The Influence of Anxiety and Avoidant Coping on Probable Cannabis Use Disorder.

Objective: Individuals with anxiety frequently use cannabis to cope and are at greater risk for developing probable cannabis use disorder (CUD). Previous literature suggests avoidant coping styles are associated with higher anxiety levels and risk for problematic cannabis use, while action-oriented coping is associated with lower anxiety and problematic cannabis use. No studies have examined whether anxiety and action-oriented coping or avoidant coping interact to influence risk for CUD, which was the aim of the present study. Method: College students were recruited as part of a cross-sectional study on cannabis use. Participants (N = 371; 72.2% female) completed the Depression Anxiety and Stress Subscale (DASS-21), Cannabis Use Disorder Identification Test-Revised (CUDIT-R), and the Brief-COPE (B-COPE). Results: The data were analyzed using logistic moderation analysis. After controlling for gender, anxiety was a positive significant predictor of probable CUD, but action-oriented coping and avoidant coping were not. The interaction between anxiety and avoidant coping on probable CUD was significant, indicating that participants with high avoidant coping (regardless of high or low anxiety) and those with high anxiety (even with low avoidant coping) were more likely to have probable CUD than those with both low anxiety and low avoidant coping. No significant interaction was observed with action-oriented coping. Conclusions: Results suggest that avoidant coping, but not action-oriented coping, influences the relationship between anxiety and risk for probable CUD. Findings emphasize the importance of targeting both anxiety and avoidant coping when considering risk for probable CUD.

Perceived Family Support Buffers the Impact of PTSD-Depression Symptoms on Suicidal Ideation in College Students.

Students reporting symptoms of posttraumatic stress disorder (PTSD) and depression are at increased risk for suicidal ideation, putting them at greater risk for suicidal behavior and attempts. Perceived social support is a robust protective factor against the impact of PTSD and depression on suicidal ideation in college students, however different forms of social support (family, friends, significant others) may have greater influence on this association. In the current study, the influence of the different types of perceived social support on the relationship between PTSD-depression symptoms and suicidal ideation in college students were examined. College students (N = 928; 71% female) were recruited in part of a cross-sectional survey study examining the role of mental health on education functioning. A hierarchical regression indicated that PTSD-depression symptoms (b = .27, p < .001) and perceived family support (b = -.04, p < .01) were significantly associated with current suicidal ideation, while perceived support from friends (b = -.02, p = .417) and significant others (b = -.01, p = .301) were not. Perceived family support interacted with PTSD-depression symptoms (b = -.03, p < .05) to weaken the positive influence of symptoms on current suicidal ideation. Perceived family support appears to be the significant component of social support that moderates the relationship between PTSD-depression symptoms and suicidal ideation. Future research should focus on strengthening family support as a potential mechanism to mitigate suicide risk among college students who may be away from their families for the first time.

Cannabis use disorder uniquely predicts educational impairment in college students over and above other mental health disorders.

Objective: The impact of cannabis use disorder (CUD) on education functioning and GPA was examined within the context of co-occurring alcohol use disorder (AUD), major depressive disorder (MDD), and post-traumatic stress disorder (PTSD). Participants: Undergraduates (N = 210) who reported using cannabis within the past six months were recruited. Methods: Hierarchical multiple regression analyses were used to determine whether CUD symptom severity and presence of probable CUD diagnosis predicted educational impairment and current GPA, over and above other mental health conditions. Results: CUD symptom severity, but not probable CUD, significantly predicted greater educational impairment, over and above probable PTSD and MDD, which were also significant predictors. CUD symptom severity, but not probable CUD, significantly predicted lower GPA. Conclusion: In addition to other common mental health conditions, CUD may be an important area of assessment and intervention for university counseling centers to foster student academic success.

The influence of cannabis use disorder on post-traumatic stress disorder symptoms, depression symptoms, and non-suicidal self-injury among college students.

Objective: The interrelationships between cannabis use disorder (CUD), post-traumatic stress disorder (PTSD) and depressive symptoms, and non-suicidal self-injury (NSSI) were examined. Participants: Undergraduates (N = 363) who reported using cannabis within the past six months were recruited. Method: Mediation analyses was conducted to examine if CUD symptoms were indirectly associated with greater risk for engagement in current NSSI through more severe PTSD and depression symptoms. A factor comprised of PTSD-depression symptoms was created given PTSD and depression symptoms were highly correlated. Results: Greater CUD symptom severity indirectly increased risk for current NSSI via more severe PTSD-depression symptoms, after accounting for gender and alcohol use disorder symptoms. Conclusion: The current study provides preliminary evidence for the negative consequences of CUD on college students' mental health symptoms and engagement in NSSI, and future longitudinal research is needed to examine the dynamic relationships between CUD, PTSD-depression symptoms, and NSSI over time.

Delivery of written exposure therapy for PTSD in a university counseling center.

Posttraumatic stress disorder (PTSD) occurs at high rates among college students, and there is an urgent need to develop brief and accessible interventions to help these at-risk students achieve academic and career success. This open-trial pilot study tested the feasibility and effectiveness of Written Exposure Therapy (WET; Sloan & Marx, 2019), a brief, five-session exposure-based treatment, when delivered in a real-world Counseling Services Center. Students who met criteria for probable PTSD were assessed at baseline, posttreatment, and 3-month follow-up using self-report assessments of PTSD and depression. Of 28 eligible college students, 22/28 (78.6%) completed at least one treatment session, and of those students, 14/22 (63.6%) completed the full five sessions, 12 of whom completed both the posttreatment assessment and the 3-month follow-up assessment. Data were analyzed using intent-to-treat (N = 22) and per-protocol (n = 12) samples. As hypothesized, in both samples, PTSD symptoms decreased from baseline to posttreatment (η² = .60-.81; very large effects), and these improvements were maintained at the 3-month follow-up. Similar findings were observed with respect to decreases in self-reported depression, but not with respect to decreases in educational impairment or increases in academic self-efficacy. Qualitative data indicated that both students and therapists found the treatment credible and acceptable. These findings offer preliminary support for the utility of WET for PTSD when delivered in a student counseling services center. Suggestions for adapting WET within a student counseling services environment are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Incidences of anxiety disorders among active duty service members between 1999 and 2018.

PURPOSE: Anxiety disorders can impact the health, performance, and retention of military service members. To inform prevention initiatives and long-term treatment planning, incidence rates across anxiety disorders were evaluated among U.S. active-duty service members over a 20-year period. METHOD: Data were extracted from the Defense Medical Epidemiological Database to examine incidence rates of generalized anxiety disorder (GAD), panic disorder (PD), agoraphobia (AG), social anxiety disorder (SAD), obsessive compulsive disorder (OCD), agoraphobia with panic disorder (AWPD), agoraphobia without history of panic disorder (AWOPD), and unspecified anxiety disorder (UAD) among 151,844 service members between 1999 and 2018 in relation to sex, age, race, marital status, military pay grade, service branch. RESULTS: Incidence rates of anxiety disorders increased significantly over the 20-year period. Anxiety disorder incidence rates ranged widely from 0.01 to 23.70 (per 1000 service members). There were significant differences in observed versus expected diagnostic rates across all demographic variables examined (p < 0.001). CONCLUSION: Incidence rates varied considerably across the anxiety disorders, with UAD being the highest. These data highlight the importance of health care professionals attending to anxiety disorders, in order to plan for service member needs, develop preventative interventions, address early detection, and deliver treatments to improve combat readiness.

Military Use of Point of Care Ultrasound (POCUS).

BACKGROUND: Point of care ultrasound (POCUS) offers multiple capabilities in a relatively small, lightweight device to military clinicians of all types and levels in multiple environments. Its application in diagnostics, procedural guidance, and patient monitoring has not been fully explored by the Military Health System (MHS). The purpose of this narrative review of the literature was to examine the overall use of POCUS in military settings, as well as the level of ultrasound training provided. METHODS: Studies related to use of POCUS by military clinicians with reported sensitivity/specificity, accuracy of exam, and/or clinical decision impact met inclusion criteria. After initial topical review and removal of duplicates, two authors selected 17 papers for consideration for inclusion. Four of the authors reviewed the 17 papers and determined the final inclusion of 14 studies. RESULTS: We identified seven prospective studies, of which three randomized subjects to groups. Five reports described use of POCUS in patients, two used healthy volunteers, two were in simulation training environments, four used animal models to simulate specific conditions, and one used a cadaver model. Clinician subjects ranged from one to 34. Conventional medics were subjects in six studies. Four studies included special operations medics. One study included nonmedical food service inspectors. The use of ultrasound in theater by deployed consultant radiologists is described in three reports. CONCLUSIONS: Military clinicians demonstrated the ability to perform focused exams, including FAST exams and fracture detection with acceptable sensitivity and specificity. POCUS in the hands of trained military clinicians has the potential to improve diagnostic accuracy and ultimately care of the war fighter.

Impact of a Standardized Patient Hand-off Tool on Communication between Emergency Medical Services Personnel and Emergency Department Staff.

INTRODUCTION: Handoff communication between Emergency Medical Services (EMS) and Emergency Department (ED) staff is critical to ensure quality patient care. In January 2016, the Southwest Texas Regional Advisory Council (STRAC) implemented MIST (Mechanism, Injuries, vital Signs, Treatments), a standardized EMS to ED handoff tool. The En route Care Research Center conducted a Pre-MIST implementation survey of ED staff in December 2015 and a Post-MIST follow-up survey in July 2017 to determine the impact of the MIST handoff tool on the perceived quality of transmission of pertinent patient information and in the overall handoff experience. METHODS: We administered a nine-item Likert scale questionnaire to Brooke Army Military Medical Center (BAMC) ED providers and nurses before and after implementation of MIST. The questionnaire captured perceived competence and satisfaction with handoff communication (Cronbach's alpha 0.73). We analyzed responses for the total sample and by occupation (providers and nurses), and we calculated odds ratios to determine items that may be most predictive of a positive handoff experience from the perspective of the ED staff. We performed chi-square tests and reported data as percentages. RESULTS: Total respondents Pre- and Post-MIST were 128 (62%) nurses and 80 (38%) providers (MDs, DOs, and PAs). Following the implementation of MIST, more respondents reported that they were "informed of prehospital treatments" (p < 0.001), that "Red/Blue Trauma Alert Criteria were conveyed" (p < 0.001), and that the "time to give the report was sufficient to convey pertinent information" (p < 0.001). Nurses more frequently reported that "Red/Blue Trauma Alert Criteria were conveyed" post-MIST (p < 0.01). Providers more frequently reported that "Assessment findings were conveyed" (p < 0.05), that they 'interrupted the report for clarification" (p < 0.04), that "time to give the report was sufficient to convey pertinent information" (p < 0.001) and that they "felt positive about the overall handoff experience" (p < 0.03) Post-MIST. Overall satisfaction with the handoff was associated with frequently being informed of prehospital treatments (OR 5.5; 2.1-14.4) and frequently receiving a copy of the prehospital record (OR 2.9; 1.1-7.2). CONCLUSIONS: These data demonstrate that providers and nurses reported an improvement in the handoff experience Post-MIST. This study supports the use of a standardized handoff tool at this critical step in patient care.

Level 1 Trauma Centers and OEF/OIF Emergency Departments: Comparison of Trauma Patient Populations.

INTRODUCTION: Brooke Army Medical Center (BAMC), the largest military hospital and the only level 1 trauma center in the DoD, cares for active duty, retired uniformed services personnel, and beneficiaries. In addition, BAMC works in collaboration with the Southwest Texas Regional Advisory Council (STRAC) and University Hospital (UH), San Antonio's other level 1 trauma center, to provide trauma care to residents of the city and 22 counties in southwest Texas from San Antonio to Mexico (26,000 square mile area). Civilian-military partnerships are shown to benefit the training of military medical personnel; however, to date, there are no published reports specific to military personnel experiences within emergency care. The purpose of the current study was to describe and compare the emergency department trauma patient populations of two level 1 trauma centers in one metropolitan city (BAMC and UH) as well as determine if DoD level 1 trauma cases were representative of patients treated in OEF/OIF emergency department settings. MATERIALS AND METHODS: We obtained a nonhuman subjects research determination for de-identified data from the US Air Force 59th Medical Wing and the University of Texas Health Science Center at San Antonio Institutional Review Boards. Data on emergency department patients treated between the years 2015 and 2017 were obtained from the two level 1 trauma centers (BAMC and UH, located in San Antonio, Texas); data included injury descriptors, ICU and hospital days, and department procedures. RESULTS: Two-proportion Z-tests indicated that trauma patients were similar across trauma centers on injury type, injury severity, and discharge status; yet trauma patients differed significantly in terms of mechanism of injury and regions of injury. BAMC received significantly greater proportions of patients injured from falls, firearms and with facial and head injuries than UH, which received significantly greater proportion of patients with thorax and abdominal injuries. In addition, a significantly greater proportion of patients spent more than 2 days in the ICU and greater than two total hospital days at BAMC than in UH. In comparison to military emergency departments in combat zones, BAMC had significantly lower rates of blood product administration and endotracheal intubations. CONCLUSIONS: The trauma patients treated at a military level 1 trauma center were similar to those treated in the civilian level 1 trauma center in the same city, indicating the effectiveness of the only DoD Level 1 trauma center to provide experience comparable to that provided in civilian trauma centers. However, further research is needed to determine if the exposure rates to specific procedures are adequate to meet predeployment readiness requirements.

The Trauma and Suicide Potential Index-5: Psychometric Evaluation in College Samples.

We provide a brief description of the development of the Trauma and Suicide Potential Index-5 (TSPI-5) and report on the psychometric properties of scores from the new instrument. The TSPI-5 is designed to assess an individual's desire to attempt suicide due to experiencing a trauma. We examined the structure of the instrument in two independent undergraduate samples. Study 1 (N = 415) examined the structure of the TSPI-5 using exploratory structural equation modeling. Study 2 (N = 538) reexamined the instrument structure using the same modeling strategy and also examined other validity estimates. Study 1 demonstrated an adequate fit to the sample data (χ2 [1, N = 415] = 215.99, p < .001, comparative fit index (CFI ) = .969, Tucker-Lewis non-normed fit index (TLI) = .939, root mean squared error of approximation (RMSEA) = .319 [90% confidence interval (CI) = .283, .356], p < .001) and suggested evidence for unidimensionality. Study 2 confirmed the unidimensionality of the TSPI-5 as shown by acceptable fit estimates to the sample data, χ2 (5, N = 538) = 80.45, p < .001, CFI = .996, TLI = .99, RMSEA = .17 (90% CI = .140, .200), p < .001. Scale reliability estimates for the TSPI-5 were good in Study 1 (omega = .94) and Study 2 (omega = .96). The TSPI-5 is a brief unidimensional instrument and its scores demonstrated good reliability and validity for assessing suicide-related behaviors due to experiencing a trauma in undergraduate samples.