Category: Mental Health Research

Barriers & Facilitators who Impact Veterans’ Engagement with Mental Health Support

Published on by Andrew MarshallLeave a comment

Research Paper Title

The journey to professional mental health support: a qualitative exploration of the barriers and facilitators impacting military veterans’ engagement with mental health treatment.

Background

It is often claimed that military veterans are reticent to seek help for mental disorders, even though delayed treatment may impair recovery and impact the wellbeing of those close to the veteran.

This paper aims to explore the barriers and facilitators to accessing professional mental health support for three groups of veterans who met criteria for a probable mental health disorder and:

  1. Do not recognise a probable mental disorder;
  2. Recognise they are affected by a mental disorder but are not seeking professional support; or
  3. Are currently seeking professional mental health support.

Methods

Qualitative telephone interviews were conducted with 62 UK military veterans. Thematic analysis identified core themes along an illustrative journey towards professional mental health support.

Results

Distinct barriers and facilitators to care were discussed by each group of veterans depicting changes as veterans moved towards accessing professional mental health support. In contrast to much of the literature, stigma was not a commonly reported barrier to care; instead care-seeking decisions centred on a perceived need for treatment, waiting until a crisis event occurred. Whilst the recognition of treatment need represented a pivotal moment, the data identified numerous key steps which had to be surmounted prior to care-seeking.

Conclusions

As care-seeking decisions within this sample appeared to centre on a perceived need for treatment future efforts designed to encourage help-seeking in UK military veterans may be best spent targeting the early identification and management of mental health disorders to encourage veterans to seek support before reaching a crisis event.

Reference

Rafferty, L.A., Wessely, S., Stevelink, S.A.M. & Greenberg, N. (2021) The journey to professional mental health support: a qualitative exploration of the barriers and facilitators impacting military veterans’ engagement with mental health treatment. European Journal of Pscyhotraumatology. 10(1).1700613. doi: 10.1080/20008198.2019.1700613.

CBT and Post-Traumatic Headache

Published on by Andrew MarshallLeave a comment

Research Paper Title

Study design for a randomised clinical trial of cognitive-behavioural therapy for post-traumatic headache.

Abstract

Post-traumatic headache (PTH) is a common debilitating condition arising from head injury and is highly prevalent among military service members and veterans with traumatic brain injury (TBI).

Diagnosis and treatment for PTH is still evolving, and surprisingly little is known about the putative mechanisms that drive these headaches.

This manuscript describes the design of a randomised clinical trial of two nonpharmacological (i.e. behavioural) interventions for PTH.

Design of this trial required careful consideration of PTH diagnosis and inclusion criteria, which was challenging due to the lack of standard clinical characteristics in PTH unique from other types of headaches.

The treatments under study differed in clinical focus and dose (i.e. number of treatment sessions), but the trial was designed to balance the treatments as well as possible.

Finally, while the primary endpoints for pain research can vary from assessments of pain intensity to objective and subjective functional measures, this trial of PTH interventions chose carefully to establish clinically relevant endpoints and to maximise the opportunity to detect significant differences between groups with two primary outcomes.

All these issues are discussed in this manuscript.

Reference

McGeary, D.D., Penzien, D.B., Resick, P.A., McGeary, C.A., Jaramillo, C.A., Eapen, B.C., Young-McCaughan, S., Nabity, P.S., Moring, J.C., Houle, T.T., Keane, T. & Peterson, A.L. (2021) Study design for a randomized clinical trial of cognitive-behavioral therapy for posttraumatic headache.

Linking Putative Blood Somatic Mutations, Alzheimer’s & PTSD

Published on by Andrew MarshallLeave a comment

Research Paper Title

Putative Blood Somatic Mutations in Post-Traumatic Stress Disorder-Symptomatic Soldiers: High Impact of Cytoskeletal and Inflammatory Proteins.

Background

The recently discovered autism/intellectual disability somatic mutations in postmortem brains, presenting higher frequency in Alzheimer’s disease subjects, compared with the controls. They further revealed high impact cytoskeletal gene mutations, coupled with potential cytoskeleton-targeted repair mechanisms.

The current study was aimed at further discerning if somatic mutations in brain diseases are presented only in the most affected tissue (the brain), or if blood samples phenocopy the brain, toward potential diagnostics.

Methods

Variant calling analyses on an RNA-seq database including peripheral blood samples from 85 soldiers (58 controls and 27 with symptoms of post-traumatic stress disorder, PTSD) was performed.

Results

High (e.g. protein truncating) as well as moderate impact (e.g., single amino acid change) germline and putative somatic mutations in thousands of genes were found. Further crossing the mutated genes with autism, intellectual disability, cytoskeleton, inflammation, and DNA repair databases, identified the highest number of cytoskeletal-mutated genes (187 high and 442 moderate impact). Most of the mutated genes were shared and only when crossed with the inflammation database, more putative high impact mutated genes specific to the PTSD-symptom cohorts versus the controls (14 versus 13) were revealed, highlighting tumour necrosis factor specifically in the PTSD-symptom cohorts.

Conclusions

With microtubules and neuro-immune interactions playing essential roles in brain neuroprotection and Alzheimer-related neurodegeneration, the current mutation discoveries contribute to mechanistic understanding of PTSD and brain protection, as well as provide future diagnostics toward personalised military deployment strategies and drug design.

Reference

Sragovich, S., Gershovits, M., Lam, J.C.K., Li, V.O.K. & Gozes, I. (2021) Putative Blood Somatic Mutations in Post-Traumatic Stress Disorder-Symptomatic Soldiers: High Impact of Cytoskeletal and Inflammatory Proteins. Journal of Alzheimer’s Disease. doi: 10.3233/JAD-201158. Online ahead of print.

Is there Satisfaction with Telehealth PTSD Treatment?

Published on by Andrew MarshallLeave a comment

Research Paper Title

Factors contributing to veterans’ satisfaction with PTSD treatment delivered in person compared to telehealth.

Background

Telehealth is an increasingly popular treatment delivery modality for mental healthcare, including evidence-based treatment for complex and intense psychopathologies such as post-traumatic stress disorder (PTSD). Despite the growing telehealth literature, there is a need for more confirmatory research on satisfaction with PTSD telehealth treatment, particularly among veterans, for whom the most rapid and permanent expansion of telehealth services has been implemented through the Department of Veterans Affairs.

Methods

The current paper integrates data from two concurrent PTSD treatment outcome studies that compared prolonged exposure therapy delivered both in person and via telehealth for veterans (N = 140). Using two different measures of satisfaction (the Charleston Psychiatric Outpatient Satisfaction Scale-Veteran Affairs Version (CPOSS) and the Service Delivery Perception Questionnaire (SDPQ)), the researchers hypothesized that PTSD improvement would predict satisfaction, but that delivery modality (in person vs telehealth) would not.

Results

Results only partially supported the hypotheses, in that PTSD symptom improvement was associated with greater satisfaction, and in-person treatment modality was associated with satisfaction as measured by the CPOSS (but not the SDPQ). Subgroup differences by sex were found, such that male veterans, typically with combat-related trauma, were more satisfied with their PTSD treatment compared to female veterans, who were most frequently seen in this study for military sexual trauma.

Conclusions

Altogether, results illustrate a need for additional satisfaction studies with diverse samples and large sample sizes. Future research may benefit from examining satisfaction throughout treatment, identifying predictors of greater PTSD improvement, and further examining demographic subgroups.

Reference

White, C.N., Kauffman, B.Y. & Acierno, R. (2021) Factors contributing to veterans’ satisfaction with PTSD treatment delivered in person compared to telehealth. Journal of Telemedicine and Telecare. doi: 10.1177/1357633X20987704. Online ahead of print.

Are There Sex Differences in Comorbidity Between Substance Use & Mental Health in Adolescents?

Published on by Andrew MarshallLeave a comment

Research Paper Title

Sex Differences in Comorbidity Between Substance Use and Mental Health in Adolescents: Two Sides of the Same Coin.

Background

This study aims to evaluate sex differences in alcohol and cannabis use and mental health disorders (MHD) in adolescents, and to evaluate the predictive role of mental health disorders for alcohol and cannabis use disorders (AUD and CUD respectively).

Method

A sample of 863 adolescents from the general population (53.7% girls, Mage = 16.62, SD = 0.85) completed a computerised battery including questions on substance use frequency, the Brief Symptom Inventory, the Cannabis Problems Questionnaire for Adolescents – Short version, the Rutgers Alcohol Problem Index and the DSM-IV-TR criteria for AUD and CUD. Bivariate analyses and binary logistic regressions were performed.

Results

Girls presented significantly more mental health problems and a higher prevalence of comorbidity between SUD and MHD. Obsessive-compulsive symptoms and phobic anxiety indicated a higher risk of AUD, whereas depression and interaction between hostility and obsessive-compulsive disorder indicated a higher risk of CUD.

Conclusions

Comorbidity between SUD and MHD is high among adolescents, and significantly higher among girls.

Reference

Fernandez-Artamendi, S. Martinez-Loredo, V. & Lopez-Nunez, C. (2021) Sex Differences in Comorbidity Between Substance Use and Mental Health in Adolescents: Two Sides of the Same Coin. Psicotherma. 33(1), pp.36-43. doi: 10.7334/psicothema2020.297.

Age at First Drink & Severity of Alcohol Dependence in Military Personnel

Published on by Andrew MarshallLeave a comment

Research Paper Title

Age at first drink and severity of alcohol dependence.

Background

Early age at first drink (AFD) has been linked to early onset and increased severity of alcohol dependence in various studies. Few Indian studies on AFD have shown a negative correlation between AFD and severity of alcohol dependence. The study aimed to explore this relationship in patients with alcohol dependence syndrome (ADS) diagnosed using ICD-10 criteria.

Methods

One hundred fifty-one consecutive patients freshly diagnosed with ADS were included in the study, which was conducted at the psychiatry unit of a tertiary care, multispecialty hospital. The Addiction Severity Index (ASI) was used to assess severity of alcohol dependence.

Results

Mean AFD was 24.85 years (range = 13-40 years). Median ASI score was 36 (range = 21 to 57). The study yielded a weak negative correlation (ρ = -.105) between AFD and ASI, which was statistically not significant.

Conclusions

The researchers found no correlation between AFD and severity of alcohol dependence at detection in Indian Armed Forces personnel, which is contrary to what has been reported worldwide and in previous Indian studies. Delayed initiation of alcohol use among those enrolling in the Indian Armed Forces and early detection of alcohol dependence within the military environment are possible explanations.

Reference

Chatterjee, K., Dwivedi, A.K. & Singh, R. (2021) Age at first drink and severity of alcohol dependence. Medical Journal, Armed Forces India. 77(1), pp.70-74. doi: 10.1016/j.mjafi.2019.05.003. Epub 2019 Oct 16.

Is It Useful to Screen for Anxiety using the GAD-7 in Pregnant Women?

Published on by Andrew MarshallLeave a comment

Research Paper Title

Validation of the Generalised Anxiety Disorder Screener (GAD-7) in Spanish Pregnant Women.

Background

Anxiety during pregnancy is one of the most common mental health problems and a significant risk factor for postpartum depression. The Generalised Anxiety Disorder-7 (GAD-7) is one of the most widely used self-report measures of anxiety symptoms available in multiple languages. This study evaluates the psychometric properties and underlying factor structures of the Spanish GAD-7 among pregnant women in Spain.

Methods

Spanish-speaking pregnant women (N = 385) were recruited from an urban obstetrics setting in Northern Spain. Women completed the GAD-7 and the anxiety subscale of the Symptom Checklist (SCL90-R) at three time points, once per trimester. The reliability, concurrent validity, and factor analyses were conducted to evaluate the psychometric properties and factor structure, respectively.

Results

In the first trimester, the GAD-7 demonstrated good internal consistency (a = 0.89). GAD-7 is positively correlated with SCL90-R (anxiety subscale; r=0.75; p < 0.001). The proposed one-factor structure is found using exploratory factor analysis -FACTOR programme – with Unweighted Least Squares procedure and optimal implementation of parallel analysis (GFI = 0.99).

Conclusions

Health providers should screen for anxiety using the GAD-7 during pregnancy among urban Spanish-speaking samples to provide appropriate follow-up care.

Reference

Soto-Balbuena, C. Rodriguez-Munoz, M.F. & Le, H-N. (2021) Validation of the Generalized Anxiety Disorder Screener (GAD-7) in Spanish Pregnant Women. Psicothema. 33(1), pp.164-170. doi: 10.7334/psicothema2020.167.

What is the Effect of ECT on Cognitive Functioning?

Published on by Andrew MarshallLeave a comment

Research Paper Title

Transient Cognitive Impairment and White Matter Hyperintensities in Severely Depressed Older Patients Treated With Electroconvulsive Therapy.

Background

Although electroconvulsive therapy (ECT) is a safe and effective treatment for patients with severe late life depression (LLD), transient cognitive impairment can be a reason to discontinue the treatment. The aim of the current study was to evaluate the association between structural brain characteristics and general cognitive function during and after ECT.

Methods

A total of 80 patients with LLD from the prospective naturalistic follow-up Mood Disorders in Elderly treated with Electroconvulsive Therapy study were examined. Magnetic resonance imaging scans were acquired before ECT. Overall brain morphology (white and grey matter) was evaluated using visual rating scales. Cognitive functioning before, during, and after ECT was measured using the Mini Mental State Examination (MMSE). A linear mixed-model analysis was performed to analyse the association between structural brain alterations and cognitive functioning over time.

Results

Patients with moderate to severe white matter hyperintensities (WMH) showed significantly lower MMSE scores than patients without severe WMH (F(1,75.54) = 5.42, p = 0.02) before, during, and post-ECT, however their trajectory of cognitive functioning was similar as no time × WMH interaction effect was observed (F(4,65.85) = 1.9, p = 0.25). Transient cognitive impairment was not associated with medial temporal or global cortical atrophy (MTA, GCA).

Conclusions

All patients showed a significant drop in cognitive functioning during ECT, which however recovered above baseline levels post-ECT and remained stable until at least 6 months post-ECT, independently of severity of WMH, GCA, or MTA. Therefore, clinicians should not be reluctant to start or continue ECT in patients with severe structural brain alterations.

Reference

Wagenmakers, M.J., Vansteelandt, K., van Exel, E., Postuma, R., Schouws, S.N.T.M., Obbels, J., Rhebergen, D., Bouckaert, F., Stek., M.L., Barkhof, F., Beekman, A.T.F., Veltman, D.J., Sienaert, P., Dols, A. & Oudega, M.L. (2021) Transient Cognitive Impairment and White Matter Hyperintensities in Severely Depressed Older Patients Treated With Electroconvulsive Therapy. The American Journal of Geriatric Psychiatry. S1064-7481(20)30597-2. doi: 10.1016/j.jagp.2020.12.028. Online ahead of print.

Aromatherapy & Mental Health

Published on by Andrew MarshallLeave a comment

Research Paper Title

The effects of Lavender and Chamomile essential oil inhalation aromatherapy on depression, anxiety and stress in older community-dwelling people: A randomised controlled trial.

Background

Considering the prevalence of mental health problems in older adults, this study aims to investigate the effect of inhalation aromatherapy using lavender and chamomile essential oils on depression, anxiety, and stress of community-dwelling older people.

Methods

A three-armed, parallel, randomised, and controlled trial design was used in this study. 183 participants were enrolled and randomly assigned to three groups (n = 61): the lavender, chamomile, and control groups. The participants in the experimental groups inhaled three drops of 1.5% lavender and chamomile essential oils for 30 nights. The participants in the control group inhaled only distilled water in a similar fashion. Data were collected using the Depression, Anxiety, and Stress-Scale (DASS) at baseline, immediately after the intervention, and one month after the intervention. Chi-square, Fisher’s exact, one-way ANOVA, and repeated measures ANOVA were used for data analysis.

Results

Statistically significant improvement occurred in depression, anxiety, and stress levels immediately and one month after the intervention in lavender and chamomile groups compared to the control group (p < 0.01).

Conclusions

Inhalation aromatherapy with both lavender and chamomile essential oils helped decrease depression, anxiety, and stress levels in community-dwelling older adults.

Reference

Ebrahimi, H., Mardani, A., Basirinezhad, M.H., Hamidzadeh, A. & Eskandari, F. (2021) The effects of Lavender and Chamomile essential oil inhalation aromatherapy on depression, anxiety and stress in older community-dwelling people: A randomized controlled trial. Explore (New York, N.Y.). doi: 10.1016/j.explore.2020.12.012. Online ahead of print.

Linking Anxiety, AUD & GABAB

Published on by Andrew MarshallLeave a comment

Research Paper Title

The influence of anxiety symptoms on clinical outcomes during baclofen treatment of alcohol use disorder: A systematic review and meta-analysis.

Background

Given the high coexistence of anxiety symptoms in people with alcohol use disorder (AUD), the researchers aimed to determine the influence of anxiety symptoms on outcomes in patients with AUD treated with GABAB receptor agonist baclofen.

Methods

A meta-analysis of 13 comparisons (published 2010-2020) including baseline and outcome data on alcohol consumption and anxiety after 12 weeks was undertaken.

Results

There were significantly higher rates of abstinent days in patients treated with baclofen compared to placebo (p = 0.004; high certainty evidence); specifically in those with higher baseline anxiety levels (p < 0.00001; high certainty evidence) compared to those with lower baseline anxiety levels (p = 0.20; moderate certainty evidence). The change in anxiety ratings over 12 weeks did not differ between those treated with baclofen or placebo (p = 0.84; moderate certainty evidence).

Conclusions

This may be due to different anxiety constructs being measured by scales not validated in this patient group, or that anxiety is not a biobehavioural mechanism by which baclofen may reduce alcohol drinking. Given the prevalence of anxiety symptoms in AUD all these factors warrant further research.

Reference

Agabio, R., Baldwin, D.S., Amaro, H., Leggio, L. & Sinclair, J.M.A. (2021) The influence of anxiety symptoms on clinical outcomes during baclofen treatment of alcohol use disorder: A systematic review and meta-analysis. Neuroscience and Biobehavioural Reviews. doi: 10.1016/j.neubiorev.2020.12.030. Online ahead of print.