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Linked to increasing consumer demand for access to health care information and to the worldwide expansion of telecommunication services, telehealth has emerged as a new domain of practice within professional psychology. Psychologists who plan to incorporate telecommunication technologies (e.g., Internet and point-to-point videoconferencing) into their practices should first conduct a self-assessment and then enhance their knowledge and skills in using these alternative forms of service delivery. The current article provides a self-study framework, known as STEPS, for psychologists to use in planning for telehealth practice. STEPS focuses on 5 key domains of telehealth practice and organizes specific self-study questions around each of these domains.

Objective: To determine in veterans whether severity of combat exposure was predictive of subsequently receiving a suicide risk assessment (SRA), and whether this relationship was meditated by depression symptomatology. Method: We conducted an electronic medical records review for SRA ratings of 486 veterans who had completed Combat Exposure Scale (CES) and Beck Depression Inventory‐II (BDI‐II) assessments in a study of Post‐Deployment Mental Health (PDMH). Results: Higher total scores on the CES and BDI‐II were characteristic of PDMH participants who subsequently (mean 29.2 months later) received an SRA from a Veterans Health Administration provider. Among participants with an SRA, those scoring at high risk had significantly greater CES and BDI‐II scores than those rated at low risk. Participants rated at low risk tended to have CES and BDI‐II scores higher than those of participants for whom no SRA was found. Relationships between combat exposures and both performance of an SRA and the SRA risk level were mediated by BDI‐II scores. Conclusion: These data extend previous findings of depression‐mediated linkages between warzone experiences and subsequent self‐reported suicide risk among veterans, by indicating chronicity of combat trauma‐related suicide risk and demonstrating a concordance between self‐reported and clinician‐reported suicidality as it relates to experiential and psychiatric factors. [ABSTRACT FROM AUTHOR]

Neuromotor impairment is a common sequela of severe traumatic brain injury (TBI) but has been understudied relative to neurocognitive outcomes. This multicenter cohort study describes the longitudinal course of neurological examination-based motor abnormalities after severe TBI. Subjects were enrolled from the four lead Department of Veterans Affairs and Defense and Veterans Brain Injury Center sites. The study cohort consisted of 102 consecutive patients (active duty, veteran, or military dependent) with severe TBI who consented during acute rehabilitation for data collection and completed all follow-up evaluations. Paresis, ataxia, and postural instability measures showed a pattern of improvement over time, with the greatest improvement occurring between the inpatient (baseline) and 6-month follow-up assessments. Involuntary movement disorders were rare at all time points. Two years following acute rehabilitation, more than one-third of subjects continued to display a neuromotor abnormality on basic neurological examination. Persistence of tandem gait abnormality was particularly common. [ABSTRACT FROM AUTHOR]

This paper discusses the implications of Periventricular Leukomalacia (PVL)lesions for the development of Nonverbal Learning Disabilities (NLD) as illustratedthrough an identical twin case study. PVL lesions were identified in an 8-year-oldchild, but were not detected in his identical twin brother who served as amatched comparison. While the nonclinical twin displayed a largely unremarkableneuropsychological profile, the clinical twin evidenced a distinct patternof social, intellectual, academic, and neuropsychological test results oftenidentified among children with PVL and those with the NLD syndrome. The clinicaland theoretical implications for this case study are discussed. [ABSTRACT FROM AUTHOR]

Introduction: Posttraumatic nightmares (PTNs) are common among service members with a history of combat or mission-related trauma and are associated with decreased well-being. Unfortunately, beyond establishing an association between mental health symptoms and PTNs, the existing literature fails to provide a more comprehensive understanding of factors associated with PTNs. The effectiveness of current recommended treatments is frequently debated, with the literature varying in levels of support. Treatment of PTN is complicated, given their association with a number of mental health difficulties including posttraumatic stress disorder (PTSD), anxiety, and depression. The present study sought to better delineate the association of these difficulties with PTNs, in an effort to inform and improve treatments for the nation's service members., Materials and Methods: This study utilized de-identified data collected during standard procedures for an interdisciplinary intensive outpatient program for service members with a history of traumatic brain injury and/or psychological health conditions (N = 1,550). Study analyses were performed under a Walter Reed National Military Medical Center institutional review board-approved protocol. Three cross-sectional forward likelihood ratio logistic regressions predicting the presence of PTNs were conducted while controlling for the alpha-blocker prazosin, as it is recommended for the treatment of PTSD-associated nightmares. Separate models were created for posttraumatic stress symptoms (PTSS), depression, and anxiety because of multicollinearity concerns. Additional variables considered for inclusion were psychological symptoms (e.g., suicide ideation, postconcussive symptoms), satisfaction with life, sleep (e.g., pain that disrupts sleep, early awakenings, sleepiness), demographics (e.g., sex, race/ethnicity, marital status, age), and military characteristics (e.g., rank, branch, special operator status, time in service)., Results: PTSS (odds ratio [OR]: 1.13), anxiety (OR: 1.19), and depression (OR: 1.19) were associated with increased odds of PTNs when controlling for prazosin. Each of the final models accounted for a significant amount of variance in the presence/absence of PTN. The included variables differed across models. The PTSS model included pain that disrupted sleep, postconcussive symptoms, special operator status, and early awakenings. The anxiety model included postconcussive symptoms, pain that disrupted sleep, special operator status, and prazosin use. The depression model included postconcussive symptoms, pain that disrupted sleep, special operator status, difficulty falling asleep within 30 min, and prazosin use. Although most variables were associated with an increased odds of PTNs, postconcussive symptoms in the PTSS model and special operator status in all 3 models were associated with decreased odds of PTNs. These findings are illustrated in Tables 2 to 4., Conclusions: Findings support the association of PTSS, anxiety, and depression to PTNs, and, importantly, suggest that other factors may be equally or more important in understanding PTNs. Notably, increased odds of PTNs were observed among patients with pain that disrupts their sleep. The cross-sectional nature of the study allows examination of these co-occurring symptoms as they would present in the clinic, potentially informing assessment and treatment strategies; however, it precludes consideration of temporal relationships. Results highlight the importance of considering comorbid symptoms and relevant military characteristics to gain a more complete understanding of PTNs. Future research utilizing longitudinal methods are needed to inform the temporal/causal aspects of these relationships., (© The Association of Military Surgeons of the United States 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)