilization, 16 showed a positive significant relationship and 6 showed a negative significant relationship. Studies showing a negative significant relationship used younger samples with more recent trauma exposure. Conclusion: Studies have shown that for the most part, substance abuse increases the likelihood of utilization, except among younger populations with more recent trauma. Longitudinal studies that access how utilization evolves over time among traumatized populations and interacts with posttraumatic stress disorder (PTSD) and substance abuse severity are necessary to better understand how decision-making processes of traumatized individuals may increase the likelihood of chronic PTSD.OBJECTIVE: Prior research has suggested that competing neurobehavioral decision-making processes might affect health outcomes among traumatized populations. Regulatory imbalances to impulsive and executive decision systems are affected by high levels of stress, including stress resulting from traumatic events. Such regulatory imbalances have been associated with addictive behaviors. However, it is not well known whether addictive behavior increases or decreases the likelihood of utilization of behavioral health services among traumatized populations. The aim of this study is to systematically review mental health utilization studies targeting traumatized populations to determine the direction of association between substance use and behavioral health utilization. METHOD: Databases of literature were searched in a systematic manner, and 37 relevant studies were recovered and analyzed. FINDINGS: Of the 37 relevant studies that included addictive behaviors as a predictor of utilization, 16 showed a positive significant relationship and 6 showed a negative significant relationship. Studies showing a negative significant relationship used younger samples with more recent trauma exposure. CONCLUSION: Studies have shown that for the most part, substance abuse increases the likelihood of utilization, except among younger populations with more recent trauma. Longitudinal studies that access how utilization evolves over time among traumatized populations and interacts with posttraumatic stress disorder (PTSD) and substance abuse severity are necessary to better understand how decision-making processes of traumatized individuals may increase the likelihood of chronic PTSD. Language: en