Depression and PTSD Co-Morbidity: What are We Missing?

Background: Posttraumatic stress disorder (PTSD) and depression comorbidity is highly common. Many hypotheses concerning this relation have been raised but the pertinent issues, including the wide clinical picture of this comorbidity, are still not clear. The current study aims to bridge these gaps. Method: We assessed PTSD, depression and comorbid indicators including dissociation, somatization, self- destructive behavior and suicidality among Israeli Yom Kippur war veterans at three time points (N = 349, 287, 301). Results: Dissociation, somatization, self-destructive behavior and suicidality were predicted separately by group (PTSD, depression and comorbidity) and time of measurement using ANOVA and Chi squared analyses. The ‘comorbidity’ group expressed significantly higher dissociation, somatization, self-destructive behavior and suicidality, revealing high vulnerability of this group. Somatization presented a curvilinear-like development, increasing between T1 and T2 and slightly declining at T3, especially among the ‘comorbidity’ group. Suicidality showed a constant increase along the three measurements, especially among the comorbidity group. Conclusions: A PTSD/depression comorbidity is both highly prevalent and long lasting and is often expressed concurrently with other related symptomatology, which causes further suffering and makes it more complicated for treatment. Implications for policy makers are briefly discussed

Individual and organizational Uses of EBP in healthcare settings

Thesis: Ph. D. in Engineering Systems: Technology, Management, and Policy, Massachusetts Institute of Technology, School of Engineering, Institute for Data, Systems, and Society, February, 2020Cataloged from student-submitted PDF version of thesis.Includes bibliographical references (pages 135-145).In the three decades since its introduction, Evidence-Based Practice (EBP) has become standard clinical practice and the subject of targeted interventions at all levels of the health system. Despite its prevalence, EBP is frequently challenged on philosophical, practical, empirical, and normative grounds. And EBP is often underused in practice relative to the considerable investment in training and sophisticated organizational interventions to implement EBP. In this dissertation, I identify what the concept of EBP means to health system stakeholders as a partial explanation for this persistent gap in EBP use and implementation outcomes. Through interviews with clinicians and healthcare administrators, I identify how providers and organizations use EBP in practice to clinical ends and in inter-professional relationships. First, I find that in contrast to the theoretical model, stakeholders vary in how they operationalize EBP for individual-level clinical use.Stakeholders endorse a range of what I call implicit mental models of EBP that imply different approaches to clinical decision-making. Respondents' implicit mental models of EBP each emphasize an incomplete aspect of the full EBP model: Resource-Based EBP emphasizes specific evidence artifacts, Decision-Making EBP emphasizes the decision-making process, and EBT-Based EBP emphasizes specific Evidence-Based Treatments. These implicit models represent the decision inputs, process, and outputs, respectively. Second, I describe how and why healthcare organizations conduct EBP interventions, despite its initial design as an individual-level clinical decision-making model. I document a range of different organizational EBP activities and interventions, including disseminating resources, training providers, and implementing local standards. These organizational EBP activities both support individual EBP use and address broader organizational ends, which may conflict.Finally, EBP takes on social and inter-professional meanings beyond its intended scope as a clinical decision-making model, which emerge in context and affect how providers understand and use EBP. Specifically, providers may renounce their standing to evaluate evidence, demonstratively use EBP, and administrators claim standing to evaluate evidence. This dissertation therefore demonstrates the varied uses of EBP that emerge in practice, contributing to our understanding of the challenges and contradictions that arise in applying general knowledge to individual cases and systematizing strategies for the same at the organization level.by Henry Alan Fingerhut.Ph. D. in Engineering Systems: Technology, Management, and PolicyPh.D.inEngineeringSystems:Technology,Management,andPolicy Massachusetts Institute of Technology, School of Engineering, Institute for Data, Systems, and Societ

A Simulation Model to Predict Long-Term Posttraumatic Stress Disorder Prevalence Following Operation Iraqi Freedom and Operation Enduring Freedom: Executive Summary

Department of Defens

Combat-related Post-Traumatic Stress Disorder (PTSD)

Thesis: S.M. in Technology and Policy, Massachusetts Institute of Technology, Institute for Data, Systems, and Society, Technology and Policy Program, 2015.Cataloged from student-submitted PDF version of thesis.Includes bibliographical references (pages 155-160).Combat-related Post-Traumatic Stress Disorder (PTSD) poses complex challenges for policymakers that systems analysis could help elucidate. True population prevalence and future clinical need are highly uncertain, because individuals' PTSD symptomatology may fluctuate in time. Though we increasingly measure policy outcomes, outcome metrics often address direct, short-term effects, so the impact on long-term prevalence is unclear. The PTSD burden involves a diverse set of actors across domains who independently make decisions based on incomplete information. Systems analysis can indicate how these local aspects of the PTSD burden jointly impact long-term prevalence and identify leverage points for PTSD mitigation. This thesis presents a systems framework and stochastic modeling approach to predict PTSD prevalence and clinical demand over the decades following the current Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF). The system developed in this study incorporates the literature on PTSD symptom dynamics and social factors governing its recognition and treatment in order to identify the structure and dynamics of the PTSD burden. The simulation results indicate the extent to which PTSD is chronic, prevalent, and resistant to treatment. The best-case model predicts that 11-16% of OEF/OIF combat veterans will maintain a long-term need for PTSD services, and as many as 23% of OEF/OIF combat veterans will seek PTSD-related health care at least once in their lives. By controlling for symptom dynamics, model results account for a large component of the variation in empirically observed prevalence rates. Sensitivity and policy analyses show that care-seeking factors tend to have the most significant effect on long-term PTSD prevalence. Model limitations and assumptions are documented, particularly regarding symptom and care-seeking dynamics and parameter interactions, to provide the basis for future empirical and analytical work to elaborate systemic complexities underlying military mental health. The current study specifically addresses OEF/OIF combat-related PTSD, however this approach may be generalized to other populations and mental health concerns. This study has three main policymaking implications. First, study predictions regarding long-term PTSD prevalence and clinical demand can be used for clinical planning and resource allocation over time. Second, baseline model results indicate the long-term limits of current best practice PTSD mitigation efforts. Third, the study identifies effective policy levers by indicating the factors with the greatest direct impact on long-term PTSD prevalence.by Henry Alan Fingerhut.S.M. in Technology and Polic