Meredith E. Charney

Mental Health Service Utilization of Somali Adolescents: Religion, Community, and School as Gateways to Healing

This mixed-method study examines the utility of the Gateway Provider Model (GPM) in understanding service utilization and pathways to help for Somali refugee adolescents. Somali adolescents living in the Northeastern United States, and their caregivers, were interviewed. Results revealed low rates of use of mental health services. However other sources of help, such as religious and school personnel, were accessed more frequently. The GPM provides a helpful model for understanding refugee youth access to services, and an elaborated model is presented showing how existing pathways to help could be built upon to improve refugee youth access to services.

PTSD and TBI co-morbidity: Scope, clinical presentation and treatment options

Abstract Primary objective: To summarize the literature on post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) and their co-morbidity, focusing on diagnosis, clinical symptoms and treatment issues relevant to the clinician. Research design: Review of the literature. Methods and procedures: Pubmed searches were performed using the terms post-traumatic stress disorder, traumatic brain injury, sleep, cognitive, depression, anxiety, treatment and combinations of these terms. Those articles relevant to the objective were included. Main outcomes and results: This study presents pathophysiological, neuroimaging and clinical data on co-morbid PTSD and TBI. It reviews associated conditions, emphasizing the impact of cognitive and sleep problems. It summarizes the emerging literature on treatment effectiveness for co-morbid PTSD and TBI, including psychotherapy, pharmacotherapy and cognitive rehabilitation. Conclusions: Both PTSD and TBI commonly occur in the general population, both share some pathophysiological characteristics and both are associated with cognitive impairment and sleep disruption. PTSD and TBI present with a number of overlapping symptoms, which can lead to over-diagnosis or misdiagnosis. Both conditions are associated with co-morbidities important in diagnosis and treatment planning. More research is needed to elucidate what treatments are effective in PTSD and TBI co-morbidity and on factors predictive of treatment success.

Military unit support, postdeployment social support, and PTSD symptoms among active duty and National Guard soldiers deployed to Iraq.

Research suggests that military unit support and community postdeployment social support are associated with fewer PTSD symptoms following military deployment. This study extended prior research by examining the associations among predeployment unit support and PTSD symptoms before Iraq deployment as well as unit support, PTSD symptoms, and postdeployment social support after deployment among 835 U.S. Army and 173 National Guard soldiers. Multiple regression analyses indicated that predeployment unit support was not significantly associated with postdeployment PTSD severity in either group of soldiers, whereas higher unit support during deployment was significantly associated with lower postdeployment PTSD severity among active duty soldiers only. Among both groups, higher levels of postdeployment social support were associated with lower levels of postdeployment PTSD symptom severity. These findings suggest that postdeployment social support is a particularly strong buffer against postdeployment PTSD symptoms among both groups of soldiers whereas the effects of unit support may be limited.

Psychometric analyses of the Clinician-Administered PTSD Scale (CAPS)--Bosnian Translation.

Methods for assessing psychological distress in culturally diverse populations are not firmly established. This study was designed to examine the psychometric properties of the Bosnian translation of the Clinician-Administered PTSD Scale (CAPS; D. D. Blake, F. W. Weathers, L. M. Nagy, D. Kaloupek, G. Klauminzer, D. Charney, et al., 1995) in a Bosnian refugee sample. The authors interviewed 115 help-seeking Bosnian refugees with the CAPS-Bosnian translation to examine its internal consistency and convergent validity, and to provide an assessment of its factor structure. This study demonstrated optimal fit with a 2-factor model of posttraumatic stress disorder (PTSD); the authors also found high reliability with a coefficient alpha of 0.92 and strong convergent validity with instruments measuring depression, anxiety, and levels of psychosocial functioning. Future directions for the assessment of PTSD in cross-cultural populations are discussed.

The Influence of Anxiety Sensitivity on a Wish to Die in Complicated Grief.

Abstract Individuals with complicated grief are at elevated risk of suicidal thoughts. Anxiety sensitivity has recently emerged as a risk factor of suicide. This study aimed to investigate a possible association between anxiety sensitivity and a wish to die in individuals with complicated grief. Participants were evaluated for participation in a treatment study and completed an ancillary questionnaire-based study. Participants were 51 bereaved adults evaluated (age: mean, 54 [SD, 13.6] years; 78% [n = 40] women). Logistic regression was used to examine the relationship between anxiety sensitivity and a wish to die. Overall, anxiety sensitivity was associated with a wish to die at the level of a medium effect size, although it did not reach statistical significance. The anxiety sensitivity social concerns subscale was significantly associated with a wish to die. These findings add to a growing literature implicating anxiety sensitivity in reporting a wish to die.

The loss of a fellow service member: Complicated grief in post-9/11 service members and veterans with combat-related posttraumatic stress disorder

Bereavement is a potent and highly prevalent stressor among service members and veterans. However, the psychological consequences of bereavement, including complicated grief (CG), have been minimally examined. Loss was assessed in 204 post‐9/11, when service members and veterans with combat‐related posttraumatic stress disorder (PTSD) took part in a multicenter treatment study. Those who reported the loss of an important person completed the inventory of complicated grief (ICG; n = 160). Over three quarters (79.41%) of the sample reported an important lifetime loss, with close to half (47.06%) reporting the loss of a fellow service member (FSM). The prevalence of CG was 24.75% overall, and nearly one third (31.25%) among the bereaved. CG was more prevalent among veterans who lost a fellow service member (FSM) (41.05%, n = 39) compared to those bereaved who did not (16.92%, n = 11; OR = 3.41, 95% CI: 1.59, 7.36). CG was associated with significantly greater PTSD severity, functional impairment, trauma‐related guilt, and lifetime suicide attempts. Complicated grief was prevalent and associated with adverse psychosocial outcomes in veterans and service members with combat‐related PTSD. Clinicians working with this population should inquire about bereavement, including loss of a FSM, and screen for CG. Additional research examining CG in this population is needed.

Five-factor model in bereaved adults with and without complicated grief

ABSTRACT Knowledge about what psychological characteristics underlie complicated grief (CG) is limited. The current study examined the five-factor personality traits in 81 bereaved adults with (n = 51) and without (n = 30) CG. A trained doctoral-level clinician evaluated participants using a structured, diagnostic psychiatric interview, and they completed self-report measures of grief and personality. A multiple regression model indicated that higher levels of neuroticism were associated with greater CG symptom severity, implicating neuroticism in the development of CG. Future prospective studies confirming it as a risk factor for the development of CG are warranted.

Evaluating Strategies for Combining Pharmacotherapy with Cognitive Behavioral Therapy

This chapter provides an overview of the rationale for combining cognitive-behavioral therapies and pharmacologic treatments. Relevant research literature is presented across a range of disorders including anxiety and related disorders, mood disorders, eating disorders, schizophrenia, and substance use disorders. In addition, practical considerations are discussed related to how the combination approach may be utilized and applied in clinical practice including a case example to highlight how a combination approach may be completed successfully in a clinical setting. Finally, novel treatment approaches are discussed as a means of highlighting future directions for the use of combined treatments.

PTSD-War Related

Cognitive-behavioral treatments show great promise for the treatment of PTSD secondary to war experiences. Clinical interventions that involve combinations of CBT techniques such as exposure therapy, AMT, and cognitive therapy need to be examined in randomized clinical trials both alone and in conjunction with pharmacological approaches. No such trials currently exist for PTSD secondary to any type of traumatic event. There is a clear need and a demand for these clinical trials.