Cohort profile: the Ohio Army National Guard Mental Health Initiative (OHARNG-MHI).

PURPOSE: Rates of mental disorders in the United States military have increased in recent years. National Guard members may be particularly at risk for mental disorders, given their dual role as citizen-soldiers and their increased involvement in combat deployments during recent conflicts. The Ohio Army National Guard Mental Health Initiative (OHARNG-MHI) was launched to assess the prevalence, incidence, and potential causes and consequences of mental disorders in this unique population. METHODS: OHARNG-MHI is a decade-long dynamic cohort study that followed over 3,000 National Guard members yearly through structured telephone interviews. RESULTS: Findings thus far have applied a pre-, peri-, post-deployment framework, identifying factors throughout the life course associated with mental disorders, including childhood events and more recent events, both during and outside of deployment. An estimated 61% of participants had at least one mental disorder in their lifetime, the majority of which initiated prior to military service. Psychiatric comorbidity was common, as were alcohol use and stressful events. Latent class growth analyses revealed four distinct trajectory paths of both posttraumatic stress and depression symptoms across four years. Only 37% of soldiers with probable past-year mental disorders accessed mental health services in the subsequent year, with substance use disorders least likely to be treated. CONCLUSION: Strengths of this study include a large number of follow-up interviews, detailed data on both military and non-military experiences, and a clinical assessment subsample that assessed the validity of the telephone screening instruments. Findings, methods, and procedures of the study are discussed, and collaborations are welcome.

Psychosocial aspects of pulmonary hypertension: a review.

Pulmonary arterial hypertension (PAH) is characterized by progressive and sustained elevation of pulmonary-artery pressure, which ultimately leads to right-ventricular failure and death. The diagnosis carries with it an uncertain and historically very bleak prognosis. Although new oral and chronic parenteral (intravenous and subcutaneous) treatments have had a significant positive medical impact on the physical functioning of individuals with PAH, patients often struggle with new short- and long-term psychosocial challenges. The purpose of the current article is to 1) provide a brief review of PAH and its treatment; 2) summarize the limited literature examining the psychosocial adjustment of those with a PAH diagnosis; and 3) provide pertinent information extrapolated from the larger literature on chronic illness that might inform us on the psychosocial challenges faced by the patient diagnosed with PAH.

Complexities of cocaine users presenting to the emergency department with chest pain: interactions between depression symptoms, alcohol use, and race.

Chest pain is the most frequent cocaine-related medical event for which patients seek treatment in inner-city emergency departments (EDs). Given that depression increases risk for poor substance use and cardiac outcomes, knowledge of correlates of depressive symptoms among these out-of-treatment cocaine users is crucial to developing interventions for these inner-city populations that frequently present to the ED. A total of 219 individuals presenting to an inner-city ED with chest pain and recent cocaine use were divided into 2 groups based on scoring positive (42%) for moderate-to-severe depression on the Patient Health Questionnaire (PHQ-9). The depression symptoms group reported a significantly greater number of standard drinks per drinking occasion (7.1 versus 4.6) and a greater number of heavy drinking days (9 versus 5). A significant 3-way interaction effect found males and non-white females reporting a greater number of heavy drinking days were more likely to be in the depression symptoms group, whereas white females with a greater number of heavy drinking days were more likely to be in the nondepression symptoms group. Depression is clearly a problem among not-in-treatment cocaine users presenting to an inner-city ED; heavy drinking in concert with cocaine use increases the risk for depression, with important interactions by race and gender.

Using the addiction severity index to predict mental and medical health service utilization.

This study assessed the utility of adding the Addiction Severity Index (ASI) to demographic and clinical diagnostic information for the purpose of predicting subsequent substance use disorder service use, and use of other healthcare services by 260 veterans admitted for outpatient substance use disorder treatment. Data collected included demographics, clinical diagnoses, assessment data from the ASI, as well as measures of six-month health service utilization (e.g., substance use disorder services, other mental health services, outpatient medical visits, urgent care visits, inpatient psychiatric and medical). Multivariate analysis using Tobit regression models showed six out of seven ASI scales were significant predictors, and that combining ASI data with demographics and clinical data significantly improved prediction of health care services. It also was found that certain psychiatric and medical diagnoses were related to service use measures, and that a diagnosis of depression was related to overall healthcare utilization.

Distal and proximal factors related to aggression severity among patients in substance abuse treatment: family history, alcohol use and expectancies.

This study examined the relationships among distal (paternal and maternal family history of alcohol problems and violence) and proximal (general alcohol use, acute use associated with conflict incidents, alcohol-aggression expectancies) factors and physical aggression severity among 125 men and 125 women recruited from substance abuse treatment. Paternal alcohol problem history (PA) was related to alcohol-aggression expectancies, but no family history factors were related to general or acute alcohol use. Separate analyses examining predictors of aggression were conducted, one with general alcohol use and one with acute alcohol use. In both analyses, alcohol use and the maternal violence (MV) by PA interaction were significant. Specifically, MV was associated with aggression severity for those with a history of PA. The general alcohol use model also revealed significant alcohol by expectancy and MV by gender interactions. The findings suggest that expectancies are not the primary mediator of the alcohol-aggression relationship, alcohol use measurement issues may impact whether expectancies are observed to moderate the alcohol-aggression relationship, and that both maternal and paternal family history factors appear to impact aggression severity.