The impact of killing on mental health symptoms in Gulf War veterans.

This study examined the impact of killing on posttraumatic stress symptomatology (PTSS), depression, and alcohol use among 317 U.S. Gulf War veterans. Participants were obtained via a national registry of Gulf War veterans and were mailed a survey assessing deployment experiences and postdeployment mental health. Overall, 11% of veterans reported killing during their deployment. Those who reported killing were more likely to be younger and male than those who did not kill. After controlling for perceived danger, exposure to death and dying, and witnessing killing of fellow soldiers, killing was a significant predictor of PTSS, frequency and quantity of alcohol use, and problem alcohol use. Military personnel returning from modern deployments are at risk of adverse mental health symptoms related to killing in war. Postdeployment mental health assessment and treatment should address reactions to killing in order to optimize readjustment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Short-term neuropsychological outcome following uncomplicated mild TBI: Effects of day-of-injury intoxication and pre-injury alcohol abuse.

Research suggests that individuals who are intoxicated at the time of traumatic brain injury (TBI) have worse cognitive outcome compared with those who are sober. Worse outcome in patients with day-of-injury intoxication might (a) be related to the increased magnitude of brain injury resulting from a variety of negative responses not present following TBI in nonintoxicated individuals, or (b) reflect the effect of pre-injury alcohol abuse that is prevalent in individuals intoxicated at the time of injury. Most studies in this area have focused on patients with moderate to severe TBIs, and on medium- to long-term neuropsychological outcome. The purpose of this study was to examine the relative contributions of day-of-injury intoxication versus pre-injury alcohol abuse on short-term cognitive recovery following mild TBI. Participants were 169 patients with uncomplicated mild TBIs who were assessed on 13 cognitive measures within 7 days postinjury. The prevalence of intoxication at the time of injury was 54.4%. The prevalence of possible pre-injury alcohol abuse was 46.2%. Overall, the results suggest that pre-injury alcohol abuse, compared with day-of-injury alcohol intoxication, had the most influence on short-term neuropsychological outcome from uncomplicated mild TBI. However, the influence of pre-injury alcohol abuse was considered small at best. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol abuse history and adjustment following spinal cord injury.

Objective: Examined the relation of alcohol abuse history to emotional adjustment and pressure sore occurrence during the 1st 3 years following Spinal Cord Injury (SCI). Study Design: Comparisons were made between varying levels of prior abuse and depression and disability acceptance. A model predicting pressure sore occurrence over 3 years was computed. Participants: One hundred seventy-five persons completed the self-report measures; 105 were available for pressure sore evaluations. Main Outcome Measures: The Inventory to Diagnose Depression, the Acceptance of Disability Scales, and pressure sore occurrence. Results: Alcohol abuse was not associated with depression or disability acceptance. Severe alcohol abuse history was associated with pressure sores over the 3 years. Conclusions: Persons with prior history of severe alcohol abuse may be at increased risk for pressure sore occurrence during the 1st years of SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronic pain in a community-based sample of men with spinal cord injury: prevalence, severity, and relationship with impairment, disability, handicap, and subjective well-being

OBJECTIVE: To assess the prevalence, severity, and correlates of chronic pain in a community-based sample of men with spinal cord injury (SCI). DESIGN: Survey. SETTING: Community. PARTICIPANTS: Seventy-seven men with SCI randomly selected from a sampling frame solicited from the community. METHOD: Participants completed standardized questionnaires assessing many areas of life, were interviewed in their homes, and underwent a physical examination at a hospital. There they were interviewed by an anesthesiologist regarding chronic pain, and a nurse administered objective pain measures. RESULTS: Seventy-five percent of the men reported chronic pain. Chronic pain was associated with more depressive symptoms, more perceived stress, and poorer self-assessed health. Greater intensity of pain was related to less paralytic impairment, violent etiology, and more perceived stress. Area of the body affected by pain was related to independence and mobility. CONCLUSIONS: Because of the high prevalence of chronic pain in the population with SCI and its relation to disability, handicap, and quality of life, health care providers need to give this issue the same priority given to other SCI health issues. Analysis of individual pain components provides better information than assessing overall pain. It is futile to treat SCI pain without giving full attention to subjective factors.     

Prevalence of Posttraumatic Stress Disorder in Persons With Spinal Cord Injuries: The Mediating Effect of Social Support.

Objectives: To evaluate the prevalence of posttraumatic stress disorder (PTSD) and to identify risk factors of PTSD in persons with spinal cord injury (SCI). Main Outcome Measures: PTSD and social support were assessed by using the Harvard Trauma Questionnaire (R. F. Mollica et al., 1992) and the Crisis Support Scale (S. Joseph, W. Yule, R. Williams, & B. Andrews, 1993). Participants: One hundred sixty-eight persons with SCI, who were an average of 14 years after injury, filled in the questionnaire. Results: The prevalence of PTSD was 7.1%. Risk factors for PTSD included complete injury, being single, and low level of social support. Conclusions: The prevalence of PTSD after SCI is similar to that in the general population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance use by persons with recent spinal cord injuries.

Obtained substance use histories from 103 persons (aged 16–63 yrs) with recent spinal cord injuries (SCIs). Lifetime exposure to and recent use of several substances with abuse potential were greater than for a like-age national sample. Intoxication at time of injury was reported by 39%. The rate of exposure to and recent use of substances with abuse potential was significantly greater for Ss who reported intoxication at injury. Intoxication at SCI onset is a marker of preinjury substance use. It is important to screen for substance abuse in persons who incur traumatic injury. Timely assessment of and intervention for substance abuse could help enhance psychosocial and vocational outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Driving after use of alcohol and marijuana in college students.

Driving after use of marijuana is almost as common as driving after use of alcohol in youth (P. M. O'Malley & L. D. Johnston, 2003). The authors compared college students' attitudes, normative beliefs and perceived negative consequences of driving after use of either alcohol or marijuana and tested these cognitive factors as risk factors for substance-related driving. Results indicated that youth perceived driving after marijuana use as more acceptable to peers and the negative consequences as less likely than driving after alcohol use, even after controlling for substance use. Results of zero-inflated Poisson regression analyses indicated that lower perceived dangerousness and greater perceived peer acceptance were associated with increased engagement in, and frequency of, driving after use of either substance. Lower perceived likelihood of negative consequences was associated with increased frequency for those who engage in substance-related driving. These results provide a basis for comparing how youth perceive driving after use of alcohol and marijuana, as well as similarities in the risk factors for driving after use of these substances. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress, expectancies, and vulnerability to substance abuse: A test of a model among homosexual men.

We hypothesize that specific attitudes or expectancies make people vulnerable to responding to stress via alcohol or drugs. This "stress-vulnerability" model was tested among homosexual men, who show elevated rates of substance abuse and have culturally specific stressors and vulnerability. Tension reduction expectancies of alcohol effects had a substantial effect on alcohol and marijuana/drug abuse, as did the use of bars as a social resource. Two stress variables—negative affectivity and discrimination attributable to sexual orientation—also had significant, though more moderate effects. Interactions of the vulnerability measures with the stress variables had significant effects on substance abuse beyond the main effects, supporting the central hypothesis. In a second analysis both simple consumption levels and "high-risk" styles of alcohol or drug use predicted alcohol or drug problems better among vulnerable than among nonvulnerable respondents. These findings strongly supported a general stress-vulnerability model of substance abuse and illustrated several important risk factors in homosexual culture. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance abuse and medical complications following spinal cord injury.

This study examined relationships between medical complications resulting in hospital stays and alcohol and illicit substance use in 71 persons with recent spinal cord injury (SCI). At 5 intervals after injury, medical records were reviewed for pressure ulcers and urinary tract infections (UTIs). Abstainers with histories of drinking problems before SCI were at greater risk for UTIs from 7 to 12 months after injury and for longer hospital stays. Former drinkers may not have implemented the self-care skills that were a focus during inpatient rehabilitation. Preinjury illicit substance abuse was related to an increased risk of pressure ulcers 30 months after SCL Clinical implications are clear: Psychologists should inquire about substance use patterns, monitor psychological well-being, and explore the ways in which self-care habits are related to substance use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief screening for psychological and substance abuse disorders in veterans with long-term spinal cord injury.

Objective: To determine rates of positive screens for psychological and substance use disorders in persons with long-term spinal cord injury (SCI). Study Design: A naturalistic cohort design wherein consecutive admissions during an 8-month period completed the screening battery. Setting: Veterans Affairs SCI Center. Participants: One hundred fifteen men, 2 women, mean age 57.4 years, injured an average of 20 years, readmitted for various reasons. Main Outcome Measures: The Alcohol Use Disorders Identification Test (AUDIT) and screening items for depression and anxiety disorders. Results: Rates of positive screens ranged from 6.2% for alcohol problems to over 40% for anxiety disorders. Positive screens for depression and anxiety correlated positively with the number of recent hospital admissions. Conclusions: Systematic brief screening for psychological and substance abuse disorders in this population revealed rates of positive screens at least equal to those in other medical patient populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Access to health care services among people with rehabilitation needs receiving Medicaid.

Objective: To investigate access to care for individuals with rehabilitation-related conditions receiving fee-for-service Medicaid. Study Design: Telephone survey. Participants: One hundred thirty-eight individuals with spinal cord injury (SCI), brain injury (BI), or stroke. Main Outcome Measures: Frequency of difficulty or failure to access medical services, perceived effect on health, services most difficult to access, and reasons for difficulty. Results: People with SCI reported the most frequent difficulty accessing services (87%), followed by persons with BI (79%) and stroke (65%). In a subgroup of respondents, 60% reported failure to receive at least 1 service; 81% reported that access difficulties affected health or daily routine. Conclusions: People with rehabilitation-related disabilities may experience greater barriers to needed services than the larger population of persons with disabilities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adult marijuana users seeking treatment.

In an effort to study the efficacy of attracting and intervening with adult marijuana users, 290 men and 92 women were screened for participation in a treatment-outcome study focused on marijuana cessation. The well-educated, self-referred sample reported using marijuana on 79 of the past 90 days before testing. Indices of the severity of marijuana abuse and general psychopathology were in the clinical range for a majority of Ss. Ss who did not report evidence of alcohol or other drug abuse (n?=?144) reported less severe consequences of marijuana use and experienced less general psychological distress than Ss who also reported lifetime (n?=?165) or current abuse (n?=?73) of other substances in addition to marijuana. The findings indicate the need for clinical research targeting adults who are dependent on marijuana. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Young-adult malt liquor drinkers: Prediction of alcohol problems and marijuana use.

Malt liquor (ML) is a cheap, high alcohol content beverage that is marketed to appeal to young adults. Findings from the few published studies of ML use suggest that it may be associated with excessive drinking, alcohol problems, and the use of illicit drugs. The authors conducted separate hierarchical multiple regressions to examine the role of ML use and psychosocial variables (e.g., personality, ML motives) in alcohol-related problems and marijuana use. Demographic characteristics served as controls. The sample consisted of 639 (456 men, 183 women) young adults (M = 22.9 years, SD = 4.2) who regularly (≥40 oz/week) consumed ML. ML use significantly and positively predicted alcohol problems, ML-specific problems, and marijuana use, above and beyond their associations with typical alcohol use. Marijuana was the illicit drug of choice, and 46% reported concurrent use of marijuana and ML. Those who concurrently used ML and marijuana began drinking at a younger age and reported more substance use (particularly marijuana) and more alcohol-related problems than did nonconcurrent users. These results suggest that ML use may represent a risk for alcohol problems and marijuana use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationships over time between mental health symptoms and transmission risk among persons living with HIV.

Relationships between mental health symptoms (anxiety and depression) or a positive state of mind and behavior associated with HIV transmission (substance use and risky sexual behavior) were explored in a longitudinal study of persons living with HIV (PLH; N = 936) who were participants in a transmission-prevention trial. Bivariate longitudinal regressions were used to estimate the correlations between mental health symptoms and HIV-related transmission acts for 3 time frames: at the baseline interview, over 25 months, and from assessment to assessment. At baseline, mental health symptoms were associated with transmission acts. Elevated levels of mental health symptoms at baseline were associated with decreasing alcohol or marijuana use over 25 months. Over 25 months, an increasingly positive state of mind was associated with decreasing alcohol or marijuana use; an increasingly positive state of mind in the immediate intervention condition and increasing depressive symptoms in the lagged condition were related to increasing risky sexual behavior. Our findings suggest that mental health symptoms precede a decrease in substance use and challenge self-medication theories. Changes in mental health symptoms and sexual behavior occur more in tandem. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Antibody responses to tetanus toxoid and Haemophilus influenzae type b conjugate vaccines following autologous peripheral blood stem cell transplantation (PBSCT)

OBJECTIVE: Although there are many anecdotal reports that psychological intervention is effective in enhancing adjustment to spinal cord injury (SCI), there are little data to support this assertion. To date, reports of few longitudinal-based controlled trials that assessed psychological outcomes for SCI persons have been published. This study was conducted to determine long-term efficacy of cognitive behavior therapy during rehabilitation. DESIGN: The study employed a nonrandomized controlled trial, and measures were taken on three occasions: before, immediately after, and 12 months after treatment. SETTING, OUTCOME MEASURES, AND INTERVENTION: Anxiety, depressive mood, and self-esteem were assessed in 28 SCI persons consecutively selected on admission to hospital, who participated in specialized group cognitive behavior therapy (CBT) during rehabilitation. CONTROLS: The intervention group's responses on the measures were compared with a control group of 41 SCI persons who only received traditional rehabilitation services during their hospitalization. RESULTS: There were no overall group differences on anxiety, depressive mood, and self-esteem, although there was a trend for the treatment group to have greater levels of improvement in depression scores across time in comparison to the control group. However, those in the treatment group who reported high levels of depressive mood before the CBT treatment were significantly less depressed 1 year after injury, compared to similar persons in the control group. CONCLUSIONS: While it appears not everyone who experiences SCI needs CBT, at least in the hospital phase of their rehabilitation, those who report high levels of depressive mood benefited greatly from CBT.     

Comparing two measures of depression in spinal cord injury.

Compared 2 measures of depression, the Zung Self-Rating Depression Scale (SRDS) and the Brief Symptom Inventory (BSI), and discussed their use with (1) 162 spinal cord injury (SCI) outpatients and (2) 30 SCI inpatients. Sample 2 was used to study the predictor validity of the tests based on clinicians' ratings of Ss' depression status. Results indicate a fair degree of correlation between these tests. Fairly good test reliability was also found. The SRDS was more clearly delineated into distinct conceptual factors than the BSI. An analysis of predictive validities of the 2 tests using test scores and independent clinician ratings suggests that the BSI and the SRDS were the most useful predictors of depression among SCI Ss. However, the SRDS was superior for identifying SCI persons at risk of being depressed during or after rehabilitation hospitalization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Utilization of fine-needle aspiration cytology and flow cytometry in the diagnosis and subclassification of primary and recurrent lymphoma

The aim of this study was to assess and compare spinal cord injured (SCI) and traumatic brain injured (TBI) persons and people from the general population concerning partner relationships, functioning, mood and global quality of life. One hundred and sixty seven SCI persons, 92 TBI persons and 264 controls participated in the study. The median age was: SCI persons 33 years (range 19 to 79 years), TBI persons 40 years (range 20 to 70 years), and controls 31 years (range 19 to 79 years). Age at injury ranged among SCI persons from 14 to 76 years (Md 28 years), and among TBI persons from 16 to 56 years (Md 32 years). Half of the SCI group (51%), 58% of the TBI group and 59% of the controls had a stable partner relationship at the time of the investigation. Many of these SCI and TBI relationships (38% and 55% respectively) were established after injury. Both SCI and TBI persons showed significantly more depressive feelings compared with the controls. Perceived quality of life (global QL rating) was significantly lower in the SCI group compared with the controls, whereas the ratings of TBI persons and controls did not differ significantly. SCI and TBI persons did not differ significantly in level of education, perceived quality of life or distress. In all three groups, global quality-of-life ratings were significantly lower among single persons compared to those with a partner relationship. It was concluded that both SCI and TBI appear to affect overall quality of life and mental well-being negatively. The number of partner relationships contracted after injury among both SCI and TBI persons indicates, however, that the injury is not a major barrier to establishing close partner relationships. Being in good spirits, that is, lack of depressive feelings has a profound impact on the perception of a high quality of life in all three groups. For the SCI and TBI persons, a high level of physical and social independence were further positive determinants of a perceived high quality of life.