Impact of veteran-led peer mentorship on posttraumatic stress disorder.

Peer mentorship shows promise as a strategy to support veteran mental health. A community-academic partnership involving a veteran-led nonprofit organization and institutions of higher education evaluated a collaboratively developed peer mentor intervention. We assessed posttraumatic stress disorder (PTSD), postdeployment experiences, social functioning, and psychological strengths at baseline, midpoint, and 12-week discharge using the PTSD Checklist for DSM-5 (PCL-5), Deployment Risk and Resilience Inventory-2, Social Adaptation Self-evaluation Scale, and Values in Action Survey. Brief weekly check-in surveys reinforced mentor contact and assessed retention. The sample included 307 veterans who were served by 17 veteran peer mentors. Mixed-effects linear models found a modest effect for PTSD symptom change, with a mean PCL-5 score reduction of 4.04 points, 95% CI [-6.44, -1.64], d = 0.44. More symptomatic veterans showed a larger effect, with average reductions of 9.03 points, 95% CI [-12.11, -5.95], d = 0.77. There were no significant findings for other outcome variables. Compared to younger veterans, those aged 32-57 years were less likely to drop out by 6 weeks, aORs = 0.32-0.26. Week-by-week hazard of drop-out was lower with mentors ≥ 35 years old, aHR = 0.62, 95% CI [0.37, 1.05]. Unadjusted survival differed by mentor military branch, p = .028, but the small mentor sample reduced interpretability. Like many community research efforts, this study lacked a control group, limiting the inferences that can be drawn. Continued study of veteran peer mentorship is important as this modality is often viewed as more tolerable than therapy.

Identifying the Underlying Factors Associated With Patients' Attitudes Toward Antidepressants: Qualitative and Quantitative Analysis of Patient Drug Reviews.

BACKGROUND: Nonadherence to antidepressants is a major obstacle to deriving antidepressants' therapeutic benefits, resulting in significant burdens on the individuals and the health care system. Several studies have shown that nonadherence is weakly associated with personal and clinical variables but strongly associated with patients' beliefs and attitudes toward medications. Patients' drug review posts in online health care communities might provide a significant insight into patients' attitude toward antidepressants and could be used to address the challenges of self-report methods such as patients' recruitment. OBJECTIVE: The aim of this study was to use patient-generated data to identify factors affecting the patient's attitude toward 4 antidepressants drugs (sertraline [Zoloft], escitalopram [Lexapro], duloxetine [Cymbalta], and venlafaxine [Effexor XR]), which in turn, is a strong determinant of treatment nonadherence. We hypothesized that clinical variables (drug effectiveness; adverse drug reactions, ADRs; perceived distress from ADRs, ADR-PD; and duration of treatment) and personal variables (age, gender, and patients' knowledge about medications) are associated with patients' attitude toward antidepressants, and experience of ADRs and drug ineffectiveness are strongly associated with negative attitude. METHODS: We used both qualitative and quantitative methods to analyze the dataset. Patients' drug reviews were randomly selected from a health care forum called askapatient. The Framework method was used to build the analytical framework containing the themes for developing structured data from the qualitative drug reviews. Then, 4 annotators coded the drug reviews at the sentence level using the analytical framework. After managing missing values, we used chi-square and ordinal logistic regression to test and model the association between variables and attitude. RESULTS: A total of 892 reviews posted between February 2001 and September 2016 were analyzed. Most of the patients were females (680/892, 76.2%) and aged less than 40 years (540/892, 60.5%). Patient attitude was significantly (P<.001) associated with experience of ADRs, ADR-PD, drug effectiveness, perceived lack of knowledge, experience of withdrawal, and duration of usage, whereas oth age (F4,874=0.72, P=.58) and gender (χ24=2.7, P=.21) were not found to be associated with patient attitudes. Moreover, modeling the relationship between variables and attitudes showed that drug effectiveness and perceived distress from adverse drug reactions were the 2 most significant factors affecting patients' attitude toward antidepressants. CONCLUSIONS: Patients' self-report experiences of medications in online health care communities can provide a direct insight into the underlying factors associated with patients' perceptions and attitudes toward antidepressants. However, it cannot be used as a replacement for self-report methods because of the lack of information for some of the variables, colloquial language, and the unstructured format of the reports.

Coming Home to Family: Now Is the Time!

Family is a metaphor for the connectedness that occupational therapy practitioners and students feel for one another, for the American Occupational Therapy Association (AOTA), and toward those served. Exploring values and cultural practices that emanate from family experiences affects how we practice occupational therapy and engage with families; how we serve and lead; and how, as the profession approaches its 100th anniversary in the United States, we strengthen AOTA by welcoming all 213,000 practitioners and students who could become active, engaged members. The heartfelt connections experienced across our worldwide occupational therapy communities, giving support and nurturance to those who show promise, breaking down barriers and creating community as extended family, creating a sense of home and belonging, encouraging participation, and building excellence, strengthen the AOTA family. AOTA Vision 2025 serves as a means to facilitate the profession's future, where health, well-being, and quality of life are the outcomes of effective occupational therapy.

Engagement, Exploration, Empowerment.

Engagement, exploration, and empowerment are significant practice strategies used by occupational therapy practitioners as a means of getting to know what matters to clients and how to facilitate their participation in everyday life. Applied to the American Occupational Therapy Association (AOTA) as an organization, professional engagement, exploration of new service contexts, and empowerment of members to take an active role in shaping the profession's future are examined. This address, given at the 2015 AOTA Annual Convention & Expo, looks to the future in terms of engaging greater numbers of members; participating in Vision 2025, a strategic planning initiative that will be unveiled at the 2016 AOTA Annual Conference & Expo; and empowering members to achieve excellence in occupational therapy.

Examining the lived experience and factors influencing education of two student veterans using photovoice methodology.

OBJECTIVE. We sought to understand the lived experience of 2 student veterans and identify factors influencing their higher education. METHOD. A qualitative research design was used with 2 student veterans who engaged in photovoice methodology. We analyzed their photographs, accompanying narratives, and discussion session transcripts using descriptive coding and thematic analysis. RESULTS. Data analysis revealed four themes: (1) reminiscence of past duty and reflections on military life, (2) transition from military life to civilian student life, (3) entry to a new stage of life, and (4) influence of the university and community environment. CONCLUSION. Findings from this study revealed factors influencing student veterans' education and can be used to develop occupation-based interventions to assist veterans who engage in higher education.

An evidence-based and occupational perspective of interventions for persons with substance-use disorders.

An interdisciplinary evidence-based review of interventions among persons with substance-use disorders was completed in 2001 as part of American Occupational Therapy Association's (AOTA's) Evidence-Based Literature Review Project (Lieberman & Scheer, 2002). Four effective interventions for adults and adolescents with substance use were identified, including brief interventions, cognitive behavioral therapy, motivational strategies, and 12-step programs. The research studies reviewed reported outcomes primarily related to reduction in alcohol and drug use. Occupational therapy interventions grounded in current evidence-based literature are suggested. Interventions are modified to include an occupational perspective leading to outcomes consistent with the Occupational Therapy Practice Framework (American Occupational Therapy Association [AOTA], 2002). Study findings propose research questions to encourage further investigation of the effectiveness of these best practice interventions.