Joseph Boscarino - Academia.edu (original) (raw)

Papers by Joseph Boscarino

Frontiers in Psychiatry, 2022

The impact of “moral injury” (MI) among deployed veterans, defined as actions in combat that viol... more The impact of “moral injury” (MI) among deployed veterans, defined as actions in combat that violate a veteran's moral beliefs and result in psychological distress, has increasingly become a significant clinical concern separate from other trauma- and stressor-related disorders. MI involves severe distress over violations of core beliefs often followed by feelings of guilt and conflict and is common among veterans with PTSD. While the psychological impact of PTSD is well-documented among veterans, this has been done less so with respect to MI. We studied MI among 1,032 deployed veterans who were outpatients in a large non-profit multi-hospital system in central Pennsylvania. The study included active duty and Guard/Reserve members, as well as veterans who were not Department of Veterans Affairs (VA) service users. Our hypothesis was that, controlling for other risk factors, veterans with high MI would have current mental disorders. Our secondary hypothesis was that MI would be a...

Digestive Diseases and Sciences, 2021

Background: This study focuses on factors that may affect female veterans’ mental health, compare... more Background: This study focuses on factors that may affect female veterans’ mental health, compared to men, and is part of a large study assessing the prevalence of mental health disorders and treatment seeking among formerly deployed US military service members. Methods: We surveyed a random sample of 1,730 veterans who were patients in a large non-VA hospital system in the US. Based on previous research, women were hypothesized to be at higher risk for psychological problems. We adjusted our models for confounding factors, including history of childhood abuse, combat exposure, stressful life events, alcohol misuse, psychological resources, and social support. Results: Among the veterans studied, 5% (N=85) were female, 96% were White, 22.9% were Iraq/Afghanistan veterans, and the mean age was 59 years old. Compared to males, female veterans were younger, unmarried, college graduates, have less combat exposure, but more likely to have lifetime PTSD (29% vs. 12%.), lifetime depression...

Journal of Patient-Centered Research and Reviews, 2017

Journal of Patient-Centered Research and Reviews, 2017

Military Behavioral Health, 2015

International Journal of Emergency Mental Health, 2013

A number of studies have assessed the association between acculturation and psychological outcome... more A number of studies have assessed the association between acculturation and psychological outcomes following a traumatic event. Some suggest that low acculturation is associated with poorer health outcomes, while others show no differences or that low acculturation is associated with better outcomes. One year after the terrorist attacks on the World Trade Center, we surveyed a multi-ethnic population of New York City adults (N= 2,368). We assessed posttraumatic stress disorder (PTSD), major depression, panic attack, anxiety symptoms, and general physical and mental health status. We classified study respondents into "low," "moderate," or "high" acculturation, based on survey responses. Bivariate results indicated that low acculturation individuals were more likely to experience negative life events, have low social support, and less likely to have pre-disaster mental health disorders. Those in the low acculturation group were also more likely to experie...

International Journal of Emergency Mental Health, 2011

Research suggests that perievent panic attacks--panic attacks in temporal proximity to traumatic ... more Research suggests that perievent panic attacks--panic attacks in temporal proximity to traumatic events--are predictive of later mental health status, including the onset of depression. Using a community sample of New York City residents interviewed 1 year and 2 years after the World Trade Center Disaster, we estimated a structural equation model (SEM) using pre-disaster psychological status and post-disaster life events, together with psychosocial resources, to assess the relationship between perievent panic and later onset depression. Bivariate results revealed a significant association between perievent panic and both year-1 and year-2 depression. Results for the SEM, however showed that perievent panic was predictive of year-1 depression, but not year-2 depression, once potential confounders were controlled Year-2 stressors and year-2 psychosocial resources were the best predictors of year-2 depression onset. Pre-disaster psychological problems were directly implicated in year-1...

International Journal of Emergency Mental Health, 2011

Dr Boscarino was in the World Trade Center complex on September 11, 2001 when the first plane str... more Dr Boscarino was in the World Trade Center complex on September 11, 2001 when the first plane struck the Twin Towers. His World Trade Center work was supported in part by grants from the National Institute of Mental Health (Grants # R01 MH66403 and R21-MH-086317) and the Pennsylvania Department of Health (Contract #4100042573).

International Journal of Emergency Mental Health, 2008

In this article we review findings from the World Trade Center Disaster (WTCD) Outcomes Study, a ... more In this article we review findings from the World Trade Center Disaster (WTCD) Outcomes Study, a prospective cohort study of 2,368 New York City (NYC) adults funded by the National Institutes of Health after the September 11 attacks. The findings reported were based on a baseline survey conducted one year after the disaster and a follow-up conducted two years post-disaster. One of the goals of this research was to assess the effectiveness of post-disaster treatments received by NYC residents following the attacks. Among the major findings of this study were the relatively small increase in mental health service utilization and the fact that only brief worksite interventions seemed to be an effective post-disaster treatment intervention. Specifically, those who received more conventional post-disaster interventions, such as formal psychotherapy sessions and/or psychotropic medicines, seemed to have poorer outcomes. Since this study was designed to assess treatment outcomes, use advan...

International Journal of Emergency Mental Health, 2005

Postdisaster crisis interventions have been viewed by many as the appropriate and immediate appro... more Postdisaster crisis interventions have been viewed by many as the appropriate and immediate approach to enhance psychological well-being among persons affected by large-scale traumatic events. Yet, studies and systematic reviews have challenged the effectiveness of these efforts. This article provides the first rigorous scientific evidence to suggest that postdisaster crisis interventions in the workplace significantly reduced mental health disorders and symptoms up to 2 years after the initial interventions. Until now, studies have neither focused on the effectiveness and safety of brief mental health services following disasters, or traumatic events generally, nor examined the long-term impact of these interventions across a spectrum of outcomes using a rigorous research design. The focus of this study was to examine the impact of brief mental health crisis interventions received at the worksite following the World Trade Center disaster (WTCD) among a random sample of New York adu...

Objectives: To help improve disaster planning and research, we studied psychosocial predictors of... more Objectives: To help improve disaster planning and research, we studied psychosocial predictors of terrorism fear and preparedness among New York City residents after the World Trade Center disaster (WTCD). Method: We conducted a random cross-sectional survey of 1,681 adults interviewed 2 years after the WTCD. Participants were living in New York City at the time of the attack and exposed to ongoing terrorist threats. Results: We found 44.9 percent (95 % confidence interval [CI] = 41.9–47.9) of residents were concerned about future attacks and 16.9 percent (95 % CI = 14.7–19.3) reported a fear level of “10 ” on a 10-point analog scale. Furthermore, 14.8 percent (95 % CI = 12.8–17.0) reported they had made some plans for a future attack, a significant increase from the previous year. In addition, although 42.6 percent (95 % CI = 39.6–45.7) indicated that they would likely wait for evacuation instructions following a chemical, biological, or nuclear attack, 34.4 percent (95 % CI = 31.5...

Abstract: Over the past 30 years, studies have shown that survivors of com-munity-wide disasters ... more Abstract: Over the past 30 years, studies have shown that survivors of com-munity-wide disasters suffer from a variety of physical and mental health pro-blems. Researchers also have documented increased substance use in the aftermath of these disasters. In the present study, we examined the relationship between alcohol use and mental health status within the context of the terrorist attacks on the World Trade Center in New York City (NYC). The data for the present report come from a 2-wave panel study of adults living in NYC on the day of the attacks. Wave 1 (W1) and Wave 2 (W2) interviews occurred one year and two years after the attacks, respectively. Overall, 2,368 individuals completed the W1 survey (cooperation rate, 63%) and 1,681 completed the W2 survey (re-interview rate, 71%). The alcohol use variables examined were binge drinking, alcohol dependence, increased days drinking, and increased drinks per day. The outcomes examined included measures of posttraumatic stress disor...

Research has suggested that exposure to psychological trauma is associated with increased abuse o... more Research has suggested that exposure to psychological trauma is associated with increased abuse of psychoactive substances, particularly alcohol. To assess this, we analyzed alcohol consumption, binge drinking, and alcohol dependence among a random sample of 1681 New York City adults 1 year and 2 years after the September 11 attacks. In multivariate models controlling for demographic factors, other stressor exposures, social psychological resources, and history of anti-social behavior, we found that greater exposure to the World Trade Center disaster (WTCD) was associated with greater alcohol consumption at 1 year and 2 years after this event. In addition, our analyses also indicated that exposure to the WTCD was associated with binge drinking at 1 year after but not 2 years after this event. Alcohol dependence, assessed as present in either year 1 or year 2, also was positively associated with greater WTCD exposures. Posttraumatic stress disorder was not associated with alcohol use...

Pharmacogenomics and Personalized Medicine

Electronic medical records (EMR) and health insurance claims data offer two potential data source... more Electronic medical records (EMR) and health insurance claims data offer two potential data sources for researchers to examine healthcare utilization patterns and the cost of care. In particular, combining the clinical and epidemiological variables typically available in EMR with cost information available in the claims data is not only intuitively sensible, but also increasingly more feasible with growing standardization of EMR across healthcare delivery systems. In this study, we compare EMR and claims data within a cohort of rheumatoid arthritis patients who received care from Geisinger Health System (GHS) and also had concurrent Geisinger Health Plan (GHP) coverage. We also develop a cost “imputation” method to obtain GHP claims-based cost estimates within EMR, even for those who did not have GHP coverage. The findings confirm that there is significant disagreement between EMR and claims data and suggest that each represent a different set of clinical phenomena. This study also i...

BMC Women's Health, 2021

Background This study focuses on factors that may disproportionately affect female veterans’ ment... more Background This study focuses on factors that may disproportionately affect female veterans’ mental health, compared to men, and is part of a larger study assessing the prevalence of mental health disorders and treatment seeking among formerly deployed US military service members. Methods We surveyed a random sample of 1,730 veterans who were patients in a large non-VA hospital system in the US. Based on previous research, women were hypothesized to be at higher risk for psychological problems. We adjusted our results for confounding factors, including history of trauma, childhood abuse, combat exposure, deployments, stressful life events, alcohol misuse, psychological resources, and social support. Results Among the veterans studied, 5% were female (n = 85), 96% were White (n = 1,161), 22.9% were Iraq/Afghanistan veterans (n = 398), and the mean age was 59 years old (SD = 12). Compared to males, female veterans were younger, unmarried, college graduates, had less combat exposure, b...

Minerva Psichiatrica, 2012

AIM: We previously developed a posttraumatic stress disorder (PTSD) screening instrument - the Ne... more AIM: We previously developed a posttraumatic stress disorder (PTSD) screening instrument - the New York PTSD Risk Score - that was effective in predicting PTSD. In the present study, we assessed a 12-month prospective version of this risk score, which is important for patient management, follow-up, and for emergency medicine. METHODS: Using data collected in a study of New York City adults after the World Trade Center Disaster (WTCD), we developed a new PTSD prediction tool. Using diagnostic test methods, including receiver operating curve (ROC) and bootstrap procedures, we examined different prediction variables to assess PTSD status 12 months after initial assessment among 1,681 trauma-exposed adults. RESULTS: While our original PTSD screener worked well in the short term, it was not specifically developed to predict long-term PTSD. In the current study, we found that the Primary Care PTSD Screener (PCPS), when combined with psychosocial predictors from the original NY Risk Score,...

General Hospital Psychiatry, 2011

ObjectiveThe objective was to develop a brief posttraumatic stress disorder (PTSD) screening inst... more ObjectiveThe objective was to develop a brief posttraumatic stress disorder (PTSD) screening instrument that is useful in clinical practice, similar to the Framingham Risk Score used in cardiovascular medicine.

Frontiers in Psychiatry, 2022

The impact of “moral injury” (MI) among deployed veterans, defined as actions in combat that viol... more The impact of “moral injury” (MI) among deployed veterans, defined as actions in combat that violate a veteran's moral beliefs and result in psychological distress, has increasingly become a significant clinical concern separate from other trauma- and stressor-related disorders. MI involves severe distress over violations of core beliefs often followed by feelings of guilt and conflict and is common among veterans with PTSD. While the psychological impact of PTSD is well-documented among veterans, this has been done less so with respect to MI. We studied MI among 1,032 deployed veterans who were outpatients in a large non-profit multi-hospital system in central Pennsylvania. The study included active duty and Guard/Reserve members, as well as veterans who were not Department of Veterans Affairs (VA) service users. Our hypothesis was that, controlling for other risk factors, veterans with high MI would have current mental disorders. Our secondary hypothesis was that MI would be a...

Digestive Diseases and Sciences, 2021

Background: This study focuses on factors that may affect female veterans’ mental health, compare... more Background: This study focuses on factors that may affect female veterans’ mental health, compared to men, and is part of a large study assessing the prevalence of mental health disorders and treatment seeking among formerly deployed US military service members. Methods: We surveyed a random sample of 1,730 veterans who were patients in a large non-VA hospital system in the US. Based on previous research, women were hypothesized to be at higher risk for psychological problems. We adjusted our models for confounding factors, including history of childhood abuse, combat exposure, stressful life events, alcohol misuse, psychological resources, and social support. Results: Among the veterans studied, 5% (N=85) were female, 96% were White, 22.9% were Iraq/Afghanistan veterans, and the mean age was 59 years old. Compared to males, female veterans were younger, unmarried, college graduates, have less combat exposure, but more likely to have lifetime PTSD (29% vs. 12%.), lifetime depression...

Journal of Patient-Centered Research and Reviews, 2017

Journal of Patient-Centered Research and Reviews, 2017

Military Behavioral Health, 2015

International Journal of Emergency Mental Health, 2013

A number of studies have assessed the association between acculturation and psychological outcome... more A number of studies have assessed the association between acculturation and psychological outcomes following a traumatic event. Some suggest that low acculturation is associated with poorer health outcomes, while others show no differences or that low acculturation is associated with better outcomes. One year after the terrorist attacks on the World Trade Center, we surveyed a multi-ethnic population of New York City adults (N= 2,368). We assessed posttraumatic stress disorder (PTSD), major depression, panic attack, anxiety symptoms, and general physical and mental health status. We classified study respondents into "low," "moderate," or "high" acculturation, based on survey responses. Bivariate results indicated that low acculturation individuals were more likely to experience negative life events, have low social support, and less likely to have pre-disaster mental health disorders. Those in the low acculturation group were also more likely to experie...

International Journal of Emergency Mental Health, 2011

Research suggests that perievent panic attacks--panic attacks in temporal proximity to traumatic ... more Research suggests that perievent panic attacks--panic attacks in temporal proximity to traumatic events--are predictive of later mental health status, including the onset of depression. Using a community sample of New York City residents interviewed 1 year and 2 years after the World Trade Center Disaster, we estimated a structural equation model (SEM) using pre-disaster psychological status and post-disaster life events, together with psychosocial resources, to assess the relationship between perievent panic and later onset depression. Bivariate results revealed a significant association between perievent panic and both year-1 and year-2 depression. Results for the SEM, however showed that perievent panic was predictive of year-1 depression, but not year-2 depression, once potential confounders were controlled Year-2 stressors and year-2 psychosocial resources were the best predictors of year-2 depression onset. Pre-disaster psychological problems were directly implicated in year-1...

International Journal of Emergency Mental Health, 2011

Dr Boscarino was in the World Trade Center complex on September 11, 2001 when the first plane str... more Dr Boscarino was in the World Trade Center complex on September 11, 2001 when the first plane struck the Twin Towers. His World Trade Center work was supported in part by grants from the National Institute of Mental Health (Grants # R01 MH66403 and R21-MH-086317) and the Pennsylvania Department of Health (Contract #4100042573).

International Journal of Emergency Mental Health, 2008

In this article we review findings from the World Trade Center Disaster (WTCD) Outcomes Study, a ... more In this article we review findings from the World Trade Center Disaster (WTCD) Outcomes Study, a prospective cohort study of 2,368 New York City (NYC) adults funded by the National Institutes of Health after the September 11 attacks. The findings reported were based on a baseline survey conducted one year after the disaster and a follow-up conducted two years post-disaster. One of the goals of this research was to assess the effectiveness of post-disaster treatments received by NYC residents following the attacks. Among the major findings of this study were the relatively small increase in mental health service utilization and the fact that only brief worksite interventions seemed to be an effective post-disaster treatment intervention. Specifically, those who received more conventional post-disaster interventions, such as formal psychotherapy sessions and/or psychotropic medicines, seemed to have poorer outcomes. Since this study was designed to assess treatment outcomes, use advan...

International Journal of Emergency Mental Health, 2005

Postdisaster crisis interventions have been viewed by many as the appropriate and immediate appro... more Postdisaster crisis interventions have been viewed by many as the appropriate and immediate approach to enhance psychological well-being among persons affected by large-scale traumatic events. Yet, studies and systematic reviews have challenged the effectiveness of these efforts. This article provides the first rigorous scientific evidence to suggest that postdisaster crisis interventions in the workplace significantly reduced mental health disorders and symptoms up to 2 years after the initial interventions. Until now, studies have neither focused on the effectiveness and safety of brief mental health services following disasters, or traumatic events generally, nor examined the long-term impact of these interventions across a spectrum of outcomes using a rigorous research design. The focus of this study was to examine the impact of brief mental health crisis interventions received at the worksite following the World Trade Center disaster (WTCD) among a random sample of New York adu...

Objectives: To help improve disaster planning and research, we studied psychosocial predictors of... more Objectives: To help improve disaster planning and research, we studied psychosocial predictors of terrorism fear and preparedness among New York City residents after the World Trade Center disaster (WTCD). Method: We conducted a random cross-sectional survey of 1,681 adults interviewed 2 years after the WTCD. Participants were living in New York City at the time of the attack and exposed to ongoing terrorist threats. Results: We found 44.9 percent (95 % confidence interval [CI] = 41.9–47.9) of residents were concerned about future attacks and 16.9 percent (95 % CI = 14.7–19.3) reported a fear level of “10 ” on a 10-point analog scale. Furthermore, 14.8 percent (95 % CI = 12.8–17.0) reported they had made some plans for a future attack, a significant increase from the previous year. In addition, although 42.6 percent (95 % CI = 39.6–45.7) indicated that they would likely wait for evacuation instructions following a chemical, biological, or nuclear attack, 34.4 percent (95 % CI = 31.5...

Abstract: Over the past 30 years, studies have shown that survivors of com-munity-wide disasters ... more Abstract: Over the past 30 years, studies have shown that survivors of com-munity-wide disasters suffer from a variety of physical and mental health pro-blems. Researchers also have documented increased substance use in the aftermath of these disasters. In the present study, we examined the relationship between alcohol use and mental health status within the context of the terrorist attacks on the World Trade Center in New York City (NYC). The data for the present report come from a 2-wave panel study of adults living in NYC on the day of the attacks. Wave 1 (W1) and Wave 2 (W2) interviews occurred one year and two years after the attacks, respectively. Overall, 2,368 individuals completed the W1 survey (cooperation rate, 63%) and 1,681 completed the W2 survey (re-interview rate, 71%). The alcohol use variables examined were binge drinking, alcohol dependence, increased days drinking, and increased drinks per day. The outcomes examined included measures of posttraumatic stress disor...

Research has suggested that exposure to psychological trauma is associated with increased abuse o... more Research has suggested that exposure to psychological trauma is associated with increased abuse of psychoactive substances, particularly alcohol. To assess this, we analyzed alcohol consumption, binge drinking, and alcohol dependence among a random sample of 1681 New York City adults 1 year and 2 years after the September 11 attacks. In multivariate models controlling for demographic factors, other stressor exposures, social psychological resources, and history of anti-social behavior, we found that greater exposure to the World Trade Center disaster (WTCD) was associated with greater alcohol consumption at 1 year and 2 years after this event. In addition, our analyses also indicated that exposure to the WTCD was associated with binge drinking at 1 year after but not 2 years after this event. Alcohol dependence, assessed as present in either year 1 or year 2, also was positively associated with greater WTCD exposures. Posttraumatic stress disorder was not associated with alcohol use...

Pharmacogenomics and Personalized Medicine

Electronic medical records (EMR) and health insurance claims data offer two potential data source... more Electronic medical records (EMR) and health insurance claims data offer two potential data sources for researchers to examine healthcare utilization patterns and the cost of care. In particular, combining the clinical and epidemiological variables typically available in EMR with cost information available in the claims data is not only intuitively sensible, but also increasingly more feasible with growing standardization of EMR across healthcare delivery systems. In this study, we compare EMR and claims data within a cohort of rheumatoid arthritis patients who received care from Geisinger Health System (GHS) and also had concurrent Geisinger Health Plan (GHP) coverage. We also develop a cost “imputation” method to obtain GHP claims-based cost estimates within EMR, even for those who did not have GHP coverage. The findings confirm that there is significant disagreement between EMR and claims data and suggest that each represent a different set of clinical phenomena. This study also i...

BMC Women's Health, 2021

Background This study focuses on factors that may disproportionately affect female veterans’ ment... more Background This study focuses on factors that may disproportionately affect female veterans’ mental health, compared to men, and is part of a larger study assessing the prevalence of mental health disorders and treatment seeking among formerly deployed US military service members. Methods We surveyed a random sample of 1,730 veterans who were patients in a large non-VA hospital system in the US. Based on previous research, women were hypothesized to be at higher risk for psychological problems. We adjusted our results for confounding factors, including history of trauma, childhood abuse, combat exposure, deployments, stressful life events, alcohol misuse, psychological resources, and social support. Results Among the veterans studied, 5% were female (n = 85), 96% were White (n = 1,161), 22.9% were Iraq/Afghanistan veterans (n = 398), and the mean age was 59 years old (SD = 12). Compared to males, female veterans were younger, unmarried, college graduates, had less combat exposure, b...

Minerva Psichiatrica, 2012

AIM: We previously developed a posttraumatic stress disorder (PTSD) screening instrument - the Ne... more AIM: We previously developed a posttraumatic stress disorder (PTSD) screening instrument - the New York PTSD Risk Score - that was effective in predicting PTSD. In the present study, we assessed a 12-month prospective version of this risk score, which is important for patient management, follow-up, and for emergency medicine. METHODS: Using data collected in a study of New York City adults after the World Trade Center Disaster (WTCD), we developed a new PTSD prediction tool. Using diagnostic test methods, including receiver operating curve (ROC) and bootstrap procedures, we examined different prediction variables to assess PTSD status 12 months after initial assessment among 1,681 trauma-exposed adults. RESULTS: While our original PTSD screener worked well in the short term, it was not specifically developed to predict long-term PTSD. In the current study, we found that the Primary Care PTSD Screener (PCPS), when combined with psychosocial predictors from the original NY Risk Score,...

General Hospital Psychiatry, 2011

ObjectiveThe objective was to develop a brief posttraumatic stress disorder (PTSD) screening inst... more ObjectiveThe objective was to develop a brief posttraumatic stress disorder (PTSD) screening instrument that is useful in clinical practice, similar to the Framingham Risk Score used in cardiovascular medicine.