Twenty-Seven-Year Follow-Up of Vietnam Air War USAF POWs and Matched Controls Not Captured: A Qualitative Study.

OBJECTIVE: To provide a follow up of a 1976 study of the impact of captivity on U.S. Air Force (USAF) POWs and USAF Controls matched for time in Southeast Asia, military rank and aircraft crew position. METHOD: Qualitative study of replies to open ended questions of positive and negative changes due to their captivity/combat experiences made by participants (POWs and Controls) who replied in both 1976 and in 2003. RESULTS: Both groups acknowledged positive and negative effects of the experiences in 1976. In 1976 and 2003 the POWs mainly reported negative effects on career and family domains but positive effects of individual development and growth. Controls reported mild negative effects on family in 1976, and benefits to their careers and sense of self in both 1976 and 2003. CONCLUSION: Captivity during the Vietnam War for USAF included two types of extreme duress which were the incarceration itself; and the repatriation experience which entailed re-assimilation despite loss of occupation and disrupted families. Despite these obstacles, POWs exhibited substantial resilience in achieving self-growth and how they regarded themselves psychologically in comparison to their matched control fellow aviators who while also suffering a lesser separation from family, tended to prosper in their careers and were proud of their accomplishments. Long term separation from work, family and friends and the inability to return to their families and careers with the effectiveness demanded by their ambition were a more devastating ongoing consequence of their captivity than the immediate suffering of their imprisonment.

Multidisciplinary Proactive Psychiatric Consultation Service: Impact on Length of Stay for Medical Inpatients.

BACKGROUND: Mental illness correlates with an increased length of stay (LOS) for patients hospitalized for medical conditions. While psychiatric consultations help manage mental illness among those hospitalized for medical conditions, consultations initiated by nonpsychiatric mental disease may lack maximum effectiveness. METHODS: In a before-and-after design, in 2 contiguous years LOS for internist-initiated, conventional consultation (CC) as usual treatment was compared to LOS of a proactive, mental health professional-initiated, multidisciplinary intervention delivered by the behavioral intervention team (BIT) on the same units. The patient populations included general medical patients with a variety of illnesses. Patients were treated in 3 different inpatient settings with a total capacity of 92 beds serving 15,858 patient visits over 3 comparison years. BIT comprised a psychiatrist, a nurse, and a social worker, each of whom performed the specific tasks of their professional discipline, while collaborating among themselves and their health-care colleagues. BIT provided timely, appropriate, and effective patient care alongside consultative advice and education to their corresponding professional peers. BIT was compared to CC on the outcome of LOS. RESULTS: There was a statistically significant reduction of LOS favoring BIT over CC for patients with an LOS of <31 days which persisted while controlling for multiple co-morbid factors. Also, a statistically significant spillover effect was suggested by the overall improvement of LOS on units implementing BIT. CONCLUSION: BIT is a promising means of lowering LOS on general medical units while providing a high level of care and staff support.