Distress In Veterans Research Articles

A - 33 Impact of Cognitive Stimulation Therapy on Neuropsychiatric Symptoms and Everyday Functioning in a Veteran Sample

Abstract Objective Cognitive stimulation therapy (CST) is a well-supported nonpharmacological intervention, found to improve or maintain global cognition, daily functioning, and quality of life with persons with dementia. There are fewer studies assessing the effect of CST on neuropsychiatric symptoms; however, pilot studies have identified improvement in depression and anxiety in studies of persons with Alzheimer’s disease. The purpose of this program evaluation was to evaluate the impact of CST on neuropsychiatric symptoms and everyday functioning is a veteran sample. Method Twenty-six male veterans diagnosed with cognitive disorder (84.6% dementia, 15.4% mild cognitive impairment) completed a 7-week CST program. The sample was diverse (46.2% White/Caucasian, 42.3% Hispanic/Latino, 7.7% Black/African American; 38.5% bilingual). Most frequent etiologies included mixed (26.8%), Alzheimer’s (23.1%), and vascular (19.2%). Ages ranged from 43–86 (M = 74.5; SD = 7.6). Pre-group/post-group assessment included Geriatric Depression Scale-Short Form (GDS-SF), Geriatric Anxiety Inventory (GAI), Neuropsychiatric Inventory (NPI-informant), Everyday Cognitive (ECOG), and Texas Functional Living Scale (TFLS). Analyses included paired-samples t-test and Wilcoxon signed-rank test. Results Post-group GAI scores were significantly lower (Median = 1) than pre-group scores (Median = 3), z = −2.574, p = 0.01, r = −0.515. There were no significant declines or improvements across other measures of neuropsychiatric symptoms. Measures of IADLs/everyday functioning also remained stable. Conclusions Consistent with prior studies, CST was effective in reducing anxiety symptoms of veterans with cognitive disorders. While measures of everyday functioning did not improve, performance and informant-report remained stable. CST presents a unique opportunity to impact both cognition and neuropsychiatric symptoms that may cause significant distress in veterans with dementia and their caregivers.

Do appraisals of military service indicate current distress in aging Vietnam War combat veterans?

Appraisals of military service, both desirable and undesirable, assessed via Elder and Clipp's (1989) scale, are associated with psychological distress in veterans. Aging combat veterans (CV) are at increased risk for posttraumatic stress disorder and other psychological disorders yet may underreport symptoms and not seek treatment that could be beneficial. It is unknown whether desirable and undesirable appraisals of military service are associated with mental health outcomes above and beyond typical risk and protective factors, such as age, education, and combat exposure. Therefore, we examined associations between appraisals of military service and assessments of psychological distress in Vietnam War CV, currently the largest cohort of aging veterans. Male Vietnam War CV aged 60 and older (n = 134) were selected from a larger study. Regression analyses examined the associations between appraisals of military service and measures of physical and psychological well-being and distress. Both desirable and undesirable appraisals of military service exhibited associations with measures of psychological distress, with undesirable appraisals being more strongly associated with distress than desirable appraisals. In regression analyses, appraisals were related to mental health outcomes over and above covariates. In addition, appraisals were more strongly related to psychological versus physical well-being measures, with undesirable appraisals more strongly related to mental health and well-being measures than desirable appraisals. Assessing appraisals of military service may identify veterans experiencing psychological distress who may benefit from referral for psychological interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Emotional Distress and Physical Activity Engagement in U.S. Veterans With Chronic Obstructive Pulmonary Disease: A Qualitative Study.

Physical activity is recommended as part of guideline-based care for managing chronic obstructive pulmonary disease (COPD) at all stages of the disease. However, physical activity interventions are less effective in individuals with co-occurring emotional distress (i.e., depression and/or anxiety symptoms). Interventions that dually promote improved physical and mental health in COPD are needed. The first step for intervention development is understanding individuals' experience of these factors. To understand the experience of emotional distress in U.S. Veterans diagnosed with COPD and to explore how emotional distress impacts physical activity engagement. Structured interviews informed by the cognitive and behavioral models of psychopathology were conducted with 29 United States Veterans with COPD (89.66% male, age 67.72 ± 6.55 years, 93.10% White) at the VA Boston Healthcare System. Interviews were audio recorded, transcribed, and underwent thematic analysis. Three major themes encapsulating 17 codes emerged through thematic analysis: (i) the experience of emotional distress in Veterans with COPD; (ii) the complex relationship between emotional distress, physical activity engagement, and COPD; (iii) contextual and personal factors. Veterans' interpretation of their COPD symptoms as unpredictable and uncontrollable and COPD-related physical limitations influenced their experience of emotional distress, while the experience of emotional distress both promoted and deterred physical activity engagement. Veterans were motivated to engage in physical activity despite experiencing emotional distress when they faced a responsibility in daily life. They identified motivational strategies and self-regulation techniques to manage emotional distress and to foster physical activity.

Diabetes distress in Veterans with type 2 diabetes mellitus: Qualitative descriptive study.

Diabetes distress (DD) is a negative psychosocial response to living with type 2 diabetes mellitus (T2DM). We sought insight into Veterans' experiences with DD in the context of T2DM self-management. The four domains in the Diabetes Distress Scale (i.e. regimen, emotional, interpersonal, healthcare provider) informed the interview guide and analysis (structural coding using thematic analysis). The mean age of the cohort (n = 36) was 59.1 years (SD 10.4); 8.3% of patients were female and 63.9% were Black or Mixed Race; mean A1C was 8.8% (SD 2.0); and mean DDS score was 2.4 (SD 1.1), indicating moderate distress. Veterans described DD and challenges to T2DM self-management across the four domains in the Diabetes Distress Scale. We found that (1) Veterans' challenges with their T2DM self-management routines influenced DD and (2) Veterans experienced DD across a wide range of domains, indicating that clinical interventions should take a "whole-person" approach.Trial Registration: NCT04587336.

Neuropsychiatric Symptoms and Caregiver Distress in Veterans with Dementia Living at Home during the COVID Pandemic

Neuropsychiatric Symptoms and Caregiver Distress in Veterans with Dementia Living at Home during the COVID Pandemic

Association between perceived distress and salivary cortisol in veterans with mTBI

Mild traumatic brain injury (mTBI) is one of the most common injuries experienced by Veterans and can frequently result in a variety of post-concussive symptoms. Post-concussive headaches (PCH), one of the most common symptoms, can persist for years after the injury occurred. The long-lasting impacts of PCH can be extremely distressing for Veterans, thus necessitating the need to find reliable biomarkers that directly relate to subjective feelings of distress. Yoga-based interventions have been shown to improve both subjective and objective markers of stress. Techniques used in yoga, such as the focus on releasing muscular tension, are also recommended as strategies for treating PCH. Thus, yoga-based interventions provide a unique context for the comparison of subjective and objective measures of distress in Veterans with PCH. In this secondary, exploratory analysis, we examined the relationship between perceived distress and cortisol in sixteen Veterans with mTBI and long-term PCH within the context of a yoga intervention feasibility study. The Visual Analogue Scale (VAS), a validated tool for measuring subjective distress, was administered to participants immediately before and after 75-min yoga classes, which occurred twice weekly over eight weeks. Participants also provided salivary cortisol (pre- and post-yoga) at in-person sessions (eight) to compare to changes in VAS scores. We found that VAS scores were significantly reduced within five of the eight assessed yoga classes, but there were no significant changes in cortisol levels. No significant correlations were found between VAS scores and salivary cortisol levels. When looking at how cortisol levels changed over time (i.e., over the series of eight yoga sessions), there was a significant downward trajectory in post-yoga cortisol, but not after taking pre-class cortisol into account (i.e., within yoga session cortisol change over time). Taken together, we found that subjective distress, but not cortisol was reduced by yoga classes. These data suggest that salivary cortisol did not match changes in perceived distress, thus emphasizing the ongoing challenges of relating subjective and objective measures.

Concussion coach for postconcussive symptoms: A randomized, controlled trial of a smartphone application with Afghanistan and Iraq war Veterans

Objective: Investigate the effectiveness of Concussion Coach, an interactive smartphone application, as a treatment for residual neurobehavioral symptoms and distress in Veterans with a history of mild traumatic brain injury (mild TBI). Methods: Veterans with mild TBI were randomized to Concussion Coach (n = 238) or Treatment-as-Usual (TAU) (n = 241) in a 3-month randomized controlled trial. Primary outcome measures included postconcussive symptom (PCS) severity as measured by the Neurobehavioral Symptom Inventory (NSI), and psychological distress as measured by the Brief Symptom Inventory-18 (BSI-18). Measures of self-efficacy, social support, and comfort with technology were administered as potential moderators and mediators. An intention-to-treat (ITT) analysis was performed (N = 461: Concussion Coach = 231 and TAU = 230) using Bayesian Network (BN)modeling. Results: The probability of decreased PCS severity was significantly greater for those assigned to Concussion Coach, .35 [.32,.37], than for TAU, .29 (.27, .32), with an odds ratio (OR) of 1.29. Also, Concussion Coach showed a significantly greater probability of increased self-efficacy (.36 [.32, .39]) than did TAU (.28 [.25, .30], OR = 1.42). In turn, self-efficacy (increased vs. decreased) showed a significantly greater probability of decreased PCS severity (.51 [.47, .54] vs. .27 [.24, .30], OR = 2.71) and decreased psychological distress (.53 [.49, .56] vs. .32 [.29, .35], OR = 2.35), suggesting that self-efficacy may have mediated Concussion Coach effects. Conclusions: Concussion Coach is effective at reducing PCS severity and psychological distress. Increased self-efficacy/perception of self-management of symptoms may be key to successful treatment of residual symptoms in those with history of concussion.

Distress evaluation in a veteran affairs oncology clinic.

Distress in oncology patients (pts) has a negative impact on quality of life, survival, and healthcare satisfaction. Higher distress leads to lower compliance with treatment and follow-up [1-8]. The 2012 American College of Surgeons Commission on Cancer (CoC) standard of care for oncology pts included an assessment for distress [1]. A screening process for distress allows the healthcare team to address these issues early and refer to appropriate resources [2-9]. This project was initiated to meet National Comprehensive Cancer Network (NCCN) and CoC standard of care, identify distress in veterans with cancer, and address these concerns. Patients who attended the Tuesday oncology clinic at the Dayton VAMC were given the NCCN Distress Thermometer (DT) during triage. The treating physician addressed problems identified. The Wilcoxon signed rank test and the Friedman test were used. DTs were completed by 296 pts from March to December 2016. Mean age was 68, 93% male, 83% white, 55% married, and 93% without PTSD. The distress level was not different from T1 through T3. Number of problems decreased over three time periods. Referrals to nutrition, mental health, and social work services increased over time. Although over time periods we found no decrease in distress scores, there was a decline in number of problems. The mean distress score at all but time 4 was < 4, which is considered mild distress. The mean distress score at T4 was 4.36 (n = 14), suggesting that the few pts who return to clinic more than three times may be experiencing more difficult personal and environmental circumstances. Patient sample ranged from those undergoing intensive cancer treatment (e.g., chemotherapy) to less intensive treatment (e.g., hormone injections) to those who completed treatment.

Apolipoprotein E ε4 Genotype Is Associated with Elevated Psychiatric Distress in Veterans with a History of Mild to Moderate Traumatic Brain Injury.

As few studies have examined the relationship between the apolipoprotein E (APOE) gene and clinical outcomes after military-related traumatic brain injury (TBI), we aimed to determine whether the ε4 allele of the APOE gene influences neuropsychiatric symptoms in veterans with a history of mild-to-moderate TBI. Participants included 133 veterans (TBI = 79; military controls [MC] = 54) who underwent APOE genotyping and were divided into ε4+ (TBI = 18; MC = 15) and ε4- (TBI = 61; MC = 39) groups. All participants underwent evaluation of psychological distress using the Beck Depression Inventory-II, Beck Anxiety Inventory, and PTSD Checklist-Military Version. Two-way analyses of variance were conducted to examine the effect of group (TBI vs. MC) and APOE-ε4 status (ε4+ vs. ε4-) across symptom measures. There was a significant main effect of group across all symptom measures (TBI > MC; all p values <0.001), no main effect of ε4 genotype (p = 0.152-0.222), and a significant interaction of group by ε4 genotype across all measures (p = 0.027-0.047). Specifically, for TBI participants, ε4+ veterans demonstrated significantly higher symptom scores across all measures when compared to ε4- veterans (p = 0.007-0.015). For MC participants, ε4 status had no effect on the severity of psychiatric symptom scores (p = 0.585-0.708). Our results demonstrate that, in our well-characterized sample of veterans with history of neurotrauma, possession of the ε4 allele conveys risk for increased symptomatology (i.e., depression, anxiety, and post-traumatic stress disorder), even well outside of the acute phase of injury. Findings suggest a meaningful relationship between APOE genotype and psychiatric distress post-TBI, and they suggest that there is a brain basis for the complex neuropsychiatric presentation often observed in this vulnerable population. Future longitudinal studies are needed in order to further our understanding of how genetic factors influence response to TBI.

Substance Use and Psychological Distress Before and After the Military to Civilian Transition.

Those currently serving in the military constitute a vulnerable population given their high-risk status for substance use, and population data suggest that veterans continue to engage in significant substance use long after their military service ends. Recent research suggests that the separation transition from active duty to civilian life may be critical in terms of the future functioning of the veteran. We sought to explore substance use prevalence, as well as potential emotional distress among veterans by retrospectively assessing substance use during active duty and following separation to examine possible changes in use over this period. This study assessed substance use and emotional distress in veterans (N = 80; 90% male) across the military to civilian transition. Repeated measures tests indicated that endorsement of alcohol use, cigarette use, and prescription drug misuse was similar during active duty and post-separation, and marijuana and hard drug use endorsement increased significantly in the 6-mo period post-separation. Further, comorbid use of different substances was common. Active duty levels of anxiety/depression and aggressive feelings were maintained from active duty to post-separation, and feeling alone and military-based trauma symptoms increased significantly. Finally, participants indicated that only a minority of the veterans they knew were doing emotionally well or did not have alcohol/substance use issues. These findings indicate a clear need for substance use and psychological intervention availability before and after transition to enable veterans to transition to civilian life effectively. Based on the many issues at work during the transition process, programs may do well to focus more specifically on identification of problems and raising awareness, rather than awaiting more severe issues in the future. Validation of the difficulties of the separation transition, veterans' feelings of isolation, and the importance of veteran community support may help newly transitioning veterans find advocates who may help them navigate existing assistance programs.

Researchers Explore Sleep Problems in Veterans

Researchers Explore Sleep Problems in Veterans

Traumatic Brain Injury-1Apolipoprotein E (APOE) e4 Genotype is Associated with Increased Psychiatric Distress in Veterans with a History of Mild-to-Moderate Traumatic Brian Injury

Traumatic Brain Injury-1Apolipoprotein E (APOE) e4 Genotype is Associated with Increased Psychiatric Distress in Veterans with a History of Mild-to-Moderate Traumatic Brian Injury

Patient distress assessment in a VA oncology clinic: A quality improvement project.

203 Background: Distress in oncology patients (pts) has a negative impact on quality of life, survival, and healthcare satisfaction. Higher distress is related to lower compliance with treatment and follow-up. The 2012 American College of Surgeons Commission on Cancer (CoC) standard of care for oncology pts included an assessment for distress. A screening process for distress allows the healthcare team to address these issues early and refer to appropriate resources. This project was initiated to meet National Comprehensive Cancer Network (NCCN) and CoC standard of care; identify distress in veterans with cancer; and address these concerns. Presented here are preliminary results. Methods: Pts who attended the Tuesday oncology clinic at the Dayton VAMC were given the NCCN Distress Thermometer (DT) during triage. The treating physician addressed problems identified. The Wilcoxon Signed Rank Test and the Friedman Test were used. Results: DTs were completed by 232 pts from March to September 2016. Mean age was 68, 93% male, 83% white, 54% married, and 93% without PTSD. The distress level was not different from T1 through T3. Number of problems decreased over three time periods, and Referrals to nutrition, mental health, and social work services increased over time (see Table). Conclusions: Although over time periods we found no decrease in distress scores, there was a decline in number of problems. The mean distress score at all but Time 4 was &lt;4, which is considered mild distress. The mean distress score at T4 was 4.36 (n=14), suggesting that the few pts who return to clinic more than three times may be experiencing more difficult personal and environmental circumstances. This pt sample ranged from those undergoing intensive cancer treatment (e.g., chemotherapy) to less intensive treatment (e.g., hormone injections) to those who completed treatment. As this tool was implemented only on one clinic day, some time points were missed if a pt was seen on a different day. [Table: see text]

Personality Assessment Inventory profiles of veterans: Differential effects of mild traumatic brain injury and psychopathology.

Neuropsychiatric complaints often accompany mild traumatic brain injury (mTBI), a common condition in post-deployed Veterans. Self-report, multi-scale personality inventories may elucidate the pattern of psychiatric distress in this cohort. This study investigated valid Personality Assessment Inventory (PAI) profiles in post-deployed Veterans. Measures of psychopathology and mTBI were examined in a sample of 144 post-deployed Veterans divided into groups: healthy controls (n = 40), mTBI only (n = 31), any mental health diagnosis only (MH; n = 25), comorbid mTBI and Posttraumatic Stress Disorder (mTBI/PTSD; n = 23), and comorbid mTBI, PTSD, and other psychological diagnoses (mTBI/PTSD/MDD+; n = 25). There were no significant differences between the mTBI and the control group on mean PAI subscale elevation, or number of subscale elevations above 60T or 70T. The other three groups had significantly higher overall mean scores, and more elevations above 60 and 70T compared to both controls and mTBI only. The mTBI/PTSD/MDD+ group showed the highest and most elevations. After entering demographics, PTSD, and number of other psychological diagnoses into hierarchical regressions using the entire sample, mTBI history did not predict mean PAI subscale score or number of elevations above 60T or 70T. PTSD was the only significant predictor. There were no interaction effects between mTBI and presence of PTSD, or between mTBI and total number of diagnoses. This study suggests that mTBI alone is not uniquely related to psychiatric distress in Veterans, but that PTSD accounts for self-reported symptom distress.

Self‐report versus observer ratings of distress and pathology in Vietnam veterans with PTSD

AbstractFew efforts have been made to examine the relationship between standard self‐report measures and observer ratings of distress in veterans suffering from post‐traumatic stress disorder (PTSD). In the present study correlations between self‐report (verbal ratings and scores on the Brief Symptom Inventory) and observer ratings (scores on the Brief Hopkins Psychiatric Rating Scale) of pathology and distress were analyzed for 40 Vietnam combat veterans participating in a weekly outpatient PTSD therapy program. The relationship of these measures to the Mississippi PTSD scale and measures of combat exposure and duration was also examined. Results suggested that the self report and observer measures of distress were significantly correlated for this group. While written self report and observer ratings were correlated with scores on the Mississippi Scale, verbal self reports of distress were not. However, the verbal self reports of distress were most strongly related to reported combat exposure.