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Papers by Valerie Hoffman
Substance Abuse: Research and Treatment, 2017
Marijuana initiation during adolescence, and early adolescence in particular, is associated with ... more Marijuana initiation during adolescence, and early adolescence in particular, is associated with adverse health consequences. Our study used 2005-2014 data from the annual, cross-sectional National Survey on Drug Use and Health to study the prevalence and correlates of marijuana initiation, use, and marijuana use disorder (MUD; abuse or dependence) among 12- to 14-year olds living in civilian US households (n = 84 954). Examined correlates included age, sex, race/ethnicity, poverty status, metropolitan status, year of survey, depression, tobacco use, alcohol use, and fighting at school. Sex differences in the correlates of lifetime use and past year marijuana initiation were tested via interaction. Lifetime prevalence of marijuana use was 5.5%; 3.2% reported past year initiation. About 1 in 6 (16.8%) past year initiates progressed to MUD within 12 months of first use. Although men had higher prevalence of lifetime use than women, past year initiation did not differ by sex. On examin...
Psychiatric Services, 2015
The study investigated perceived helpfulness of counseling or medication in a national sample of ... more The study investigated perceived helpfulness of counseling or medication in a national sample of adolescents with a major depressive episode. Methods: Secondary data analysis of the National Survey on Drug Use and Health was conducted. The sample comprised adolescents (ages 12-17) with a past-year major depressive episode who reported receiving either counseling and no medication (N=2,000) or medication and counseling (N=1,300) for depression in the past year. Adolescents who received counseling only evaluated the helpfulness of counseling, and adolescents who received medication and counseling evaluated the helpfulness of medication. Responses were analyzed by using descriptive statistics and ordered logistic regression models. Results: Among adolescents who received counseling only, 10% reported that counseling was extremely helpful, 22% that it helped a lot, 25% that it helped some, 24% that it helped a little, and 20% that it was not at all helpful. Among adolescents who received medication and counseling, 17% reported that medication was extremely helpful, 30% that it helped a lot, 22% that it helped somewhat, 16% that it helped a little, and 15% that it was not at all helpful. In adjusted models, adolescents with greater parental support and fewer than two delinquent behaviors in the past year were more likely to endorse treatment as helpful.
Depression is a debilitating disorder associated with many poor health outcomes, including increa... more Depression is a debilitating disorder associated with many poor health outcomes, including increased comorbidity and early mortality. Despite the advent of new digital health interventions, few have been tested among patients with more severe forms of depression. As such, we examined whether 150 patients with at least moderately severe depressive symptoms (PHQ-9>=15) experienced significant reductions in depressive symptoms after participation in a therapist-supported, evidence-based program delivered via smartphone app. An-intent-to-treat analysis showed that patients with at least moderately severe depressive symptoms at pre-program assessment experienced significant decreases in depressive symptoms at end-of treatment (mean PHQ-9 reduction=7.3, Hedges’ g = 1.7]) that were maintained at 1-, 3-, 6-, and 12-months post-program. Also, 40% of patients with at least moderately severe depressive symptoms at baseline and 32% of patients with severe depressive symptoms (PHQ-9>=20) a...
A continual rise in the prevalence of depression underscores the need for effective, long-lasting... more A continual rise in the prevalence of depression underscores the need for effective, long-lasting interventions that can be widely accessed. To address this, we created a comprehensive, smartphone-based, 8-week digital intervention comprising several evidence-based practices for adults with depression. Recently, there has been substantial support for heart rate variability biofeedback (HRV-B) as a primary or adjunct treatment for several mental health disorders, including depression. The objectives of this study were to determine if the addition of HRV-B to our original intervention was feasible and whether patients in the HRV-B (“enhanced”) intervention were more likely to experience clinically significant improvements in depressive symptoms than patients in our original (“standard”) intervention. In this quasi-experimental, matched subjects study, patients in the enhanced group (n = 48) completed a total average of 3.86 hours of HRV-B practice across 25.8 sessions, and were more l...
BACKGROUND Depression is one of the most common mental health disorders and severely impacts phys... more BACKGROUND Depression is one of the most common mental health disorders and severely impacts physical, psychological and social functioning. To address access barriers to care, we developed Ascend - a smartphone-delivered, therapist-supported, 8-week intervention based on several evidence-based psychological treatments for depression and anxiety. OBJECTIVE A feasibility study reported that Ascend is associated with a post-intervention reduction in depression symptoms among 102 adults with elevated depression. Here, we examined whether Ascend is also associated with a reduction in symptoms of anxiety, and critically, whether reductions in symptoms of depression and anxiety are maintained up to 12 months post-intervention. METHODS We examined whether the previously-reported, end-of-treatment improvements among 102 adults with elevated symptoms of depression extended up to 12 months post-treatment for depression symptoms (measured by the Patient Health Questionnaire [PHQ-9]), and up to...
Military Medicine, 2012
We examine lifetime eating disorders (EDOs) and associations with post-traumatic stress disorder ... more We examine lifetime eating disorders (EDOs) and associations with post-traumatic stress disorder (PTSD) and sexual trauma during various stages of the life course (childhood, during military service, and lifetime) among women veterans. The sample included 1,004 women aged 20 to 52 years who had enrolled at 2 Midwestern Veterans Affairs Medical Centers or outlying clinics completed a retrospective telephone interview. Over 16% reported a lifetime EDO (4.7% had received a diagnosis, and an additional 11.5% self-reported suffering from an EDO). Associations were found between lifetime EDO, PTSD, and sexual trauma. Relationships maintained significance for both diagnosed and self-reported EDOs as well as lifetime completed rape and attempted sexual assaults. Sexual trauma during military service was more strongly associated with lifetime EDOs than childhood sexual trauma. The significant associations found between EDOs, PTSD, and sexual trauma indicate that EDO screening among women veterans with PTSD or histories of sexual trauma may be warranted.
Annals of internal medicine, Jan 9, 2016
Major depressive disorder (MDD) is common among children and adolescents and is associated with f... more Major depressive disorder (MDD) is common among children and adolescents and is associated with functional impairment and suicide. To update the 2009 U.S. Preventive Services Task Force (USPSTF) systematic review on screening for and treatment of MDD in children and adolescents in primary care settings. Several electronic searches (May 2007 to February 2015) and searches of reference lists of published literature. Trials and recent systematic reviews of treatment, test-retest studies of screening, and trials and large cohort studies for harms. Data were abstracted by 1 investigator and checked by another; 2 investigators independently assessed study quality. Limited evidence from 5 studies showed that such tools as the Beck Depression Inventory and Patient Health Questionnaire for Adolescents had reasonable accuracy for identifying MDD among adolescents in primary care settings. Six trials evaluated treatment. Several individual fair- and good-quality studies of fluoxetine, combined...
Approximately one in five children and adolescents living in the United States has one or more me... more Approximately one in five children and adolescents living in the United States has one or more mental, emotional, or behavioral health disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSMIV) criteria in any given year. These disorders contribute to problems with family, peers, and academic functioning. They may exacerbate coexisting conditions and may reduce quality of life. They also increase the risk of involvement with the criminal justice system and other risktaking behaviors and suicide.
Objective: Patients (30–50%) with non-psychotic major depression will not respond despite an adeq... more Objective: Patients (30–50%) with non-psychotic major depression will not respond despite an adequate trial of antidepressant medication. This study evaluated risperidone as an augmenting agent for patients who failed or only partially responded to an adequate trial of an antidepressant medication. Method: Ninety-seven patients with unipolar non-psychotic major depression who were not responsive to antidepressant monotherapy were randomized to risperidone (0.5–3 mg/day) or placebo augmentation in a four-week, double-blind, placebo controlled treatment trial. The primary outcome measure was remission defined by a score of 610 on the Montgomery–Asberg Depression Rating Scale (MADRS). Secondary outcomes measures were the Hamilton Rating Scale for Depression, the Clinician Global Impression of Severity scale and the overall satisfaction item of the Quality of Life and Enjoyment Questionnaire. Results: Subjects in both treatment groups improved significantly over time. The odds of remitting were significantly better for patients in the risperidone vs. placebo arm (OR = 3.33, p = .011). At the end of 4 weeks of treatment 52% of the risperidone augmentation group remitted (MADRS 6 10) compared to 24% of the placebo augmentation group (CMH(1) = 6.48, p = .011), but the two groups were converging. Patients in the risperidone group also reported significantly more improvement in quality-of-life than patients in the placebo group. There were no between-group differences in the number of adverse events reported, however, weight gain was significantly higher in the group receiving risperidone. Conclusion: Augmentation of an antidepressant with risperidone for patients with difficult-to-treat depression leads to more rapid response and a higher remission rate and better quality-of-life.
Substance Abuse: Research and Treatment, 2017
Marijuana initiation during adolescence, and early adolescence in particular, is associated with ... more Marijuana initiation during adolescence, and early adolescence in particular, is associated with adverse health consequences. Our study used 2005-2014 data from the annual, cross-sectional National Survey on Drug Use and Health to study the prevalence and correlates of marijuana initiation, use, and marijuana use disorder (MUD; abuse or dependence) among 12- to 14-year olds living in civilian US households (n = 84 954). Examined correlates included age, sex, race/ethnicity, poverty status, metropolitan status, year of survey, depression, tobacco use, alcohol use, and fighting at school. Sex differences in the correlates of lifetime use and past year marijuana initiation were tested via interaction. Lifetime prevalence of marijuana use was 5.5%; 3.2% reported past year initiation. About 1 in 6 (16.8%) past year initiates progressed to MUD within 12 months of first use. Although men had higher prevalence of lifetime use than women, past year initiation did not differ by sex. On examin...
Psychiatric Services, 2015
The study investigated perceived helpfulness of counseling or medication in a national sample of ... more The study investigated perceived helpfulness of counseling or medication in a national sample of adolescents with a major depressive episode. Methods: Secondary data analysis of the National Survey on Drug Use and Health was conducted. The sample comprised adolescents (ages 12-17) with a past-year major depressive episode who reported receiving either counseling and no medication (N=2,000) or medication and counseling (N=1,300) for depression in the past year. Adolescents who received counseling only evaluated the helpfulness of counseling, and adolescents who received medication and counseling evaluated the helpfulness of medication. Responses were analyzed by using descriptive statistics and ordered logistic regression models. Results: Among adolescents who received counseling only, 10% reported that counseling was extremely helpful, 22% that it helped a lot, 25% that it helped some, 24% that it helped a little, and 20% that it was not at all helpful. Among adolescents who received medication and counseling, 17% reported that medication was extremely helpful, 30% that it helped a lot, 22% that it helped somewhat, 16% that it helped a little, and 15% that it was not at all helpful. In adjusted models, adolescents with greater parental support and fewer than two delinquent behaviors in the past year were more likely to endorse treatment as helpful.
Depression is a debilitating disorder associated with many poor health outcomes, including increa... more Depression is a debilitating disorder associated with many poor health outcomes, including increased comorbidity and early mortality. Despite the advent of new digital health interventions, few have been tested among patients with more severe forms of depression. As such, we examined whether 150 patients with at least moderately severe depressive symptoms (PHQ-9>=15) experienced significant reductions in depressive symptoms after participation in a therapist-supported, evidence-based program delivered via smartphone app. An-intent-to-treat analysis showed that patients with at least moderately severe depressive symptoms at pre-program assessment experienced significant decreases in depressive symptoms at end-of treatment (mean PHQ-9 reduction=7.3, Hedges’ g = 1.7]) that were maintained at 1-, 3-, 6-, and 12-months post-program. Also, 40% of patients with at least moderately severe depressive symptoms at baseline and 32% of patients with severe depressive symptoms (PHQ-9>=20) a...
A continual rise in the prevalence of depression underscores the need for effective, long-lasting... more A continual rise in the prevalence of depression underscores the need for effective, long-lasting interventions that can be widely accessed. To address this, we created a comprehensive, smartphone-based, 8-week digital intervention comprising several evidence-based practices for adults with depression. Recently, there has been substantial support for heart rate variability biofeedback (HRV-B) as a primary or adjunct treatment for several mental health disorders, including depression. The objectives of this study were to determine if the addition of HRV-B to our original intervention was feasible and whether patients in the HRV-B (“enhanced”) intervention were more likely to experience clinically significant improvements in depressive symptoms than patients in our original (“standard”) intervention. In this quasi-experimental, matched subjects study, patients in the enhanced group (n = 48) completed a total average of 3.86 hours of HRV-B practice across 25.8 sessions, and were more l...
BACKGROUND Depression is one of the most common mental health disorders and severely impacts phys... more BACKGROUND Depression is one of the most common mental health disorders and severely impacts physical, psychological and social functioning. To address access barriers to care, we developed Ascend - a smartphone-delivered, therapist-supported, 8-week intervention based on several evidence-based psychological treatments for depression and anxiety. OBJECTIVE A feasibility study reported that Ascend is associated with a post-intervention reduction in depression symptoms among 102 adults with elevated depression. Here, we examined whether Ascend is also associated with a reduction in symptoms of anxiety, and critically, whether reductions in symptoms of depression and anxiety are maintained up to 12 months post-intervention. METHODS We examined whether the previously-reported, end-of-treatment improvements among 102 adults with elevated symptoms of depression extended up to 12 months post-treatment for depression symptoms (measured by the Patient Health Questionnaire [PHQ-9]), and up to...
Military Medicine, 2012
We examine lifetime eating disorders (EDOs) and associations with post-traumatic stress disorder ... more We examine lifetime eating disorders (EDOs) and associations with post-traumatic stress disorder (PTSD) and sexual trauma during various stages of the life course (childhood, during military service, and lifetime) among women veterans. The sample included 1,004 women aged 20 to 52 years who had enrolled at 2 Midwestern Veterans Affairs Medical Centers or outlying clinics completed a retrospective telephone interview. Over 16% reported a lifetime EDO (4.7% had received a diagnosis, and an additional 11.5% self-reported suffering from an EDO). Associations were found between lifetime EDO, PTSD, and sexual trauma. Relationships maintained significance for both diagnosed and self-reported EDOs as well as lifetime completed rape and attempted sexual assaults. Sexual trauma during military service was more strongly associated with lifetime EDOs than childhood sexual trauma. The significant associations found between EDOs, PTSD, and sexual trauma indicate that EDO screening among women veterans with PTSD or histories of sexual trauma may be warranted.
Annals of internal medicine, Jan 9, 2016
Major depressive disorder (MDD) is common among children and adolescents and is associated with f... more Major depressive disorder (MDD) is common among children and adolescents and is associated with functional impairment and suicide. To update the 2009 U.S. Preventive Services Task Force (USPSTF) systematic review on screening for and treatment of MDD in children and adolescents in primary care settings. Several electronic searches (May 2007 to February 2015) and searches of reference lists of published literature. Trials and recent systematic reviews of treatment, test-retest studies of screening, and trials and large cohort studies for harms. Data were abstracted by 1 investigator and checked by another; 2 investigators independently assessed study quality. Limited evidence from 5 studies showed that such tools as the Beck Depression Inventory and Patient Health Questionnaire for Adolescents had reasonable accuracy for identifying MDD among adolescents in primary care settings. Six trials evaluated treatment. Several individual fair- and good-quality studies of fluoxetine, combined...
Approximately one in five children and adolescents living in the United States has one or more me... more Approximately one in five children and adolescents living in the United States has one or more mental, emotional, or behavioral health disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSMIV) criteria in any given year. These disorders contribute to problems with family, peers, and academic functioning. They may exacerbate coexisting conditions and may reduce quality of life. They also increase the risk of involvement with the criminal justice system and other risktaking behaviors and suicide.
Objective: Patients (30–50%) with non-psychotic major depression will not respond despite an adeq... more Objective: Patients (30–50%) with non-psychotic major depression will not respond despite an adequate trial of antidepressant medication. This study evaluated risperidone as an augmenting agent for patients who failed or only partially responded to an adequate trial of an antidepressant medication. Method: Ninety-seven patients with unipolar non-psychotic major depression who were not responsive to antidepressant monotherapy were randomized to risperidone (0.5–3 mg/day) or placebo augmentation in a four-week, double-blind, placebo controlled treatment trial. The primary outcome measure was remission defined by a score of 610 on the Montgomery–Asberg Depression Rating Scale (MADRS). Secondary outcomes measures were the Hamilton Rating Scale for Depression, the Clinician Global Impression of Severity scale and the overall satisfaction item of the Quality of Life and Enjoyment Questionnaire. Results: Subjects in both treatment groups improved significantly over time. The odds of remitting were significantly better for patients in the risperidone vs. placebo arm (OR = 3.33, p = .011). At the end of 4 weeks of treatment 52% of the risperidone augmentation group remitted (MADRS 6 10) compared to 24% of the placebo augmentation group (CMH(1) = 6.48, p = .011), but the two groups were converging. Patients in the risperidone group also reported significantly more improvement in quality-of-life than patients in the placebo group. There were no between-group differences in the number of adverse events reported, however, weight gain was significantly higher in the group receiving risperidone. Conclusion: Augmentation of an antidepressant with risperidone for patients with difficult-to-treat depression leads to more rapid response and a higher remission rate and better quality-of-life.