Treatment‐Resistant Depression and Risk of Suicide

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99660/1/sltb12022.pd

Reported Barriers to Mental Health Care in Three Samples of U.S. Army National Guard Soldiers at Three Time Points

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108379/1/jts21942.pd

Strong Military Families Intervention Enhances Parenting Reflectivity And Representations In Families With Young Children

Military families face many challenges due to deployment and parental separation, and this can be especially difficult for families with young children. The Strong Military Families (SMF) intervention is for military families with young children, and consists of two versions: the Multifamily Group, and a Home‐based psychoeducational written materials program. The Multifamily Group was designed to enhance positive parenting through both educational components and in vivo feedback and support during separations and reunions between parents and children (n = 78 parents). In the present study, we examine parenting reflectivity and mental representations in mothers versus fathers in military families, service members versus civilian spouses/parenting partners, and before versus after participation in the SMF Multifamily Group and Home‐based interventions. Parenting reflectivity and mental representations were coded from the Working Model of the Child Interview (WMCI; C.H. Zeanah & D. Benoit, 1995). Results suggest that neither parenting reflectivity nor WMCI typology differs between mothers and fathers in military families, or between service members and civilian parenting partners. Furthermore, there was substantial stability in parenting reflectivity and WMCI typology from baseline to posttest, but participation in the Multifamily Group, relative to Home‐based, was associated with improvements in both parenting reflectivity and WMCI ratings from baseline to postintervention.RESUMENLas familias militares enfrentan muchos retos debido a las distantes asignaciones de servicio y la separación de los padres, lo cual puede ser específicamente difícil para familias con niños pequeños. La intervención Familias Militares Fuertes (SMF) es para familias militares con niños pequeños y consta de dos versiones: un Grupo Múltiple de Familias y un programa sicoeducativo de materiales escritos con base en casa. El Grupo Múltiple de Familias se diseñó para mejorar la crianza positiva tanto a través de componentes educativos como de reacciones y apoyo en vivo durante las separaciones y reuniones entre padres y niños (n = 78 padres). En el presente estudio, examinamos el poder de reflexión sobre la crianza y las representaciones mentales en mamás vs. papás en familias militares, miembros del servicio militar vs. cónyuges civiles/parejas conyugales en la crianza, y antes vs. después de la participación en el Grupo Múltiple de Familias SMF y en las intervenciones con base en casa. El poder de reflexión sobre la crianza y las representaciones mentales se codificaron usando el Modelo de Trabajo de la Entrevista del Niño –WMCI‐ (Zeanah y Benoit, 1995). Los resultados sugieren que ni el poder de reflexión ni la tipología del WMCI difieren entre mamás y papás en familias militares, o entre miembros del servicio militar y sus parejas conyugales civiles en la crianza. Es más, se dio una estabilidad de importancia en el poder de reflexión y la tipología WMCI entre el punto de referencia y la examinación posterior, pero la participación en el Grupo Múltiple de Familias, en relación con la intervención en casa, se asoció con mejoras tanto en el poder de reflexión como en los puntajes WMCI entre el punto de referencia y la intervención posterior.RÉSUMÉLes familles de militaires font face à de nombreux défis du fait des déploiements et de la séparation parentale, et cela peut s’avérer particulièrement difficile pour les familles avec de jeunes enfants. L’intervention Familles Militaires fortes (ici abrégé en français FMF, SMF en anglais, pour Strong Military Families) est destinée aux familles de militaires avec de jeunes enfants et consiste en deux versions: un Groupe Multifamilial, et une intervention à domicile avec programme de matériel psychoéducatif écrit. Le Groupe Multifamilial a été conçu afin de mettre en valeur le parentage positif à travers des composantes éducatives et du feedback in vivo et du soutien durant les séparations et les réunions entre les parents et les enfants (n = 78 parents). Dans cette étude nous examinons la réflectivité de parentage et les représentations mentales chez les mères et les pères de familles de militaires, les membres du service comparés aux épouses civiles et aux partenaires de parentage civils, et avant par rapport à après la participation au Groupe Multifamilial FMF et les interventions à domicile. La réflectivité de parentage et les représentations mentales ont été codées à partir du Modèle de Travail de l’Entretien de l’Enfant (Zeanah & Benoit, 1995). Les résultats suggèrent que ni la réflectivité de parentage ni le Modèle de Travail de l’Entretien de l’Enfant ne diffèrent entre les mères et les pères dans les familles militaires ou entre les membres du service et les partenaires de parentage civils. De plus il y avait une stabilité importante dans la réflectivité de parentage et la typologie du Modèle de Travail de l’Entretien de l’Enfant du niveau de référence jusqu’après le test, mais la participation au Groupe Multifamilial, par rapport à la participation à domicile, était liée à des améliorations dans à la fois la réflectivité de parentage et les scores du Modèle de Travail de l’Entretien de l’Enfant du niveau de référence à après l’intervention.ZUSAMMENFASSUNGMilitärische Familien stehen durch den Einsatz und die Trennung der Eltern vor vielen Herausforderungen, was besonders für Familien mit Kleinkindern schwierig sein kann. Die Intervention „Strong Military Families“ (SMF) richtet sich an Militärfamilien mit Kleinkindern und besteht aus zwei Versionen: Aus einer Mehrfamiliengruppe und einem psychoedukativen schriftlichen Materialprogramm für Zuhause. Die Mehrfamiliengruppe wurde entwickelt, um die positive Elternschaft sowohl durch pädagogische Komponenten als auch durch in vivo Feedback und Unterstützung bei Trennungen und Wiedervereinigungen zwischen Eltern und Kindern (n = 78 Eltern) zu fördern. In der vorliegenden Studie untersuchen wir die Reflektivität und mentalen Repräsentationen von Eltern bei Müttern vs. Vätern in militärischen Familien, Dienstmitgliedern vs. zivilen Ehepartnern/Erziehungspartnern und vor vs. nach der Teilnahme an der SMF Mehrfamiliengruppe und psychoedukativen Intervention Zuhause. Die elterliche Reflektivität und mentalen Repräsentationen wurden aus dem “Working Model of the Child Interview” (WMCI; Zeanah & Benoit, 1995) kodiert. Die Ergebnisse deuten darauf hin, dass sich weder die elterliche Reflektivität noch die Typologie der WMCI zwischen Müttern und Vätern in Militärfamilien oder zwischen Dienstmitgliedern und zivilen Ehepartnern unterscheiden. Außerdem gab es eine beträchtliche Stabilität in der elterlichen Reflektivität und WMCI‐Typologie vom Beginn der Untersuchungen bis zum Post‐Test, aber die Teilnahme an der Mehrfamiliengruppe, im Vergleich zur psychoedukativen Intervention Zuhause, war mit Verbesserungen sowohl in der elterlichen Reflektivität als auch in der WMCI‐Bewertung vom Untersuchungsbeginn zur Post‐Intervention verbunden.抄録強い軍人家族介入 The Strong Military Families が、 幼い子どものいる家族における育児の内省性 Reflectivity と表象を増強する軍人家族は配属や親との分離のために多くの困難に直面する。そしてこれは幼い子どものいる家族には特に困難になり得る。強い軍人家族The Strong Military Families (SMF)介入は、幼い子どものいる軍人家族のためのもので、2つの型がある。それらは、複数家族グループと資料を用いて家庭で行う心理教育的プログラムである。複数家族グループは、教育的な要素および親子の分離と再会のその場でのフィードバックと支援の両者を通して、ポジティブな育児を増強するようにデザインされた(n = 78人の親)。この研究では、私たちは、軍人家族の母親対父親、軍人対民間人の配偶者/養育パートナー、そしてSMF複数家族グループと家庭での介入に参加前対参加後において、育児の内省性と心的表象を調査した。育児の内省性と心的表象は、the Working Model of the Child Interview (Zeanah & Benoit, 1995) によってコード化された。結果から、軍人家族の母親と父親、あるいは軍人と民間人の養育パートナーの間に、育児の内省性あるいはWMCIタイプについて違いは示されなかった。さらに、基準線からテスト後にかけて、育児の内省性およびWMCIタイプにかなりの安定性があったが、家庭におけるプログラムに比べて、複数家族グループに参加することは、育児の内省性およびWMCI評価の両者の基準線から介入後への改善と関連していた。摘要強大軍人家庭干預增強在有子女家庭中的育兒反思能力和表現由於軍事部署和父母在不同地方居住, 軍人家庭面臨許多挑戰, 這些挑戰對於有小孩的家庭尤其嚴重。強大軍人家庭干預 (SMF) 是為有小孩的軍人家庭進行的干預, 包括兩個版本: 一個多家庭小組和一個家庭式的心理教育書面材料計劃。多家庭小組旨在通過教育丶反饋和支持, 在父母與子女 (78名父母) 的分離和團聚期間, 加強積極的父母教養。在本研究中, 我們考察在軍人家庭丶服務人員與平民配偶/養育夥伴的父母, 以及參與 SMF 多家庭小組和家庭式干預前後的父母反思和心理表徵。我們以兒童訪談的工作模式 (Zeanah&Benoit, 1995), 編碼父母反思能力和心理表徵。結果表明, 在軍人家庭父母之間, 或服務人員和平民養育夥伴之間, 父母反思能力和WMCI類型學並無不同。此外, 從基線到測試後, 父母反思能力和WMCI類型相當穩定, 但和家庭式干預相比, 多家庭小組的參與, 與從基線到干預後的父母反思能力和WMCI評分之改善相關。ملخصالتدخل القوى عند العائلات العسكرية يعزز الأداء التأملي الوالدي والتمثيلات الذهنية في الرعاية الوالدية للعائلات تجاه أطفالهم الصغارالعائلات العسكرية تواجه كثيرا من التحديات بسبب حركات التنقل العسكري والانفصال بين الوالدين وهذا يكون أشد صعوبة بالنسبة للعائلات ذوي الأطفال الصغار. التدخل القوي للعائلات العسكرية (SMF) هو برنامج يتكون من جانبين: مجموعة متعددة الأسر وبرنامج منزلي للمواد التعليمية النفسية المكتوبة. تم تشكيل المجموعة متعددة الأسر لتعزيز الرعاية الوالدية الإيجابية من خلال مكونات تعليمية وتغذية مرتدة ودعم أثناء فترات انفصال الأسر ولم الشمل بين الوالدين والأطفال (n = 78). في الدراسة الحالية نستخدم الأداء التأملي الوالدي والتمثيلات الذهنية عند الأمهات مقابل الآباء في الأسر العسكرية وأفراد الخدمة بالمقارنة مع الأزواج والوالدين المدنيين وكذلك المقارنة بين قبل وبعد المشاركة في برنامج (SMF). تم ترميز الأداء التأملي الوالدي والتمثيلات الذهنية من خلال النموذج العامل للمقابلة الشخصية مع الطفل (زينة وبينوا 1995). تشير النتائج إلى عدم اختلاف الأداء التأملي الوالدي ونمط النموذج العامل لمقابلة الطفل (WMCI) بين الآباء والأمهات في الأسر العسكرية أو بين أفراد الخدمة والأزواج والآباء المدنيين. بالإضافة إلى ذلك كان هناك استقرار جوهري في الأداء التأملي الوالدي ونمط النموذج العامل بين خط البداية والاختبار البعدي ولكن المشاركة في مجموعة متعددة الأسر بالمقارنة مع البرنامج المنزلي كانت مقترنة بتحسن في كل من الأداء التأملي الوالدي وتقييمات (WMCI) بين خط البداية وتدخل الاختبار البعدي.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141683/1/imhj21690_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141683/2/imhj21690.pd

On deciding to have a lobotomy:either lobotomies were justified or decisions under risk should not always seek to maximise expected utility

In the 1940s and 1950s thousands of lobotomies were performed on people with mental disorders. These operations were known to be dangerous, but thought to offer great hope. Nowadays, the lobotomies of the 1940s and 1950s are widely condemned. The consensus is that the practitioners who employed them were, at best, misguided enthusiasts, or, at worst, evil. In this paper I employ standard decision theory to understand and assess shifts in the evaluation of lobotomy. Textbooks of medical decision making generally recommend that decisions under risk are made so as to maximise expected utility (MEU) I show that using this procedure suggests that the 1940s and 1950s practice of psychosurgery was justifiable. In making sense of this finding we have a choice: Either we can accept that psychosurgery was justified, in which case condemnation of the lobotomists is misplaced. Or, we can conclude that the use of formal decision procedures, such as MEU, is problematic

Innovation in health economic modelling of service improvements for longer-term depression: demonstration in a local health community

Background The purpose of the analysis was to develop a health economic model to estimate the costs and health benefits of alternative National Health Service (NHS) service configurations for people with longer-term depression. Method Modelling methods were used to develop a conceptual and health economic model of the current configuration of services in Sheffield, England for people with longer-term depression. Data and assumptions were synthesised to estimate cost per Quality Adjusted Life Years (QALYs). Results Three service changes were developed and resulted in increased QALYs at increased cost. Versus current care, the incremental cost-effectiveness ratio (ICER) for a self-referral service was £11,378 per QALY. The ICER was £2,227 per QALY for the dropout reduction service and £223 per QALY for an increase in non-therapy services. These results were robust when compared to current cost-effectiveness thresholds and accounting for uncertainty. Conclusions Cost-effective service improvements for longer-term depression have been identified. Also identified were limitations of the current evidence for the long term impact of services

Hippocampal - diencephalic - cingulate networks for memory and emotion: An anatomical guide

This review brings together current knowledge from tract tracing studies to update and reconsider those limbic connections initially highlighted by Papez for their presumed role in emotion. These connections link hippocampal and parahippocampal regions with the mammillary bodies, the anterior thalamic nuclei, and the cingulate gyrus, all structures now strongly implicated in memory functions. An additional goal of this review is to describe the routes taken by the various connections within this network. The original descriptions of these limbic connections saw their interconnecting pathways forming a serial circuit that began and finished in the hippocampal formation. It is now clear that with the exception of the mammillary bodies, these various sites are multiply interconnected with each other, including many reciprocal connections. In addition, these same connections are topographically organised, creating further subsystems. This complex pattern of connectivity helps explain the difficulty of interpreting the functional outcome of damage to any individual site within the network. For these same reasons, Papez’s initial concept of a loop beginning and ending in the hippocampal formation needs to be seen as a much more complex system of hippocampal–diencephalic–cingulate connections. The functions of these multiple interactions might be better viewed as principally providing efferent information from the posterior medial temporal lobe. Both a subcortical diencephalic route (via the fornix) and a cortical cingulate route (via retrosplenial cortex) can be distinguished. These routes provide indirect pathways for hippocampal interactions with prefrontal cortex, with the preponderance of both sets of connections arising from the more posterior hippocampal regions. These multi-stage connections complement the direct hippocampal projections to prefrontal cortex, which principally arise from the anterior hippocampus, thereby creating longitudinal functional differences along the anterior–posterior plane of the hippocampus

Determinants of National Guard Mental Health Service Utilization in VA versus Non‐VA Settings

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134155/1/hesr12446.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134155/2/hesr12446-sup-0001-AppendixSA1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134155/3/hesr12446_am.pd

Buddy-to-Buddy, a citizen soldier peer support program to counteract stigma, PTSD, depression, and suicide

Citizen soldiers (National Guard and Reserves) represent approximately 40% of the two million armed forces deployed to Afghanistan and Iraq. Twenty-five to forty percent of them develop PTSD, clinical depression, sleep disturbances, or suicidal thoughts. Upon returning home, many encounter additional stresses and hurdles to obtaining care: specifically, many civilian communities lack military medical/psychiatric facilities; financial, job, home, and relationship stresses have evolved or have been exacerbated during deployment; uncertainty has increased related to future deployment; there is loss of contact with military peers; and there is reluctance to recognize and acknowledge mental health needs that interfere with treatment entry and adherence. Approximately half of those needing help are not receiving it. To address this constellation of issues, a private–public partnership was formed under the auspices of the Welcome Back Veterans Initiative. In Michigan, the Army National Guard teamed with the University of Michigan and Michigan State University to develop innovative peer-to-peer programs for soldiers (Buddy-to-Buddy) and augmented programs for military families. Goals are to improve treatment entry, adherence, clinical outcomes, and to reduce suicides. This manuscript describes training approaches, preliminary results, and explores future national dissemination.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79148/1/j.1749-6632.2010.05719.x.pd

Re-engagement in Psychotherapy for PTSD in Veterans

This infographic summarizes the findings of: Buchholz, K.R., Bohnert, K.M., Pfeiffer, P.N., Valenstein, M., Ganoczy, D., Anderson, R.E., & Sripada, R.K. (2017). Reengagement in PTSD psychotherapy: A case-control study. General Hospital Psychiatry, 48, 20-24. doi: 10.1016/j.genhosppsych.2017.06.009https://commons.und.edu/psych-pp/1000/thumbnail.jp

Validation of key behaviourally based mental health diagnoses in administrative data: suicide attempt, alcohol abuse, illicit drug abuse and tobacco use

<p>Abstract</p> <p>Background</p> <p>Observational research frequently uses administrative codes for mental health or substance use diagnoses and for important behaviours such as suicide attempts. We sought to validate codes (<it>International Classification of Diseases, 9^thedition, clinical modification </it>diagnostic and E-codes) entered in Veterans Health Administration administrative data for patients with depression versus a gold standard of electronic medical record text ("chart notation").</p> <p>Methods</p> <p>Three random samples of patients were selected, each stratified by geographic region, gender, and year of cohort entry, from a VHA depression treatment cohort from April 1, 1999 to September 30, 2004. The first sample was selected from patients who died by suicide, the second from patients who remained alive on the date of death of suicide cases, and the third from patients with a new start of a commonly used antidepressant medication. Four variables were assessed using administrative codes in the year prior to the index date: suicide attempt, alcohol abuse/dependence, drug abuse/dependence and tobacco use.</p> <p>Results</p> <p>Specificity was high (≥ 90%) for all four administrative codes, regardless of the sample. Sensitivity was ≤75% and was particularly low for suicide attempt (≤ 17%). Positive predictive values for alcohol dependence/abuse and tobacco use were high, but barely better than flipping a coin for illicit drug abuse/dependence. Sensitivity differed across the three samples, but was highest in the suicide death sample.</p> <p>Conclusions</p> <p>Administrative data-based diagnoses among VHA records have high specificity, but low sensitivity. The accuracy level varies by different diagnosis and by different patient subgroup.</p