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Transplantation, 2015
Anticipating poor recovery due to impaired self-management and appointment-keeping, clinicians ma... more Anticipating poor recovery due to impaired self-management and appointment-keeping, clinicians may consider serious mental illness (SMI) a significant concern in organ transplantation. However, little empirical evidence exists regarding posttransplantation outcomes for patients with SMI. This study analyzed health services data to evaluate posttransplantation 3-year survival by SMI status in a nationwide cohort of patients in the Veterans Health Administration (VHA). A total of 960 recipients of solid organ or bone marrow transplants were identified from Veterans Health Administration administrative data extracts for fiscal years 2006 to 2009. Of these, 164 (17%) had an SMI diagnosis before transplantation (schizophrenia, posttraumatic stress, major depressive, and bipolar disorders); 301 (31%) had some other mental illness diagnosis (such as anxiety, adjustment reactions, or substance abuse); and 495 (52%) had no mental health diagnosis. Twenty-two patients (2%) required retransplantation and 208 patients (22%) died during follow-up. Data on whether these were primary or repeat transplantations were unavailable. Rates of attendance at postoperative outpatient visits and number of months for which immunosuppressive drugs fills were recorded were similar among mental illness groups, as were rates of diagnosed immunological rejection. Three-year mortality was equivalent among mental health groups: no mental health (19%) versus other mental illness (23%) versus SMI (27%; χ = 5.11; df = 2; P = .08). In adjusted survival models, no effect of mental health status was observed. Serious mental illness diagnosis does not appear to be associated with adverse transplantation outcomes over the first 3 years; however, a potentially diverging survival curve may portend higher mortality at 5 years.
Psychiatry Research, 2014
The objective of the present research was to develop and evaluate a critical warzone experiences ... more The objective of the present research was to develop and evaluate a critical warzone experiences (CWE) scale for use with Iraq/Afghanistan veterans. The psychometric properties of the CWE were evaluated across three independent samples of Iraq/Afghanistan veterans. Despite its brevity (7 items), the CWE exhibited good internal consistency (average α ¼ 0.83), good temporal stability (1-year test-retest reliability¼0.73), good concurrent validity with lengthier measures of warzone experiences (average r ¼0.74), and a clear unidimensional factor structure (average factor loading¼ 0.69). Study 2 confirmed the CWE's factor structure through confirmatory factor analysis, and structural equation modeling demonstrated a strong association between CWE and post-deployment mental health, β ¼0.49, po 0.001. Study 3 provided further support for the predictive validity of the CWE by demonstrating that it was associated with PTSD diagnosis, clinician-rated PTSD symptom severity, and global functional impairment in an independent sample of Iraq/Afghanistan veterans (average r ¼0.59). While replication of these findings in more diverse samples is needed, the preliminary evidence from these studies indicates that the CWE is a brief, reliable, and valid measure of critical warzone experiences among Iraq/ Afghanistan war veterans.
Transplantation, 2015
Anticipating poor recovery due to impaired self-management and appointment-keeping, clinicians ma... more Anticipating poor recovery due to impaired self-management and appointment-keeping, clinicians may consider serious mental illness (SMI) a significant concern in organ transplantation. However, little empirical evidence exists regarding posttransplantation outcomes for patients with SMI. This study analyzed health services data to evaluate posttransplantation 3-year survival by SMI status in a nationwide cohort of patients in the Veterans Health Administration (VHA). A total of 960 recipients of solid organ or bone marrow transplants were identified from Veterans Health Administration administrative data extracts for fiscal years 2006 to 2009. Of these, 164 (17%) had an SMI diagnosis before transplantation (schizophrenia, posttraumatic stress, major depressive, and bipolar disorders); 301 (31%) had some other mental illness diagnosis (such as anxiety, adjustment reactions, or substance abuse); and 495 (52%) had no mental health diagnosis. Twenty-two patients (2%) required retransplantation and 208 patients (22%) died during follow-up. Data on whether these were primary or repeat transplantations were unavailable. Rates of attendance at postoperative outpatient visits and number of months for which immunosuppressive drugs fills were recorded were similar among mental illness groups, as were rates of diagnosed immunological rejection. Three-year mortality was equivalent among mental health groups: no mental health (19%) versus other mental illness (23%) versus SMI (27%; χ = 5.11; df = 2; P = .08). In adjusted survival models, no effect of mental health status was observed. Serious mental illness diagnosis does not appear to be associated with adverse transplantation outcomes over the first 3 years; however, a potentially diverging survival curve may portend higher mortality at 5 years.
Psychiatry Research, 2014
The objective of the present research was to develop and evaluate a critical warzone experiences ... more The objective of the present research was to develop and evaluate a critical warzone experiences (CWE) scale for use with Iraq/Afghanistan veterans. The psychometric properties of the CWE were evaluated across three independent samples of Iraq/Afghanistan veterans. Despite its brevity (7 items), the CWE exhibited good internal consistency (average α ¼ 0.83), good temporal stability (1-year test-retest reliability¼0.73), good concurrent validity with lengthier measures of warzone experiences (average r ¼0.74), and a clear unidimensional factor structure (average factor loading¼ 0.69). Study 2 confirmed the CWE's factor structure through confirmatory factor analysis, and structural equation modeling demonstrated a strong association between CWE and post-deployment mental health, β ¼0.49, po 0.001. Study 3 provided further support for the predictive validity of the CWE by demonstrating that it was associated with PTSD diagnosis, clinician-rated PTSD symptom severity, and global functional impairment in an independent sample of Iraq/Afghanistan veterans (average r ¼0.59). While replication of these findings in more diverse samples is needed, the preliminary evidence from these studies indicates that the CWE is a brief, reliable, and valid measure of critical warzone experiences among Iraq/ Afghanistan war veterans.