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1.
Mil Med ; 189(1-2): 30-32, 2024 Jan 23.
Article in English | MEDLINE | ID: mdl-37525945

ABSTRACT

Preventing suicide remains a top clinical priority of the Department of Veterans Affairs (VA). In 2019, U.S. military veterans experienced a suicide rate of 52.3% higher than non-Veteran U.S. adults. Cigarette smoking has been found to be independently associated with an elevated risk of suicidal ideation, attempts, plans, and deaths among veterans and non-veterans. However, tobacco use is frequently overlooked in suicide risk assessment and mitigation and is not yet a target for intervention in VA suicide prevention protocols. In this commentary, we recommend that cigarette smoking be considered in suicide risk assessment protocols and that tobacco cessation interventions be considered as a potential beneficial treatment intervention to reduce the risk of suicide. Given the public health threat of suicide among veterans, it is essential to elucidate promising areas of intervention for those at high risk of suicide. Cigarette smoking is a modifiable target, associated with suicide risk, for which there are evidence-based interventions. Therefore, tobacco use disorder identification and treatment should be considered for inclusion in VA suicide risk protocols.


Subject(s)
Cigarette Smoking , Suicide , Veterans , Adult , Humans , United States/epidemiology , Cigarette Smoking/epidemiology , Suicidal Ideation , Suicide Prevention
3.
Contemp Clin Trials ; 131: 107250, 2023 08.
Article in English | MEDLINE | ID: mdl-37271412

ABSTRACT

BACKGROUND: Tobacco and cannabis co-use is a growing public health problem. The synergistic effects of cannabis and nicotine on neurobiological systems that mediate reward and shared environmental cues reinforcing use may make tobacco smoking cessation more difficult. N-acetylcysteine (NAC), an FDA-approved medication and over-the-counter supplement, has shown promise in animal studies and randomized controlled trials (RCTs) in reducing tobacco and cannabis craving and use. NAC's potential efficacy in treating addiction may be attributable to its central nervous system effects in reducing excessive glutamatergic activity, oxidative stress, and inflammation. To date, no RCT has examined NAC for smoking cessation among dual users of tobacco and cannabis. METHOD: In a double-blind, placebo-controlled RCT, we will examine NAC for smoking cessation among dual users of tobacco and cannabis. Sixty adult cigarette-cannabis co-users are randomized to receive NAC 3600 mg per day or placebo over 8 weeks. Participants in both groups receive 8 weekly cognitive behavioral therapy sessions addressing smoking cessation and cannabis reduction. Outcomes are assessed at Weeks 0, 4, 8, and 12. Primary aims are to determine NAC's efficacy in decreasing cigarette craving, nicotine dependence, and use; and cannabis craving and use. Exploratory aims include examination of changes in neurocognition with NAC and their potential mediational effects on cigarette and cannabis use outcomes. CONCLUSION: Results will inform smoking cessation treatment among dual users of tobacco and cannabis. CLINICALTRIALS: gov Identifier: NCT04627922.


Subject(s)
Cannabis , Smoking Cessation , Tobacco Use Disorder , Adult , Humans , Smoking Cessation/methods , Acetylcysteine/therapeutic use , Tobacco Use Disorder/therapy , Randomized Controlled Trials as Topic
4.
Contemp Clin Trials ; 126: 107096, 2023 03.
Article in English | MEDLINE | ID: mdl-36693589

ABSTRACT

BACKGROUND: Chronic pain and opioid use disorder (OUD) individually represent a risk to health and well-being. Concerningly, there is evidence that they are frequently co-morbid. While few treatments exist that simultaneously target both conditions, preliminary work has supported the feasibility of an integrated behavioral treatment targeting pain interference and opioid misuse. This treatment combined Acceptance and Commitment Therapy (ACT) and Mindfulness-Based Relapse Prevention (ACT+MBRP). This paper describes the protocol for the adequately powered efficacy study of this integrated treatment. METHODS: A multisite randomized controlled trial will examine the efficacy of ACT+MBRP in comparison to a parallel education control condition, focusing on opioid safety and pain education. Participants include veterans (n = 160; 21-75 years old) recruited from three Veterans Administration (VA) Healthcare Systems with chronic pain who are on a stable dose of buprenorphine. Both conditions include twelve weekly 90 min group sessions delivered via telehealth. Primary outcomes include pain interference (Patient Reported Outcome Measurement Information System - Pain Interference) and hazardous opioid use (Current Opioid Misuse Measure), which will be examined at the end of the active treatment phase and through 12 months post-intervention. Secondary analyses will evaluate outcomes including pain intensity, depression, pain-related fear, and substance use, as well as treatment mechanisms. CONCLUSION: This study will determine the efficacy of an integrated behavioral treatment program for pain interference and hazardous opioid use among veterans with chronic pain and OUD who are prescribed buprenorphine, addressing a critical need for more integrated treatments for chronic pain and OUD. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04648228.


Subject(s)
Acceptance and Commitment Therapy , Buprenorphine , Chronic Pain , Opioid-Related Disorders , Veterans , Humans , Young Adult , Adult , Middle Aged , Aged , Analgesics, Opioid/therapeutic use , Chronic Pain/drug therapy , Opioid-Related Disorders/drug therapy , Buprenorphine/therapeutic use
5.
Addict Behav ; 139: 107589, 2023 04.
Article in English | MEDLINE | ID: mdl-36565531

ABSTRACT

BACKGROUND: Craving is a distressing symptom of opioid use disorder (OUD) that can be alleviated with medications for OUD (MOUD). Buprenorphine is an effective MOUD that may suppress craving; however, treatment discontinuation and resumed opioid use is common during the early phases of treatment. More information on the craving response through the high-risk period of initiating buprenorphine may provide meaningful information on how to better target craving, which in turn may enhance outcomes. This systematic review investigated buprenorphine doses and formulations on craving during the induction and maintenance phases of treatment, and for context also compared the craving response to other MOUD (i.e., methadone, extended-release naltrexone [XR-NTX]). METHODS: PubMed, PsycInfo, Embase, and Cochrane Central databases were searched for randomized trials of buprenorphine versus placebo, various buprenorphine formulations/doses, or other MOUD that included a measure of opioid craving. RESULTS: A total of 10 studies were selected for inclusion. Buprenorphine and buprenorphine/naloxone (BUP/NAL) were each associated with lower craving than placebo over time. Craving was greater among those prescribed lower versus higher buprenorphine doses. In comparison to other MOUD, buprenorphine or BUP/NAL was linked to greater craving than methadone in 3 of the 6 studies. BUP/NAL was associated with greater reported craving than XR-NTX. DISCUSSION: Craving is reduced over time with buprenorphine and BUP/NAL, although other MOUD may provide greater reductions in craving. Although there is currently considerable variability in the measurement of craving, it may be a valuable concept to address with individuals receiving MOUD, especially early in treatment.


Subject(s)
Buprenorphine , Opioid-Related Disorders , Humans , Buprenorphine/therapeutic use , Analgesics, Opioid/therapeutic use , Narcotic Antagonists/therapeutic use , Craving , Delayed-Action Preparations , Randomized Controlled Trials as Topic , Opioid-Related Disorders/drug therapy , Naltrexone/therapeutic use , Buprenorphine, Naloxone Drug Combination/therapeutic use , Methadone/therapeutic use
8.
Front Psychiatry ; 12: 750686, 2021.
Article in English | MEDLINE | ID: mdl-34950067

ABSTRACT

Agitation is a common symptom encountered among patients treated in psychiatric emergency settings. While there are many guidelines available for initial management of the acutely agitated patient, there is a notable dearth of guidelines that delineate recommended approaches to the acutely agitated patient in whom an initial medication intervention has failed. This manuscript aims to fill this gap by examining evidence available in the literature and providing clinical algorithms suggested by the authors for sequential medication administration in patients with persistent acute agitation in psychiatric emergency settings. We discuss risk factors for medication-related adverse events and provide options for patients who are able to take oral medications and for patients who require parenteral intervention. We conclude with a discussion of the current need for well-designed studies that examine sequential medication options in patients with persistent acute agitation.

9.
Psychol Trauma ; 13(6): 611-620, 2021 Sep.
Article in English | MEDLINE | ID: mdl-33507793

ABSTRACT

OBJECTIVE: Attitudes and beliefs related to immersion in military culture can affect postseparation transition to the civilian setting. The etiology and complexity of these reactions are often overlooked by mental health providers, which can result in negative consequences for treatment. This qualitative study examined veterans' perceptions of military culture and the impact of military service on veterans' values, beliefs, and behaviors. The goal of this research was to identify aspects of military culture that are important for health care providers to consider as they care for veterans and to inform culturally sensitive mental health care for veterans. METHOD: Fifty-two military veterans completed a self-report survey and participated in semistructured focus groups. RESULTS: Participants reported diverse military experiences, and many endorsed a high level of continuing identification with aspects of military culture. Seven broad themes related to military culture emerged from qualitative analyses: (a) military values, beliefs, and behaviors; (b) relationships; (c) occupational habits and practices; (d) acquired skills; (e) communication; (f) affiliation; and (g) psychological health and well-being. CONCLUSION: This thematic analysis elucidated strategies to improve mental health services for veterans, using a nuanced model that encourages providers to better distinguish aspects of cultural transition from psychopathology. Results underscored the importance of training mental health providers to ensure sensitivity to military culture. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Subject(s)
Military Personnel , Veterans , Acculturation , Communication , Humans , Military Personnel/psychology , Qualitative Research , Veterans/psychology
10.
Mil Med ; 186(1-2): 24-29, 2021 Jan 30.
Article in English | MEDLINE | ID: mdl-33005932

ABSTRACT

INTRODUCTION: Individuals with substance use disorders and/or mental health (MH) conditions have higher rates of cigarette smoking than the general population. Electronic nicotine delivery systems (ENDS) while gaining popularity pose health risks. Herein we investigate risk perceptions and attitudes toward e-cigarettes in military Veterans with MH conditions. MATERIALS AND METHODS: Participants included U.S. Veterans receiving services from Veterans Administration MH/substance use disorder clinics in the San Francisco Bay Area (N = 98; 95% male, 44% White, 34% Black/African American), who completed a survey on smoking and health. Results compare attitudes and perceptions regarding e-cigarette use between ever and never e-cigarette users. The study was reviewed by the Institutional Review Board at both the Veterans Administration and University. RESULTS: Most respondents reported being current/past cigarette smokers (91%) and over a third reported having ever used an e-cigarette (38%). Most believed that e-cigarettes are not safe, are potentially dangerous, are potentially addictive if they use every day and are tempting and appealing to youth. Fifty-one percent of ever-users agreed with a statement that e-cigarettes can help people quit smoking regular cigarettes completely, and there was a significant difference in this belief when comparing them with never-users (23% agreed); χ2 = 9.259, P = 0.010. CONCLUSIONS: Proportion of e-cigarette use in this Veteran sample is greater than the general population. We observed high risk perception about e-cigarettes among all respondents and differences in perceived helpfulness of e-cigarettes for quitting in ever-users versus never-users in this sample. More consistent assessment of tobacco use among Veterans, with inclusion of ENDS use, would help inform prevention and treatment priorities, especially as information on health impacts of ENDS surfaces.

11.
Drug Alcohol Depend ; 214: 108149, 2020 09 01.
Article in English | MEDLINE | ID: mdl-32712569

ABSTRACT

BACKGROUND: Topiramate is an effective treatment for alcohol use disorder (AUD) and has also been used in the care of mild traumatic brain injury (mTBI). This pilot study aimed to obtain a preliminary assessment of topiramate's efficacy in reducing alcohol use and post-concussive symptoms, and its potential negative impact on cognitive function in 32 Veterans with co-occurring AUD and mTBI. METHODS: This was a prospective 12-week, randomized, double-blind, placebo-controlled pilot study of flexible-dose topiramate or placebo. Primary outcome was reduction of drinking days per week within the topiramate arm. Secondary outcomes included between group comparisons of alcohol use and craving, post-concussive symptoms, and cognitive function. RESULTS: Drinking days per week significantly decreased within both the topiramate and placebo arm. There were no significant treatment-by-week interactions on alcohol use/craving, or post-concussive symptoms in intent-to-treat analyses. In per-protocol analyses, topiramate significantly reduced number of drinks per week compared with placebo. Topiramate transiently impaired verbal fluency and working memory. Processing speed, cognitive inhibition, and mental flexibility significantly improved between weeks 1 and 12, regardless of treatment arm. CONCLUSIONS: Significant improvement occurred in both the topiramate and placebo groups over 12 weeks of treatment in alcohol use and post-concussive symptoms. Among treatment completers there was greater reduction of alcohol use in the topiramate arm. Topiramate was also associated with negative but transient effects on cognitive function. Results suggest both a possible benefit for topiramate treatment in reducing alcohol use and some potential for negative cognitive effects in Veterans with AUD and mTBI.


Subject(s)
Alcoholism/drug therapy , Anticonvulsants/therapeutic use , Brain Injuries, Traumatic/complications , Post-Concussion Syndrome/complications , Topiramate/therapeutic use , Adult , Alcohol Drinking , Alcoholism/psychology , Cognition , Craving , Double-Blind Method , Female , Humans , Male , Middle Aged , Pilot Projects , Prospective Studies , Treatment Outcome , Veterans/psychology
12.
Mil Med ; 185(9-10): e1872-e1875, 2020 09 18.
Article in English | MEDLINE | ID: mdl-32314788

ABSTRACT

Buprenorphine induction can lead to precipitated opioid withdrawal, even when using novel techniques such as transdermal buprenorphine. Involuntary limb movements are a distressing symptom of precipitated withdrawal that can be difficult to treat. We report a case of a military veteran transitioning from methadone to buprenorphine for the treatment of opioid use disorder (OUD) using small doses of transdermal buprenorphine. Herein, we review the literature associated with opioid withdrawal-related restlessness. Despite the known risk of concurrent benzodiazepine and buprenorphine administration, including decreased respiratory rate and death, we present a clinical presentation in which this medication combination may be necessary while under medical supervision. We suggest a stepwise algorithm for pharmacotherapy in patients experiencing involuntary limb movements associated with precipitated withdrawal. To safeguard the success of medication-assisted treatment (MAT) for opioid addiction, clinicians should be aware of potential clinical challenges when managing precipitated opioid withdrawal in patients with complex psychiatric comorbidities.


Subject(s)
Buprenorphine/adverse effects , Opioid-Related Disorders , Veterans , Humans , Methadone/adverse effects , Opioid-Related Disorders/complications , Opioid-Related Disorders/drug therapy , Psychotic Disorders , Substance Withdrawal Syndrome/diagnosis , Substance Withdrawal Syndrome/drug therapy , Substance Withdrawal Syndrome/etiology
13.
Nicotine Tob Res ; 22(4): 560-569, 2020 04 17.
Article in English | MEDLINE | ID: mdl-30874289

ABSTRACT

INTRODUCTION: Smoking is a lethal public health problem that is common in US military veterans, particularly those with posttraumatic stress disorder (PTSD). Mobile applications (apps) to promote smoking cessation are a scalable and low-cost approach that may facilitate treatment engagement. METHODS: This qualitative study examined the acceptability, user experience, and perceptions of a smoking cessation app, Stay Quit Coach (SQC), when incorporated into evidence-based smoking cessation treatment. US military veterans with PTSD who smoked at least five cigarettes per day for 15 of the past 30 days and stated an interested in cessation were eligible to participate. Participants' baseline comfort levels with mobile technology was measured using the Perceptions of Mobile Phone Interventions Questionnaire-Patient version (PMPIQ-P). At treatment end, semi-structured qualitative interviews were conducted. RESULTS: Twenty participants were enrolled and 17 (85.0%) participated in the qualitative interview at treatment end. PMPIQ-P scores at baseline ranged from 4.97 to 5.25 (SDs = 0.73-1.04), reflecting moderately high comfort with mobile technology among participants. Qualitative analyses indicated that most participants: (1) endorsed mobile technology as an appealing format for smoking cessation treatment, due to convenience and instantaneous access; and (2) expressed highest perceived helpfulness for interactive app features. Recommendations to improve SQC clustered into four thematic areas: (1) increasing personalization, (2) including more self-tracking features, (3) increasing visual cues, and (4) sharing progress with peers. CONCLUSIONS: SQC was perceived as an acceptable and useful tool to support smoking cessation in a sample of veteran smokers with PTSD. Qualitative data provided valuable insights that can inform the continued development of SQC and other apps for smoking cessation. IMPLICATIONS: Given the high lethality associated with cigarette smoking, it is crucial to identify scalable, low-risk strategies to promote smoking cessation, particularly in high-risk populations. Mobile technology is a promising approach that can be used to augment evidence-based smoking cessation treatment. Results of this qualitative study support the use of the SQC mobile app when incorporated into evidence-based smoking cessation treatment for veterans with PTSD and provide future directions for refinement of the SQC app. These findings also highlight the importance of using a patient-centered approach in designing apps intended for a clinical population.


Subject(s)
Cell Phone/statistics & numerical data , Health Behavior , Mobile Applications/standards , Smoking Cessation/methods , Smoking/therapy , Stress Disorders, Post-Traumatic/complications , Veterans/psychology , Adolescent , Adult , Aged , Behavior Therapy/methods , Female , Humans , Male , Middle Aged , Patient Compliance , Qualitative Research , Smokers , Smoking/epidemiology , Smoking/psychology , Surveys and Questionnaires , Veterans/statistics & numerical data , Young Adult
15.
Rehabil Psychol ; 64(3): 377-382, 2019 Aug.
Article in English | MEDLINE | ID: mdl-30985153

ABSTRACT

OBJECTIVE: This study aimed to identify modifiable factors associated with perceived functioning among veterans with high symptoms of posttraumatic stress disorder (PTSD). METHOD: Two hundred fifty-one post-9/11 veterans completed a survey of psychosocial symptoms and functioning; a subset participated in a follow-up survey (n = 109). Latent profile analysis (LPA) at baseline identified groups that differed by level of functioning (high/low). Items utilized in the LPA analysis were derived from the World Health Organization Quality of Life-Bref self-report measure. Veterans with high PTSD symptoms in both groups were compared and logistic regression was utilized to predict group membership. RESULTS: Veterans with high functioning/high symptoms (n = 45) had significantly lower alcohol use and sleep problems, and higher postdeployment social support, posttraumatic growth, and optimism than veterans with low functioning/high symptoms (n = 100). Fewer sleep difficulties and higher postdeployment social support and optimism were associated with membership in the high functioning/high symptom group. CONCLUSIONS: These findings support the importance of identifying factors that can facilitate higher social, occupational, and general functional capacity for those with high levels of PTSD symptomatology. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Subject(s)
Optimism/psychology , Sleep Wake Disorders/epidemiology , Social Support , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychology , Veterans/psychology , Adult , Afghan Campaign 2001- , Comorbidity , Female , Follow-Up Studies , Humans , Iraq War, 2003-2011 , Male , Quality of Life/psychology , Sleep Wake Disorders/psychology , Surveys and Questionnaires , United States/epidemiology , Veterans/statistics & numerical data
16.
Psychiatr Rehabil J ; 41(4): 351-355, 2018 Dec.
Article in English | MEDLINE | ID: mdl-29975084

ABSTRACT

OBJECTIVE: This investigation aimed to better understand perceived barriers to academic success and preferences for a veteran-specific psychosocial course among veterans with symptoms of posttraumatic stress (PTS). METHOD: Ninety-three veterans participated in this investigation as part of a larger study examining psychosocial functioning among veterans with PTS symptoms. Participants completed a self-report survey focused on perceived barriers to academic success and psychoeducational preferences related to health and well-being. RESULTS: Perceived barriers to academic success reported as most problematic were sleep difficulties, stress, depression, and financial concerns. Results indicated that veterans would be interested in attending an on-campus course focusing on these areas. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: These findings contribute to the understanding of student veterans with PTS symptoms' perceived needs and inform the development of campus programs for this population. (PsycINFO Database Record (c) 2018 APA, all rights reserved).


Subject(s)
Academic Success , Patient Acceptance of Health Care/psychology , Patient Education as Topic , Patient Preference/psychology , Psychotherapy , Stress Disorders, Post-Traumatic/psychology , Students/psychology , Veterans/psychology , Adult , Female , Humans , Male , Middle Aged , Universities , Young Adult
17.
Mil Med ; 183(suppl_1): 371-378, 2018 03 01.
Article in English | MEDLINE | ID: mdl-29635621

ABSTRACT

Objectives: The Deployment Anxiety Reduction Training (DART) is a manualized tool that was developed and piloted with active duty service members and recently deployed veterans regarding their response to potential and experienced acute combat stress reactions. DART is low risk and has high potential to be beneficial. It is a brief, one-session, non-pharmacological approach designed to reduce symptoms of peritraumatic panic and increase resilience in the face of a potentially traumatic stressor. Methods: This study was a mixed-methods pilot study to assess the utility and acceptability of DART during deployment. Results: Self-report and interview responses indicated that participants generally found the DART techniques acceptable and easy to understand. Overall, the techniques were perceived as likely to be helpful with high utility, although there was variation in perceived helpfulness among the different techniques. Participants overwhelmingly positively endorsed delivery of the DART protocol through use of smartphone technology. Conclusions: Results indicate that the DART components were considered highly acceptable and feasible for use in the deployed environment.


Subject(s)
Anxiety/prevention & control , Military Personnel/psychology , Teaching/standards , Adult , Anxiety/psychology , Female , Humans , Male , Military Personnel/education , Military Personnel/statistics & numerical data , Pilot Projects , Program Development/methods , Program Evaluation/methods , Risk Factors , Teaching/psychology
18.
Am J Prev Med ; 54(1): 124-128, 2018 Jan.
Article in English | MEDLINE | ID: mdl-29074319

ABSTRACT

INTRODUCTION: The purpose of this study is to examine the feasibility and acceptability of incorporating a mobile application, Stay Quit Coach, into an integrated care smoking-cessation treatment protocol for veterans with posttraumatic stress disorder (PTSD). METHODS: Participants included veteran smokers aged 18-69 years with PTSD. The integrated care protocol includes eight weekly PTSD-informed cognitive behavioral therapy sessions for smoking cessation, followed by monthly booster sessions and a prescription for standard smoking-cessation medications if desired. Participants used Stay Quit Coach as desired. Outcome measures at 3-month follow-up included: adherence (sessions attended), 30-day point-prevalence abstinence bioverified with carbon monoxide <6 parts per million, past-30 day mean daily cigarette use, exhaled carbon monoxide, nicotine dependence, and PTSD symptom severity. Repeated outcomes were analyzed with random-intercept linear mixed models. Data were collected in 2015-2016 and analyses were conducted in 2016-2017. RESULTS: Participants (n=20) were 95% male and 5% female; mean age 41.4 (SD=16.2) years. Thirteen participants (65%) attended all scheduled sessions, four (20%) did not adhere to the protocol on schedule, and three (15%) were lost to follow-up. At 3-month follow-up, six of 17 completers (35.3%) had bioverified 30-day point-prevalence abstinence. Nicotine dependence, carbon monoxide levels, and past 30-day cigarette use significantly decreased and PTSD symptoms were unchanged from baseline to follow-up. Participants self-reported using Stay Quit Coach 2.5 (SD=2.2) days/week; 15 of 17 (88.2%) reported using Stay Quit Coach <30 minutes/week; two of 17 (11.8%) reported using Stay Quit Coach 30-60 minutes/week. CONCLUSIONS: Although results must be interpreted with caution given the lack of control group and small sample size, findings indicate that integrating Stay Quit Coach into integrated care was feasible and acceptable.


Subject(s)
Mobile Applications , Smokers/psychology , Smoking Cessation , Stress Disorders, Post-Traumatic/complications , Veterans/psychology , Adult , Cognitive Behavioral Therapy/methods , Female , Humans , Male
19.
Mil Med ; 182(9): e1745-e1750, 2017 09.
Article in English | MEDLINE | ID: mdl-28885931

ABSTRACT

BACKGROUND: Exercise has beneficial effects for physical health outcomes and has also been shown to reduce the severity of psychological health symptoms. Recent studies have shown a potentially positive impact of exercise on posttraumatic stress disorder (PTSD). Prominent among those with PTSD, sleep disturbance and nightmares are among the top three PTSD symptoms commonly reported by treatment-seeking Veterans. Regular physical exercise has been consistently associated with better sleep. This study utilized a longitudinal design to explore the relationship between exercise and sleep among Veterans with PTSD symptoms at baseline and one-year follow-up. MATERIALS AND METHODS: Veterans (n = 76) who served in support of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn were recruited for this study. Correlations were assessed between PTSD symptoms, sleep, and engagement in exercise at each time point (baseline, one-year follow-up). Regression analyses were conducted to examine the relationship between engagement in exercise at baseline and PTSD symptoms at one-year follow-up, as well as sleep quality at one-year follow-up. Regression models controlled for demographic variables (age and gender), alcohol use, baseline PTSD symptoms, and baseline sleep quality. RESULTS: Multiple regression analyses demonstrated that engagement in exercise at baseline was significantly associated with better sleep quality at one-year follow-up while controlling for age, gender, alcohol use, baseline PTSD symptoms, and baseline sleep quality (ß = -0.128, p < 0.05). Multiple regression analyses examining the relationship between engagement in exercise at baseline and PTSD symptoms at one-year follow-up (controlling for age, gender, alcohol use, baseline PTSD symptoms, and baseline sleep quality) did not yield statistically significant results (ß = 0.053, p = 0.57). CONCLUSION: Results from the present study found that engagement in exercise at baseline was associated with better sleep quality at one-year follow-up. These findings were consistent with the current literature suggesting exercise can have a positive impact on sleep quality. Furthermore, our findings suggest that exercise could be considered as an adjunctive intervention for individuals with PTSD-particularly for those patients whose difficulties with sleep are predominant. Given that exercise is highly accessible and is embedded in the military culture, future research should examine the way in which exercise can be leveraged in PTSD treatment, specifically in ameliorating sleep difficulties. Exercise may also reap demonstrable public health benefits in multiple psychological and physical domains and reduce the psychiatric and medical morbidity and mortality associated with PTSD.


Subject(s)
Exercise/psychology , Sleep Hygiene , Stress Disorders, Post-Traumatic/complications , Veterans/psychology , Adult , Afghan Campaign 2001- , Cohort Studies , Dreams/psychology , Female , Humans , Iraq War, 2003-2011 , Male , Middle Aged , Prospective Studies , Sleep Wake Disorders/epidemiology , Sleep Wake Disorders/psychology , Stress Disorders, Post-Traumatic/psychology
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