Ursula A. Kelly

More than military sexual trauma: Interpersonal violence, PTSD, and mental health in women veterans

Military sexual trauma (MST) is reported by 20-40% of female veterans. The purpose of this study of female veterans referred for MST treatment was to examine the relationships between lifetime trauma (physical, sexual, and psychological) and posttraumatic stress disorder (PTSD), depression, physical health, and quality of life using retrospective cross-sectional data from medical records. Of the 135 participants, 95.4% reported at least one trauma in addition to MST, most notably sexual abuse as adult civilians (77.0%) and as children (52.6%). PTSD, depression, and sleep difficulty rates were clinically significant. Chronic pain (66.4%) was associated with childhood abuse, physical health, sleep difficulties, and coping. Integrating mental and physical health treatment is necessary to treat MST and PTSD in female veterans.

Symptoms of PTSD and major depression in Latinas who have experienced intimate partner violence

The purpose of this study was to describe symptoms of PTSD and major depression in abused Latinas and to explore the relationships among intimate partner violence (IPV) experiences, these symptoms, and health related quality of life (HRQOL). The rate of PTSD was 69.7%% and of major depressive disorder (MDD) was 57.6%%. The comorbidity of PTSD and MDD was 54.5%%. PTSD and MDD were not consistently correlated with IPV, although some significant relationships were found. PTSD and MDD symptoms were highly correlated with HRQOL. The impact of PTSD and MDD on psychological well-being and functioning in Latinas needs further investigation.

Community-based PTSD Treatment for Ethnically Diverse Women Who Experienced Intimate Partner Violence: A Feasibility Study

The objectives of this study were to: (1) Determine the feasibility of a community-based intervention for Latinas with PTSD who experienced IPV; (2) Explore the intervention effectiveness in reducing PTSD and improving quality of life, social support and self-efficacy. This was a feasibility study, using intervention pre-test/post-test qualitative and quantitative data. The experience of living through and surviving IPV was far more important than ethnicity in cultural identity. Significant reductions in PTSD and MDD and increased self-efficacy were sustained 6-months post-intervention. Culturally relevant mental health IPV interventions can be feasible and appropriate across ethnic groups.

The odd couple: using biomedical and intersectional approaches to address health inequities

ABSTRACT Background: Better understanding and addressing health inequities is a growing global priority. Objective: In this paper, we contribute to the literature examining complex relationships between biological and social dimensions in the field of health inequalities. Specifically, we explore the potential of intersectionality to advance current approaches to socio-biological entwinements. Design: We provide a brief overview of current approaches to combining both biological and social factors in a single study, and then investigate the contributions of an intersectional framework to such work. Results: We offer a number of concrete examples of how intersectionality has been used empirically to bring both biological and social factors together in the areas of HIV, post-traumatic stress disorder, female genital circumcision/mutilation/cutting, and cardiovascular disease. Conclusion: We argue that an intersectional approach can further research that integrates biological and social aspects of human lives and human health and ultimately generate better and more precise evidence for effective policies and practices aimed at tackling health inequities.

An Evolving Integrative Treatment Program for Military Sexual Trauma (MST) and One Veteran's Experience

Military sexual trauma (MST) increases the risk for Posttraumatic Stress Disorder (PTSD) and multiple other comorbidities, presenting substantial challenges for nurses and psychiatric and medical clinicians. A specialized VA Medical Center outpatient program is patterned after Hermans three-phased, empirically-supported, recovery treatments. We use a case example of a female veteran MST survivor to illustrate our treatment model. She presented to our program meeting diagnostic criteria for PTSD, Major Depressive Disorder, and a history of substance abuse. Post-treatment she demonstrated improved scores on measures of PTSD, quality of life, and socialization. This model shows promise for treatment of MST survivors with PTSD.

Determining Psychoneuroimmunologic Markers of Yoga as an Intervention for Persons Diagnosed With PTSD: A Systematic Review:

There is a growing body of research on yoga as a therapeutic intervention for psychological symptoms of post-traumatic stress disorder (PTSD) accompanied by speculations on underlying physiologic mechanisms. The purpose of this systematic review is to identify, qualitatively evaluate, and synthesize studies of yoga as an intervention for PTSD that measured physiologic outcomes in order to gain insights into potential mechanisms. The focus is on studies evaluating yoga as a therapeutic intervention for PTSD rather than for trauma exposure, PTSD prevention, or subclinical PTSD. Multiple databases were searched for publications from the past two decades using terms derived from the question, “In people with PTSD, what is the effect of yoga on objective outcomes?” Eligibility criteria included yoga-only modalities tested as an intervention for formally diagnosed PTSD with at least one physiologic outcome. Results of this review confirmed that, though much of the published literature proposes physiological mechanisms underlying yoga’s effects on PTSD, very few studies (n = 3) have actually evaluated physiological evidence. Additionally, several studies had methodological limitations. In light of the limited data supporting yoga’s beneficial effects on autonomic nervous system dysregulation, we present a theoretical model of the psychoneuroimmunologic processes associated with PTSD and the effects yoga may have on these processes to guide future research. Gaps in the literature remain for mechanisms related to activation of the hypothalamic–pituitary–adrenal axis and inflammation. Additional rigorous mechanistic studies are needed to guide development of effective yoga interventions for PTSD to augment existing evidence-based PTSD treatments.

The PTSD Toolkit for Nurses: Assessment, intervention, and referral of veterans.

Approximately 20% of veterans suffer from posttraumatic stress disorder (PTSD). NPs are well positioned to provide early detection and assist veterans with access to life-saving treatment. The PTSD Toolkit for Nurses helps nurses improve their skills in assessing PTSD and provides a specialized intervention and referral procedure that promotes help-seeking behavior among veterans.

Forensic Psychiatric/Mental Health Nursing: Behind Closed Doors

Incidents like the shootings in Arizona earlier this year bring to public attention the fact that there are members of our society who are mentally disturbed and who also may commit sometimes serious crimes. Although most of the debate centers on how to prevent these crimes, the fact that these perpetrators have to be cared for remains. Forensic psychiatric nurses care for clients who have broken the law, sometimes through committing crimes that are heinous and grab the public’s attention. When public interest has waned, these clients still need psychiatric treatment, often for very long periods, and sometimes for the remainder of their lives. Once high-profile offenders are imprisoned or placed in forensic inpatient settings, any remaining public attention is typically on victims and on prevention strategies—How can we recognize “disturbed” individuals before they commit such atrocities? What went wrong? Relative to the incarcerated offender, the public breathes a collective sigh of relief—out of sight, out of mind. On the other end of the public attention spectrum, perpetrators of crimes known only to the victims and the legal system are considered criminals first, mentally ill