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Objectives To date, no research has systematically evaluated screening instruments for gambling disorder to assess their accuracy and the quality of the research. This systematic review evaluated screening instruments for gambling disorder to inform decision makers about choices for population-level screening. Study Design and Setting On May 22, 2017 and January 4, 2019, we searched PubMed, PsycInfo, EMBASE, and Cochrane for studies that evaluated screening instruments for gambling disorder. Studies were included if (1) the screening instrument was in English, (2) the screening instrument was compared to a reference standard semistructured interview based on Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases diagnoses of gambling disorder, and (3) data were reported on psychometric properties of the instrument. Results We identified 31 different screening instruments from 60 studies. Only three instruments from three separate studies were eligible for inclusion in the systematic review. Conclusion Few screening instruments for gambling disorder have been validated with sufficient methodological quality to be recommended for use across a large health system.

Purpose This study’s purpose is to inform future research decisions about optimal measures for identifying combat deployments. We aim to evaluate four commonly utilized measures available in population-level administrative data to identify combat deployments in recent military operations among active duty Army personnel. Methods We compare these measures in three ways: (1) agreement (assessing the extent to which soldiers were differentially identified as combat deployed via each measure); (2) validity (calculating the sensitivity of each measure against a criterion measure); and (3) corroboration (examining how each measure predicted subsequent incidence of traumatic brain injury and post-traumatic stress disorder). Results We found that using personnel records to identify deployments to Iraq, Afghanistan, and/or Kuwait captured over 98% of combat-related deployments identified via self-reported measures. The addition of Kuwait allowed for detection of nearly 100% of battle injuries, improving sensitivity from 94.5% to 99.8%. However, self-reported combat exposure measures showed the largest differential in subsequent incidence of traumatic brain injury and post-traumatic stress disorder. Completeness and accuracy of different combat deployment measures varied significantly. Conclusions Using personnel records to identify deployment to Iraq, Afghanistan, and/or Kuwait was the most valid and comprehensive measure of combat deployment. However, self-reported combat exposure measures were more predictive of combat-related outcomes.

BACKGROUND AND OBJECTIVES To estimate the diagnostic prevalence and incidence of gambling disorder among United States service members and to identify associated risk factors, including demographics, history of mental illness or substance misuse, and proximity to legalized gambling vicinities. METHODS Gambling disorder cases comprised active component Service members who received a pathological or problem gambling diagnosis between October 1, 2005 and September 30, 2015. There were 901 cases (392 incidents) during the study period. Controls were matched on the case military entrance date (N = 43,564). Geospatial distance between gambling venue and military treatment facilities were calculated, then multivariable logistic regression and survival analyses were conducted. RESULTS The 10-year prevalence of gambling disorder was 6.6 per 100,000. Men were 3.5 times more likely than women to receive a gambling disorder diagnosis. Other risk factors included age over 24, Asian or Black race, formerly married, and enlisted rank. The odds of gambling disorder increased with duration and proximity to gambling venues, ranging from 2.0 to 3.9. Service members with prior substance misuse or mental health conditions were 3.9 times and 6.3 times more likely to receive a disordered gambling diagnosis than those without substance misuse or mental illness history, respectively. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE The results of this study reveal that proximity to gambling venues and slot machines on bases, as well as a history of substance misuse or mental disorders, are important risk factors for gambling disorder in the US military. Department of Defense screening policies that focus on high-risk populations are appropriate. (Am J Addict 2021;00:00-00).

BACKGROUND: Present‐centered therapy (PCT) is a non‐trauma, manualized psychotherapy for adults with post‐traumatic stress disorder (PTSD). PCT was originally designed as a treatment comparator in trials evaluating the effectiveness of trauma‐focused cognitive‐behavioral therapy (TF‐CBT). Recent trials have indicated that PCT may be an effective treatment option for PTSD and that patients may drop out of PCT at lower rates relative to TF‐CBT. OBJECTIVES: To assess the effects of PCT for adults with PTSD. Specifically, we sought to determine whether (1) PCT is more effective in alleviating symptoms relative to control conditions, (2) PCT results in similar alleviation of symptoms compared to TF‐CBT, based on an a priori minimally important differences on a semi‐structured interview of PTSD symptoms, and (3) PCT is associated with lower treatment dropout as compared to TF‐CBT. SEARCH METHODS: We searched the Cochrane Common Mental Disorders Controlled Trials Register, the Cochrane Library, Ovid MEDLINE, Embase, PsycINFO, PubMed, and PTSDpubs (previously called the Published International Literature on Traumatic Stress (PILOTS) database) (all years to 15 February 2019 search). We also searched the World Health Organization (WHO) trials portal (ICTRP) and ClinicalTrials.gov to identify unpublished and ongoing trials. Reference lists of included studies and relevant systematic reviews were checked. Grey literature searches were also conducted to identify dissertations and theses, clinical guidelines, and regulatory agency reports. SELECTION CRITERIA: We selected all randomized clinical trials (RCTs) that recruited adults diagnosed with PTSD to evaluate PCT compared to TF‐CBT or a control condition. Both individual and group PCT modalities were included. The primary outcomes of interest included reduced PTSD severity as determined by a clinician‐administered measure and treatment dropout rates. DATA COLLECTION AND ANALYSIS: We complied with the Cochrane recommended standards for data screening and collection. Two review authors independently screened articles for inclusion and extracted relevant data from eligible studies, including the assessment of trial quality. Random‐effects meta‐analyses, subgroup analyses, and sensitivity analyses were conducted using mean differences (MD) and standardized mean differences (SMD) for continuous data or risk ratios (RR) and risk differences (RD) for dichotomous data. To conclude that PCT resulted in similar reductions in PTSD symptoms relative to TF‐CBT, we required a MD of less than 10 points (to include the 95% confidence interval) on the Clinician‐Administered PTSD Scale (CAPS). Five members of the review team convened to rate the quality of evidence across the primary outcomes. Any disagreements were resolved through discussion. Review authors who were investigators on any of the included trials were not involved in the qualitative or quantitative syntheses. MAIN RESULTS: We included 12 studies (n = 1837), of which, three compared PCT to a wait‐list/minimal attention (WL/MA) group and 11 compared PCT to TF‐CBT. PCT was more effective than WL/MA in reducing PTSD symptom severity (SMD ‐0.84, 95% CI ‐1.10 to ‐0.59; participants = 290; studies = 3; I² = 0%). We assessed the quality of this evidence as moderate. The results of the non‐inferiority analysis comparing PCT to TF‐CBT did not support PCT non‐inferiority, with the 95% confidence interval surpassing the clinically meaningful cut‐off (MD 6.83, 95% CI 1.90 to 11.76; 6 studies, n = 607; I² = 42%). We assessed this quality of evidence as low. CAPS differences between PCT and TF‐CBT attenuated at 6‐month (MD 1.59, 95% CI ‐0.46 to 3.63; participants = 906; studies = 6; I² = 0%) and 12‐month (MD 1.22, 95% CI ‐2.17 to 4.61; participants = 485; studies = 3; I² = 0%) follow‐up periods. To confirm the direction of the treatment effect using all eligible trials, we also evaluated PTSD SMD differences. These results were consistent with the primary MD outcomes, with meaningful effect size differences between PCT and TF‐CBT at post‐treatment (SMD 0.32, 95% CI 0.08 to 0.56; participants = 1129; studies = 9), but smaller effect size differences at six months (SMD 0.17, 95% CI 0.05 to 0.29; participants = 1339; studies = 9) and 12 months (SMD 0.17, 95% CI 0.03 to 0.31; participants = 728; studies = 5). PCT had approximately 14% lower treatment dropout rates compared to TF‐CBT (RD ‐0.14, 95% CI ‐0.18 to ‐0.10; participants = 1542; studies = 10). We assessed the quality of this evidence as moderate. There was no evidence of meaningful differences on self‐reported PTSD (MD 4.50, 95% CI 3.09 to 5.90; participants = 983; studies = 7) or depression symptoms (MD 1.78, 95% CI ‐0.23 to 3.78; participants = 705; studies = 5) post‐treatment. AUTHORS' CONCLUSIONS: Moderate‐quality evidence indicates that PCT is more effective in reducing PTSD severity compared to control conditions. Low quality of evidence did not support PCT as a non‐inferior treatment compared to TF‐CBT on clinician‐rated post‐treatment PTSD severity. The treatment effect differences between PCT and TF‐CBT may attenuate over time. PCT participants drop out of treatment at lower rates relative to TF‐CBT participants. Of note, all of the included studies were primarily designed to test the effectiveness of TF‐CBT which may bias results away from PCT non‐inferiority.The current systematic review provides the most rigorous evaluation to date to determine whether PCT is comparably as effective as TF‐CBT. Findings are generally consistent with current clinical practice guidelines that suggest that PCT may be offered as a treatment for PTSD when TF‐CBT is not available.

Background To promote evidence-based health care, clinical providers and decision makers rely on scientific evidence to inform best practices. Evidence synthesis (ES) is a key component of this process that serves to inform health care decisions by integrating and contextualizing research findings across studies. Objective This paper describes the process of establishing an ES capability in the Military Health System dedicated to psychological health topics. Research designs The goal of establishing the current ES capability was to facilitate evidence-based decision-making among clinicians, clinic managers, research funders, and policymakers, through the production and dissemination of trustworthy ES reports. We describe how we developed this capability, provide an overview of the types of evidence syntheses products we use to respond to different stakeholders, and detail the procedures established for selecting and prioritizing synthesis topics. Results We report on the productivity, acceptability, and impact of our efforts. Our reports were used by a variety of stakeholders and working groups, briefed to major committees, included in official reports and policies, and cited in clinical practice guidelines and the peer-reviewed literature. Conclusions Our experiences thus far suggest that the current ES capability offers a needed service within our health system. Our framework may help inform other agencies interested in developing or sponsoring a similar capability.

Remotely piloted aircraft (RPA), also known as drones, have been used extensively in the recent conflicts in Iraq and Afghanistan. Although RPA pilots in the U.S. Air Force (USAF) have reported high levels of stress and fatigue, rates of mental health (MH) diagnoses and counseling in this population are unknown. We calculated incidence rates of 12 specific MH outcomes among all active component USAF RPA pilots between 1 October 2003 and 31 December 2011, and by various demographic and military variables. We compared these rates to those among all active component USAF manned aircraft (MA) pilots deployed to Iraq/Afghanistan during the same period. The unadjusted incidence rates of all MH outcomes among RPA pilots (n=709) and MA pilots (n=5,256) were 25.0 per 1,000 person-years and 15.9 per 1,000 person-years, respectively (adjusted incidence rate ratio=1.1, 95% confidence interval=0.9-1.5; adjusted for age, number of deployments, time in service, and history of any MH outcome). Th ere was no significant difference in the rates of MH diagnoses, including post-traumatic stress disorder, depressive disorders, and anxiety disorders between RPA and MA pilots. Military policymakers and clinicians should recognize that RPA and MA pilots have similar MH risk profiles.