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

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.

Is there Satisfaction with Telehealth PTSD Treatment?

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.

Mile Marker (2017)

Introduction

A veteran of Afghanistan and Iraq, Korey Rowe is on the road of recovery from PTSD along with his former Rakkasan Brothers. “Mile Marker” investigates new techniques used to treat PTSD and takes a look into veterans’ lives today.

Outline

“Mile Marker”, focuses on a two-tour veteran of Afghanistan and Iraq, Korey Rowe, along with his former Rakkasan Brothers on their long road to recovery from PTSD. The Rakkasans were the invading force for both Middle Eastern Theatre Wars where Korey and his unit were the tip of the spear, twice. This film investigates new and controversial techniques and methods for treating PTSD but more than that, it is a look into the lives of veterans in America today. Travelling 8,000 miles across the United States and back, Korey departs from his home in California, to check in with his former battle buddies across America, who served with him 15 years ago in the 187th Infantry Regiment of the 101st Airborne Air Assault Division. Along the way, he interviews psychologists and specialists from the National Center for PTSD in White River Junction, Vermont for a balanced understanding of the underlying symptoms and associated triggers for those with PTSD. This is an authentic portrayal of veterans…

Production & Filming Details

  • Director(s): Korey Rowe.
  • Producer(s):
    • Dylan Avery … associate producer.
    • Roland Rojas … producer.
    • Jessie Whitney … associate producer.
  • Writer(s): Valerie Boyer.
  • Music:
  • Cinematography: Dylan Avery.
  • Editor(s): Korey Rowe.
  • Production: Otsego Media and Prism Pictures.
  • Distributor(s):
  • Release Date: 2017.
  • Running Time: 94 minutes.
  • Rating: 16+.
  • Country: US.
  • Language: English.

Video Link

Identifying Two Novel Distinct Epigenetic Biotypes for PTSD

Research Paper Title

Epigenetic biotypes of post-traumatic stress disorder in war-zone exposed veteran and active duty males.

Background

Post-traumatic stress disorder (PTSD) is a heterogeneous condition evidenced by the absence of objective physiological measurements applicable to all who meet the criteria for the disorder as well as divergent responses to treatments.

Methods

This study capitalised on biological diversity observed within the PTSD group observed following epigenome-wide analysis of a well-characterised Discovery cohort (N = 166) consisting of 83 male combat exposed veterans with PTSD, and 83 combat veterans without PTSD in order to identify patterns that might distinguish subtypes.

Results

Computational analysis of DNA methylation (DNAm) profiles identified two PTSD biotypes within the PTSD+ group, G1 and G2, associated with 34 clinical features that are associated with PTSD and PTSD comorbidities.

The G2 biotype was associated with an increased PTSD risk and had higher polygenic risk scores and a greater methylation compared to the G1 biotype and healthy controls.

The findings were validated at a 3-year follow-up (N = 59) of the same individuals as well as in two independent, veteran cohorts (N = 54 and N = 38), and an active duty cohort (N = 133).

In some cases, for example Dopamine-PKA-CREB and GABA-PKC-CREB signalling pathways, the biotypes were oppositely dysregulated, suggesting that the biotypes were not simply a function of a dimensional relationship with symptom severity, but may represent distinct biological risk profiles underpinning PTSD.

Conclusions

The identification of two novel distinct epigenetic biotypes for PTSD may have future utility in understanding biological and clinical heterogeneity in PTSD and potential applications in risk assessment for active duty military personnel under non-clinician-administered settings, and improvement of PTSD diagnostic markers.

Reference

Yang, R., Gautam, A., Getnet, D., Daigle, B.J., Miller, S., Misganaw, B., Dean, K.R., Kumar, R., Muhie, S., Wang, K., Lee, I., Abu-Amara, D., Flory, J.D., PTSD Systems Biology Consortium, Hood, L., Wolkowitz, O.M., Mellon, S.H., Doyle 3rd, F.J., Yehuda, R., Marmar, C.R., Ressler, K.J., Hammamieh, R. & Jett, M. (2020) Epigenetic biotypes of post-traumatic stress disorder in war-zone exposed veteran and active duty males. Molecular Psychiatry. doi: 10.1038/s41380-020-00966-2. Online ahead of print.

Does the Peer Support Role Enhance Veteran Engagement?

Research Paper Title

Military veteran engagement with mental health and well-being services: a qualitative study of the role of the peer support worker.

Background

Many UK military veterans experiencing mental health and well-being difficulties do not engage with support services to get the help they need. Some mental health clinics employ Peer Support Workers (PSWs) to help veteran patients engage, however it is not known how the role influences UK veteran engagement.

Therefore the aim of this research was to gain insight into the role of peer support in UK veteran engagement with mental health and well-being services.

Method

A qualitative study based on 18 semi-structured interviews with veterans, PSWs and mental health clinicians at a specialist veteran mental health and well-being clinic in Scotland.

Results

Four themes of the PSW role as positive first impression, understanding professional friend, helpful and supportive connector, and an open door were identified across all participants. The PSWs’ military connection, social and well-being support and role in providing veterans with an easily accessible route to dis-engage and re-engage with the service over multiple engagement attempts were particularly crucial.

Conclusions

The Peer Support role enhanced veteran engagement in the majority of instances. Study findings mirrored existing peer support literature, provided new evidence in relation to engaging UK veterans, and made recommendations for future veteran research and service provision.

Reference

Weir, B., Cunningham, M., Abraham, L. & Allanson-Oddy, C. (2017) Military veteran engagement with mental health and well-being services: a qualitative study of the role of the peer support worker. Journal of Mental Health. 28(6), pp.647-653.

Epigenetic Biotypes of Post-Traumatic Stress Disorder

Research Paper Title

Epigenetic biotypes of post-traumatic stress disorder in war-zone exposed veteran and active duty males.

Background

Post-traumatic stress disorder (PTSD) is a heterogeneous condition evidenced by the absence of objective physiological measurements applicable to all who meet the criteria for the disorder as well as divergent responses to treatments.

Methods

This study capitalised on biological diversity observed within the PTSD group observed following epigenome-wide analysis of a well-characterised Discovery cohort (N = 166) consisting of 83 male combat exposed veterans with PTSD, and 83 combat veterans without PTSD in order to identify patterns that might distinguish subtypes.

Results

Computational analysis of DNA methylation (DNAm) profiles identified two PTSD biotypes within the PTSD+ group, G1 and G2, associated with 34 clinical features that are associated with PTSD and PTSD comorbidities.

The G2 biotype was associated with an increased PTSD risk and had higher polygenic risk scores and a greater methylation compared to the G1 biotype and healthy controls.

The findings were validated at a 3-year follow-up (N = 59) of the same individuals as well as in two independent, veteran cohorts (N = 54 and N = 38), and an active duty cohort (N = 133). In some cases, for example Dopamine-PKA-CREB and GABA-PKC-CREB signaling pathways, the biotypes were oppositely dysregulated, suggesting that the biotypes were not simply a function of a dimensional relationship with symptom severity, but may represent distinct biological risk profiles underpinning PTSD.

Conclusions

The identification of two novel distinct epigenetic biotypes for PTSD may have future utility in understanding biological and clinical heterogeneity in PTSD and potential applications in risk assessment for active duty military personnel under non-clinician-administered settings, and improvement of PTSD diagnostic markers.

Reference

Yang, R., Gautam, A., Getnet, D., Daigle, B.J., Miller, S., Misganaw, B., Dean, K.R., Kumar, R., Muhie, S., Wang, K., Lee, I., Abu-Amara, D., Flory, J.D., PTSD Systems Biology Consortium, Hood, L., Wolkowitz, O.M., Mellon, S.H., Doyle 3rd, F.J., Yehuda, R., Marmar, C.R., Ressler, K.J., Hammamieh, R. & Jett, M. (2020) Epigenetic biotypes of post-traumatic stress disorder in war-zone exposed veteran and active duty males. Molecular Psychiatry. doi: 10.1038/s41380-020-00966-2. Online ahead of print.

What is the Impact of Military Service Exposures & Psychological Resilience on the Mental Health Trajectories of Older Male Veterans?

Research Paper Title

The Impact of Military Service Exposures and Psychological Resilience on the Mental Health Trajectories of Older Male Veterans.

Background

The researchers examine the impact of exposure to the dead, dying, and wounded (DDW) during military service on the later-life depressive symptom trajectories of male United States veterans, using psychological resilience as an internal resource that potentially moderates negative consequences.

Methods

The Health and Retirement Study (2006-2014) and linked Veteran Mail Survey were used to estimate latent growth curve models of depressive symptom trajectories, beginning at respondents’ first report of resilience.

Results

Veterans with higher levels of resilience do not have increased depressive symptoms in later life, despite previous exposure to DDW. Those with lower levels of resilience and previous exposure to DDW experience poorer mental health in later life.

Conclusions

Psychological resilience is important for later-life mental health, particularly for veterans who endured potentially traumatic experiences. The researches discuss the importance acknowledging the role individual resources play in shaping adaptation to adverse life events and implications for mental health service needs.

Reference

Urena, S., Taylor, M.G. & Carr, D.C. (2020) The Impact of Military Service Exposures and Psychological Resilience on the Mental Health Trajectories of Older Male Veterans. Journal of Aging and Health. doi: 10.1177/0898264320975231. Online ahead of print.

Is Psychological Resilience Important for Later-Life Mental Health?

Research Paper Title

The Impact of Military Service Exposures and Psychological Resilience on the Mental Health Trajectories of Older Male Veterans.

Background

The researchers examine the impact of exposure to the dead, dying, and wounded (DDW) during military service on the later-life depressive symptom trajectories of male United States veterans, using psychological resilience as an internal resource that potentially moderates negative consequences.

Methods

The Health and Retirement Study (2006-2014) and linked Veteran Mail Survey were used to estimate latent growth curve models of depressive symptom trajectories, beginning at respondents’ first report of resilience.

Results

Veterans with higher levels of resilience do not have increased depressive symptoms in later life, despite previous exposure to DDW. Those with lower levels of resilience and previous exposure to DDW experience poorer mental health in later life.

Conclusions

Psychological resilience is important for later-life mental health, particularly for veterans who endured potentially traumatic experiences. The researchers discuss the importance acknowledging the role individual resources play in shaping adaptation to adverse life events and implications for mental health service needs.

Reference

Urena, S. Taylor, M.G. & Carr, D.C. (2020) The Impact of Military Service Exposures and Psychological Resilience on the Mental Health Trajectories of Older Male Veterans. Journal of Aging and Health. doi: 10.1177/0898264320975231. Online ahead of print.

3MDR & PTSD: Breaking Through Avoidance & Increasing Engagement

Research Paper Title

Perceived treatment processes and effects of interactive motion-assisted exposure therapy for veterans with treatment-resistant posttraumatic stress disorder: a mixed methods study.

Background

A novel intervention, Multi-modular motion-assisted memory desensitisation and reconsolidation (3MDR), aims to reduce avoidance and improve engagement for patients with posttraumatic stress disorder (PTSD) who did not sufficiently respond to previous treatments. It has been found to effectively reduce PTSD symptoms for veterans with treatment-resistant PTSD. Symptomatic measures alone might not capture all treatment effects, and addition of qualitative outcomes may provide deeper understanding of treatment processes and treatment-induced changes.

The purpose of this was to study the perspectives of veterans with treatment-resistant PTSD on 3MDR treatment processes and effects and explore the relation of their experiences to PTSD symptom improvement.

Methods

A convergent parallel mixed methods design was applied. For the qualitative part, open-ended question interviews were conducted until data saturation was reached (N = 10). Thematic analysis, rooted in grounded theory, was performed. Quantitative data included pre- to posttreatment responder status based on a structured clinical interview for PTSD.

Results

Treatment processes endorsed by the veterans were engaging, regulating distress, feeling supported, facing traumatic memories, allowing emotions, associating, and disengaging from trauma. In terms of effects, veterans reported positive changes following 3MDR, including openness, new learning, self-understanding, closure, and reintegration. High comparability across themes was observed for responders and non-responders, except for the themes closure and reintegration, which were reported more often or more in depth by responders.

Conclusions

Veterans indicated 3MDR treatment processes that complied with its aims of breaking through avoidance and increasing engagement, thereby facilitating traumatic memory retrieval and processing. However, this did not necessarily translate into PTSD symptom improvement for all veterans. Walking towards trauma-related pictures was highlighted as unique component of 3MDR and connected to specific treatment processes and effects. Positive changes following 3MDR were experienced outside the domain of PTSD symptom improvement, implicating that 3MDR may beneficially impact veterans beyond symptom changes alone.

Reference

van Gelderen, M.J., Nijdam, M.J., Dubbink, G.E., Sleijpen, M. & Vermetten, E. (2020) Perceived treatment processes and effects of interactive motion-assisted exposure therapy for veterans with treatment-resistant posttraumatic stress disorder: a mixed methods study.

What are the Correlates of Suicidal Ideation & Behaviours Among Former Military Personnel Not Enrolled in the Veterans Health Administration?

Research Paper Title

Correlates of Suicidal Ideation and Behaviours Among Former Military Personnel Not Enrolled in the Veterans Health Administration.

Background

The current study sought to explore suicidal concomitants, both demographic and psychological, among former military personal.

Methods

The sample included 645 veterans who are at increased risk for suicide but have not yet pursued Veterans Health Administration (VHA) services.

Results

Descriptive statistics revealed that these veterans are primarily young Caucasian males who served in the US Army.

In terms of psychological characteristics, the current sample reported clinically significant levels of depression, post-traumatic stress, and insomnia.

Furthermore, respondents acknowledged use of various substances and high levels of perceived burdensomeness and thwarted belongingness.

Conclusions

The demographic and psychological makeup of the researchers sample was somewhat similar to that of VHA-connected veterans except that their sample was slightly more educated and reported less physical pain.

Reference

Raines, A.M., Allan, N.P., Franklin, C.L., Huet, A. Constans, J.I. & Stecker, T. (2020) Correlates of Suicidal Ideation and Behaviors Among Former Military Personnel Not Enrolled in the Veterans Health Administration. Archives of Suicide Research. 24(4), pp.517-533. doi: 10.1080/13811118.2019.1660286. Epub 2019 Dec 2.