Telemental Health Services Benefit Native Veterans

 WASHINGTON — After American Indian and Alaska Native veterans initially tried telemental health services, their use of any health services significantly increased, as did the proportion receiving psychotropic medication, a new study found.1

Telemental Health Services is the provision of mental-health services from a distance, using telecommunications technologies

The authors of the study said this is the first examination of service use at specialty telemental health clinics by American Indian and Alaska Native veterans.

“The purpose of this investigation was to describe characteristics — demographic, treatment and service use — of patients utilizing these clinics and to better understand the impact of the telehealth clinics on patients’ healthcare in the U.S. Department of Veterans Affairs,” the authors wrote.

For the study, the researchers examined this population’s use of services provided by two specialty telemental health clinics focused on PTSD. The researchers conducted a retrospective chart and electronic medical-record review for 85 male veterans who used services at the clinics from 2001 through 2006. The researchers documented service use and other characteristics before and after the patients’ initial telemental health intake.

What they found was that patients’ use of any health services increased after a patient’s initial telemental health intake from 63 of the 85 veterans before the initial telemental health intake to 78 of the 85 veterans after the initial telemental health service. The proportion receiving psychotropic medication also increased from 22 before telemental health intake to 60 after telemental health intake.

In addition, the researchers wrote that they observed a “nonsignificant trend” toward lower rates of hospitalization among these patients and fewer hospitalizations per patient.

“We believe that this trend is an indication of better assessment, referral and linkage to the larger VA system and resources,” they wrote.

Study author Jay Shore, MD, MPH, the Native Domain lead for the Office of Rural Health at the Veterans Rural Health Resource Center-Western Region, told U.S. Medicine that the study “is an important link in building the evidence around the effectiveness of these clinics.”

Shore said American Indians and Alaska Native veterans experience disparities in care and that telemental health is a way to reach these veterans who are the most rural of all veteran groups, according to data.

“We know that American Indian veterans serve at the highest rate per capita of any ethnic group of the U.S. military,” he said. “Second, there is evidence, at least from the Vietnam era, that shows that certain groups of Native veterans suffer the consequences of deployment, like PTSD, at much higher rates than the general population.”

The authors cited limitations to the study, including its “descriptive nature.”

“Even though service use was examined before and after telemental health intake, no external control group was used,” they wrote. In addition, they said that retrospective chart reviews are inherently limited because “such a design lacks prospective data, randomization and the ability to examine specific patient-level clinical outcomes.”

Still, the authors wrote that the study “provides an important first look at the service characteristics of American Indian and Alaska Native veterans receiving treatment for PTSD in VA specialty clinics.”

They also concluded that the findings “contribute to the growing evidence supporting the use of specialty telemental health clinics for rural Native veterans.”  

The study was sponsored and funded by the Veterans Rural Health Resource Center-Western Region, Office of Rural Health, Department of Veterans Affairs and the National Center on Minority Health and Health Disparities.

1, Shore JH, Brooks E, Anderson H, Bair B, Dailey N, Kaufmann LJ, Manson S.

Characteristics of Telemental Health Service Use by American Indian Veterans.

Psychiatr Serv. 2012 Feb 1;63(2):179-81. PubMed PMID: 22302338.


Adult ADHD Linked to PTSD Severity

A new study examined attention deficit hyperactivity disorder (ADHD) comorbidity in military veterans with a high prevalence of PTSD and evaluated the relationships between these disorders and exposure to traumatic events.1

For the study, researchers used a sample that included 222 male and female military veterans who were administered structured clinical interviews based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

The results showed that 54.5% met the criteria for current PTSD, 11.5% of whom also met the criteria for current adult ADHD. Level of trauma exposure and ADHD severity were significant predictors of current PTSD severity.

“Evaluation of the underlying structure of symptoms of PTSD and ADHD using confirmatory factor analysis yielded a best-fitting measurement model that comprised four PTSD factors and three ADHD factors,” the authors wrote. “Standardized estimates of the correlations among PTSD and ADHD factors suggested that the largest proportion of shared variance underlying PTSD-ADHD comorbidity is related to problems with modulating arousal levels that are common to both disorders (i.e., hyperarousal and hypoarousal).”

1. Harrington KM, Miller MW, Wolf EJ, Reardon AF, Ryabchenko KA, Ofrat S. Attention deficit hyperactivity disorder comorbidity in a sample of veterans with posttraumatic stress disorder. Compr Psychiatry. 2012 Feb 1. [Epub ahead of print] PubMed PMID: 22305866.


Military Service Linked to Depression Risk

A recent study sought to examine the effect of depression on the association between a history of military service and life satisfaction among a nationally representative sample of U.S. men.1

The researchers obtained data from 57,905 men using the 2006 Behavioral Risk Factor Surveillance survey that assessed depression, history of military service and life satisfaction. Multivariable logistic regression was conducted, controlling for demographics and physical health characteristics.

The researchers found that, in non-depressed men, a history of military service was associated with higher odds of life satisfaction. However, the researchers also found that “interaction between depression and a history of military service was significant, OR (95% CI) = 0.56 (0.38-0.84), such that a history of military service was associated with equivalent odds of satisfaction in depressed men, OR (95% CI) = 0.78 (0.56-1.09).”

Intervention efforts targeting depression in men with a history of military service may have a significant impact on their well-being,” the researchers concluded. “Future research should replicate these findings, examine potential mechanisms of the effects and study the utility of life satisfaction measures in this population.”

1. Britton PC, Ouimette PC, Bossarte RM. The effect of depression on the association between military service and life satisfaction. Qual Life Res. 2012

Jan 28. [Epub ahead of print] PubMed PMID: 22286221.

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