Examining the Performance of the MMPI-2-RF in a Sample of Pretransplant Military Veterans.

The present study aimed to describe the personality and psychopathology dimensions reported by veterans seeking organ transplantation, as well as to identify those dimensions associated with subsequent presurgical recommendations and transplant outcomes. Data were collected from 245 veterans undergoing a pretransplant psychological evaluation that included the MMPI-2-RF. Three treatment recommendations resulting from these evaluations, three recommendation adherence variables, and two transplant outcomes were extracted from electronic medical records. The sample's MMPI-2-RF scale scores were compared to the normative sample and two other presurgical samples and contrasted across subgroups defined by organ transplanted. Point-biserial correlations and logistic regression analyses examined associations between MMPI-2-RF scale scores and the eight measured outcomes. Results indicated that over-reporting, internalizing tendencies, negative emotionality, and a lack of positive emotions were uniquely predictive of mental health treatment recommendation, whereas somatic over-reporting, externalizing tendencies, and disinhibition were predictive of substance use treatment recommendation. Veterans who reported higher levels of activation were less likely to initiate mental health treatment. Finally, veterans with greater somatic preoccupation were less likely to be listed for organ transplant. More suspicious and mistrustful veterans were less likely to receive the transplant. These findings offer support for the role of the MMPI-2-RF in veteran pretransplant evaluations.

Pre-deployment personality traits predict prescription opioid receipt over 2-year post-deployment period in a longitudinal cohort of deployed National Guard soldiers.

BACKGROUND: While military service members are at risk forpain conditions, receipt of prescribed opioids is associated with a range of serious adverse outcomes. The goal of this study is to examine the association between pre-deployment personality traits and receipt of prescription opioids after return from deployment. METHOD: Data were drawn from the Readiness and Resilience in National Guard Soldiers (RINGS) cohort study, an ongoing study of post-deployment health. Participants (N = 522) completed baseline assessments one month prior to deploying to Iraq (2006-2007). At baseline, we assessed personality traits using abbreviated versions of the Personality Psychopathology Five scales from the Minnesota Multiphasic Personality Inventory-2. Follow-up assessments were conducted three months, one year, and two years post-deployment. The primary outcome was total amount of prescribed opioids dispensed from Department of Veterans Affairs outpatient pharmacies in the two-year period following soldiers' return from deployment. Unadjusted and adjusted negative binomial regression models examined the relationships of pre-deployment personality traits, demographics (age, gender, and rank), baseline trauma symptoms, deployment related risk factors (difficult living/working environment, deployment injury, combat exposure), and post-deployment trauma symptoms with post-deployment opioid prescribing. RESULTS: Disconstraint, negative emotionality, and introversion/low positive emotionality were associated with receipt of more prescribed opioids over the two years after return from deployment. Personality traits measured at baseline remained statistically significantly after adjusting for all eight baseline and deployment risk factors of interest. CONCLUSIONS: Understanding how pre-deployment personality traits contribute to post-deployment prescription opioid use could inform efforts to improve veterans' health.

Examining and Improving Provider Adherence to the Primary Care Mental Health Integration Model.

INTRODUCTION: The Veterans Health Administration (VHA) is a national leader in integrated care, known in the VHA as the Primary Care Mental Health Integration (PCMHI) model. This model is associated with improved quality of services and same-day access for veterans. There has been some recent development of PCMHI/integrated care competencies within VHA and across the nation. To fully implement these competencies, however, PCMHI providers must not only be trained, but their adherence to the PCMHI model must also be assessed. While there have been recent advances, there has been little research that has examined the adherence of PCMHI providers to the model or methods to improve adherence. MATERIALS AND METHODS: The present study sought to examine and improve the clinical practice of a team of eight PCMHI providers to make practice more adherent to the PCMHI model. This study was conducted at a large Midwestern VA Medical Center using interventions based in assessment, feedback, and training-measured at three points in time. The Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ; Beehler GP, Funderburk JS, Possemato K, et al.: Psychometric assessment of the primary care behavioral health provider adherence questionnaire (PPAQ). Transl Behav Med 2013; 3: 379-91.) was used to assess provider adherence and the PPAQ toolkit was used to provide tailored recommendations for improving provider practice. In addition, the VHA "Foundations Manual" and Functional Tool outlined essential behavioral targets that are consistent with the PCMHI model and the "essential provider behaviors" from the PPAQ. A combination of individual and group interventions was presented and adherence, pre and post, was assessed with the PPAQ and with evaluation of clinical practice data. RESULTS: Results indicated that the behavior of PCMHI providers changed over time, with providers exhibiting more PCMHI consistent behaviors and fewer inconsistent behaviors. Adherence to the PCMHI model increased. CONCLUSION: Providing assessment, feedback, and training in the PCMHI model changed the clinical practice of PCMHI providers and resulted in improved adherence. Clinical and research implications are discussed.

Using patient aligned care team marketing to identify cognitive impairment in primary care.

INTRODUCTION: Cognitive impairment is a growing concern that is costly for individuals and health care systems and is often undiagnosed. Early recognition of cognitive impairment allows patients and families the opportunity to discuss long-term care planning and to arrange financial and legal affairs. Identification of cognitive impairment allows for better evaluation and accommodation of functional deficits. Most individuals with cognitive impairment receive care exclusively through primary care. Primary care providers are typically overburdened, and subsequently cognitive impairment may be unrecognized and untreated. Efficient methods of detecting cognitive impairment are needed in primary care. METHOD: The present investigation examined the effect of a simple marketing strategy on the frequency of referral for cognitive screening in primary care. The frequency of referral for cognitive screening was measured for the 12 months prior to and following the marketing effort. Data for the period 2 years after the marketing effort were examined to determine if increases in referral for cognitive screening were maintained. RESULTS: Results demonstrate that this modest marketing effort significantly increased the number of individuals who were referred for cognitive impairment screening, and this increase was maintained over time. Also, the majority of those who were evaluated screened positive for cognitive impairment. DISCUSSION: This brief marketing effort increased the frequency of referral for cognitive screening and identified individuals with cognitive impairment in primary care. Implications for future research and for management of cognitive impairment in primary care are detailed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Evaluating an online stress management intervention for college students.

The goal of this study was to assess the feasibility and effectiveness of a theory-based online intervention designed to improve stress management in undergraduate students. The intervention focused on present control because it has been found to be associated with a range of positive outcomes, including lower levels of depression, anxiety, and stress, controlling for a range of other variables (e.g., Frazier et al., 2011, 2012). Two pilot studies were first conducted to confirm that our intervention could increase present control. We then randomly assigned psychology students (n = 292) who were prescreened to have lower scores on the present control subscale of the Perceived Control Over Stressful Events Scale (Frazier et al., 2011) to 1 of 3 conditions: the present control intervention, the present control intervention plus feedback, and stress-information only. Seventy-six percent (n = 223) began the intervention, and 87% (n = 195) of those completed the posttest and 3-week follow-up. The 2 present control intervention groups had lower levels of stress, depression, and anxiety symptoms (on the Depression Anxiety Stress Scales; Lovibond & Lovibond, 1995) and perceived stress (on the Perceived Stress Scale; Cohen, Kamarck, & Mermelstein, 1983) relative to the stress-information-only group at posttest and 3-week follow-up (mean between group d at follow-up = .35, mean within group d for intervention groups at follow-up = -.46). Further, mediation analyses revealed that these effects were mediated by changes in present control. Our intervention represents a potentially valuable tool for college mental health services.

Further development of the temporal model of control.

The temporal model of control (Frazier, Berman, & Steward, 2001) posits that different temporal aspects of control (i.e., past, present, and future) have markedly different relations with adjustment and need to be clearly distinguished from each other. The Perceived Control over Stressful Events Scale (PCOSES; Frazier, Keenan, et al., 2011) was recently developed to assess these different aspects of control and to advance understanding of the role of perceived control in adjustment to stressful life events. The goals of the 2 studies presented here were to expand the temporal model of control by developing a new subscale of the PCOSES and to gather additional evidence regarding the temporal model. In Study 1, we developed a new future likelihood subscale and found evidence for the internal consistency, test-retest reliability, and construct validity of its scores in a sample of undergraduate students (N = 201). In Study 2, we confirmed the 4-factor structure of the PCOSES with the new future likelihood subscale using confirmatory factor analysis in another sample of undergraduates (N = 1,084). Study 2 also provided additional evidence, consistent with the temporal model, that the PCOSES subscales were differentially related to distress and other forms of adjustment (e.g., physical health) and that present control and future likelihood were associated with less event-related distress after controlling for 4 known correlates of distress (e.g., social support). Implications for counseling psychology research and practice are discussed.

Military to civilian questionnaire: a measure of postdeployment community reintegration difficulty among veterans using Department of Veterans Affairs medical care.

The primary objective of this study was to describe the development, reliability, and construct validity of scores on the Military to Civilian Questionnaire (M2C-Q), a 16-item self-report measure of postdeployment community reintegration difficulty. We surveyed a national, stratified sample of 1,226 Iraq and Afghanistan veterans who used U.S. Department of Veterans Affairs (VA) medical care; 745 completed the M2C-Q and validated mental health screening measures. All analyses were based on weighted estimates. The internal consistency of the M2C-Q was .95 in this sample. Factor analyses indicated a single total score was the best-fitting model. Total scores were associated with measures theoretically related to reintegration difficulties including perception of overall difficulty readjusting back into civilian life (R(2) = .49), probable PTSD (d = 1.07), probable problem drug or alcohol use (d = 0.34), and overall mental health (r = -.83). Subgroup analyses revealed a similar pattern of findings in those who screened negative for PTSD. Nonwhite and unemployed veterans reported greater community reintegration difficulty (d = 0.20 and 0.45, respectively). Findings offer preliminary support for the reliability and construct validity of M2C-Q scores.

A qualitative study of U.S. veterans' reasons for seeking Department of Veterans Affairs disability benefits for posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) is the most prevalent compensable mental disorder within the U.S. Department of Veterans Affairs disability system and the number of veterans with PTSD service-connected disability has increased steadily over the past decade. An understanding of the reasons veterans apply for PTSD disability status may inform interpretation of this increase and policies and interventions to assist veterans with military-related PTSD. The authors conducted an exploratory qualitative study to describe the reasons veterans seek PTSD disability benefits and explored differences between those who served in different military service eras. They gathered data through in-depth interviews with 44 purposefully selected U.S. veterans, and conducted content analysis of transcribed interviews using inductive and deductive analysis with constant comparison. Participants described 5 interrelated categories of reasons for seeking PTSD disability benefits, including 3 internal factors (tangible need, need for problem identification or clarification, beliefs that justify/legitimize PTSD disability status) and 2 external factors (encouragement from trusted others and professional assistance). There were no major differences by service era. Findings may help policy makers, providers, and researchers understand what veterans hope to achieve through PTSD disability and the instrumental role of social networks and government systems in promoting the pursuit of PTSD disability status.

Perceived past, present, and future control and adjustment to stressful life events.

Perceived control is a central construct in psychology and is key to understanding individual differences in poststress outcomes (Frazier, Berman, & Steward, 2001). The goals of the current studies (using 4 samples of undergraduate students, total N = 1,421) were to examine the relations between different aspects of perceived control and poststress outcomes and to differentiate perceived control over specific events from related constructs (i.e., general control beliefs, coping strategies). To accomplish these goals, we first developed a new measure of perceived past, present, and future control over stressful life events. The data supported the content validity, factor structure, internal consistency and test-retest reliability, and convergent and discriminant validity of the new measure. Consistent with the temporal model of control (Frazier et al., 2001), these 3 forms of control had very different relations with adjustment. Present control was consistently related to lower distress levels in cross-sectional, longitudinal, and prospective analyses. Present control also predicted outcomes beyond the effects of general control beliefs and coping strategies. Past and future control had nonsignificant or positive relations with distress, although future control was associated with better outcomes (i.e., course grades) when the stressor was controllable. Thus, our measure can be used to assess the relations between perceived past, present, and future control and outcomes across a range of stressors. Because the relations between these 3 forms of control and outcomes differ markedly, measures that combine these aspects of control hinder the understanding of the important role of perceived control in adjustment to stress.