Traumatic stressor exposure and post-traumatic symptoms in homeless veterans.

OBJECTIVES: To better understand potential risk factors for post-traumatic stress disorder (PTSD) and homelessness in veterans, we studied trauma exposure and responses in archival data on 115 homeless veterans. METHODS: Rates of exposure to military and a variety of civilian high magnitude stressor (HMS) and persistent post-traumatic distress (PPD) events and symptoms of post-traumatic stress were assessed. The relationships between frequency of different trauma types and symptoms of post-traumatic stress were examined. RESULTS: Exposure to both HMS and PPD events were extremely high in this sample, with particularly high exposure to adult (82%) and childhood (62%) interpersonal violence HMS events and HMS events during military service (53%). Exposure to both military and civilian PPD events was associated with significantly higher levels of PTSD symptoms than exposure to no PPD events or only civilian PPD events, and almost all HMS event types were significantly correlated with both PTSD and dissociation symptoms. CONCLUSIONS: Post-traumatic symptoms and military and civilian traumatic stressors of all types should be assessed in homeless veterans because they may be contributing to poor social and occupational functioning.

Development and validation of a brief self-report measure of trauma exposure: the Trauma History Screen.

Although information about individuals' exposure to highly stressful events such as traumatic stressors is often very useful for clinicians and researchers, available measures are too long and complex for use in many settings. The Trauma History Screen (THS) was developed to provide a very brief and easy-to-complete self-report measure of exposure to high magnitude stressor (HMS) events and of events associated with significant and persisting posttraumatic distress (PPD). The measure assesses the frequency of HMS and PPD events, and it provides detailed information about PPD events. Test-retest reliability was studied in four samples, and temporal stability was good to excellent for items and trauma types and excellent for overall HMS and PPD scores. Comprehensibility of items was supported by expert ratings of how well items appeared to be understood by participants with relatively low reading levels. In five samples, construct validity was supported by findings of strong convergent validity with a longer measure of trauma exposure and by correlations of HMS and PPD scores with posttraumatic stress disorder (PTSD) symptoms. The psychometric properties of the THS appear to be comparable or better than longer and more complex measures of trauma exposure.

Motivational interview improves treatment entry in homeless veterans.

Motivational Interviewing (MI) has successfully been used to facilitate entry and compliance in drug and alcohol treatment programs. Some questions have been raised as to the effectiveness of MI in severely distressed populations. This study aims to assess the effectiveness of MI in a population of homeless, unemployed, and substance dependent veterans who are being wait-listed for entry into a residential treatment program. Seventy-five veterans placed on a wait-list were randomized to receive a single MI or standard (Std) intake interview. Outcomes assessed were entry, and length of stay (LOS). Secondary outcomes assessed included program completion and rates of graduation. Readiness to change and self-efficacy were assessed before and after the interview. Significantly more participants entered the program in the MI group (95%) than in the Std group (71%). Although those in the MI group remained in the program longer, and had higher program completion and graduation rates, these differences were not statistically significant. No significant between-group or within-group differences were found in readiness or self-efficacy. This study demonstrates that a single, easily administered intervention can increase program entry. Also based on the study findings, further research into the question of whether MI can increase program retention, in a severely distressed population, is warranted.

Client predictors of treatment retention and completion in a program for homeless veterans.

This study assessed the value of a specific set of client variables in predicting treatment retention and completion of a rehabilitation program for homeless veterans. Participants were 596 (22 female) military veterans admitted to the Palo Alto, California Veterans Administration domicilary program between 1992 and 1995. Information was collected on a number of demographic and background characteristics previously used to predict treatment retention and outcomes. Results indicated that clients who were younger, female, and currently diagnosed with a depressive disorder, showed the highest rates of treatment retention and completion, whereas a current personality disorder diagnosis or history of psychiatric treatment was related to poorer rates of retention and completion. These results may be informative for identifying ways to modify this and other similar treatments to apply to a larger client population. The study's limitations were noted.

Causes of death among male veterans who received residential treatment for PTSD.

Previous studies have shown elevated mortality among psychiatric and substance abusing patients, including veterans with PTSD. Although early studies showed elevated deaths from external causes among Vietnam veterans in the early postwar years, more recent studies have also shown increased health problems among veterans with PTSD. This study compared mortality due to behavioral causes versus other diseases among 1,866 male veterans treated for PTSD. Death certificates obtained for 110 veterans indicated behavioral causes accounted for 62.4% of deaths, standardized mortality ratio = 3.4-5.5, including accidents (29.4%), chronic substance abuse (14.7%), and intentional death by suicide, homicide, or police (13.8%). Results suggest possible opportunities to improve outcomes of this at-risk patient population through harm reduction interventions and improved continuity of care.

A comparison of self-report measures of nicotine dependence among male drug/alcohol-dependent cigarette smokers.

This study examined the psychometric properties and validity of the Fagerström Tolerance Questionnaire (FTQ), the Fagerström Test for Nicotine Dependence (FTND), and the Heaviness of Smoking Index (HSI) when used as self-report measures of nicotine dependence among male drug/alcohol-dependent smokers (n=191 participants in a large stop-smoking study). All three measures had fairly low internal consistency. The FTQ and FTND had similar two-factor structures, but the FTND factor structure accounted for a greater percentage of the item variance. All three measures were significantly correlated in the expected directions with several independent self-report and biochemical indicators of nicotine dependence (e.g., cigarette pack-years, cotinine) and with baseline measures of smoking topography. The FTND outperformed the FTQ on several correlations, and the HSI outperformed both the FTQ and the FTND. Results concerning correlations between each of the three measures and indicators of compensation in response to reductions in nicotine availability were equivocal. The HSI and FTND were predictive of at least 4 weeks of biochemically verified postquit abstinence among a subsample of individuals receiving smoking treatment (n=93). All three measures had mediocre psychometric properties, and the magnitudes of their relationships with independent indicators were generally modest. All three measures appeared to be valid as self-report measures of nicotine dependence among male drug/alcohol-dependent individuals. The HSI appeared to be the best of the three measures; thus, studies of drug/alcohol-dependent smokers should be sure to report the results from this measure. Efforts to develop self-report measures of nicotine dependence with better properties and performance in this population should continue to be pursued.