Jonathan D. Green

Longitudinal associations between post-traumatic stress disorder and metabolic syndrome severity.

BACKGROUND Post-traumatic stress disorder (PTSD) is associated with elevated risk for metabolic syndrome (MetS). However, the direction of this association is not yet established, as most prior studies employed cross-sectional designs. The primary goal of this study was to evaluate bidirectional associations between PTSD and MetS using a longitudinal design. METHOD A total of 1355 male and female veterans of the conflicts in Iraq and Afghanistan underwent PTSD diagnostic assessments and their biometric profiles pertaining to MetS were extracted from the electronic medical record at two time points (spanning ~2.5 years, n = 971 at time 2). RESULTS The prevalence of MetS among veterans with PTSD was just under 40% at both time points and was significantly greater than that for veterans without PTSD; the prevalence of MetS among those with PTSD was also elevated relative to age-matched population estimates. Cross-lagged panel models revealed that PTSD severity predicted subsequent increases in MetS severity (β = 0.08, p = 0.002), after controlling for initial MetS severity, but MetS did not predict later PTSD symptoms. Logistic regression results suggested that for every 10 PTSD symptoms endorsed at time 1, the odds of a subsequent MetS diagnosis increased by 56%. CONCLUSIONS Results highlight the substantial cardiometabolic concerns of young veterans with PTSD and raise the possibility that PTSD may predispose individuals to accelerated aging, in part, manifested clinically as MetS. This demonstrates the need to identify those with PTSD at greatest risk for MetS and to develop interventions that improve both conditions.

Network models of DSM–5 posttraumatic stress disorder: Implications for ICD–11.

Recent proposals for revisions to the 11th edition of the International Classification of Diseases (ICD–11) posttraumatic stress disorder (PTSD) diagnostic criteria have argued that the current symptom constellation under the Diagnostic and Statistical Manual of Mental Disorders-5 is unwieldy and includes many symptoms that overlap with other disorders. The newly proposed criteria for the ICD–11 include only 6 symptoms. However, restricting the symptoms to those included in the ICD–11 has implications for PTSD diagnosis prevalence estimates, and it remains unclear whether these 6 symptoms are most strongly associated with a diagnosis of PTSD. Network analytic methods, which assume that psychiatric disorders are networks of interrelated symptoms, provide information regarding which symptoms are most central to a network. We estimated network models of PTSD in a national sample of veterans of the Iraq and Afghanistan wars. In the full sample, the most central symptoms were persistent negative emotional state, efforts to avoid external reminders, efforts to avoid thoughts or memories, inability to experience positive emotions, distressing dreams, and intrusive distressing thoughts or memories; that is, 3 of the 6 most central items to the network would be eliminated from the diagnosis under the current proposal for ICD–11. An empirically defined index summarizing the most central symptoms in the network performed comparably to an index reflecting the proposed ICD–11 PTSD criteria at identifying individuals with an independently assessed DSM–5 defined PTSD diagnosis. Our results highlight the symptoms most central to PTSD in this sample, which may inform future diagnostic systems and treatment.

Pilot trial of gender-based motivational interviewing for increasing mental health service use in college men.

Men are considerably less likely to seek professional and nonprofessional help for mental disorders. Prior findings indicate that adherence to masculine norms contributes to stigma about internalizing disorders and help seeking. There are currently no empirically supported interventions for increasing help seeking in men with internalizing symptoms. To address this need, we conducted a pilot study of gender-based motivational interviewing (GBMI) for men with internalizing symptoms. GBMI is a single session of assessment and feedback integrating gender-based and motivational interviewing principles (Addis, 2012). College men (N = 35) with significant internalizing symptoms and no recent help seeking were randomized to either GBMI or a no-treatment control and were followed for 2 months. GBMI had a significant effect on seeking help from parents and a trend for seeking professional help, but did not have a significant effect on seeking help from friends or partners. The size of the effect of GBMI on professional and nonprofessional help seeking ranged from small to medium. GBMI shows promise for improving mens help-seeking behaviors and warrants further development and investigation.

Mild Traumatic Brain Injury, PTSD, and Psychosocial Functioning Among Male and Female U.S. OEF/OIF Veterans.

This study examined the unique and combined relationship between mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) with psychosocial functioning in a cohort of 1,312 U.S. male and female veterans of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF) enrolled in the Veterans After-Discharge Longitudinal Registry (Project VALOR). We assessed mTBI with structured screening questions reflective of current TBI classification standards and PTSD via the SCID-IV PTSD module; all other variables were assessed by self-report questionnaires. We identified significant diagnostic group differences in psychosocial functioning for both sexes. Individuals with PTSD, with or without a history of mTBI, reported significantly worse psychosocial functioning than individuals with mTBI alone or neither mTBI nor PTSD (males, η(2) p = .11, p < .001; females, η(2) p = .14, p < .001), even after adjusting for demographics and severity of chronic pain. The results suggested that veterans experiencing PTSD, regardless of whether they had a history of mTBI, were at increased risk for long-term psychosocial impairment. Further research examining possible benefits from improved access to resources and treatment to address these needs would be valuable.

The Association Between Masculinity and Nonsuicidal Self-Injury

Several known risk factors for nonsuicidal self-injury (NSSI), such as negative emotionality and deficits in emotion skills, are also associated with masculinity. Researchers and clinicians suggest that masculine norms around emotional control and self-reliance may make men more likely to engage in self-harm. Masculinity has also been implicated as a potential risk factor for suicide and other self-damaging behaviors. However, the association between masculinity and NSSI has yet to be explored. In the current study, a sample of 912 emerging adults from two universities in the Northeastern United States completed a web-based questionnaire assessing adherence to masculine norms, engagement in NSSI, and known risk factors for NSSI (demographics and number of self-injurers known). Stronger adherence to masculine norms predicted chronic NSSI (five or more episodes throughout the life span) above and beyond other known risk factors. Adherence to masculine norms was related to methods of NSSI. Clinical implications are discussed, including discussions of masculine norms in treatment settings. Future research should examine what specific masculine norms are most closely linked to NSSI and other self-damaging behaviors.

A longitudinal study of risk factors for suicide attempts among Operation Enduring Freedom and Operation Iraqi Freedom veterans

Suicide rates among veterans have increased markedly since the onset of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF; LeardMann et al., 2013). Identification of factors with the greatest contribution to suicide risk among veterans is needed to inform risk assessment and to identify intervention targets.

Acceptance and Commitment Therapy for Depression and Anxiety

Acceptance and commitment therapy (ACT) is an evidenced-based therapy used to treat a variety of mental disorders and medical conditions, including anxiety and depression. In this article, we describe the philosophical and theoretical basis for ACT as well as the therapy itself. We then review the outcome research literature on ACT for anxiety and depression. This review indicates modest evidence supporting the use of ACT to treat anxiety and depression; and further indicates that many of the existing studies have important limitations that undermine our full confidence in inferences regarding the efficacy of ACT for anxiety and depression.

Is Suicidal Behavior in Mood Disorders Altered by Comorbid PTSD

Background: Suicide is a leading cause of death among US veterans. Associations between depression, posttraumatic stress disorder (PTSD), and suicidal behaviors have been found in this population, yet minimal research has explored how manifestations of self-injurious behavior (SIB) may vary among different diagnostic presentations. Aims: This study aimed to identify clinically useful differences in SIB among veterans who experience comorbid mood disorder and PTSD (CMP) compared with those who experience a mood disorder alone (MDA). Method: Participants were 57 US military veterans who reported an incident of intentional SIB. The semistructured Post Self-Injury/Attempted Self-Injury Debriefing Interview was used to examine characteristics of the SIB. Results: Veterans diagnosed with CMP were more likely than those with MDA to (a) report that the SIB was impulsive and (b) to be under the influence of substances at the time of self-injury. Limitations: Generalizability may be limited by small sample size and predominantly European American, male demographics. While highly relevant to routine clinical practice, caution is recommended, as study diagnoses were attained from medical records rather than structured interviews. Conclusion: Safety planning that emphasizes protection against impulsive suicide attempts (e.g., means restriction) may be especially important among veterans with comorbid mood disorder and PTSD.

The Direct and Indirect Self-Harm Inventory (DISH): A new measure for assessing high-risk and self-harm behaviors among military veterans.

Screeners in use at the Department of Veterans Affairs (VA) do not query high-risk and self-harm behaviors that are thought to be more common among veterans, especially male veterans, and may use stigmatizing language to query self-harm behaviors, resulting in underreporting. As such, many veteran’s high-risk and self-harm behaviors may go undetected. The present study outlines the development and initial validation of the Direct and Indirect Self-Harm Inventory (DISH), a measure designed to detect high-risk and self-harm behaviors thought to be more common among veterans and to avoid the use of stigmatizing language. We also examined whether, and to what degree, novel behaviors assessed on the DISH longitudinally predict future suicide-related outcomes. Seventy-eight veterans enrolled in VA care and presenting with varying degrees of suicide risk completed the DISH as part of a larger study. Participants also completed the Self-Injurious Thoughts and Behaviors Interview (SITBI; Nock, Holmberg, Photos, & Michel, 2007), a well-validated assessment of self-harm behaviors. The DISH demonstrated good convergent validity with overlapping items on the SITBI (percent agreement ranged from 66.7% to 88.9%). Participants were more likely to report high-risk and indirect self-harm behaviors, but not direct self-harm behaviors, on the DISH than on the SITBI. None of the behaviors assessed on the DISH or the SITBI predicted future suicide-related outcomes. Though additional research is needed to further validate the DISH (e.g., test–retest reliability), the present study suggests that the DISH may be an improvement over existing measures for detecting high-risk and indirect self-harm behaviors in veterans.

Examining the diagnostic utility of the DSM-5 PTSD symptoms among male and female returning veterans

Posttraumatic stress disorder (PTSD) diagnostic criteria have been criticized for including symptoms that overlap with commonly comorbid disorders, which critics argue undermines the validity of the diagnosis and inflates psychiatric comorbidity rates. In response, the upcoming 11th edition of the International Classification of Diseases (ICD‐11) will offer PTSD diagnostic criteria that are intended to promote diagnostic accuracy. However, diagnostic utility analyses have not yet assessed whether these criteria minimize diagnostic errors. The present study examined the diagnostic utility of each PTSD symptom in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM‐5) for males and females.