Jodi McKibben - Academia.edu (original) (raw)

Papers by Jodi McKibben

Research paper thumbnail of SuicidalBehaviorsandtheUse ofMentalHealthServicesAmong ActiveDutyArmySoldiers

Research paper thumbnail of MentalHealthService UtilizationintheU.S.Army

Research paper thumbnail of Sleep deprivation and adverse health effects in United States Coast Guard responders to Hurricanes Katrina and Rita

Sleep Health, 2015

Objective: Disaster responders are increasingly called upon to assist in various natural and manm... more Objective: Disaster responders are increasingly called upon to assist in various natural and manmade disasters. A critical safety concern for this population is sleep deprivation; however, there are limited published data regarding sleep deprivation and disaster responder safety. Design: We expanded upon a cross-sectional study of 2695 United States Coast Guard personnel who responded to Hurricanes Katrina and Rita. Data were collected via survey on self-reported timing and location of deployment, missions performed, health effects, medical treatment sought, average nightly sleep, and other lifestyle variables. We created a 4-level sleep deprivation metric based on both average nightly reported sleep (≤5 hours; N5 hours) and length of deployment (≤2 weeks; N2 weeks) to examine the association between sustained sleep deprivation and illnesses, injuries, and symptoms using logistic regression to calculate odds ratios (ORs) and 95% confidence intervals. Results: The strongest, statistically significant positive ORs for the highest sleep deprivation category compared with the least sleep-deprived category were for mental health and neurologic effects, specifically depression (OR = 6.76), difficulty concentrating (OR = 8.33), and confusion (OR = 11.34), and for dehydration (OR = 9.0). Injuries most strongly associated with sleep deprivation were twists, sprains, and strains (OR = 6.20). Most health outcomes evaluated had monotonically increasing ORs with increasing sleep deprivation, and P tests for trend were statistically significant. Conclusion: Agencies deploying disaster responders should understand the risks incurred to their personnel by sustained sleep deprivation. Improved planning of response efforts to disasters can reduce the potential for sleep deprivation and lead to decreased morbidity in disaster responders.

Research paper thumbnail of Depressive Symptom Severity and Community Collective Efficacy following the 2004 Florida Hurricanes

PloS one, 2015

There is a lack of research investigating community-level characteristics, such as community coll... more There is a lack of research investigating community-level characteristics, such as community collective efficacy, mitigating the impact of disasters on psychological health, specifically depression. We examined the association of community collective efficacy with depressive symptom severity in Florida public health workers (n = 2249) exposed to the 2004 hurricane season using a multilevel approach. Cross-sectional anonymous questionnaires were distributed electronically to all Florida Department of Health (FDOH) personnel that assessed depressive symptom severity and collective efficacy nine months after the 2004 hurricane season. Analyses were conducted at the individual level and community level using zip codes. The majority of participants were female (81.9%), and ages ranged from 20 to 78 years (median = 49 years). The majority of participants (73.4%) were European American, 12.7% were African American, and 9.2% were Hispanic. Using multilevel analysis, our data indicate that h...

Research paper thumbnail of Predicting Future Onset of PTSD Using ASD Versus PTSD Diagnoses in a Major Burn Population

Research paper thumbnail of Suicidal Behaviors and the Use of Mental Health Services Among Active Duty Army Soldiers

Psychiatric Services, 2014

Research paper thumbnail of Sleep and Arousal as Risk Factors for Adverse Health and Work Performance in Public Health Workers Involved in the 2004 Florida Hurricane Season

Disaster Medicine and Public Health Preparedness, 2010

ABSTRACTBackground: We examined the relation of sleep disturbance and arousal to work performance... more ABSTRACTBackground: We examined the relation of sleep disturbance and arousal to work performance, mental and physical health, and day-to-day functioning in Florida Department of Health (FDOH) employees 9 months after the 2004 Florida hurricane season.Methods: FDOH employees were contacted via e-mail 9 months after the 2004 hurricanes. Participants (N = 2249) completed electronic questionnaires including measures of sleep disturbance, arousal, work performance, physical health, mental health, day-to-day function, hurricane injury, and work demand.Results: More than 18% of FDOH employees reported ≥25% reduced work performance and 11% to 15.3% reported ≥7 “bad” mental or physical health days in the past month. Sleep disturbance and elevated arousal were strongly associated with impaired work performance (odds ratios [ORs] 3.33 and 3.34, respectively), “bad” mental health (ORs 3.01 and 3.64), “bad” physical health (ORs 3.21 and 2.01), and limited day-to-day function (ORs 4.71 and 2.32)...

Research paper thumbnail of Disaster-Related Exposures and Health Effects Among US Coast Guard Responders to Hurricanes Katrina and Rita

Journal of Occupational & Environmental Medicine, 2014

Research paper thumbnail of Psychological Distress After Major Burn Injury

Psychosomatic Medicine, 2007

Objective-To track the prevalence and stability of clinically significant psychological distress ... more Objective-To track the prevalence and stability of clinically significant psychological distress and to identify potentially modifiable inhospital symptoms predictive of long-term distress (physical, psychological, and social impairment). Method-We obtained data from the Burn Model Systems project, a prospective, multisite, cohort study of major burn injury survivors. The Brief Symptom Inventory (BSI) was used to assess symptoms in-hospital (n = 1232) and at 6 (n = 790), 12 (n = 645), and 24 (n = 433) months post burn. Distress was examined dimensionally (BSI's Global Severity Index (GSI)) and categorically (groups formed by dichotomizing GSI: T score ≥63). Attrition was unrelated to inhospital GSI score. Results-Significant in-hospital psychological distress occurred in 34% of the patients, and clinically significant and reliable change in symptom severity by follow-up visits occurred infrequently. Principal components analysis of in-hospital distress symptoms demonstrated "alienation" and "anxiety" factors that robustly predicted distress at 6, 12, and 24 months, controlling for correlates of baseline distress. Conclusions-This is the largest prospective, multisite, cohort study of patients with major burn injury. We found that clinically significant in-hospital psychological distress was common and tends to persist. Two structural components of in-hospital distress seemed particularly predictive of long-term distress. Research is needed to determine if early recognition and treatment of patients with in-hospital psychological distress can improve long-term outcomes.

Research paper thumbnail of Mental Health Service Utilization in the U.S. Army

Psychiatric Services, 2013

U.S. Army personnel experience significant burden from mental disorders, particularly during time... more U.S. Army personnel experience significant burden from mental disorders, particularly during times of war and with multiple deployments. This study identified the rates and predictors of mental health service use by Army soldiers and examined the association of daily functioning with the various types of mental health service use. This study used the U.S. Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel, which sampled 10,400 Army soldiers, representing 508,088 soldiers. Mental health service utilization over a 12-month period included receiving counseling or therapy from a general medical doctor, receiving counseling or therapy from a mental health professional, and being prescribed medications for depression, anxiety, or sleep. Current functioning was assessed with the Health-Related Quality of Life-4 instrument. Of the active U.S. Army, 21% had used mental health services in the previous 12 months, and 48% of them had used two or more services. About 7% of soldiers saw a mental health specialist and were prescribed medication. Women (incidence rate ratio [IRR]=1.39, 95% confidence interval [CI]=1.19-1.63) and enlisted soldiers (IRR=1.93, CI=1.49-2.50) were more likely than others to use a greater number of services. Soldiers with higher versus lower levels of impaired functioning were 7.82 times more likely (CI=6.03-10.14) to use mental health services, 4.40 times more likely (CI=3.83-5.05) to use more services, and 3.18 times more likely (CI=1.85-5.49) to see a mental health specialist and to be prescribed medication. A substantial proportion of the Army accesses mental health services. Soldiers using the highest levels of care had the greatest impairment.

Research paper thumbnail of Posttraumatic Stress Disorder and Community Collective Efficacy following the 2004 Florida Hurricanes

PLoS ONE, 2014

There is a paucity of research investigating the relationship of community-level characteristics ... more There is a paucity of research investigating the relationship of community-level characteristics such as collective efficacy and posttraumatic stress following disasters. We examine the association of collective efficacy with probable posttraumatic stress disorder and posttraumatic stress disorder symptom severity in Florida public health workers (n = 2249) exposed to the 2004 hurricane season using a multilevel approach. Anonymous questionnaires were distributed electronically to all Florida Department of Health personnel nine months after the 2004 hurricane season. The collected data were used to assess posttraumatic stress disorder and collective efficacy measured at both the individual and zip code levels. The majority of participants were female (80.42%), and ages ranged from 20 to 78 years (median = 49 years); 73.91% were European American, 13.25% were African American, and 8.65% were Hispanic. Using multi-level analysis, our data indicate that higher community-level and individual-level collective efficacy were associated with a lower likelihood of having posttraumatic stress disorder (OR = 0.93, CI = 0.88-0.98; and OR = 0.94, CI = 0.92-0.97, respectively), even after adjusting for individual sociodemographic variables, community socioeconomic characteristic variables, individual injury/damage, and community storm damage. Higher levels of community-level collective efficacy and individual-level collective efficacy were also associated with significantly lower posttraumatic stress disorder symptom severity (b = 20.22, p,0.01; and b = 20.17, p,0.01, respectively), after adjusting for the same covariates. Lower rates of posttraumatic stress disorder are associated with communities with higher collective efficacy. Programs enhancing community collective efficacy may be an important part of prevention practices and possibly lead to a reduction in the rate of posttraumatic stress disorder post-disaster.

Research paper thumbnail of Child Neglect in Army Families: A Public Health Perspective

Military Medicine, 2011

Military families include 2.9 million people, with approximately 40% of all service members havin... more Military families include 2.9 million people, with approximately 40% of all service members having at least one child. Rates of child neglect in this population have increased in recent years, but little is known about the characteristics of the neglect. To better identify targets for intervention, it is necessary that we refine our understanding of child neglect in the military. In this review, we examine definitions of child neglect and the specific definitions used by the U.S. Army. We identify domains of neglect and caregiver behaviors and affiliated. We suggest that this approach can inform prevention efforts within the Institute of Medicine's framework for preventive interventions. Understanding risk and protective factors in the military family are important to interventions for child neglect in military families. INTRODUCTION Sustaining the health of military families is critical to force protection.' The health of our .soldiers, sailors, marines, and airmen is closely tied to their military family. Understanding the health and well-being of the military family is crucial to sustaining the health and functioning of soldiers. During times of high operational tempo and war deployments as at the present time, service members and their spouses show increased rates of psychiatric illness and distress and experience unique Stressors and challenges such as single parenting caused by deployment.-Before OEF and OIF, military deployment was associated with increased child maltreatment.'"* Rates of child maltreatment in the U.S. Army ranged from 7.4 per 1,000 children in 1988 to 6.59 per 1,000 children in 1997.^ Between 1990 and 2004, the rates of maltreatment in the Army declined by 65%, driven largely by a decline in the rate of physical abuse during that time.*" Community factors are also associated with child neglect. Both community poverty' and social disorganization are known to promote child neglect and community violence. In addition, neighborhood and community social, interactional, and institutional resources can account for neighborhood-level variations in a variety of socially disruptive behaviors such as delinquency, violence, depression, and high-risk behaviors." Additional community variables are likely to be associated with U.S. Army child neglect, but these have not been studied." Recently the effects of war on Army families are evident in increased rates of child neglect reported in the U.S. Army.''' Child neglect is one form of child maltreatment. Child neglect can range from a child left in a car by himself while a mother tries to run in to do an errand to substantial endangerment of a child's health. All types of child maltreatment are a substantial threat to the well-being of children.'"'"'^ Recent Center for the Study of Traumatic Stress.

Research paper thumbnail of Combat-injured service members and their families: The relationship of child distress and spouse-perceived family distress and disruption

Journal of Traumatic Stress, 2010

Combat injury in military service members affects both child and family functioning. This prelimi... more Combat injury in military service members affects both child and family functioning. This preliminary study examined the relationship of child distress postinjury to preinjury deployment-related family distress, injury severity, and family disruption postinjury. Child distress postinjury was assessed by reports from 41 spouses of combatinjured service members who had been hospitalized at two military tertiary care treatment centers. Families with high preinjury deployment-related family distress and high family disruption postinjury were more likely to report high child distress postinjury. Spouse-reported injury severity was unrelated to child distress. Findings suggest that early identification and intervention with combat-injured families experiencing distress and disruption may be warranted to support family and child health, regardless of injury severity. Nearly 34,000 soldiers, sailors, Marines, and airmen have been injured in Operations Iraqi Freedom and Enduring Freedom (Department of Defense, 2009). Many of these injuries have been serious, resulting in amputation, severe soft tissue and orthopedic injury, traumatic brain injury (TBI), and burns (Grieger et al., 2006). As nearly half of service members are married, many of the injured return to families with children of various ages. The disruption to families and children after a parent has been injured can be substantial (Cozza, Chun, & Miller, in press; Cozza, Chun, & Polo, 2005). Children in families of injured service members experience sudden changes in living arrangements, schedules, parenting practices, and the amount of time spent with their parents. Clinicians have observed that many children appear anxious, saddened, or troubled

Research paper thumbnail of Predicting Post Traumatic Stress Disorder from Acute Stress Disorder in Burn Injured Patients: A Longitudinal Study

Journal of Burn Care & Research, 2006

Methods: A total of 247 hospitalized patients> 18 years of age with major burns based ... more Methods: A total of 247 hospitalized patients> 18 years of age with major burns based on ABA criteria participated in this longitudinal outcome study. The participants completed the Stanford Acute Stress Reaction Questionnaire (SASRQ) or Acute Stress Disorder Scale (ASDS) at discharge, and the Davidson Trauma Scale (DTS) at 1 month, 6 months, 1 year, and 2 years post-discharge.

Research paper thumbnail of Measuring Post-Burn Participation in Home, Work and Social Roles

Journal of Burn Care & Research, 2006

Participants (n= 314) were burn survivors consenting to a multi-site, longitudinal outcome study:... more Participants (n= 314) were burn survivors consenting to a multi-site, longitudinal outcome study:≥ 16 yo, major burns (ABA criteria), SF-36, and CIQ. Information was gathered at discharge on function and activity using SF-36 Physical Composite (PCS) and Mental Composite (MCS) Scales and dichotomized to form physical (PCS≤ 37.25 versus> 37.25) and psychological (MCS≤ 32.40 versus> 32.40) impairment groups. To set CIQ benchmarks for substantial difficulty participating in work (CIQ-W), home (CIQ-H), and ...

Research paper thumbnail of Screening for Symptoms of Acute Stress Disorder in Patients with Burn Injuries: An Evaluation of the Stanford Acute Stress Reaction Questionnaire

Journal of Burn Care & Research, 2006

Methods: Data was obtained from 223 inpatients age 16 years and older who met ABA criteria for se... more Methods: Data was obtained from 223 inpatients age 16 years and older who met ABA criteria for severe burn injury. Patients completed the SASRQ and were administered a SCID for symptoms of PTSD during the hospitalization. Data was collected within 4 weeks of the burn in 83% of the cases. In the other 17%, it was collected more than 4 weeks post-burn due to acute medical problems. We calculated rates of ASD based on the SASRQ and for acute PTSD using both the SCID and the SASRQ. We assessed the diagnostic utility of the ...

Research paper thumbnail of Early Predictors of Long Term Psychological Distress

Journal of Burn Care & Research, 2006

Participants were: ≥16 yo, surviving major burns, consenting to a multi-site, longitudinal outcom... more Participants were: ≥16 yo, surviving major burns, consenting to a multi-site, longitudinal outcome study. Brief Symptom Inventory (BSI) at discharge (n = 689) assess in-hospital symptoms, follow-up BSI assess symptoms at 6 (6M: n = 689), 12 (12M: n = 550), and 24 (24M: n = 373) months postburn. Sample attrition was not related to in-hospital distress on BSI (p's > .05). Multivariate logistic regression models (MLR) used in-hospital distress symptoms to predict High Distress and Low Distress groups (BSI's Global Severity Index: GSI ≥ 63 versus GSI < 63) at 6, 12 ...

Research paper thumbnail of Early Predictors of Long Term Impairment Following Burn Injury

Journal of Burn Care & Research, 2006

Introduction: Rapid and effective closure of full-thickness burn wounds remains a limiting factor... more Introduction: Rapid and effective closure of full-thickness burn wounds remains a limiting factor in burns of greater than 50% of the total body surface area (TBSA). Hypothetically, cultured skin substitutes (CSS) consisting of autologous cultured keratinocytes and fibroblasts attached to collagen-based sponges may reduce requirements for donor skin, numbers of grafting procedures, and time of intensive care during hospitalization. Methods: To test this hypothesis, CSS were prepared from split-thickness skin biopsies collected after enrollment of 54 burn patients by Informed Consent into a study protocol approved by the local Institutional Review Board. CSS and split-thickness skin autograft (AG) were applied in a matched-pair design with each patient serving as their own control. Data collection consisted of photographs, area measurements of donor skin and healed wounds after grafting (nϭ54), and qualitative outcome by the Vancouver Scale for burn scar (nϭ47). Data are expressed below as: A) % area closed at post-operative day (POD) 14, B) % TBSA closed at POD 28, C) ratio of closed to donor areas at POD 28, D) correlation of % TBSA closed with CSS and % TBSA FT burn, and E) ordinal scoring by the Vancouver Scale after one year. Results: Engraftment at POD 14 was 79.9Ϯ1.9% for CSS and 95.7Ϯ1.4 for AG. Percentage TBSA closed at POD 28 was 19.1Ϯ2.2% for CSS, and 50.5Ϯ1.8 for AG. The ratio of closed to donor areas at POD 28 was 61.8Ϯ6.5 for CSS, and 4.0Ϯ0.0 for AG. Each of these values was significantly different between the graft types. Correlation of % TBSA closed with CSS at POD 28 with % TBSA full-thickness burn generated an r value of 0.64 (pϽ0.0001). Vancouver Scale scores at one year after were not different for erythema, pliability or scar height, but pigmentation remained deficient in CSS. Conclusions: These results demonstrate that CSS reduce requirements for donor skin harvesting for grafting of excised, full-thickness burns of greater than 50% TBSA with qualitative outcome that is comparable to meshed AG. Availability of CSS for treatment of extensive, deep burns may reduce time to wound closure, morbidity and mortality in this patient population.

Research paper thumbnail of Case identification in psychiatric epidemiology: A review

International Review of Psychiatry, 2007

Psychiatric epidemiologic surveys since 1980 have relied heavily on a small number of survey diag... more Psychiatric epidemiologic surveys since 1980 have relied heavily on a small number of survey diagnostic instruments for case ascertainment, which encode reports of respondents to highly structured interview questions delivered by interviewers without clinical training. Many validations of these survey diagnostic instruments have been carried out. This paper reviews the success of the survey diagnostic instruments, for eight diagnostic categories, in validations with a psychiatrist examination as the gold standard. Public databases were searched for potentially relevant publications, of which more than 1000 were located. Tables show sensitivity, specificity, Kappa, sample source and size, survey instrument and validation method. The number of validation studies relevant to the eight disorders ranged from 8 for schizophrenia to 29 for major depressive disorder. Reported sensitivities ranged from zero to 100%, and specificities from 22% to 100%. Results for common mental disorders such as major depressive disorder, alcohol disorder, drug disorder, and agoraphobic disorder are better than for panic disorder, obsessive compulsive disorder, bipolar disorder, and schizophrenia. The validity of case ascertainment in psychiatric epidemiology is still in question.

Research paper thumbnail of Epidemiology of burn injuries II: Psychiatric and behavioural perspectives

International Review of Psychiatry, 2009

Modern technological advances have decreased the incidence and severity of burn injuries, and med... more Modern technological advances have decreased the incidence and severity of burn injuries, and medical care improvements of burn injuries have significantly increased survival rates, particularly in developed countries. Still, fire-related burn injuries are responsible for 300,000 deaths and 10 million disability-adjusted life years lost annually worldwide. The extent to which psychiatric and behavioural factors contribute to the incidence and outcomes of these tragedies has not been systematically documented, and the available data is often insufficient to reach definitive conclusions. Accordingly, this article reviews the evidence of psychiatric and behavioural risk factors and prevention opportunities for burn injuries worldwide. Psychiatric prevalence rates and risk factors for burn injuries, prevalence and risks associated with 'intentional' burn injuries (self-immolation, assault, and child maltreatment), and prevention activities targeting the general population and those with known psychiatric and behavioural risk factors are discussed. These issues are substantially interwoven with many co-occurring risk factors. While success in teasing apart the roles and contributions of these factors rests upon improving the methodology employed in future research, the nature of this entanglement increases the likelihood that successful interventions in one problem area will reap benefits in others.

Research paper thumbnail of SuicidalBehaviorsandtheUse ofMentalHealthServicesAmong ActiveDutyArmySoldiers

Research paper thumbnail of MentalHealthService UtilizationintheU.S.Army

Research paper thumbnail of Sleep deprivation and adverse health effects in United States Coast Guard responders to Hurricanes Katrina and Rita

Sleep Health, 2015

Objective: Disaster responders are increasingly called upon to assist in various natural and manm... more Objective: Disaster responders are increasingly called upon to assist in various natural and manmade disasters. A critical safety concern for this population is sleep deprivation; however, there are limited published data regarding sleep deprivation and disaster responder safety. Design: We expanded upon a cross-sectional study of 2695 United States Coast Guard personnel who responded to Hurricanes Katrina and Rita. Data were collected via survey on self-reported timing and location of deployment, missions performed, health effects, medical treatment sought, average nightly sleep, and other lifestyle variables. We created a 4-level sleep deprivation metric based on both average nightly reported sleep (≤5 hours; N5 hours) and length of deployment (≤2 weeks; N2 weeks) to examine the association between sustained sleep deprivation and illnesses, injuries, and symptoms using logistic regression to calculate odds ratios (ORs) and 95% confidence intervals. Results: The strongest, statistically significant positive ORs for the highest sleep deprivation category compared with the least sleep-deprived category were for mental health and neurologic effects, specifically depression (OR = 6.76), difficulty concentrating (OR = 8.33), and confusion (OR = 11.34), and for dehydration (OR = 9.0). Injuries most strongly associated with sleep deprivation were twists, sprains, and strains (OR = 6.20). Most health outcomes evaluated had monotonically increasing ORs with increasing sleep deprivation, and P tests for trend were statistically significant. Conclusion: Agencies deploying disaster responders should understand the risks incurred to their personnel by sustained sleep deprivation. Improved planning of response efforts to disasters can reduce the potential for sleep deprivation and lead to decreased morbidity in disaster responders.

Research paper thumbnail of Depressive Symptom Severity and Community Collective Efficacy following the 2004 Florida Hurricanes

PloS one, 2015

There is a lack of research investigating community-level characteristics, such as community coll... more There is a lack of research investigating community-level characteristics, such as community collective efficacy, mitigating the impact of disasters on psychological health, specifically depression. We examined the association of community collective efficacy with depressive symptom severity in Florida public health workers (n = 2249) exposed to the 2004 hurricane season using a multilevel approach. Cross-sectional anonymous questionnaires were distributed electronically to all Florida Department of Health (FDOH) personnel that assessed depressive symptom severity and collective efficacy nine months after the 2004 hurricane season. Analyses were conducted at the individual level and community level using zip codes. The majority of participants were female (81.9%), and ages ranged from 20 to 78 years (median = 49 years). The majority of participants (73.4%) were European American, 12.7% were African American, and 9.2% were Hispanic. Using multilevel analysis, our data indicate that h...

Research paper thumbnail of Predicting Future Onset of PTSD Using ASD Versus PTSD Diagnoses in a Major Burn Population

Research paper thumbnail of Suicidal Behaviors and the Use of Mental Health Services Among Active Duty Army Soldiers

Psychiatric Services, 2014

Research paper thumbnail of Sleep and Arousal as Risk Factors for Adverse Health and Work Performance in Public Health Workers Involved in the 2004 Florida Hurricane Season

Disaster Medicine and Public Health Preparedness, 2010

ABSTRACTBackground: We examined the relation of sleep disturbance and arousal to work performance... more ABSTRACTBackground: We examined the relation of sleep disturbance and arousal to work performance, mental and physical health, and day-to-day functioning in Florida Department of Health (FDOH) employees 9 months after the 2004 Florida hurricane season.Methods: FDOH employees were contacted via e-mail 9 months after the 2004 hurricanes. Participants (N = 2249) completed electronic questionnaires including measures of sleep disturbance, arousal, work performance, physical health, mental health, day-to-day function, hurricane injury, and work demand.Results: More than 18% of FDOH employees reported ≥25% reduced work performance and 11% to 15.3% reported ≥7 “bad” mental or physical health days in the past month. Sleep disturbance and elevated arousal were strongly associated with impaired work performance (odds ratios [ORs] 3.33 and 3.34, respectively), “bad” mental health (ORs 3.01 and 3.64), “bad” physical health (ORs 3.21 and 2.01), and limited day-to-day function (ORs 4.71 and 2.32)...

Research paper thumbnail of Disaster-Related Exposures and Health Effects Among US Coast Guard Responders to Hurricanes Katrina and Rita

Journal of Occupational & Environmental Medicine, 2014

Research paper thumbnail of Psychological Distress After Major Burn Injury

Psychosomatic Medicine, 2007

Objective-To track the prevalence and stability of clinically significant psychological distress ... more Objective-To track the prevalence and stability of clinically significant psychological distress and to identify potentially modifiable inhospital symptoms predictive of long-term distress (physical, psychological, and social impairment). Method-We obtained data from the Burn Model Systems project, a prospective, multisite, cohort study of major burn injury survivors. The Brief Symptom Inventory (BSI) was used to assess symptoms in-hospital (n = 1232) and at 6 (n = 790), 12 (n = 645), and 24 (n = 433) months post burn. Distress was examined dimensionally (BSI's Global Severity Index (GSI)) and categorically (groups formed by dichotomizing GSI: T score ≥63). Attrition was unrelated to inhospital GSI score. Results-Significant in-hospital psychological distress occurred in 34% of the patients, and clinically significant and reliable change in symptom severity by follow-up visits occurred infrequently. Principal components analysis of in-hospital distress symptoms demonstrated "alienation" and "anxiety" factors that robustly predicted distress at 6, 12, and 24 months, controlling for correlates of baseline distress. Conclusions-This is the largest prospective, multisite, cohort study of patients with major burn injury. We found that clinically significant in-hospital psychological distress was common and tends to persist. Two structural components of in-hospital distress seemed particularly predictive of long-term distress. Research is needed to determine if early recognition and treatment of patients with in-hospital psychological distress can improve long-term outcomes.

Research paper thumbnail of Mental Health Service Utilization in the U.S. Army

Psychiatric Services, 2013

U.S. Army personnel experience significant burden from mental disorders, particularly during time... more U.S. Army personnel experience significant burden from mental disorders, particularly during times of war and with multiple deployments. This study identified the rates and predictors of mental health service use by Army soldiers and examined the association of daily functioning with the various types of mental health service use. This study used the U.S. Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel, which sampled 10,400 Army soldiers, representing 508,088 soldiers. Mental health service utilization over a 12-month period included receiving counseling or therapy from a general medical doctor, receiving counseling or therapy from a mental health professional, and being prescribed medications for depression, anxiety, or sleep. Current functioning was assessed with the Health-Related Quality of Life-4 instrument. Of the active U.S. Army, 21% had used mental health services in the previous 12 months, and 48% of them had used two or more services. About 7% of soldiers saw a mental health specialist and were prescribed medication. Women (incidence rate ratio [IRR]=1.39, 95% confidence interval [CI]=1.19-1.63) and enlisted soldiers (IRR=1.93, CI=1.49-2.50) were more likely than others to use a greater number of services. Soldiers with higher versus lower levels of impaired functioning were 7.82 times more likely (CI=6.03-10.14) to use mental health services, 4.40 times more likely (CI=3.83-5.05) to use more services, and 3.18 times more likely (CI=1.85-5.49) to see a mental health specialist and to be prescribed medication. A substantial proportion of the Army accesses mental health services. Soldiers using the highest levels of care had the greatest impairment.

Research paper thumbnail of Posttraumatic Stress Disorder and Community Collective Efficacy following the 2004 Florida Hurricanes

PLoS ONE, 2014

There is a paucity of research investigating the relationship of community-level characteristics ... more There is a paucity of research investigating the relationship of community-level characteristics such as collective efficacy and posttraumatic stress following disasters. We examine the association of collective efficacy with probable posttraumatic stress disorder and posttraumatic stress disorder symptom severity in Florida public health workers (n = 2249) exposed to the 2004 hurricane season using a multilevel approach. Anonymous questionnaires were distributed electronically to all Florida Department of Health personnel nine months after the 2004 hurricane season. The collected data were used to assess posttraumatic stress disorder and collective efficacy measured at both the individual and zip code levels. The majority of participants were female (80.42%), and ages ranged from 20 to 78 years (median = 49 years); 73.91% were European American, 13.25% were African American, and 8.65% were Hispanic. Using multi-level analysis, our data indicate that higher community-level and individual-level collective efficacy were associated with a lower likelihood of having posttraumatic stress disorder (OR = 0.93, CI = 0.88-0.98; and OR = 0.94, CI = 0.92-0.97, respectively), even after adjusting for individual sociodemographic variables, community socioeconomic characteristic variables, individual injury/damage, and community storm damage. Higher levels of community-level collective efficacy and individual-level collective efficacy were also associated with significantly lower posttraumatic stress disorder symptom severity (b = 20.22, p,0.01; and b = 20.17, p,0.01, respectively), after adjusting for the same covariates. Lower rates of posttraumatic stress disorder are associated with communities with higher collective efficacy. Programs enhancing community collective efficacy may be an important part of prevention practices and possibly lead to a reduction in the rate of posttraumatic stress disorder post-disaster.

Research paper thumbnail of Child Neglect in Army Families: A Public Health Perspective

Military Medicine, 2011

Military families include 2.9 million people, with approximately 40% of all service members havin... more Military families include 2.9 million people, with approximately 40% of all service members having at least one child. Rates of child neglect in this population have increased in recent years, but little is known about the characteristics of the neglect. To better identify targets for intervention, it is necessary that we refine our understanding of child neglect in the military. In this review, we examine definitions of child neglect and the specific definitions used by the U.S. Army. We identify domains of neglect and caregiver behaviors and affiliated. We suggest that this approach can inform prevention efforts within the Institute of Medicine's framework for preventive interventions. Understanding risk and protective factors in the military family are important to interventions for child neglect in military families. INTRODUCTION Sustaining the health of military families is critical to force protection.' The health of our .soldiers, sailors, marines, and airmen is closely tied to their military family. Understanding the health and well-being of the military family is crucial to sustaining the health and functioning of soldiers. During times of high operational tempo and war deployments as at the present time, service members and their spouses show increased rates of psychiatric illness and distress and experience unique Stressors and challenges such as single parenting caused by deployment.-Before OEF and OIF, military deployment was associated with increased child maltreatment.'"* Rates of child maltreatment in the U.S. Army ranged from 7.4 per 1,000 children in 1988 to 6.59 per 1,000 children in 1997.^ Between 1990 and 2004, the rates of maltreatment in the Army declined by 65%, driven largely by a decline in the rate of physical abuse during that time.*" Community factors are also associated with child neglect. Both community poverty' and social disorganization are known to promote child neglect and community violence. In addition, neighborhood and community social, interactional, and institutional resources can account for neighborhood-level variations in a variety of socially disruptive behaviors such as delinquency, violence, depression, and high-risk behaviors." Additional community variables are likely to be associated with U.S. Army child neglect, but these have not been studied." Recently the effects of war on Army families are evident in increased rates of child neglect reported in the U.S. Army.''' Child neglect is one form of child maltreatment. Child neglect can range from a child left in a car by himself while a mother tries to run in to do an errand to substantial endangerment of a child's health. All types of child maltreatment are a substantial threat to the well-being of children.'"'"'^ Recent Center for the Study of Traumatic Stress.

Research paper thumbnail of Combat-injured service members and their families: The relationship of child distress and spouse-perceived family distress and disruption

Journal of Traumatic Stress, 2010

Combat injury in military service members affects both child and family functioning. This prelimi... more Combat injury in military service members affects both child and family functioning. This preliminary study examined the relationship of child distress postinjury to preinjury deployment-related family distress, injury severity, and family disruption postinjury. Child distress postinjury was assessed by reports from 41 spouses of combatinjured service members who had been hospitalized at two military tertiary care treatment centers. Families with high preinjury deployment-related family distress and high family disruption postinjury were more likely to report high child distress postinjury. Spouse-reported injury severity was unrelated to child distress. Findings suggest that early identification and intervention with combat-injured families experiencing distress and disruption may be warranted to support family and child health, regardless of injury severity. Nearly 34,000 soldiers, sailors, Marines, and airmen have been injured in Operations Iraqi Freedom and Enduring Freedom (Department of Defense, 2009). Many of these injuries have been serious, resulting in amputation, severe soft tissue and orthopedic injury, traumatic brain injury (TBI), and burns (Grieger et al., 2006). As nearly half of service members are married, many of the injured return to families with children of various ages. The disruption to families and children after a parent has been injured can be substantial (Cozza, Chun, & Miller, in press; Cozza, Chun, & Polo, 2005). Children in families of injured service members experience sudden changes in living arrangements, schedules, parenting practices, and the amount of time spent with their parents. Clinicians have observed that many children appear anxious, saddened, or troubled

Research paper thumbnail of Predicting Post Traumatic Stress Disorder from Acute Stress Disorder in Burn Injured Patients: A Longitudinal Study

Journal of Burn Care & Research, 2006

Methods: A total of 247 hospitalized patients> 18 years of age with major burns based ... more Methods: A total of 247 hospitalized patients> 18 years of age with major burns based on ABA criteria participated in this longitudinal outcome study. The participants completed the Stanford Acute Stress Reaction Questionnaire (SASRQ) or Acute Stress Disorder Scale (ASDS) at discharge, and the Davidson Trauma Scale (DTS) at 1 month, 6 months, 1 year, and 2 years post-discharge.

Research paper thumbnail of Measuring Post-Burn Participation in Home, Work and Social Roles

Journal of Burn Care & Research, 2006

Participants (n= 314) were burn survivors consenting to a multi-site, longitudinal outcome study:... more Participants (n= 314) were burn survivors consenting to a multi-site, longitudinal outcome study:≥ 16 yo, major burns (ABA criteria), SF-36, and CIQ. Information was gathered at discharge on function and activity using SF-36 Physical Composite (PCS) and Mental Composite (MCS) Scales and dichotomized to form physical (PCS≤ 37.25 versus> 37.25) and psychological (MCS≤ 32.40 versus> 32.40) impairment groups. To set CIQ benchmarks for substantial difficulty participating in work (CIQ-W), home (CIQ-H), and ...

Research paper thumbnail of Screening for Symptoms of Acute Stress Disorder in Patients with Burn Injuries: An Evaluation of the Stanford Acute Stress Reaction Questionnaire

Journal of Burn Care & Research, 2006

Methods: Data was obtained from 223 inpatients age 16 years and older who met ABA criteria for se... more Methods: Data was obtained from 223 inpatients age 16 years and older who met ABA criteria for severe burn injury. Patients completed the SASRQ and were administered a SCID for symptoms of PTSD during the hospitalization. Data was collected within 4 weeks of the burn in 83% of the cases. In the other 17%, it was collected more than 4 weeks post-burn due to acute medical problems. We calculated rates of ASD based on the SASRQ and for acute PTSD using both the SCID and the SASRQ. We assessed the diagnostic utility of the ...

Research paper thumbnail of Early Predictors of Long Term Psychological Distress

Journal of Burn Care & Research, 2006

Participants were: ≥16 yo, surviving major burns, consenting to a multi-site, longitudinal outcom... more Participants were: ≥16 yo, surviving major burns, consenting to a multi-site, longitudinal outcome study. Brief Symptom Inventory (BSI) at discharge (n = 689) assess in-hospital symptoms, follow-up BSI assess symptoms at 6 (6M: n = 689), 12 (12M: n = 550), and 24 (24M: n = 373) months postburn. Sample attrition was not related to in-hospital distress on BSI (p's > .05). Multivariate logistic regression models (MLR) used in-hospital distress symptoms to predict High Distress and Low Distress groups (BSI's Global Severity Index: GSI ≥ 63 versus GSI < 63) at 6, 12 ...

Research paper thumbnail of Early Predictors of Long Term Impairment Following Burn Injury

Journal of Burn Care & Research, 2006

Introduction: Rapid and effective closure of full-thickness burn wounds remains a limiting factor... more Introduction: Rapid and effective closure of full-thickness burn wounds remains a limiting factor in burns of greater than 50% of the total body surface area (TBSA). Hypothetically, cultured skin substitutes (CSS) consisting of autologous cultured keratinocytes and fibroblasts attached to collagen-based sponges may reduce requirements for donor skin, numbers of grafting procedures, and time of intensive care during hospitalization. Methods: To test this hypothesis, CSS were prepared from split-thickness skin biopsies collected after enrollment of 54 burn patients by Informed Consent into a study protocol approved by the local Institutional Review Board. CSS and split-thickness skin autograft (AG) were applied in a matched-pair design with each patient serving as their own control. Data collection consisted of photographs, area measurements of donor skin and healed wounds after grafting (nϭ54), and qualitative outcome by the Vancouver Scale for burn scar (nϭ47). Data are expressed below as: A) % area closed at post-operative day (POD) 14, B) % TBSA closed at POD 28, C) ratio of closed to donor areas at POD 28, D) correlation of % TBSA closed with CSS and % TBSA FT burn, and E) ordinal scoring by the Vancouver Scale after one year. Results: Engraftment at POD 14 was 79.9Ϯ1.9% for CSS and 95.7Ϯ1.4 for AG. Percentage TBSA closed at POD 28 was 19.1Ϯ2.2% for CSS, and 50.5Ϯ1.8 for AG. The ratio of closed to donor areas at POD 28 was 61.8Ϯ6.5 for CSS, and 4.0Ϯ0.0 for AG. Each of these values was significantly different between the graft types. Correlation of % TBSA closed with CSS at POD 28 with % TBSA full-thickness burn generated an r value of 0.64 (pϽ0.0001). Vancouver Scale scores at one year after were not different for erythema, pliability or scar height, but pigmentation remained deficient in CSS. Conclusions: These results demonstrate that CSS reduce requirements for donor skin harvesting for grafting of excised, full-thickness burns of greater than 50% TBSA with qualitative outcome that is comparable to meshed AG. Availability of CSS for treatment of extensive, deep burns may reduce time to wound closure, morbidity and mortality in this patient population.

Research paper thumbnail of Case identification in psychiatric epidemiology: A review

International Review of Psychiatry, 2007

Psychiatric epidemiologic surveys since 1980 have relied heavily on a small number of survey diag... more Psychiatric epidemiologic surveys since 1980 have relied heavily on a small number of survey diagnostic instruments for case ascertainment, which encode reports of respondents to highly structured interview questions delivered by interviewers without clinical training. Many validations of these survey diagnostic instruments have been carried out. This paper reviews the success of the survey diagnostic instruments, for eight diagnostic categories, in validations with a psychiatrist examination as the gold standard. Public databases were searched for potentially relevant publications, of which more than 1000 were located. Tables show sensitivity, specificity, Kappa, sample source and size, survey instrument and validation method. The number of validation studies relevant to the eight disorders ranged from 8 for schizophrenia to 29 for major depressive disorder. Reported sensitivities ranged from zero to 100%, and specificities from 22% to 100%. Results for common mental disorders such as major depressive disorder, alcohol disorder, drug disorder, and agoraphobic disorder are better than for panic disorder, obsessive compulsive disorder, bipolar disorder, and schizophrenia. The validity of case ascertainment in psychiatric epidemiology is still in question.

Research paper thumbnail of Epidemiology of burn injuries II: Psychiatric and behavioural perspectives

International Review of Psychiatry, 2009

Modern technological advances have decreased the incidence and severity of burn injuries, and med... more Modern technological advances have decreased the incidence and severity of burn injuries, and medical care improvements of burn injuries have significantly increased survival rates, particularly in developed countries. Still, fire-related burn injuries are responsible for 300,000 deaths and 10 million disability-adjusted life years lost annually worldwide. The extent to which psychiatric and behavioural factors contribute to the incidence and outcomes of these tragedies has not been systematically documented, and the available data is often insufficient to reach definitive conclusions. Accordingly, this article reviews the evidence of psychiatric and behavioural risk factors and prevention opportunities for burn injuries worldwide. Psychiatric prevalence rates and risk factors for burn injuries, prevalence and risks associated with 'intentional' burn injuries (self-immolation, assault, and child maltreatment), and prevention activities targeting the general population and those with known psychiatric and behavioural risk factors are discussed. These issues are substantially interwoven with many co-occurring risk factors. While success in teasing apart the roles and contributions of these factors rests upon improving the methodology employed in future research, the nature of this entanglement increases the likelihood that successful interventions in one problem area will reap benefits in others.