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Durham, NC, United States

Ulmer C.S.,Durham VAMC | Ulmer C.S.,Duke University | Edinger J.D.,Durham VAMC | Edinger J.D.,Duke University | And 2 more authors.
Journal of Clinical Sleep Medicine | Year: 2011

Study Objectives: A significant portion of US military personnel are returning from deployment with trauma-related sleep disturbance, and disrupted sleep has been proposed as a mechanism for the development of medical conditions in those with posttraumatic stress disorder (PTSD). Although individuals with PTSD may realize improved sleep with either PTSD treatment or CBT for insomnia, many continue to experience residual sleep difficulties. Newly developed interventions designed to address nightmares are effective to this end, but often do not fully remove all aspects of PTSD-related sleep difficulties when used in isolation. A combined intervention involving both a nightmare-specific intervention and CBT for insomnia may lead to more marked reductions in PTSD-related sleep disturbances. Methods: Twenty-two veterans meeting criteria for PTSD were enrolled in the study. A combined intervention comprised of CBT for insomnia and imagery rehearsal therapy was evaluated against a usual care comparison group. Results: Intent-to-treat analyses revealed medium to large treatment effect sizes for all sleep diary outcomes, and very large treatment effects for insomnia severity, sleep quality, and PTSD symptoms. Conclusions: Findings demonstrate that an intervention targeting trauma-specific sleep disturbance produces large shortterm effects, including substantial reductions in PTSD symptoms and insomnia severity. Future research should focus on the optimal approach to the treatment of comorbid PTSD and sleep disturbance in terms of sequencing, and should assure that sleep-focused interventions are available and acceptable to our younger veterans, who were more likely to drop out of treatment.

McClernon F.J.,Duke University | McClernon F.J.,VISN 6 Mental Illness Research | van Voorhees E.E.,Duke University | English J.,Duke University | And 3 more authors.
Nicotine and Tobacco Research | Year: 2011

Introduction: Smokers with attention deficit hyperactivity disorder (ADHD) have greater difficulty quitting than those without ADHD, but preliminary data (McClernon, Kollins, Lutz, Fitzgerald, Murray, Redman, et al., 2008) suggest equivalent severity of withdrawal symptoms following brief abstinence. The objective of this study was to characterize the differential effects of intermediate term smoking abstinence on self-reported withdrawal and ADHD symptoms in adult smokers with and without ADHD. Methods: Forty adult (50% female), nontreatment seeking moderate-to-heavy smokers with and without ADHD were enrolled in a 12-day quit study in which monetary incentives were provided for maintaining biologically verified abstinence. Self-reported withdrawal, mood, and ADHD symptoms were measured pre- and post-quitting. Results: ADHD and controls did not vary on smoking or demographic variables. Significant Group × Session interactions were observed across a broad range of withdrawal symptoms and were generally characterized by greater withdrawal severity among ADHD smokers, particularly during the first 5 days of abstinence. In addition, Group × Sex × Session interactions were observed for craving, somatic symptoms, negative affect, and habit withdrawal; these interactions were driven by greater withdrawal severity among females with ADHD. Group × Session interactions were not observed for ADHD symptom scales. Conclusions: The results of this study suggest that smokers with ADHD, and ADHD females in particular, experience greater comwithdrawal severity during early abstinence-independent of effects on ADHD symptoms. Whereas additional research is needed to pinpoint mechanisms, our findings suggest that smoking cessation interventions targeted at smokers with ADHD should address their more severe withdrawal symptoms following quitting. © The Author 2011. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.

Elbogen E.B.,University of North Carolina at Chapel Hill | Elbogen E.B.,VISN 6 Mental Illness Research | Johnson S.C.,University of North Carolina at Chapel Hill | Wagner H.R.,VISN 6 Mental Illness Research | And 7 more authors.
Journal of Clinical Psychiatry | Year: 2012

Objective: After returning home, a subset of Iraq and Afghanistan War veterans report engaging in aggression toward others. This study is the first to identify variables empirically related to decreased risk of community violence among veterans. Method: The authors conducted a national survey from July 2009 to April 2010 in which participants were randomly drawn from over 1 million US military service members who served after September 11, 2001. Data were collected from a total of 1,388 Iraq and Afghanistan War era and theater veterans. The final sample included veterans from all 50 states and all military branches. Results: One-third of survey respondents selfidentified committing an act of aggression toward others during the past year, mostly involving minor aggressive behavior. Younger age, criminal arrest record, combat exposure, probable posttraumatic stress disorder, and alcohol misuse were positively related to violence toward others. Controlling for these covariates, multivariate analyses showed that stable living situation and the perception of having control over one's life were associated with reduced odds of severe violence (R2 = 0.24, χ27 = 145.03, P < .0001). Greater resilience, perceiving positive social support, and having money to cover basic needs were linked to reduced odds of other physical aggression (R2 = 0.20, χ28 = 188.27, P < .0001). Conclusions: The study identifies aggression as a problem for a subset of Iraq and Afghanistan War veterans who endorsed few protective factors. Analyses revealed that protective factors added incremental value to statistical modeling of violence, even when controlling for robust risk factors. The data indicate that, in addition to clinical interventions directed at treating mental health and substance abuse problems, psychosocial rehabilitation approaches aimed at improving domains of basic functioning and psychological well-being may also be effective in modifying risk and reducing violence among veterans. © Copyright 2012 Physicians Postgraduate Press, Inc.

Elbogen E.B.,University of North Carolina at Chapel Hill | Elbogen E.B.,VISN 6 Mental Illness Research | Johnson S.C.,University of North Carolina at Chapel Hill | Ryan Wagner H.,Duke University | And 3 more authors.
Military Medicine | Year: 2012

Research has yet to examine the relationship between financial well-being and community reintegration of veterans. To address this, we analyzed data from n = 1,388 Iraq and Afghanistan War Era Veterans who completed a national survey on post deployment adjustment. The results indicated that probable major depressive disorder, posttraumatic stress disorder, and traumatic brain injury were associated with financial difficulties. However, regardless of diagnosis, veterans who reported having money to cover basic needs were significantly less likely to have post deployment adjustment problems such as criminal arrest, homelessness, substance abuse, suicidal behavior, and aggression. Statistical analyses also indicated that poor money management (e.g., incurring significant debt or writing bad checks) was related to maladjustment, even among veterans at higher income levels. Given these findings, efforts aimed at enhancing financial literacy and promoting meaningful employment may have promise to enhance outcomes and improve quality of life among returning veterans.

Runnals J.J.,VISN 6 Mental Illness Research | Runnals J.J.,Duke University | Garovoy N.,Outreach | McCutcheon S.J.,Mental Health Services | And 12 more authors.
Women's Health Issues | Year: 2014

Background: Given recent, rapid growth in the field of women veterans' mental health, the goal of this review was to update the status of women veterans' mental health research and to identify current themes in this literature. The scope of this review included women veterans' unique mental health needs, as well as gender differences in veterans' mental health needs. Methods: Database searches were conducted for relevant articles published between January 2008 and July 2011. Searches were supplemented with bibliographic reviews and consultation with subject matter experts. Findings: The database search yielded 375 titles; 32 met inclusion/exclusion criteria. The women veterans' mental health literature crosses over several domains, including prevalence, risk factors, health care utilization, treatment preferences, and access barriers. Studies were generally cross-sectional, descriptive, mixed-gender, and examined Department of Veterans Affairs (VA) health care users from all service eras. Results indicate higher rates of specific disorders (e.g., depression) and comorbidities, with differing risk factors and associated medical and functional impairment for female compared with male veterans. Although satisfaction with VA health care is generally high, unique barriers to care and indices of treatment satisfaction exist for women. Conclusions: There is a breadth of descriptive knowledge in many content areas of women veterans' mental health; however, the research base examining interventional and longitudinal designs is less developed. Understudied content areas and targets for future research and development include certain psychiatric disorders (e.g., schizophrenia), the effects of deployment on woman veterans' families, and strategies to address treatment access, attrition, and provision of gender-sensitive care. © 2014 Jacobs Institute of Women's Health.

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