A-94 Characterization of Million Veteran Program (MVP) Enrollees with Comprehensive TBI Evaluation (CTBIE) Data: An Analysis of Neurobehavioral Symptoms

2021 ◽  
Vol 36 (6) ◽  
pp. 1141-1141
Author(s):  
Erin Ozturk ◽  
Catherine Chanfreau-Coffinier ◽  
McKenna S Sakamoto ◽  
Victoria C Merritt ◽  
Lisa Delano-Wood
Keyword(s):  
Behavioral Health ◽  
Mental Health Treatment ◽  
Diagnostic Group ◽  
Sociodemographic Characteristics ◽  
Veterans Health ◽  
Health Treatment ◽  
Symptom Resolution ◽  
Neurobehavioral Symptoms ◽  
Post Hoc

Abstract Objective Using a large sample of U.S. Veterans enrolled in the Million Veteran Program (MVP), we sought to evaluate neurobehavioral symptoms obtained from the Veterans Health Administration’s Comprehensive Traumatic Brain Injury Evaluation (CTBIE). Method Eligible participants (N = 12,144) included MVP-enrolled Veterans who completed the CTBIE, a clinician-administered interview that assesses for historical, deployment-related TBIs and evaluates current symptoms using the Neurobehavioral Symptom Inventory (NSI). Clinicians completing the CTBIE made clinical determinations about each participant’s TBI diagnostic status (n = 7631 CTBIE+, n = 4513 CTBIE-) as well as likely symptom etiology (TBI: n = 612, Behavioral Health: n = 4965, Combination TBI and Behavioral Health [Comorbid]: n = 2773, Symptom Resolution; n = 750; and Other: n = 1282). We evaluated the association of TBI diagnostic group and symptom etiology group with neurobehavioral symptoms using ANCOVAs adjusted for sociodemographic characteristics. Results Results showed a significant effect of TBI on the NSI total score (p < 0.001, ηp2 = 0.02), with CTBIE+ Veterans endorsing greater symptoms than CTBIE- Veterans. There was also a significant association of symptom etiology group with the NSI total score (p < 0.001, ηp2 = 0.07). Post-hoc analyses showed that the Behavioral Health and Comorbid groups endorsed significantly greater symptoms compared to the TBI, Symptom Resolution, and Other groups. A similar pattern of results was found for all NSI symptom domain scores (vestibular, somatic, cognitive, and affective) and symptom breadth scores. Conclusions Findings from this large epidemiologic MVP study bolster prior work suggesting that behavioral health (e.g., depression, PTSD) greatly contributes to post-concussive symptom endorsement in chronic TBI. Results further highlight the importance of prioritizing mental health treatment in this vulnerable population.

scholarly journals Perinatal Symptoms and Treatment Engagement in Female Veterans

2021 ◽  
Author(s):  
Elizabeth H Anderson ◽  
Carolyn Morrow ◽  
Kristin M Mattocks ◽  
Geetha Shivakumar
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Symptom Severity ◽  
Psychiatric Diagnosis ◽  
Mental Health Treatment ◽  
Treatment Engagement ◽  
Perinatal Period ◽  
Veterans Health ◽  
Health Treatment ◽  
Pregnancy And Postpartum

ABSTRACT Introduction Women veterans using Veterans Health Care Administration maternity benefits have a high prevalence of mental health disorders, including depression, PTSD, and anxiety. Additionally, women with psychiatric histories often experience a relapse or worsening of symptoms during pregnancy and postpartum. Adequate perinatal mental healthcare engagement is critical to optimizing outcomes for mother and child. Materials and Methods This study evaluated psychiatric symptom severity and predictors of women veteran’s mental health treatment engagement during pregnancy and postpartum at the VA North Texas Health Care System. Seventy women using Veterans Health Administration were assessed longitudinally via chart review and interviews (including the Edinburgh Postnatal Depression Scale) during pregnancy and postpartum. A Friedman test was used to evaluate the change in symptom severity during (1) the 6 months before pregnancy, (2) pregnancy, and (3) postpartum. Multivariate logistic regressions were used to determine predictors of attending outpatient mental health appointments. Potential predictors examined included sociodemographic factors, symptoms of depression, history of military sexual assault, presence of a pre-pregnancy psychiatric diagnosis, and attendance of mental health appointments before pregnancy. Results Approximately 40% of participants demonstrated at least mild psychiatric symptoms before pregnancy, and symptom severity did not significantly change across the perinatal period (pre-pregnancy, pregnancy, and postpartum) X2 (2, n = 70) = 3.56, P = .17. Depressive symptoms during the 2nd or 3rd trimester were a significant predictor for attendance of mental health appointments during both pregnancy (OR = 1.18, 95% CI, 1.04 to 1.34) and postpartum (OR = 1.18, 95% CI, 1.02 to 1.36). An active psychiatric diagnosis during the 6 months before pregnancy was also a significant predictor of attendance following delivery (OR = 14.63, 95% CI, 1.55 to 138.51). Conclusion Our results demonstrate that women with prior histories of mental health conditions will continue to be symptomatic, and this is a good predictor of mental health treatment engagement during the perinatal period.

Mental health and addiction service use among United States veterans with liver disease nationally in the Veterans Health Administration

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Lamia Haque ◽  
Robert Rosenheck
Keyword(s):  
Mental Health ◽  
United States ◽  
Drug Dependence ◽  
Mental Health Treatment ◽  
Addiction Treatment ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Health Treatment ◽  
Content Type

Purpose While many studies have shown that liver diseases (LD) can be caused or exacerbated by substance use disorders (SUD), few have examined the proportion of adults with LD and SUD who receive mental health and addiction treatment or correlates of such use. Design/methodology/approach Using national Fiscal Year (FY) 2012 data from the United States Veterans Health Administration (VHA), the authors studied all 43,246 veterans diagnosed with both LD and SUD in FY 2012 and compared those who received mental health treatment (n = 30,456; 70.4%) to those who did not (n = 12,790; 29.6%). Findings Veterans who received mental health treatment were less like to be older than 75 years of age, more likely to have served during recent Middle East conflicts (Operation Iraqi Freedom or Operation Enduring Freedom), more likely to have been recently homeless and to have drug dependence as contrasted with alcohol dependence when compared with those who did not receive mental health treatment. Although the majority, 70.4%, received mental health treatment, only 30.6% of the total received specialized addiction treatment, and these veterans were more likely to experience homelessness and have drug dependence diagnoses. Originality/value This is the first study as per the authors’ best knowledge that broadly examines mental health and addiction treatment received by veterans with LD and SUD. High rates of mental health treatment in this population likely reflect the integrated nature of the VHA and its emphasis on providing comprehensive services to homeless veterans. Further research is needed to identify barriers to specialized addiction treatment in this population.

Mental Health and Drug Treatment Need vs. Capacity

2020 ◽  
pp. 108-123
Keyword(s):  
Mental Health ◽  
Health Services ◽  
Behavioral Health ◽  
Mental Health Treatment ◽  
Standing Position ◽  
Psychiatric Evaluation ◽  
Full Time ◽  
Health Treatment ◽  
Treatment Need ◽  
Local District

In 2018, the local District of Columbia auditor found that a section of the Department of Behavioral Health that performed psychiatric evaluations had significant staff turnover and long-standing position vacancies and that there had been a several-week period when approximately one-fourth of the Division's full-time positions were vacant. As a result, the Department's psychiatric evaluation waitlist grew, delaying many defendants' evaluations beyond the statutorily permissible timeframe. When the problem persisted, DC Superior Court judges threatened contempt citations. Moreover, the Department relied on a network of small to mid-sized nonprofit agencies to provide the vast majority of public behavioral health services. However, many of these nonprofits had experienced lengthy delays in reimbursement stemming from the Department of Behavioral Health's billing software, and some were forced to close. These circumstances suggested the CSOSA clients would have been unlikely to have received mental health treatment.

scholarly journals Pediatric Primary Care Provider Comfort with Mental Health Practices: A Needs Assessment of Regions with Shortages of Treatment Access

2021 ◽  
Author(s):  
Amie F. Bettencourt ◽  
Rebecca A. Ferro ◽  
Jami-Lin L. Williams ◽  
Kainat N. Khan ◽  
Rheanna E. Platt ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Treatment ◽  
Pairwise Comparisons ◽  
Health Practices ◽  
Treatment Access ◽  
Health Treatment ◽  
Friedman's Test ◽  
Mental Health Practices ◽  
Post Hoc

Abstract Objectives Nearly 50% of children with a mental health concern do not receive treatment. Child Psychiatry Access Programs like Behavioral Health Integration in Pediatric Primary Care (BHIPP) address regional shortages of mental health treatment access by providing training and consultation to primary care providers (PCPs) in managing mental health concerns. This study assessed PCPs’ comfort with mental health practices to inform expansion of BHIPP services. Methods Pediatric PCPs in 114 practices in three rural regions of Maryland were recruited to participate in a survey about their comfort with mental health practices and access to mental health providers for referral. Descriptives, Friedman’s test, and post hoc pairwise comparisons were used to examine survey responses. Results Participants were 107 PCPs. Most respondents were physicians (53.3%) or nurse practitioners/physician’s assistants (39.3%). Friedman’s test, χ2(7)= 210.15, p<.001, revealed significant within and between-group differences in PCP comfort with mental health practices. Post hoc pairwise comparisons indicated greater comfort providing mental health screening and referrals compared to prescribing psychiatric medications, providing psychoeducation or in-office mental health interventions. A Wilcoxon-signed rank test showed significantly more respondents agreed they could find a therapist than a psychiatrist in a timely manner, Z= −5.93, p<.001. Conclusions Pediatric PCPs were more comfortable with providing mental health assessment and referrals than treatment. However, PCPs reported difficulty finding therapists and psychiatrists for their patients. Findings underscore the need for longitudinal training to increase PCP comfort with mental health treatment. Additionally, strategies such as telepsychiatry are needed to address the disproportionate need for child psychiatrists.

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