A simulation workshop to introduce coping skills.

BACKGROUND: Experiencing clinical catastrophes can result in long-lasting emotional and psychological impacts. In other fields, crisis simulation has been used to train professionals in coping skills. APPROACH: Our workshop combined a simulated case with a clinical debrief and expert-led teaching on coping skills. The '4Rs' mnemonic, Recognise, Reflect, Reframe and Reach-out, describes the key elements. This is grounded in social, cognitive and behavioural theories of stress and coping. EVALUATION: All 96 anesthesiology residents from one residency programme participated, in small groups, and a mixed methods analysis was used. The scenario was deemed stressful. The workshop introduced new techniques, with 72/87 (82.75%) reporting new coping skills in use at 1-month follow-up. For many residents, the descriptive language regarding their performance and abilities shifted from critical, negative self-talk to positive and team-focused immediately following the workshop. A striking finding from evaluations at all timepoints was that negative comments were typically self-referencing whereas positive ones referenced colleague support and the team. IMPLICATIONS: Combining stress exposure with formal exploration of emotional responses and coping skills teaching in this workshop was feasible, with benefits at 1-month follow-up. This laid the groundwork for a resilience curriculum and wider departmental interest in the topic of coping and stress responses.

The association of resilience on psychiatric, substance use, and physical health outcomes in combat trauma-exposed military service members and veterans.

Objective: Although Combat exposure is associated with a range of psychiatric outcomes, many veterans do not develop psychopathology. Resilience is a multifaceted construct associated with reduced risk of distress and psychopathology; however, few studies have examined the relationship of resilience with a broader spectrum of health outcomes following combat exposure. It also remains important to determine the association of resilience above and beyond other documented risk and protective factors. Method: In a sample of combat-exposed veterans (N = 1,046) deployed to Iraq and Afghanistan, we examined a quantitative method for exploring relative psychological resilience (discrepancy-based psychiatric resilience; DBPR) and tested the hypothesis that resilience would be associated with reduced risk for psychiatric diagnosis count, substance use, and physical health outcomes, above and beyond other known correlates (e.g. combat exposure, social support). Results: In the final model, results suggested an inverse association of discrepancy-based psychiatric resilience with current psychiatric diagnosis count (ß = -0.57, p < .001), alcohol use (ß = -0.16, p < .001), drug use (ß = -0.13, p < .001), and physical health concerns (ß = -0.42, p < .001) after accounting for other relevant risk and protective factors. Conclusions: Results extend the nomological net of this quantitative resilience construct to include other relevant health outcomes, and demonstrate that resilience may have more of a buffering relationship with psychiatric and physical health concerns compared to substance use outcomes.

Objetivo: Aunque la exposición a combate se asocia con una serie de consecuencias psiquiátricas, muchos veteranos no desarrollan psicopatología. La resiliencia es un constructo multifacético asociado con riesgo reducido de estrés y psicopatología; sin embargo, pocos estudios han examinado la relación de la resiliencia con un espectro más amplio de resultados de salud después de la exposición al combate. También sigue siendo importante determinar la asociación de la resiliencia más allá de otros factores de riesgo y protectores documentados.Método: En una muestra de veteranos expuestos a combate (N=1.046) desplegados en Iraq y Afganistán, examinamos un método cuantitativo para explorar la resiliencia psicológica relativa (resiliencia psiquiátrica basada en la discrepancia; DBPR en su sigla en inglés) y probó la hipótesis que la resiliencia se asociaría con un riesgo reducido para el recuento del diagnóstico psiquiátrico, uso de sustancias y resultados en salud física, más allá de otros correlatos conocidos (ej., exposición a combate, apoyo social).Resultados: En el modelo final, los resultados sugirieron una asociación inversa de DBPR con el recuento del diagnóstico psiquiátrico actual (ß = −0.57, p < .001), consumo de alcohol (ß = −0.16, p < .001), consumo de drogas (ß = −0.13, p < .001), y preocupaciones de salud física (ß = −0.42, p < .001) después de considerar otros factores relevantes de riesgo y protectores.Conclusiones: Los resultados extienden la red nomológica de este constructo cuantitativo de resiliencia para incluir otros resultados relevantes de salud y demostrar que la resiliencia podría tener una relación más amortiguadora con los problemas de salud física y psiquiátrica en comparación con los resultados de consumo de sustancias.

Exploring resilience models in a sample of combat-exposed military service members and veterans: a comparison and commentary.

Background: The term resilience is applied in numerous ways in the mental health field, leading to different perspectives of what constitutes a resilient response and disparate findings regarding its prevalence following trauma. Objective: illustrate the impact of various definitions on our understanding and prevalence of resilience, we compared various resilience definitions (absence of PTSD, absence of current mental health diagnosis, absence of generalized psychological distress, and an alternative trauma load-resilience discrepancy model of the difference between actual and predicted distress given lifetime trauma exposure) within a combat-exposed military personnel and veteran sample. Method: In this combat-trauma exposed sample (N = 849), of which approximately half were treatment seeking, rates of resilience were determined across all models, the kappa statistic was used to determine the concordance and strength of association across models, and t-tests examined the models in relation to a self-reported resilience measure. Results: Prevalence rates were 43.7%, 30.7%, 87.4%, and 50.1% in each of the four models. Concordance analyses identified 25.7% (n = 218) considered resilient by all four models (kappa = .40, p < .001). Correlations between models and self-reported resilience were strong, but did not fully overlap. Conclusions:The discussion highlights theoretical considerations regarding the impact of various definitions and methodologies on resilience classifications, links current findings to a systems-based perspective, and ends with suggestions for future research approaches on resilience.

Antecedentes: El término resiliencia se ha aplicado de muchas maneras en el campo de la salud mental, llevando a diferentes perspectivas de lo que constituye una respuesta resiliente y hallazgos dispares relacionados a la prevalencia después de un trauma. Objetivos: Para Ilustrar el impacto de las diversas definiciones en nuestra compresión y prevalencia de la resiliencia, comparamos varias definiciones de resiliencia (ausencia de TEPT, ausencia de un diagnóstico de salud mental actual, ausencia de malestar psicológico generalizado, y un modelo alternativo de discrepancia entre la carga y la resiliencia del trauma de la diferencia entre la angustia real y la prevista dada la exposición al trauma a lo largo de la vida) entre personal militar expuesto a combate y una muestra de veteranos. Método: En esta muestra expuesta a trauma de combate (N= 849), de la cual aproximadamente la mitad estaba en búsqueda de tratamiento, las tasas de resiliencia se determinaron en todos los modelos, el kappa estadístico se usó para determinar la concordancia y la fuerza de asociación en todos los modelos, y el t-test examinó los modelos en relación a la medida de resiliencia auto-reportada. Resultados: La tasas de prevalencia variaron desde 43,7%, 30,7%, 87,4% y 50,1% en los cuatro modelos respectivamente. El análisis de concordancia identificó un 25,7% (n=218) considerado resiliente por los cuatro modelos (kappa= .40, p< .001). Las correlaciones entre los modelos y la resiliencia auto-reportada fueron fuertes, pero no se superpusieron por completo. Conclusiones: la discusión resalta las consideraciones teóricas sobre el impacto de las distintas definiciones y metodologías sobre las clasificaciones de resiliencia, vincula el hallazgo actual con una perspectiva basada en sistemas y finaliza con sugerencias para futuros enfoques de investigación en resiliencia.

Development and evaluation of a behavioral pain management treatment program in a Veterans Affairs Medical Center.

Chronic pain complaints are highly prevalent among Veterans seeking Veterans Affairs health care, and the implementation of effective behavioral health interventions is vital to meet patient needs. Research supports the use of cognitive behavioral therapy for the treatment of chronic pain; however, varying guidelines regarding length of treatment and modality (i.e., group vs. individual) complicate clinical planning and program development. This study aimed to evaluate treatment outcomes and equivalence of 3 variations (12, 10, and 6 weeks of group treatment) of cognitive behavioral therapy for chronic pain using clinical program data collected from Veterans enrolled in Veterans Affairs health services in a large tertiary care setting. Across groups, Veterans showed improvements in negative pain-related thinking and decreases in pain-related disability and distress. In general, patient outcomes regarding pain-related distress and disability for the 6-week group were equivalent or better than the 12- and 10-week groups. Preliminary results support the effectiveness of brief behavioral interventions for chronic pain. The findings have important practical implications, as briefer treatments may offer comparable therapeutic impact as longer, more time-intensive treatment protocols. This study offers a unique examination of treatment development and evaluation processes informed by real-world clinical needs and patient feedback.

Testing the temporal relationship between maternal and adolescent depressive and anxiety symptoms in a community sample.

Transactional models have been used to explain the relationship between maternal depression and child behavioral problems; however, few studies have examined transactional models for maternal depression and adolescent depression and anxiety. Using an autoregressive cross-lagged analysis, we examined the longitudinal association between maternal and adolescent depression to determine the extent to which maternal depression influences adolescent depression and anxiety, and vice versa, over the course of a 4-year period. Participants were a community sample of 277 mother-adolescent dyads with offspring 10 to 14 years of age at the 1st year used in the analyses (43.7% female; 35% African American, 2.9% Hispanic/Latino). Depressive symptoms were assessed using maternal self-report (Center for Epidemiological Studies-Depression Scale; Radloff, 1977), and adolescent depression and anxiety were assessed by self-report (Revised Child Anxiety and Depression Scale; Chorpita, Yim, Moffitt, Umemoto, & Francis, 2000). The final model, χ(2)(14) = 23.74, p = .05 (TLI = .97, CFI = .98, RMSEA = .05), indicated that maternal depression was significantly associated with adolescent depression 2 years later. Of interest, adolescent depression did not significantly predict maternal depression, and the association between maternal and adolescent depression was not moderated by gender, age, or ethnicity. The association between maternal depression and adolescent anxiety was weaker than that observed for adolescent depression. Results suggest that the transaction model of maternal depression may not extend to adolescent depression and anxiety. Furthermore, maternal depression can have an enduring effect on adolescent depression, and continued research and clinical monitoring over extended periods is warranted.

Longitudinal interactions of pain and posttraumatic stress disorder symptoms in U.S. Military service members following blast exposure.

UNLABELLED: Military personnel returning from conflicts in Iraq and Afghanistan often endorse pain and posttraumatic stress disorder (PTSD) symptoms, either separately or concurrently. Associations between pain and PTSD symptoms may be further complicated by blast exposure from explosive munitions. Although many studies have reported on the prevalence and disability associated with polytraumatic injuries following combat, less is known about symptom maintenance over time. Accordingly, this study examined longitudinal interactive models of co-occurring pain and PTSD symptoms in a sample of 209 military personnel (mean age = 27.4 years, standard deviation = 7.6) who experienced combat-related blast exposure. Autoregressive cross-lagged analysis examined longitudinal associations between self-reported pain and PTSD symptoms over a 1-year period. The best-fitting covariate model indicated that pain and PTSD were significantly associated with one another across all assessment periods, χ² (3) = 3.66, P = .30, Tucker-Lewis index = .98, comparative fit index = 1.00, root mean squared error of approximation = .03. PTSD symptoms had a particularly strong influence on subsequent pain symptoms. The relationship between pain and PTSD symptoms is related to older age, race, and traumatic brain injury characteristics. Results further the understanding of complex injuries among military personnel and highlight the need for comprehensive assessment and rehabilitation efforts addressing the interdependence of pain and co-occurring mental health conditions. PERSPECTIVE: This longitudinal study demonstrates that pain and PTSD symptoms strongly influence one another and interact across time. These findings have the potential to inform the integrative assessment and treatment of military personnel with polytrauma injuries and who are at risk for persistent deployment-related disorders.

Using the SRQ-20 factor structure to examine changes in mental distress following typhoon exposure.

Empirical research is limited regarding postdisaster assessment of distress in developing nations. This study aimed to evaluate the factor structure of the 20-item Self-Reporting Questionnaire (SRQ-20) before and after an acute trauma, Typhoon Xangsane, in order to examine changes in mental health symptoms in an epidemiologic sample of Vietnamese adults. The study examined a model estimating individual item factor loadings, thresholds, and a latent change factor for the SRQ-20's single "general distress" common factor. The covariates of sex, age, and severity of typhoon exposure were used to evaluate the disaster-induced changes in SRQ-20 scores while accounting for possible differences in the relationship between individual measurement scale items and the latent mental health construct. Evidence for measurement noninvariance was found. However, allowing sex and age effects on the pre-typhoon and post-typhoon factors accounted for much of the noninvariance in the SRQ-20 measurement structure. A test of no latent change failed, indicating that the SRQ-20 detected significant individual differences in distress between pre- and post-typhoon assessment. Conditioning on age and sex, several typhoon exposure variables differentially predicted levels of distress change, including evacuation, personal injury, and peri-event fear. On average, females and older individuals reported higher levels of distress than males and younger individuals, respectively. The SRQ-20 is a valid and reasonably stable instrument that may be used in postdisaster contexts to assess emotional distress and individual changes in mental health symptoms.

Diagnostic accuracy of three scoring methods for the Davidson Trauma Scale among U.S. military veterans.

Self-report questionnaires are frequently used to identify PTSD among U.S. military personnel and Veterans. Two common scoring methods used to classify PTSD include: (1) a cut score threshold and (2) endorsement of PTSD symptoms meeting DSM-IV-TR symptom cluster criteria (SCM). A third method requiring a cut score in addition to SCM has been proposed, but has received little study. The current study examined the diagnostic accuracy of three scoring methods for the Davidson Trauma Scale (DTS) among 804 Afghanistan and Iraq war-era military Service Members and Veterans. Data were weighted to approximate the prevalence of PTSD and other Axis I disorders in VA primary care. As expected, adding a cut score criterion to SCM improved specificity and positive predictive power. However, a cut score of 68-72 provided optimal diagnostic accuracy. The utility of the DTS, the role of baseline prevalence, and recommendations for future research are discussed.

Race as a moderator of the relationship between distress tolerance and cigarette smoking.

The present study examined the role of distress tolerance (DT) and race in relation to cigarette smoking. For this study, between 2008 and 2010, 153 women (62.1% White, 37.9% African American) from the Washington, DC metropolitan area completed a computerized behavioral DT task and self-reported smoking history. Results suggest that low DT (OR = .23, p = .03) and the interaction between DT and race (OR = 4.58, p = .05) were significantly related to greater odds of being a smoker, such that African American women, but not White women, with low DT were at increased risk for being a lifetime smoker.

Correlates of pain symptoms among Iraq and Afghanistan military personnel following combat-related blast exposure.

Pain complaints are highly prevalent among military servicemembers and Veterans of the recent combat operations in Iraq and Afghanistan. The high comorbidity of pain with conditions such as posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) underscores the importance of a greater understanding of factors associated with complex polytraumatic injuries among military personnel. The present study aimed to identify correlates of current pain among 201 U.S. military personnel who reported at least one blast experience during combat deployment (age [mean +/­ standard deviation]: 27.20 +/­ 7.58 yr). Theoretically derived subsets of variables were analyzed in successive hierarchical regression models to determine correlates of self-reported pain symptoms. Preliminary models evaluated demographic features, medical and injury characteristics (e.g., TBI classification), psychosocial history (e.g., trauma exposure), and psychiatric variables. A final model was then derived, in which older age, possible or probable mild TBI, depression symptoms, and PTSD re-experiencing symptoms emerged as significant correlates of pain. The findings further the understanding of polytrauma symptoms among military personnel by identifying specific patient characteristics and comorbidity patterns related to pain complaints. Increased awareness of demographic, psychiatric, or medical factors implicated in pain will enhance comprehensive clinical assessment and intervention efforts.

Evaluation of the psychometric properties of the Self-Reporting Questionnaire (SRQ-20) in a sample of Vietnamese adults.

PURPOSE: There are significant gaps in the literature on the prevalence of mental health problems and associated needs in Vietnam. A thorough understanding of culture-specific expressions of psychiatric distress is vital for the identification of the mental health needs of a community, and more research on the development and evaluation of culturally-sensitive mental health assessments is warranted. This study aims to evaluate the psychometric properties of the World Health Organization 20-item Self-Reporting Questionnaire (SRQ-20) in an epidemiologic study of Vietnamese adults. METHODS: A latent variable modeling approach investigated the underlying factor structure of the SRQ-20 items. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted on SRQ-20 item-level data gathered from 4980 participants. RESULTS: Based on scree plots and EFA results, two latent structures were deemed plausible and were subsequently subjected to further modeling. A bi-factor model (BFM) and a correlated three-factor model solution (Negative Affect, Somatic Complaints, and Hopelessness) provided reasonable fits. The BFM specifies a single dominant General Distress factor (all SRQ-20 items) with orthogonal group factors for the subsets of items: Negative Affect (9 items), Somatic Complaints (8 items), and Hopelessness (3 items). This model fit the data as well or better than the three-factor model. Results also showed differences in endorsement rates of SRQ-20 items among males and females. CONCLUSIONS: Study results provide an evaluation of the psychometric properties of a commonly used screening tool and offer insight into the presentation of mental distress in a representative sample of Vietnamese adults.