Psychological Services最新文献

Trauma is associated with disordered eating in many populations. Military personnel, a population with strict focus on maintaining body condition, experience traumatic events at a higher rate than civilian populations; however, little is known about the relationship between trauma and eating disturbances among service members and Veterans. This analysis evaluated the association between posttraumatic stress disorder (PTSD) diagnosis and eating disturbances in a sample of postdeployment Veterans. The effect of potential confounding (e.g., age, sex, body mass index) and protective factors (positive affect and well-being [PAWB]) was also evaluated. Participants were 527 post-9/11 Veterans (80.7% male). All participants completed the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; the Neuro-QOL PAWB Scale; and the Eating Disturbances Scale as part of a multisite longitudinal study evaluating postdeployment mental health. Hierarchical linear regression evaluated direct and indirect effects of independent variables on eating disturbances. Analyses indicated lifetime PTSD diagnosis was no longer associated with eating disturbances after accounting for PAWB (B = 0.33, p = .29). The indirect effect of PAWB on the relationship between PTSD and eating disturbances was significant (B = 0.33, 95% confidence interval [0.53, 1.17]). Age, sex, and body mass index did not alter these relationships. Results support an association between PTSD and eating disturbances in the military population that does not appear to be contingent upon demographic factors. Further, analyses suggest that PAWB may function as a key influence for positive adjustment among Veterans at risk for eating disturbances. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Among military veterans in the United States, criminal legal system involvement is a risk factor for homelessness; however, the magnitude of and contributors to this association are not well understood. This study used national Electronic Health Record data from the Veterans Health Administration (VHA) to determine homelessness risk among veterans after legal involvement compared with veterans without legal involvement. Among veterans who received VHA health care in fiscal year 2022 and had no prior year homelessness or receipt of VHA homeless services, all veterans were coded as with legal involvement, defined by having an encounter with the VHA's Veterans Justice Programs (VJP), or without legal involvement; veterans without legal involvement were randomly selected without replacement by a 1:2 ratio. A Cox proportional hazards regression model was used to assess the risk of homelessness in the year after a veteran's index date (first VJP encounter for veterans with legal involvement, first clinical encounter for veterans without legal involvement). There were 24,679 veterans with legal involvement (33%) and 49,358 veterans without legal involvement (67%), with homeless rates of 22% and 2%, respectively. Veterans with legal involvement had a six times higher risk of homelessness over 1 year compared with veterans without legal involvement (adjusted hazard ratio = 6.15, 95% CI [5.73, 6.60], p < .0001). Veterans are at elevated risk for homelessness after legal involvement, suggesting the value of implementation approaches to engage VJP-involved veterans in primary prevention services and policy changes that enable engagement in housing services for legal-involved veterans. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Development and validation of screening tools for eating disorders is crucial for enhancing early intervention efforts among military-connected populations. The recently released Minnesota Multiphasic Personality Inventory-3 (MMPI-3) includes the novel Eating Concerns (EAT) scale to assess aspects of problematic eating behavior. Our study evaluated the effectiveness of EAT by comparing it to a multidimensional indicator of eating disorder-related pathology. We examined responses from 349 U.S. National Guard veterans and their romantic partners using both the MMPI-3 and the Eating Pathology Symptoms Inventory (EPSI). Participants were 53% men, 47% women, 76% employed, and 97% White. The EAT scale best reflected EPSI domains of binge eating, body dissatisfaction, purging, negative attitudes toward obesity, and restricting. Furthermore, the EAT scale uniquely predicted multiple EPSI scale scores above and beyond other conceptually relevant MMPI-3 scales. Analyses based on gender revealed notable group differences and changes in the strength of associations for EAT and specific EPSI domain scores. Our findings provide support for the incremental and convergent validity of the EAT scale with implications for the increasing use of the MMPI-3 in the U.S. Veterans Affairs health care systems. Overall, EAT appears to effectively identify problematic eating behaviors associated with the item content of the scale (binging, restricting, purging). However, identification of less stereotypic clinically relevant behaviors related to eating or body image (e.g., excessive exercise) may require additional targeted assessment. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

U.S. Armed Forces members experience specific demands and stressors that lead to several risk factors of self-harm or harm against others. Military spouses face unique challenges as partners of service members and are often placed in a position to intervene in potentially harmful situations. This study aimed to use qualitative methods to explore military spouses' exposure to their active-duty partner's risk of violence perpetration, firearm suicide, and associated circumstances such as alcohol use and access to personally owned firearms. Participants were adult spouses/partners of active-duty service members, Reserve or Guard members, or recent Veterans (referred to as "military spouses"). Participants completed a 30- to 60-min in-depth interview. An inductive-deductive approach and pattern coding were used to identify trends and key themes. A total of 34 military spouses participated in interviews. Most participants were female (97.06%), White (76.47%), and non-Hispanic (88.24%). Nearly two thirds (61.76%) of participants reported that they and/or their spouse had access to at least one personally owned firearm within their home. Military spouses shared experiences with real-time crisis management related to harmful or hazardous alcohol use and threats of intimate partner violence and firearm suicide. Participants also noted several perceived barriers to prevention and intervention resources and strategies. Due to military spouses' significant exposure to their partner's suicidal behaviors and threat of violence perpetration, as well as the increased access to lethal means (i.e., firearms) and potential for harmful or hazardous alcohol use, existing prevention and intervention strategies may be insufficient. There are multiple intervention opportunities for health care providers to fill this gap. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Intimate partner violence (IPV) poses a tremendous public health burden across large health care systems. While the predominant response to IPV focuses on individual screening and referral, relationship and family services provide an opportunity to prevent low-risk verbal aggression from escalating and to address some forms of bidirectional physical IPV. This study examines mental health and screening variables associated with IPV experience and subsequent referral to family services using a large national data set of N = 256,894 patients screened for IPV in the first year of the Veterans Health Administration's adoption of a national IPV screen. Of those screened, 7.4% reported any IPV, 1.4% reported severe IPV, and only 0.1% received a referral for couple and family services within the next 90 days. Mental health conditions associated with greater likelihood of IPV (e.g., personality disorders, posttraumatic stress disorder, substance use disorders, and depression) were in turn associated with greater likelihood of referral. Despite the overlap between IPV and mental health conditions that benefit from couple-based interventions, referrals remained infrequent. Referrals were often placed by a different clinic than the service assessing the IPV. Risk behaviors for severe violence (e.g., choking) and suicide ideation were also associated with increased couple and family service referrals, underscoring the need for integrated assessment and risk management. These findings highlight important opportunities for health care systems to enhance the alignment of IPV screening and appropriate treatment recommendations by strengthening screening-to-referral pathways for family services and integrating systematic safety assessments. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Understanding the prevalence of mental health concerns, rates of treatment access, and barriers to care can help identify strategies for improving mental health support and access. In a sample of U.S. military servicemembers, we examined (a) the rate and type of care sought for various mental health concerns and (b) barriers to care across presenting concerns. We conducted cross-sectional analyses using web-based survey data collected via population-based stratified random sampling from the Department of Defense 2018 Health-Related Behavior Survey (N = 33,641 U.S. military servicemembers, 67.1% male). We assessed the percentage of participants reporting a range of mental health concerns (e.g., posttraumatic stress disorder, suicidality, aggression, and alcohol problems) who received various treatments, perceived an unmet treatment need, and reported specific barriers to care. Treatment rates were highest for suicidality and posttraumatic stress disorder and lowest for alcohol binges, gambling problems, and risky sexual behavior. Practical difficulties with care access, concerns about confidentiality, and concerns about harm to career were among the most endorsed barriers across all mental health variables. Treatment rates were similar or slightly higher than previous findings for internalizing psychopathology, and rates were generally lower for externalizing behaviors. Significant treatment gaps persist for all mental health concerns examined. Organization-based interventions to enhance access to confidential care and allow time off for mental health treatment may help close treatment gaps for all mental health concerns. Prevention and intervention efforts should focus on raising awareness about the health and social consequences of externalizing behavior to encourage help-seeking from mental health professionals in these areas. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

This study aimed to understand the factors contributing to psychological distress among nonconsultant hospital doctors in Ireland. To achieve this goal, we first sought to identify correlates of psychological distress among help-seeking physicians and, second, to explore the experiences of doctors working within Irish hospitals. The study employed a mixed-method approach. Correlates of psychological distress were identified through a secondary analysis of data obtained from n = 170 physicians accessing counseling services from 2020 to 2022, collected by the Royal College of Physicians of Ireland. Multiple linear regression was used to examine how age, gender, specialty, work hours, mental health history, and familial background were associated with increased vulnerability to adverse mental health, measured by a psychologist's "level of concern" for the physician. In addition, physician's experiences of working within Irish hospitals were explored using semistructured interviews with n = 10 doctors. Data were analyzed through thematic analysis. Descriptive statistics indicated a higher proportion of female doctors seeking counseling services, with 123 out of 170 female participants. Greater concern for physician's well-being was associated with younger age, less years of training, and female sex. Workplace culture, barriers to accessing mental health resources, illegal working hours, and understaffing all emerged as themes describing physicians' experiences of working in Irish hospitals. These findings underscore the multifaceted nature of psychological distress among nonconsultant hospital doctors and emphasize the importance of addressing systemic barriers to support their mental well-being. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Suicide rates have increased substantially among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) veterans, as well as among women veterans. The Veterans Crisis Line (VCL) is a resource available to all veterans as part of the Department of Veterans Affairs' multifaceted suicide prevention strategy. Despite well-documented gender differences in suicide risk and reasons for contacting the VCL, little is known about AANHPI veterans' use of the VCL and whether their reasons for contacting the VCL differ by gender. This descriptive analysis examined the demographics, reasons for contacting the VCL, and suicide risk assessment ratings for AANHPI veterans who contacted the VCL, by gender, as a first step to better understand VCL use in this heterogenous population. Using VCL and Veterans Affairs administrative data, we examined demographics, reasons for contacting the VCL, and suicide risk assessment ratings for 1,645 AANHPI veterans who contacted the VCL in Calendar Year 2020, stratified by gender and disaggregated between Asian American (AA) and Native Hawaiian and Pacific Islander (NHPI) veterans. Mental health was indicated as the most frequent reason for VCL contact for AANHPI women (84.8% of contacts) and men (66.1% of contacts). Suicidal thoughts or crises (34.5% of women, 27.5% of men) were noted as the second most frequent reason for contact across groups, followed by relationship problems (23.7% of women, 21.4% of men). We observed some similar patterns across race/ethnicity and gender subgroups, with some variation between groups. Nearly three quarters (74.6%) of NHPI women endorsed suicide risk screen indicator(s), with lower proportions among AA women (69.1%), AA men (57.8%), and NHPI men (57.3%). Additionally, 12.7% of NHPI women, 9.8% of NHPI men, 8.1% of AA men, and 5.6% of AA women were rated by VCL responders as being at elevated suicide risk. These initial descriptive findings highlight the importance of disaggregating data both by gender and race/ethnicity among AANHPI veterans. Further study of suicide risk and protective factors salient to each subgroup of AANHPI veterans is a critical next step to suicide prevention among these veterans. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

African American veterans who use tobacco use evidence-based tobacco-cessation treatment less than other racial/ethnic groups, contributing to higher tobacco-related treatment burden for them. This study aimed to assess barriers and facilitators African American patients face before engaging in Veterans Health Administration behavioral tobacco-cessation treatment services, as an initial step to identify new implementation strategies. African American veterans (N = 30) who use tobacco at a large Veterans Affairs Medical Center completed interviews about perceived barriers and facilitators to behavioral treatment, views on telehealth, and suggested care improvements. We used a combination of deductive and inductive analytic approaches and identified four themes: (1) Ambivalence towards Quitting Tobacco: Patients described how low motivation to quit and intense withdrawal symptoms impede treatment engagement, despite known health risks; (2) Limited Interaction with Health Care System: Patients described how histories of mistrust and stigma toward treatment impact engagement with the health care system, resulting in lack of awareness of treatment options and preference for self-reliance in quitting; (3) Individualized Factors for Engagement: Patients described how persistent providers, access to telehealth modalities, personal health complications exacerbated by tobacco use, and benefits of positive lifestyle change increase motivation for treatment; and (4) Suggestions for Culturally Tailored Treatment Engagement: Patients expressed a desire for more African American group-specific outreach, including targeted advertisement and culturally aware providers to combat mistrust of the health care system. Findings indicate that generating patient-driven implementation strategies such as tailored education and proactive outreach are necessary to increase engagement of African American patients in tobacco-cessation treatment programs. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

The Veterans Health Administration (VHA) has rolled out evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD); however, reach has remained low, and there is a need for briefer interventions. The National Center for PTSD conducted a facilitated learning collaborative to train clinicians and support VHA PTSD teams in their adoption of an emerging best practice, written exposure therapy (WET). Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) evaluation framework, the present study utilized longitudinal data from 178 clinicians and 556 patients across seven training cohorts to evaluate key clinical and implementation outcomes and whether clinic (i.e., implementation climate) or clinician factors (i.e., treatment attitudes) were associated with effectiveness and implementation. Intent-to-treat analyses indicated WET was effective in reducing PTSD (d = 0.54) and depression symptoms (d = 0.39). Data indicated that 87.60% of clinicians reported using WET 6 months postconsultation. Clinic-wide reach was modest after training (14.53% of individuals with PTSD); however, WET-trained clinicians continued to offer WET to an average of 87.38% of their patients. Fidelity remained high after training, with essential session elements most often being offered "always" (M = 6.65 on a scale from 1 to 7). More positive postconsultation clinician treatment attitudes predicted higher posttraining rates of having patients engaged in WET. Clinician treatment attitudes and implementation climate did not predict any other implementation or effectiveness outcomes examined. Results suggest that WET implementation is advancing in VHA, with good clinical outcomes. Data provide evidence that a facilitated learning collaborative can be used to support and scale EBPs. (PsycInfo Database Record (c) 2025 APA, all rights reserved).