Relative Risk of All-Cause Medical Evacuation for Behavioral Health Conditions in U.S. Central Command.

INTRODUCTION: Behavioral health disorders are the leading category of evacuations from the U.S. Central Command (USCENTCOM) area of responsibility. Understanding the relative risk of behavioral health conditions associated with all-cause evacuation is important for the allocation of resources to reduce the evacuation burden. MATERIALS AND METHODS: Data from the USTRANSCOM Regulating and Command & Control Evacuation System and Theater Medical Data Store covering personnel deployed to the USCENTCOM area of responsibility between January 1, 2017 and December 31, 2021 were collected and analyzed. All individuals who were diagnosed with a behavioral health-specific ICD-9 (290-316) or ICD-10 (F00-F99) code during the period were included. Using the earliest medical encounter, the number of individuals diagnosed with a particular code and the frequency individuals were evacuated being diagnosed with any code were calculated. RESULTS: The mean monthly USCENTCOM population during this period was 62,535. A total of 22,870 individuals were diagnosed with a behavioral health-related disorder during the study period. Of this population, 1,414 individuals required an evacuation. The relative risk of the top 30 diagnosis codes used during the initial visit of individuals during the study period was calculated. Within this group of initial diagnoses, F32.9 'Major depressive disorder, single episode, unspecified' had the highest proportion evacuated at 15.9%. CONCLUSIONS: There is a broad array of behavioral health-specific diagnoses used initially in the care of behavioral health disorders with a great variation in their association with evacuation risk. Variations of diagnoses associated with anxiety, depressive, and adjustment disorders are most associated with eventual evacuation.

Online simulation-based education in graduate education: Initial implementation and content revision description.

Treating those with mental illness frequently requires collaboration among health care providers from different disciplines as well as easy access to care. Neither interprofessional collaboration (IPC) nor accessible care can be assumed to automatically occur or be available in the busy health care environment. Early and deliberate exposure of graduate students in health care disciplines to interprofessional educational activities is imperative to strengthen IPC. Empirical evidence supports the linkage between interprofessional education (IPE) early-on in training and IPC. Additionally, early and focused training of graduate students in health care disciplines to telebehavioral health (TBH) can help promote care access. The current literature supports TBH as an effective treatment approach that enhances access to care. Thus, the creation of educational activities for graduate students in health care disciplines that use early exposure and training in both: IPE and TBH approaches to enhance IPC can position future providers to provide quality patient care, especially given the COVID-19 pandemic implications on health care and education. This article describes the authors' experience in implementing and evaluating an interprofessional, simulation-based educational activity in psychopharmacology using a TBH approach in graduate nursing and psychology students. This quality improvement process used the plan-do-study-act cycle of continuous quality improvement to establish the initial implementation and the 11 steps of the International Nursing Association for Clinical Simulation and Learning standards of best practice to then refine this educational activity. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Adjustment Disorders in U.S. Active Duty Military Women: A Scoping Review for the Years 2000 to 2018.

BACKGROUND: Adjustment disorder (AD) is the most common mental health diagnosis in the U.S. military and is more than twice as likely to be diagnosed in active duty servicewomen as compared with male servicemembers. The literature on ADs, particularly in female servicemembers, has not been reviewed yet. We conducted a scoping review of the literature to explore the degree of research activity and summarize current literature gaps. METHODS: We created a PRISMA-ScR checklist and prospectively registered it in Open Science Framework. The literature search included articles (including studies and reports) published between 2000 and 2018 in either the grey literature or the following databases: Ovid Medline, CINAHL, Embase, PsycINFO, Web of Science, and Ovid Cochrane. We used DistillerSR to conduct title and abstracts screening, full-text screening, and data charting. The social ecological model for military women's health framework was used to organize the results. RESULTS: After screening 1,304 records, 29 were included for data charting. Most frequently, studies were descriptive (cross-sectional) (25%), with no randomized controlled studies. The studies primarily focused on ADs' risk factors in servicewomen (76%), followed by military readiness (38%). Only 14% addressed recommendations for treatments based on expert opinion, although they did not directly test interventions, and 7% focused on health outcomes. CONCLUSIONS: ADs affect the health of U.S. military women and military readiness, yet little is known about their successful treatment or health outcomes. Additional research in those areas is warranted.

Well-being, Self-transcendence, and Resilience of Parental Caregivers of Children in Active Cancer Treatment: Where Do We Go From Here?

BACKGROUND: Childhood cancer profoundly impacts the well-being of many parental caregivers in the United States yearly. Empirical evidence is extensive for negative well-being and scarce for positive well-being in this population. OBJECTIVE: Study aims were to (1) describe resilience, self-transcendence, and positive (general well-being) and negative well-being (depression and anxiety); (2) examine if caregiver-related personal factors (resilience and/or demographic characteristics) and/or child-related contextual factors (child's cancer and/or demographic characteristics) are associated with well-being; and (3) test if self-transcendence mediates the relationship between resilience and well-being. METHODS: A cross-sectional study whereby 80 caregivers of children diagnosed with childhood cancer for at least 2 months completed study questionnaires. Descriptive statistics explored sample demographics, well-being, self-transcendence, and resilience levels. Bivariate correlations examined factors associated with well-being. One-way analysis of variance and independent-samples t tests explored differences in well-being across levels of independent variables. Baron and Kenny's mediation analysis tested if self-transcendence mediated the relationship between resilience and well-being. RESULTS: Positive well-being and negative well-being coexist in parental caregivers. No child-related contextual factors related to caregivers' well-being. Parental caregivers' resilience and self-transcendence positively related to their general well-being and negatively related to their depression and anxiety. Satisfaction with current financial status positively related to general well-being and negatively related to depression. Self-transcendence mediated the relationship between resilience and well-being. CONCLUSIONS: Findings confirm the importance of focusing on both positive and negative well-being, their associated factors, and mediators. IMPLICATIONS FOR PRACTICE: The authors discuss practice implications to enhance self-transcendence such as journaling, mindfulness techniques, activities to connect with nature, and others.

Research Driven Policy: Is Financial Capacity Related to Dangerousness?

Current Veterans administration policy directly links a Veteran's adjudged capacity to manage personal financial resources with their ability to purchase or possess a firearm, pursuant to the regulatory authority of the National Instant Criminal Background Check System (NICS). Preventing Veterans' suicide is a highly laudable public health objective. Effectively utilizing scientific research to "inform" public policy is equally important. The authors should be congratulated for their efforts. However, it is important in utilizing large set population-based data, especially social science data, to evaluate policy alternatives that there be substantial face (i.e., clinical) validity. Correlation does not necessarily represent causation.

Nursing theory as a guide into uncharted waters: Research with parents of children undergoing cancer treatment.

Being a parental caregiver for a child who is undergoing cancer treatment profoundly impacts significant numbers of parental caregivers and their well-being. This article focuses on the use of theory, philosophy, and empirical knowledge in guiding research designed to both describe and explain influences on well-being of parental caregivers of children undergoing cancer treatment. Other aspects of the research are discussed as well, including practice-relevant findings. Findings indicated the co-existence of both positive and negative well-being and that each has unique predictors. Self-transcendence mediated the relationship between resilience and well-being in parental caregivers. Clinical implications for these findings are also presented.