Psychological burden of PTSD, depression, and their comorbidity in the U.S. veteran population: Suicidality, functioning, and service utilization

Nichter, Brandon; Norman, Sonya B.; Haller, Moira; Pietrzak, Robert H.

doi:10.1016/j.jad.2019.06.072

Cited by 98 publications

(73 citation statements)

References 60 publications

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“…As anticipated from their well-established empirical comorbidity (e.g. Nichter, Norman, Haller, & Pietrzak, 2019), the depression node had bridge edges to all of the PTSD symptom clusters except avoidance. Lastly, combat exposure was associated with the intrusion cluster, but with none of the other PTSD clusters, nor with depression or the moral injury subscales.…”

Section: Discussionmentioning

confidence: 75%

Associations between moral injury, PTSD clusters, and depression among Israeli veterans: a network approach

Levi‐Belz

Greene

Zerach

2020

European Journal of Psychotraumatology

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Background: Moral Injury (MI) is one of the adverse consequences of combat. Following exposure to potentially morally injurious events (PMIEs)--events perceived as violations of deep moral beliefs by oneself or trusted individuals--a significant minority of veterans could develop posttraumatic stress disorder (PTSD) and depression. Objective: The current study represents the first attempt to apply a network analysis model to examine an exploratory empirical conceptualization of a network of PMIEs during military service, post-traumatic stress disorder (PTSD) symptom clusters, depression, and combat exposure among Israel Defence Forces veterans. Method: A volunteer sample of 191 Israeli combat veterans were recruited during 2017, and completed validated self-report questionnaires tapping PMIEs, PTSD, and depression in a cross-sectional design study. A regularized Gaussian graphical model was estimated. Results: Network analysis revealed strong bridge associations between the PTSD nodes and most of the PMIEs nodes. The nodes of PMIE-betrayal and PTSD negative alterations in cognitions and mood (NACM) symptom cluster were found to have a bridging function between other PMIEs and PTSD. Depression was found to be connected to most of the PMIEs and PTSD nodes. Conclusions: The study's findings offer an overview of the complex relationships between PMIEs and PTSD clusters among Israeli veterans. PMIEs--notably, betrayal-based experiences--are related to PTSD clusters directly and through depressive symptoms. Some possible mechanisms for the links between PMIEs and PTSD and the clinical implications related to specific interventions are discussed. ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 75%

Associations between moral injury, PTSD clusters, and depression among Israeli veterans: a network approach

Levi‐Belz

Greene

Zerach

2020

European Journal of Psychotraumatology

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“…The knowledge gained from studying veterans in non-VA health care settings is important for monitoring the quality of care received by all veterans in a more generalizable manner, especially among those who are generally less likely to use the VA health care system [ 22 , 23 ]. Most US veteran populations are community based and study samples drawn from VA hospitals and military clinics are biased in that they likely overrepresent treatment-seeking veterans in more urban areas [ 24 ]. Consequently, the current study is conducted to assess the impact of recent service changes that may have differentially affected rural areas [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, the current study is conducted to assess the impact of recent service changes that may have differentially affected rural areas [ 25 ]. At this time, the consensus is that, at least for the near future, multiple data sources (both VA and non-VA) will be required to study post-deployment health outcomes among US veterans [ 2 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Mental health status in veterans residing in rural versus non-rural areas: results from the veterans’ health study

et al. 2020

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Background The majority of Veterans Affair (VA) hospitals are in urban areas. We examined whether veterans residing in rural areas have lower mental health service use and poorer mental health status. Methods Veterans with at least 1 warzone deployment in central and northeastern Pennsylvania were randomly selected for an interview. Mental health status, including PTSD, major depression, alcohol abuse and mental health global severity, were assessed using structured interviews. Psychiatric service use was based on self-reported utilization in the past 12 months. Results were compared between veterans residing in rural and non-rural areas. Data were also analyzed using multivariate logistic regression to minimize the influence by confounding factors. Results A total of 1730 subjects (55% of the eligible veterans) responded to the survey and 1692 of them had complete geocode information. Those that did not have this information (n = 38), were excluded from some analyses. Veterans residing in rural areas were older, more often of the white race, married, and experienced fewer stressful events. In comparison to those residing in non-rural areas, veterans residing in rural areas had lower global mental health severity scores; they also had fewer mental health visits. In multivariate logistic regression, rural residence was associated with lower service use, but not with PTSD, major depression, alcohol abuse, and global mental health severity score after adjusting confounding factors (e.g., age, gender, marital status and education). Conclusions Rural residence is associated with lower mental health service use, but not with poor mental health in veterans with former warzone deployment, suggesting rural residence is possibly protective.

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“…For example, trauma serves as a potent risk factor for adolescent depression and poor responses to treatment (Shamseddeen et al, ), and also creates a risk for post‐traumatic stress disorder (PTSD). Assessment of the presence and degree of PTSD symptoms is important, as severe PTSD symptoms may enhance domains of depressive symptomatology (Nichter, Norman, Haller, & Pietrzak, ). For example, sleep disturbances associated with MDD may be exacerbated by trauma‐related nightmares, and the ability to engage in and enjoy social activities may be inherently compromised by hypervigilance.…”

Section: Risk Factors and Diagnostic Challengesmentioning

confidence: 99%

Annual Research Review: Defining and treating pediatric treatment‐resistant depression

Dwyer

Stringaris

Brent

et al. 2020

Child Psychology Psychiatry

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Background Adolescent major depressive disorder (MDD) is a significant health problem, associated with substantial morbidity, cost, and mortality. Depression is a significant risk factor for suicide, which is now the second leading cause of death in young people. Up to twenty per cent of adolescents will experience MDD before adulthood, and while a substantial proportion will improve with standard‐of‐care treatments (psychotherapy and medication), roughly one third will not. Methods Here, we have reviewed the literature in order to discuss the concept of treatment‐resistant depression (TRD) in adolescence, examine risk factors, diagnostic difficulties, and challenges in evaluating symptom improvement, and providing guidance on how to define adequate medication and psychotherapy treatment trials. Results We propose a staging model for adolescent TRD and review the treatment literature. The evidence base for first‐ and second‐line treatments primarily derives from four large pediatric clinical trials (TADS, TORDIA, ADAPT, and IMPACT). After two medications and a trial of evidence‐based psychotherapy have failed to alleviate depressive symptoms, the evidence becomes quite thin for subsequent treatments. Here, we review the evidence for the effectiveness of medication switches, medication augmentation, psychotherapy augmentation, and interventional treatments (i.e., transcranial magnetic stimulation, electroconvulsive therapy, and ketamine) for adolescent TRD. Comparisons are drawn to the adult TRD literature, and areas for future pediatric depression research are highlighted. Conclusions As evidence is limited for treatments in this population, a careful consideration of the known risks and side effects of escalated treatments (e.g., mood stabilizers and atypical antipsychotics) is warranted and weighed against potential, but often untested, benefits.

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Psychological burden of PTSD, depression, and their comorbidity in the U.S. veteran population: Suicidality, functioning, and service utilization

Cited by 98 publications

References 60 publications

Associations between moral injury, PTSD clusters, and depression among Israeli veterans: a network approach

Associations between moral injury, PTSD clusters, and depression among Israeli veterans: a network approach

Mental health status in veterans residing in rural versus non-rural areas: results from the veterans’ health study

Annual Research Review: Defining and treating pediatric treatment‐resistant depression

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