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Archive for the ‘mental health and substance abuse’ Category

Mental Health Stigma in the Military

October 30, 2014 Comments off

Mental Health Stigma in the Military
Source: RAND Corporation

Despite the efforts of both the U.S. Department of Defense (DoD) and the Veterans Health Administration to enhance mental health services, many service members are not regularly seeking needed care when they have mental health problems. Without appropriate treatment, these mental health problems can have wide-ranging and negative impacts on the quality of life and the social, emotional, and cognitive functioning of affected service members. The services have been actively engaged in developing policies, programs, and campaigns designed to reduce stigma and increase service members’ help-seeking behavior. However, there has been no comprehensive assessment of these efforts’ effectiveness and the extent to which they align with service members’ needs or evidence-based practices. The goal of this research was to assess DoD’s approach to stigma reduction — how well it is working and how it might be improved. To address these questions, RAND researchers used five complementary methods: (1) literature review, (2) a microsimulation modeling of costs, (3) interviews with program staff, (4) prospective policy analysis, and (5) an expert panel. The priorities outlined in this report represent a first step for where additional program and policy development and research and evaluation are needed to improve understanding of how best to get service members with mental health disorders the needed treatment as efficiently and effectively as possible.

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PTSD Research Quarterly — Impact of Mass Shootings

October 28, 2014 Comments off

PTSD Research Quarterly — Impact of Mass Shootings (PDF)
Source: National Center for PTSD (VA)

Norris (2007) provided an excellent introduction to the literature on mass shootings. Our goal is to provide an update on this literature. Norris focused on individual, as well as broader community factors in examining responses to mass shootings. Our guide focuses solely on quantitative studies examining factors at the level of the individual that appear to be related to adjustment following a mass shooting.

Our definition of a mass shooting involves an individual (with few exceptions, a male), acting alone and with generally personal rather than political motivation, entering a densely populated space and shooting as many people as possible. In addition, while not required in the definition, the shooter typically takes, his or her, own life. Our guide to the literature proceeds chronologically, with an emphasis on studies that use longitudinal data.

Workplace suicide prevention: a systematic review of published and unpublished activities

October 26, 2014 Comments off

Workplace suicide prevention: a systematic review of published and unpublished activities
Source: Health Promotion International

There are a number of published studies on workplace suicide prevention activities, and an even larger number of activities that are not reported on in academic literature. The aim of this review was to provide a systematic assessment of workplace suicide prevention activities, including short-term training activities, as well as suicide prevention strategies designed for occupational groups at risk of suicide. The search was based on Meta-analysis of Observational Studies in Epidemiology (MOOSE) Guidelines. The databases used for the searches were the Cochrane Trials Library and PubMed. A range of suicide prevention websites were also searched to ascertain the information on unpublished workplace suicide prevention activities. Key characteristics of retrieved studies were extracted and explained, including whether activities were short-term training programmes or developed specifically for occupations at risk of suicide. There were 13 interventions relevant for the review after exclusions. There were a few examples of prevention activities developed for at-risk occupations (e.g. police, army, air force and the construction industry) as well as a number of general awareness programmes that could be applied across different settings. Very few workplace suicide prevention initiatives had been evaluated. Results from those that had been evaluated suggest that prevention initiatives had beneficial effects. Suicide prevention has the potential to be integrated into existing workplace mental health activities. There is a need for further studies to develop, implement and evaluate workplace suicide prevention programmes.

Do (Even) Depressed Individuals Believe That Life Gets Better and Better? The Link Between Depression and Subjective Trajectories for Life Satisfaction

October 24, 2014 Comments off

Do (Even) Depressed Individuals Believe That Life Gets Better and Better? The Link Between Depression and Subjective Trajectories for Life Satisfaction
Source: Clinical Psychological Science

We investigated the widespread belief that life gets better and better over time—as revealed in individuals’ “subjective trajectories” for life satisfaction (LS) derived from their ratings of recollected past, current, and anticipated future LS—among depressed (i.e., current major depressive disorder, fully remitted, partially remitted) and nondepressed groups using a two-wave longitudinal sample of American adults. Linear and inclining subjective trajectories (past LS < current LS < future LS) were normative among nondepressed individuals, as were nonlinear but inclining subjective trajectories (past LS ~ current LS < future LS) among depressed individuals. Furthermore, Wave 1 temporal-perspective LS ratings uniquely predicted risk of depression 10 years later (Wave 2), even after we controlled for baseline depression status. Thus, the use of a novel temporally expanded perspective revealed that even depressed individuals view their lives as improving over time and that such beliefs predict heightened (rather than less) risk of future depression.

Web-Based Intervention Programs for Depression: A Scoping Review and Evaluation

October 22, 2014 Comments off

Web-Based Intervention Programs for Depression: A Scoping Review and Evaluation
Source: Journal of Medical Internet Research

Background:
Although depression is known to affect millions of people worldwide, individuals seeking aid from qualified health care professionals are faced with a number of barriers to treatment including a lack of treatment resources, limited number of qualified service providers, stigma associated with diagnosis and treatment, prolonged wait times, cost, and barriers to accessibility such as transportation and clinic locations. The delivery of depression interventions through the Internet may provide a practical solution to addressing some of these barriers.

Objective:
The purpose of this scoping review was to answer the following questions: (1) What Web-delivered programs are currently available that offer an interactive treatment component for depression?, (2) What are the contents, accessibility, and usability of each identified program?, and (3) What tools, supports, and research evidence are available for each identified program?

Methods:
Using the popular search engines Google, Yahoo, and Bing (Canadian platforms), two reviewers independently searched for interactive Web-based interventions targeting the treatment of depression. The Beacon website, an information portal for online health applications, was also consulted. For each identified program, accessibility, usability, tools, support, and research evidence were evaluated and programs were categorized as evidence-based versus non-evidence-based if they had been the subject of at least one randomized controlled trial. Programs were scored using a 28-point rating system, and evidence- versus non-evidence-based programs were compared and contrasted. Although this review included all programs meeting exclusion and inclusion criteria found using the described search method, only English language Web-delivered depression programs were awarded an evaluation score.

Results:
The review identified 32 programs meeting inclusion criteria. There was a great deal of variability among the programs captured in this evaluation. Many of the programs were developed for general adolescent or adult audiences, with few (n=2) focusing on special populations (eg, military personnel, older adults). Cognitive behavioral therapy was the most common therapeutic approach used in the programs described. Program interactive components included mood assessments and supplementary homework sheets such as activity planning and goal setting. Only 12 of the programs had published evidence in support of their efficacy and treatment of depressive symptoms.

Conclusions:
There are a number of interactive depression interventions available through the Internet. Recommendations for future programs, or the adaptation of existing programs include offering a greater selection of alternative languages, removing registration restrictions, free trial periods for programs requiring user fees, and amending programs to meet the needs of special populations (eg, those with cognitive and/or visual impairments). Furthermore, discussion of specific and relevant topics to the target audience while also enhancing overall user control would contribute to a more accessible intervention tool.

Veteranness : Representations of Combat-related PTSD in U.S. Popular Visual Media

October 20, 2014 Comments off

Veteranness : Representations of Combat-related PTSD in U.S. Popular Visual Media (PDF)
Source: Michigan Technological University (Keranen)

Posttraumatic stress and PTSD are becoming familiar terms to refer to what we often call the invisible wounds of war, yet these are recent additions to a popular discourse in which images of and ideas about combat-affected veterans have long circulated. A legacy of ideas about combat veterans and war trauma thus intersects with more recent clinical information about PTSD to become part of a discourse of visual media that has defined and continues to redefine veteran for popular audiences.

In this dissertation I examine realist combat veteran representations in selected films and other visual media from three periods: during and after World Wars I and II (James Allen from I Am a Fugitive from a Chain Gang, Fred Derry and Al Stephenson from The Best Years of Our Lives); after the Vietnam War (Michael from The Deer Hunter, Eriksson from Casualties of War), and post 9/11 (Will James from The Hurt Locker, a collection of veterans from Wartorn: 1861-2010.) Employing a theoretical framework informed by visual media studies, Barthes’ concept of myth, and Foucault’s concept ofdiscursive unity, I analyze how these veteran representations are endowed with PTSD symptom-like behaviors and responses that seem reasonable and natural within the narrative arc. I contend that veteran myths appear through each veteran representation as the narrative develops and resolves. I argue that these veteran myths are many and varied but that they crystallize in a dominant veteran discourse, a discursive unity that I term veteranness. I further argue that veteranness entangles discrete categories such as veteran, combat veteran, and PTSD with veteran myths, often tying dominant discourse about combat-related PTSD to outdated or outmoded notions that significantly affect our attitudes about and treatment of veterans.

A basic premise of my research is that unless and until we learn about the lasting effects of the trauma inherent to combat, we hinder our ability to fulfill our responsibilities to war veterans. A society that limits its understanding of posttraumatic stress, PTSD and post-war experiences of actual veterans affected by war trauma to veteranness or veteran myths risks normalizing or naturalizing an unexamined set of sociocultural expectations of all veterans, rendering them voice-less, invisible, and, ultimately disposable.

Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study

October 16, 2014 Comments off

Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study
Source: BMC Medicine

Background
Excess body weight, physical activity, smoking, alcohol consumption and certain dietary factors are individually related to colorectal cancer (CRC) risk; however, little is known about their joint effects. The aim of this study was to develop a healthy lifestyle index (HLI) composed of five potentially modifiable lifestyle factors – healthy weight, physical activity, non-smoking, limited alcohol consumption and a healthy diet, and to explore the association of this index with CRC incidence using data collected within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

Methods
In the EPIC cohort, a total of 347,237 men and women, 25- to 70-years old, provided dietary and lifestyle information at study baseline (1992 to 2000). Over a median follow-up time of 12 years, 3,759 incident CRC cases were identified. The association between a HLI and CRC risk was evaluated using Cox proportional hazards regression models and population attributable risks (PARs) have been calculated.

Results
After accounting for study centre, age, sex and education, compared with 0 or 1 healthy lifestyle factors, the hazard ratio (HR) for CRC was 0.87 (95% confidence interval (CI): 0.44 to 0.77) for two factors, 0.79 (95% CI: 0.70 to 0.89) for three factors, 0.66 (95% CI: 0.58 to 0.75) for four factors and 0.63 (95% CI: 0.54 to 0.74) for five factors; P-trend <0.0001. The associations were present for both colon and rectal cancers, HRs, 0.61 (95% CI: 0.50 to 0.74; P for trend <0.0001) for colon cancer and 0.68 (95% CI: 0.53 to 0.88; P-trend <0.0001) for rectal cancer, respectively (P-difference by cancer sub-site = 0.10). Overall, 16% of the new CRC cases (22% in men and 11% in women) were attributable to not adhering to a combination of all five healthy lifestyle behaviours included in the index.

Conclusions
Combined lifestyle factors are associated with a lower incidence of CRC in European populations characterized by western lifestyles. Prevention strategies considering complex targeting of multiple lifestyle factors may provide practical means for improved CRC prevention.

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