Stephanie Brooks Holliday

Concurrent Validity of the Defense and Veterans Pain Rating Scale in VA Outpatients.

OBJECTIVE The purpose of this report is to investigate the concurrent validity of the Defense and Veterans Pain Rating Scale (DVPRS) with other validated self-report measures in U.S. veterans. DESIGN This correlational study was conducted using two samples of outpatients at the Washington, DC Veterans Affairs Medical Center who completed self-report measures relevant to pain conditions, including pain disability, quality of life, and mental health. Study 1 and 2 consisted of n = 204 and n = 13 participants, respectively. METHODS Bivariate Spearman correlations were calculated to examine the correlation among total scores and subscale scores for each scale of interest. Multiple linear regressions were also computed in Study 1. RESULTS In Study 1, the DVPRS interference scale (DVPRS-II) was significantly correlated with the Pain Disability Questionnaire (PDQ) (ρ = 0.69, P < 0.001) and the Veterans RAND 36-item Health Survey physical and mental component scales (ρ = -0.37, P < 0.001; ρ = -0.46, P < 0.001, respectively). When controlling for sex, age, and other self-report measures, the relationship between the DVPRS-II and PDQ remained significant. In Study 2, pain interference on the DVPRS and Brief Pain Inventory were highly correlated (ρ = 0.90, P < 0.001); however, the intensity scale of each measure was also highly associated with the interference summary scores. CONCLUSIONS These findings provide preliminary evidence for the concurrent validity of the DVPRS as a brief, multidimensional measure of pain interference that make it a practical tool for use in primary care settings to assess the impact of pain on daily functioning and monitor chronic pain over time.

Depression, posttraumatic stress, and alcohol misuse in young adult veterans: the transdiagnostic role of distress tolerance

BACKGROUND Alcohol misuse is common among young adult veterans, and is commonly associated with depression and posttraumatic stress disorder (PTSD). In fact, rates of comorbid depression, PTSD, and problem drinking are high in this population. Although distress tolerance, the capacity to experience and withstand negative psychological states, has been examined as a potential transdiagnostic factor that accounts for the development of mental health disorders, problem drinking, and the comorbidity between these presenting concerns, its role has not been evaluated in a veteran population. METHODS Young adult veterans were recruited for an online survey related to alcohol use. Participants (n=783) completed self-report measures of alcohol use, depression and PTSD symptoms, and distress tolerance. Mediation models were conducted to examine whether distress tolerance mediated the relationship between (1) probable PTSD, (2) probable depression, and (3) comorbid probable PTSD and depression with alcohol misuse. Moderated mediation models were conducted to examine gender as a moderator. RESULTS Significant bivariate associations were observed among mental health symptoms, distress tolerance, and alcohol misuse. Distress tolerance significantly mediated the relationship between probable depression and PTSD (both alone and in combination) and alcohol misuse. Evidence of moderated mediation was present for probable PTSD and probable comorbid PTSD and depression, such that the indirect effect was stronger among males. CONCLUSIONS These results suggest that distress tolerance may be a transdiagnostic factor explaining the comorbidity of depression and PTSD with alcohol misuse in young adult veterans. These findings may inform screening and intervention efforts with this high-risk population.

Prevalence and consequences of sleep problems in military wives

STUDY OBJECTIVES Despite the prevalence of sleep problems among service members, few prior studies have examined the rate of sleep problems among military spouses, who also face the stresses of deployment and military life. This is the first study of spouses of US service members to examine the prevalence of sleep disturbances, effect of service member deployment, and associated physical and psychosocial outcomes. DESIGN Cross-sectional analysis of RAND Deployment Life Study data. SETTING Self-report measures administered via telephone and web-based surveys in Fall 2012. PARTICIPANTS Female military spouses (n = 1805) aged 19 to 65 years (M = 33.5 [8.3]), married to service members across branches and components (73% previously, 10% currently, and 16% never deployed). MEASUREMENTS Spouses self-reported sleep duration, sleep quality, daytime fatigue, and daytime impairment. Outcomes included self-rated health, marital satisfaction, and depressive symptoms. RESULTS Eighteen percent of spouses reported extreme short sleep duration, which is higher than rates reported in the general population. Spouses indicated worse sleep when the service member was currently or previously deployed, although deployment status was not associated with sleep duration or daytime impairment. Greater sleep disturbances were significantly associated with all three outcomes, with the strongest association observed with greater depressive symptoms. CONCLUSIONS This is the first report to document high rates of short sleep duration and poor sleep quality among spouses of service members. Furthermore, sleep problems were independent correlates of poor mental and physical health. Findings highlight the importance of addressing sleep issues in military families as well as in service members.

The association between discrimination and PTSD in African Americans: exploring the role of gender

ABSTRACT Background: Research has demonstrated the adverse impact that discrimination has on physical and mental health. However, few studies have examined the association between discrimination and symptoms of posttraumatic stress disorder (PTSD). There is evidence that African Americans experience higher rates of PTSD and are more likely to develop PTSD following trauma exposure than Whites, and discrimination may be one reason for this disparity. Purpose: To examine the association between discrimination and PTSD among a cross-sectional sample largely comprising African American women, controlling for other psychosocial stressors (psychological distress, neighborhood safety, crime). Methods: A sample of 806 participants was recruited from two low-income predominantly African American neighborhoods. Participants completed self-report measures of PTSD symptoms, perceived discrimination, perceived safety, and psychological distress. Information on neighborhood crime was obtained through data requested from the city. Multivariate linear regression models were estimated to assess adjusted relationships between PTSD symptoms and discrimination. Results: Discrimination was significantly associated with PTSD symptoms with a small effect size, controlling for relevant sociodemographic variables. This association remained consistent after controlling for psychological distress, perceived safety, and total neighborhood crime. There was no evidence of a gender by discrimination interaction. Participants who experienced any discrimination were significantly more likely to screen positive for PTSD. Conclusions: Discrimination may contribute to the disparate rates of PTSD experienced by African Americans. PTSD is associated with a range of negative consequences, including poorer physical health, mental health, and quality of life. These results suggest the importance of finding ways to promote resilience in this at-risk population.

The Association Between Discharge Status, Mental Health, and Substance Misuse Among Young Adult Veterans

Although 85% of military service members are discharged honorably, veterans who engage in misconduct during military service may receive other types of administrative or punitive discharges. The discharge type not only affects eligibility for benefits, but is associated with negative downstream consequences (e.g., homelessness, criminal justice involvement). However, limited empirical research has examined the mental health and substance use-related needs of veterans who were not Honorably discharged, and the few that have only focus on veterans who received punitive discharges. This study addressed gaps in the research literature on discharge status by examining differences in mental health, substance use, and attitudes toward psychological treatment among veterans who received Honorable, General Under Honorable Conditions, and Other Than Honorable (OTH) discharges. Young adult veterans (N = 734) were recruited online and completed a battery of self-report measures. Results indicated that veterans who received General and OTH discharges endorsed significantly greater rates of mental health conditions and substance misuse. They also reported more negative perceptions of mental health care. Because these veterans may also experience more barriers to accessing mental health services, it is critical to consider ways to connect these veterans with needed services.

Using marijuana, drinking alcohol or a combination of both: the association of marijuana, alcohol and sexual risk behaviour among adolescents

Background Although the association between alcohol use and sexual risk behaviour has been well-documented, there is little understanding of whether marijuana use alone or combining marijuana with alcohol use contributes to sexual risk behaviour among adolescents. METHODS A diverse sample of sexually active adolescents (n = 616) aged 12-18 years (50.32% Hispanic; 31.17% Black) completed a survey on alcohol use, marijuana use and sexual risk behaviour during a visit to a primary care clinic. RESULTS Adolescents were more likely to report having had two or more sexual partners in the past 3 months if they reported using both alcohol and marijuana (OR=3.90, P<0.0001), alcohol alone (OR=2.51, P<0.0001) or marijuana alone (OR=1.89, P<0.001) compared with adolescents who reported no use during the past month. Adolescents were more likely to report having both two or more partners and condomless sex if they used both alcohol and marijuana (OR=3.19, P<0.001) or alcohol alone (OR=3.41, P<0.01) in the past month compared with adolescents who reported using marijuana alone or had no use of either. CONCLUSIONS Providers should screen for both alcohol and marijuana use among adolescents and discuss how use of alcohol or alcohol in conjunction with marijuana may be associated with sexual risk behaviours.

Veteran participation in the integrative health and wellness program: Impact on self-reported mental and physical health outcomes.

Complementary and integrative health (CIH) services are being used more widely across the nation, including in both military and veteran hospital settings. Literature suggests that a variety of CIH services show promise in treating a wide range of physical and mental health disorders. Notably, the Department of Veterans Affairs is implementing CIH services within the context of a health care transformation, changing from disease based health care to a personalized, proactive, patient-centered approach where the veteran, not the disease, is at the center of care. This study examines self-reported physical and mental health outcomes associated with participation in the Integrative Health and Wellness Program, a comprehensive CIH program at the Washington DC VA Medical Center and one of the first wellbeing programs of its kind within the VA system. Using a prospective cohort design, veterans enrolled in the Integrative Health and Wellness Program filled out self-report measures of physical and mental health throughout program participation, including at enrollment, 12 weeks, and 6 months. Analyses revealed that veterans reported significant improvements in their most salient symptoms of concern (primarily pain or mental health symptoms), physical quality of life, wellbeing, and ability to participate in valued activities at follow-up assessments. These results illustrate the potential of CIH services, provided within a comprehensive clinic focused on wellbeing not disease, to improve self-reported health, wellbeing, and quality of life in a veteran population. Additionally, data support recent VA initiatives to increase the range of CIH services available and the continued growth of wellbeing programs within VA settings. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Do Sleep and Psychological Distress Mediate the Association Between Neighborhood Factors and Pain

Objective Pain affects millions of American adults. However, individuals from socioeconomically disadvantaged groups experience higher rates of pain, and individuals from racial/ethnic minorities report greater pain severity and pain-related disability. Some studies find an association between neighborhood socioeconomic status and pain. The present study aimed to further understand the association between neighborhood disadvantage and pain, including the role of objective (e.g., crime rates) and subjective neighborhood characteristics (e.g., perceived safety, neighborhood satisfaction), and to examine sleep and psychological distress as potential mediators of these associations. Methods The sample included 820 participants from two predominantly African American socioeconomically disadvantaged neighborhoods. Trained data collectors interviewed participants on a number of self-report measures, and objective neighborhood characteristics were obtained from city crime data and street segment audits. Results Subjective characteristics, specifically perceived infrastructure and perceived safety, were associated with pain. Based on bootstrapped regression models, sleep efficiency and psychological distress were tested as mediators of the association between these neighborhood factors and pain. Results of mediation testing indicated that psychological distress served as a significant mediator. Though sleep efficiency was not a mediator, it had a significant independent association with pain. Conclusions Understanding the contribution of sleep problems and psychological distress to pain among at-risk individuals living in disadvantaged neighborhoods is important to identifying ways that individual- and neighborhood-level interventions may be leveraged to reduce pain-related disparities.

Influence of mental health and alcohol or other drug use risk on adolescent reported care received in primary care settings

BackgroundTo describe patterns of alcohol and other drug (AOD) use risk and adolescent reported primary care (PC) screening and intervention, and examine associations of AOD risk and mental health with reported care received.MethodsWe analyzed data from cross-sectional surveys collected from April 3, 2013 to November 24, 2015 from 1279 diverse adolescents ages 12–18 who reported visiting a doctor at least once in the past year. Key measures were AOD risk using the Personal Experience Screening Questionnaire; mental health using the 5-item Mental Health Inventory; binary measures of adolescent-reported screening and intervention.ResultsHalf (49.2%) of the adolescents reported past year AOD use. Of the 769 (60.1%) of adolescents that reported being asked by a medical provider in PC about AOD use, only 37.2% reported receiving screening/intervention. The odds of reported screening/intervention were significantly higher for adolescents with higher AOD risk and lower mental health scores.ConclusionsAdolescents at risk for AOD use and poor mental health are most likely to benefit from brief intervention. These findings suggest that strategies are needed to facilitate medical providers identification of need for counseling of both AOD and mental health care for at risk youth.Trials registrationclinicaltrials.gov, Identifier: NCT01797835, March 2013.

Relationship Quality: Implications for Sleep Quality and Sleep Disorders

Substantial research has shown that both the presence and quality of close relationships are critical for optimal physical health and well-being. When considering the pathways linking close relationships with health, the extant research has primarily focused on pathways such as health behaviors or physiological stress responses that are measured during the daytime, but has largely neglected potential nighttime pathways. However, we spend roughly one-third of our lives in bed, and for many, sleep is a shared health behavior with a spouse or partner. Sleep is a quintessential restorative health behavior, yet until recently, there has been very little systematic study of the dyadic nature of sleep. Therefore, the purpose of the present chapter is to provide a review of the literature on current findings related to the dyadic nature of sleep and the implications for relationship health, as well as to provide a heuristic framework for guiding future research that considers how sleep and close relationships may dynamically interact, and ultimately shape health and well-being.