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Background and Objective: Adverse Childhood Experiences(ACEs) have a powerful influence on mental health, physical health, and life expectancy. Screening for ACEs and the clinician response to ACEs are critical to addressing the health and well-being of children; however, little is known about the actions clinicians take in response to ACE screening. Therefore, we aimed to examine clinician responses to ACE screening at five California pediatric clinics in a large public health care system., Methods: Patient demographics, indicators of social and behavioral determinants of health (e.g., housing insecurity), the number of ACEs endorsed on a screening instrument, and the actions clinicians took in response to each ACE screen were collected. Data was collected from May to October 2021. These data were used to examine the association between number of ACEs reported and clinician response, controlling for patient demographics and their social and behavioral determinants of health using multiple logistic regression., Results: Five participating pediatric clinics conducted 2,652 ACE screens in six-months. Clinicians documented an action twice as often when ACEs were present, after controlling for patient demographics and their social and behavioral determinants of health (odds ratio(OR) = 2.2, 95 % confidence interval(CI): 1.5-3.3, p-value < 0.0001). Clinicians were three times more likely to record referrals to mental health clinicians, social workers, and community organizations relative to anticipatory guidance when the number of ACEs increased from one to three to four or more (OR=3.2, 95 %CI: 1.6-6.5, p < 0.0001)., Conclusion: Findings provide early information that ACE screening results are associated with patient care., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 RAND Corporation. Published by Elsevier Inc.)

Introduction: This qualitative research study explored the perspectives of adolescents, 12 to 19-years-old, and caregivers of children under 12-years-old on the acceptibility of adverse childhood experiences (ACEs) screenings in five pediatric clinics., Method: A constructivist grounded theory approach was utilized. One-on-one semistructured phone interviews were conducted with 44 adolescents and 95 caregivers of children less than 12 years old. Interviews were analyzed using thematic analysis., Results: Most participants reported feeling comfortable discussing ACEs with their providers. Some reported that screening helped build trust. Others expressed privacy concerns and did not receive information about the reason for screening. Adolescent patients shared conflicting feelings-of both comfort and discomfort. Caregivers attending to multiple children, foster parents, and monolingual Spanish speakers disclosed unique challenges to ACEs screening. We found no evidence of lasting adverse effects., Discussion: Participants generally found ACEs screenings acceptable. Some adolescents identified benefits from the experience. However, clinics planning to adopt routine ACEs screening should ensure clear messaging on why screening is occurring, anticipate and address privacy concerns, and adopt workflows to discuss screening results., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: To understand clinician and clinical staff perspectives on the implementation of routine Adverse Childhood Experience (ACE) screening in pediatric primary care., Methods: We conducted a qualitative evaluation in 5 clinics in Los Angeles County, California, using 2 rounds of focus group discussions: during an early phase of the initiative, and 7 months later. In the first round, we conducted 14 focus group discussions with 67 participants. In the second round, we conducted 12 focus group discussions with 58 participants. Participants comprised clinic staff involved in ACE screening, including frontline staff that administer the screening, medical clinicians that use screening to counsel patients and make referrals, and psychosocial support staff who may receive referrals., Results: Themes were grouped into 3 categories: (1) screening acceptability and perceived utility, (2) implementation and quality improvement, and (3) effects of screening on patients and clinicians. Regarding screening acceptability and perceived utility, clinicians generally considered ACE screening to be acceptable and useful. In terms of implementation and quality improvement, significant barriers included: insufficient time for screening and response, insufficient training, and lack of clarity about referral networks and resources that could be offered to patients. Lastly, regarding effects of screening, clinicians expressed that ACE screening helped elicit important patient information and build trust with patients. Further, no adverse events were reported from screening., Conclusions: Clinic staff felt ACE screening was feasible, acceptable, and beneficial within pediatric care settings to improve trauma-informed care and that ACE screening could be strengthened by addressing time constraints and limited referral resources., (© 2023 Annals of Family Medicine, Inc.)

Objective: The purpose of this study was to examine the associations between oil spill exposure, trauma history, and behavioral health 6 years after the Deepwater Horizon oil spill (DHOS). We hypothesized that prior trauma would exacerbate the relationship between oil spill exposure and behavioral health problems., Methods: The sample included 2,520 randomly selected adults in coastal areas along the Gulf of Mexico. Participants reported their level of oil spill exposure, trauma history, depression, anxiety/worry, illness anxiety, and alcohol use., Results: Individuals with more traumatic experiences had a significantly higher risk for all measured behavioral health problems after controlling for demographic factors and DHOS exposure. Those with higher levels of DHOS exposure were not at greater risk for behavioral health problems after controlling for prior trauma, with the exception of illness anxiety. There was no evidence that trauma history moderated the association between DHOS exposure and behavioral health., Conclusions: Findings suggest that trauma exposure may be a better indicator of long-term behavioral health risk than DHOS exposure among disaster-prone Gulf Coast residents. DHOS exposure may be a risk factor for illness anxiety but not more general behavioral health concerns. Trauma history did not appear to exacerbate risk for behavioral health problems among Gulf residents exposed to the DHOS. (Disaster Med Public Health Preparedness. 2019;13:497-503).

Background: Crisis support services have historically been offered by phone-based suicide prevention hotlines, but are increasingly becoming available through alternative modalities, including Internet chat and text messaging., Aims: To better understand differences in the use of phone and chat/text services., Method: We conducted semistructured interviews with call responders at the Veterans Crisis Line who utilize multimodal methods to respond to veterans in crisis., Results: Responders indicated that veterans may access the chat/text service primarily for reasons that included a desire for anonymity and possible inability to use the phone. Responders were divided on whether callers and chatters presented with different issues or risk of suicide; however, they suggested that veterans frequently use chat/text to make their first contact with mental health services., Limitations: We spoke with call responders, not the veterans themselves. Additionally, as this is qualitative research, applicability to other settings may be limited., Conclusion: While new platforms offer promise, participants also indicated that chat services can supplement phone lines, but not replace them.

Background: Women veterans are at increasingly high risk of suicide, but little is known about the concerns and needs of this population. This is, in part, owing to the low base rate of suicide and the inability to conduct retrospective interviews with individuals who died. In this study, we used a qualitative approach to gain insight about the concerns and nature of comments regarding suicidal ideation and intent among women veterans calling the Veterans Crisis Line (VCL)., Methods: Fifty-four VCL call responders were interviewed in the spring of 2015. They were asked about the concerns and level of suicide risk of women veteran callers with whom they have spoken and about the ways in which women callers are similar to or different from men callers. Interviews were transcribed and thematic analyses were conducted to examine patterns or themes emerging from the data., Findings: Military sexual trauma and non-suicidal self-harm were two commonly reported concerns of women veteran callers according to responders. VCL responders also noted differences between men and women veteran callers, including differences in clinical presentation, suicidal means, and protective factors., Conclusions: Our findings shed light on potential avenues to prevent suicide among women veterans, although we spoke to VCL responders about their impressions, rather than to women veterans themselves. Efforts to 1) prevent and treat the consequences of military sexual trauma, 2) recognize, prevent, and treat non-suicidal self-harm, and 3) restrict access to lethal means most commonly reported among women veteran callers may be helpful to mitigate suicide risk in this vulnerable group of veterans., (Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.)

Purpose: Geographic moves have been reported to have a negative impact on the mental health of children, but it is often difficult to separate the effect of the move from the circumstances that impelled it. Military populations may offer a way to examine this issue. Moves are common in military families, but parental employment and healthcare coverage remain constant., Methods: Children of military parents with geographic moves in 2008 were compared with those without geographic moves with regard to the odds of mental health service use in 2009., Results: This study included 548,336 children aged 6-17 years, and 179,486 (25%) children moved in 2008. Children aged 6-11 years with a geographic move had higher odds of mental health and outpatient visits (odds ratio [OR] 1.03; 95% confidence interval [CI] 1.01-1.06). Children aged 12-17 years with a geographic move had higher odds of mental outpatient visits (OR 1.04; 95% CI 1.01-1.07), psychiatric hospitalizations (OR 1.19; 95% CI 1.07-1.32), and emergency psychiatric visits (OR 1.20; 95% CI 1.07-1.32)., Conclusion: Children with a geographic move in the previous year have increased odds of mental health encounters. Among adolescents, this increase extends to psychiatric hospitalizations and emergency visits., (Published by Elsevier Inc.)

Objective: Members of the US armed forces have been heavily deployed in support of wars in Afghanistan and Iraq. This study examined the affect of a parent's deployment to war on the rate of psychiatric hospitalization among their children., Methods: This was a retrospective cohort study. Records of children of active duty personnel during fiscal years 2007 through 2009 were linked with their parent's deployment records. Psychiatric hospitalizations were identified using International Classification of Diseases, Ninth Revision codes on admission. Odds ratios (OR) of hospitalization were determined using both univariate and multivariate logistic regression. Lengths of hospital stay were also compared by linear regression using Duan's smearing estimate method., Results: A total of 377,565 children aged 9-17 years were included along with data on both their active duty and civilian parent. Mean child age was 12.53 years (S.D.: 2.5 years); 51% were male. Mean age of active duty parent was 37.8 years (S.D.: 5.2 years); 93% were male, 90% were married and 62% were white. In the study, 2533 children were hospitalized for a mental or behavioral health disorder in fiscal year 2009 with a median length of stay of 8 days. After adjusting for demographic data and past psychiatric history of the child, active duty parent and civilian parent, the OR of hospitalization for children with a recently deployed parent was 1.10 (95% confidence interval: 1.01-1.19). The OR of hospitalization increased with increasing length of deployment with a positive test of trend. There was no statistically significant difference in distribution of admission diagnoses or length of hospital stay based on deployment by the active duty parent., Conclusions: Psychiatric hospitalization increased by 10% among children aged 9-17 years when a military parent was recently deployed. The odds of hospitalization increased with increasing length of a parent's deployment., (Published by Elsevier Inc.)

Objective: The authors conducted a 15-week randomized controlled trial of the alpha-1 adrenoreceptor antagonist prazosin for combat trauma nightmares, sleep quality, global function, and overall symptoms in active-duty soldiers with posttraumatic stress disorder (PTSD) returned from combat deployments to Iraq and Afghanistan., Method: Sixty-seven soldiers were randomly assigned to treatment with prazosin or placebo for 15 weeks. Drug was titrated based on nightmare response over 6 weeks to a possible maximum dose of 5 mg midmorning and 20 mg at bedtime for men and 2 mg midmorning and 10 mg at bedtime for women. Mean achieved bedtime doses were 15.6 mg of prazosin (SD=6.0) and 18.8 mg of placebo (SD=3.3) for men and 7.0 mg of prazosin (SD=3.5) and 10.0 mg of placebo (SD=0.0) for women. Mean achieved midmorning doses were 4.0 mg of prazosin (SD=1.4) and 4.8 mg of placebo (SD=0.8) for men and 1.7 mg of prazosin (SD=0.5) and 2.0 mg of placebo (SD=0.0) mg for women. Primary outcome measures were the nightmare item of the Clinician-Administered PTSD Scale (CAPS), the Pittsburgh Sleep Quality Index, and the change item of the Clinical Global Impressions Scale anchored to functioning. Secondary outcome measures were the 17-item CAPS, the Hamilton Depression Rating Scale, the Patient Health Questionnaire-9, and the Quality of Life Index. Maintenance psychotropic medications and supportive psychotherapy were held constant., Results: Prazosin was effective for trauma nightmares, sleep quality, global function, CAPS score, and the CAPS hyperarousal symptom cluster. Prazosin was well tolerated, and blood pressure changes did not differ between groups., Conclusions: Prazosin is effective for combat-related PTSD with trauma nightmares in active-duty soldiers, and benefits are clinically meaningful. Substantial residual symptoms suggest that studies combining prazosin with effective psychotherapies might demonstrate further benefit.

Background: Physical and mental function are strong indicators of disability and mortality. OEF/OIF Veterans returning from deployment have been found to have poorer function than soldiers who have not deployed; however the reasons for this are unknown., Methods: A prospective cohort of 790 soldiers was assessed both pre- and immediately after deployment to determine predictors of physical and mental function after war., Results: On average, OEF/OIF Veterans showed significant declines in both physical (t=6.65, p<.0001) and mental function (t=7.11, p<.0001). After controlling for pre-deployment function, poorer physical function after deployment was associated with older age, more physical symptoms, blunted systolic blood pressure reactivity and being injured. After controlling for pre-deployment function, poorer mental function after deployment was associated with younger age, lower social desirability, lower social support, greater physical symptoms and greater PTSD symptoms., Conclusions: Combat deployment was associated with an immediate decline in both mental and physical function. The relationship of combat deployment to function is complex and influenced by demographic, psychosocial, physiological and experiential factors. Social support and physical symptoms emerged as potentially modifiable factors.

Suicide is a leading cause of death among men and women in the United States Military. Using a retrospective chart review design, the current study investigated gender differences on documented traumas for people admitted to a military inpatient psychiatric unit for suicide-related thoughts or behaviors (N = 656). Men more often had no documented lifetime traumas and women more often had 2 or more trauma types. Women had significantly more documented incidences of childhood sexual abuse, adulthood sexual assault, adulthood physical assault, and pregnancy loss. The gender gap in documented trauma types for childhood and adulthood traumas persisted even after adjusting for demographic variables, psychiatric diagnoses, and comorbid trauma types (i.e., trauma types other than the one being used as the dependent variable). Given the observed gender differences in documented traumas, professionals working with military women admitted for suicide-related thoughts or behaviors need to consider trauma in the context of treatment.

Objective: The objective of the study was to develop and implement a stepped collaborative care intervention targeting posttraumatic stress disorder (PTSD) and related comorbidities to enhance the population impact of early trauma-focused interventions., Method: We describe the design and implementation of the Trauma Survivors Outcomes and Support study. An interdisciplinary treatment development team was composed of trauma surgical, clinical psychiatric and mental health services "change agents" who spanned the boundaries between frontline trauma center clinical care and acute care policy. Mixed method clinical epidemiologic and clinical ethnographic studies informed the development of PTSD screening and intervention procedures., Results: Two hundred seven acutely injured trauma survivors with high early PTSD symptom levels were randomized into the study. The stepped collaborative care model integrated care management (i.e., posttraumatic concern elicitation and amelioration, motivational interviewing and behavioral activation) with cognitive behavioral therapy and pharmacotherapy targeting PTSD. The model was feasibly implemented by frontline acute care masters in social work and nurse practioner providers., Conclusions: Stepped care protocols targeting PTSD may enhance the population impact of early interventions developed for survivors of individual and mass trauma by extending the reach of collaborative care interventions to acute care medical settings and other nonspecialty posttraumatic contexts., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Purpose: It was decided to explore the variables that would need to be considered when planning, revising, or evaluating the outcomes of a whole curriculum, based on the principles of Problem-Based Learning., Summary: A set of major variables was identified at a workshop discussion with academics from medical, dental, and veterinary science faculties. These variables were subsequently reviewed and described by a small group of colleagues in Great Britain, with additional assistance from colleagues in different parts of the world., Conclusions: The descriptions of 13 variables has been assembled, primarily with a focus on medical education. This guide has been published on the Internet, in order to solicit comments and suggestions from teachers in medicine, dentistry, and veterinary science across the world with the intention of producing a more universally applicable second edition of the guide.

Objectives: This research examines the relationship of veteran status with functional status transitions in older Americans., Methods: Data for this study come from the Survey of Asset and Health Dynamics among the Oldest Old. We use a structural multinomial logit model to decompose the effect of older veterans into the direct effect and the indirect effects via physical health conditions and mental disorders on functional status transitions., Results: Although there is no distinct association among those functionally independent at baseline, veteran status significantly impacts age-dependent transitions from functional dependence to other statuses. At age 85, the excess mortality and the lower level of functional resolution among functionally dependent veterans are considerable., Conclusions: Physical health is more important than mental health in transmitting the effect of veteran status on functional status transitions in functionally dependent persons.

Although the health benefits of exercise for individuals with Persian Gulf War veterans illnesses (GWVI) are documented, many of these individuals do not exercise regularly enough to obtain benefits. The purpose of this study was to investigate factors predicting exercise compliance among individuals with GWVI in a multicenter, randomized, clinical trial. Participants were 1,092 veterans who reported at least two of the following cardinal symptoms of GWVI: (1) fatigue, (2) musculoskeletal pain, and (3) cognitive problems. Participants received exercise alone or exercise and cognitive-behavioral therapy. The overall level of compliance was relatively low during the exercise treatment phase (46.2%) and decreased by one-half during the follow-up period (23.0%). Predictors of compliance during treatment included less pain and greater age, motivation, and body mass index. Predictors of compliance during the follow-up period included less pain and greater age. The results highlight factors that affect adoption and maintenance of physical activity in a population with GWVI.