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During the last year, the study team continued follow-up data collection, boasting high retention rates. Three-month follow-up was completed in January 2014, with an overall completion rate of 93% across both arms. Six-month follo...
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During the last year, the study team continued follow-up data collection, boasting high retention rates. Three-month follow-up was completed in January 2014, with an overall completion rate of 93% across both arms. Six-month follow-up was completed in March 2014, with an overall completion rate of 90% across both arms. Twelve-month follow-up is projected to be completed by October 2014; the current overall completion rate is 86% across both arms. Investigators are prepared to conduct full analyses of the data as soon as the final two participants have completed the 12-month follow-up assessments. In the last year, all partnering institutions established data safeguarding plans and data transfer agreements to ensure datasets are properly transferred between institutions for data analysis. Investigators submitted a design manuscript to the journal Contemporary Clinical Trials and are preparing revisions to that manuscript. Investigators continued work on multiple manuscripts and presentations, including a main outcomes manuscript, and presentations on trial design at the 29th Annual Meeting of the International Society for Traumatic Stress Studies (ISTSS) in November 2013 in Philadelphia, PA and at the Military Health System Research Symposium (MHSRS) in August 2014 in Ft. Lauderdale, FL.
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Over the course of the last year, the study team received IRB approval and began recruiting participants at five of the six study sites (Joint Base Lewis-McChord, Ft. Bliss, Ft. Campbell, Ft. Carson, and Ft. Stewart). As of August...
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Over the course of the last year, the study team received IRB approval and began recruiting participants at five of the six study sites (Joint Base Lewis-McChord, Ft. Bliss, Ft. Campbell, Ft. Carson, and Ft. Stewart). As of August 31, 2012, 368 total referrals across the five active sites had been received; 179 participants had been enrolled and randomized into the study (86 participants into the STEPS UP arm; 93 participants into the optimized usual care arm); 53 participants completed the 3-month follow-up assessment; and 6 participants completed the 6-month follow-up. We are awaiting HRPO approval of our final site (Ft. Bragg); we anticipate beginning recruitment at Ft. Bragg in September 2012. Multiple amendments have been approved by the WRNMMC IRB, including an amendment that revised eligibility criteria and updated data collection forms. The study intervention has been refined to include a web-based care management support tool; nurse-assisted web- based cognitive-behavioral therapy options for PTSD and depression; a modularized telephonic cognitive-behavioral therapy option for PTSD and depression; and a preference-based stepped care approach to primary care PTSD and depression treatment sequencing. We have continued to hire and train site and centralized personnel.
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Since late 2001, U.S. military forces have been engaged in conflicts around the globe most notably in Iraq and Afghanistan. These conflicts have exacted a substantial toll on soldiers, marines, sailors, and airmen, and this toll g...
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Since late 2001, U.S. military forces have been engaged in conflicts around the globe most notably in Iraq and Afghanistan. These conflicts have exacted a substantial toll on soldiers, marines, sailors, and airmen, and this toll goes beyond the well-publicized casualty figures. It extends to the stress that repetitive deployments can have on the individual service member and his or her family. This stress can manifest itself in different ways increased divorce rates, spouse and child abuse, mental distress, substance abuse but one of the most troubling manifestations is suicides, which are increasing across the U.S. Department of Defense (DoD). The increase in suicides among members of the military has raised concern among policymakers, military leaders, and the population at large.
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The purpose of the STEPS UP (STepped Enhancement of PTSD Services Using Primary Care) trial is to compare centralized telephonic care management with preference-based stepped PTSD and depression care to optimized usual care. We hy...
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The purpose of the STEPS UP (STepped Enhancement of PTSD Services Using Primary Care) trial is to compare centralized telephonic care management with preference-based stepped PTSD and depression care to optimized usual care. We hypothesize that the STEPS UP intervention will lead to improvements in (1) PTSD and depression symptom severity (primary hypothesis); (2) anxiety and somatic symptom severity, alcohol use, mental health functioning, work functioning; (3) costs and cost-effectiveness. We further hypothesize that qualitative data will show (4) patients, their family members, and participating clinicians find that the STEPS UP intervention is an acceptable, effective, and satisfying approach to deliver and receive PTSD and depression care. STEPS UP is a six-site, two-parallel arm (N = 1,500) randomized controlled effectiveness trial with quarterly follow-up for 12 months comparing centralized telephonic stepped-care management to optimized usual PTSD and depression care.
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Since 2001, 1.64 million U.S. troops have been deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) in Afghanistan and Iraq. Evidence suggests the psychological toll of these deployments may be disproportionately h...
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Since 2001, 1.64 million U.S. troops have been deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) in Afghanistan and Iraq. Evidence suggests the psychological toll of these deployments may be disproportionately high compared with the physical injuries of combat. Concerns have been most recently centered on two combat-related injuries in particular: post-traumatic stress disorder and traumatic brain injury. Many recent reports have referred to these as the signature wounds of the Afghanistan and Iraq conflicts. With the increasing incidence of suicide and suicide attempts among returning veterans, concern about depression is also on the rise. The study discussed in this monograph focuses on post-traumatic stress disorder, major depression, and traumatic brain injury, not only because of current high-level policy interest but also because, unlike the physical wounds of war, these conditions are often invisible to the eye, remaining invisible to other service members, family members, and society in general. All three conditions affect mood, thoughts, and behavior; yet these wounds often go unrecognized and unacknowledged. The effect of traumatic brain injury is still poorly understood, leaving a large gap in knowledge related to how extensive the problem is or how to address it. RAND conducted a comprehensive study of the post-deployment health-related needs associated with post-traumatic stress disorder, major depression, and traumatic brain injury among OEF/OIF veterans, the health care system in place to meet those needs, gaps in the care system, and the costs associated with these conditions and with providing quality health care to all those in need. This monograph presents the results of that study. These results should be of interest to mental health treatment providers; health policy makers, particularly those charged with caring for our nation's veterans; and U.S. service men and women, their families, and the concerned public.
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My testimony will briefly discuss the prevalence of post-traumatic stress disorder and depression, as well as the incidence of traumatic brain injury among service members returning from Operations Enduring Freedom and Iraqi Freed...
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My testimony will briefly discuss the prevalence of post-traumatic stress disorder and depression, as well as the incidence of traumatic brain injury among service members returning from Operations Enduring Freedom and Iraqi Freedom; the costs to society associated with these conditions and of providing care to those afflicted with these conditions, and the gaps in the care systems designed to treat these conditions among our nation's service members and veterans. These findings form the basis of several recommendations which will be presented in the testimony of my colleague, Terri Tanielian. Together, Ms. Tanielian and I co-directed more than 30 researchers at RAND in the completion of this study and our testimony is drawn from the same body of work.
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This literature review, one of eight commissioned by the Special Assistant to the Deputy Secretary of Defense for Gulf War Illnesses, summarizes the existing scientific literature on the health effects of stress that may have affe...
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This literature review, one of eight commissioned by the Special Assistant to the Deputy Secretary of Defense for Gulf War Illnesses, summarizes the existing scientific literature on the health effects of stress that may have affected military personnel who served in Operations Desert Shield and Desert Storm. The eight RAND reviews are intended to complement efforts by the Defense Department and other federal agencies in their attempt to understand the full range of health implications of service in that conflict. Many veterans have reported an array of physical and mental health complaints since the war. Whether veterans are experiencing either higher than expected rates of identifiable illnesses with known etiologies or other illnesses from unidentified origins is not yet clear.
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