Poster Abstracts with Poster Board Numbers - Cimvhr€“)National)Institute)for)Occupational) ......
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POSTER ABSTRACTS
Transcript of Poster Abstracts with Poster Board Numbers - Cimvhr€“)National)Institute)for)Occupational) ......
POSTER ABSTRACTS
Poster Board #1 Contribution of Perceived Cognitive Function to Quality of Life in Post 9/11 Veterans with Post-‐Traumatic Stress Disorder Keyword: Clinical Practice Population Type: Military/Veterans Country/Region: USA Silverberg, Noah D., PhD1; Wojtowicz, Magdalena, PhD2; Bui, Eric T., MD2; Wershba, Rebecca, PhD2; Zafonte, Ross, DO3; Simon, Naomi M., MD, MSc2; Iverson, Grant L., PhD2 1University of British Columbia, Harvard Medical School, Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, MA, USA 2Harvard Medical School, Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, MA, USA 3Harvard Medical School, Spaulding Rehabilitation Hospital Network, Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, MA, USA Although ancillary to the core triad of re-‐experiencing, avoidance, and hyperarousal symptoms, cognitive complaints are a diagnostic feature of Post-‐Traumatic Stress Disorder (PTSD) and may be an important determinant of quality of life in PTSD. We evaluated this hypothesis in a cross-‐sectional sample of post-‐9/11 United States military service members and veterans seeking mental health treatment at a tertiary clinic. A consecutive series of 175 patients with a clinical diagnosis of PTSD completed a battery of questionnaires at intake, including the PTSD Checklist (PCL), Neurobehavioral Symptom Inventory (NSI), and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-‐LES-‐Q). The NSI-‐Cog is a four-‐item cognitive symptom subscale of the NSI. Participants with probable invalid responding on the NSI were excluded (N=27; 15%). Using moderate severity as the threshold, 80% endorsed problems with concentration, 75% with memory, 52% with making decisions, and 64% with slowed thinking/organization. Endorsement rates in the subgroup with no traumatic brain injury (TBI) diagnosis (n=121) were similarly high (51-‐78%). In a regression analysis, PTSD symptom severity (PCL; B=-‐.203, p=.049) and cognitive symptom severity (NSI-‐Cog; B=-‐.252, p=.014) each independently predicted quality of life, after adjusting for the presence/absence of TBI and other comorbid diagnoses. In conclusion, major cognitive complaints were common in this PTSD cohort and helped to explain quality of life. Cognitive difficulties should be considered as a target for adjunctive treatment of PTSD, even in patients with no history of TBI.
Poster Board #2 Comorbidity and Symptom Burden in Treatment-‐Seeking Post-‐911 Veterans Keyword: Clinical/intervention Research Population Type: Military/Veterans Country/Region: USA Wojtowicz, Magdalena, PhD1; Silverberg, Noah D., PhD2; Bui, Eric, MD1; Zafonte, Ross, DO3; Simon, Naomi M., ND, MSc1; Iverson, Grant L., PhD1 1Harvard Medical School, Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, MA, USA 2University of British Columbia, Harvard Medical School, Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, MA, USA 3Harvard Medical School, Spaulding Rehabilitation Hospital Network, Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, MA, USA Limited data is available on the mental health needs of veterans seeking care in the community. We examined the degree of comorbidity and symptom burden in a cross-‐sectional sample of treatment seeking post-‐911 US military veterans seen at a non-‐VA clinic (N=570). The most common diagnoses included posttraumatic stress disorder (PTSD; n=369; 64.7%), depression (n=277; 48.6%), alcohol use/abuse (n=197; 34.6%), traumatic brain injury (TBI; n=129; 22.6), and substance use/abuse (n=103; 18.1%). A total of 90 individuals (15.8%) received 1 diagnosis, 182 (31.9%) received 2 diagnoses, 153 (26.8%) received 3 diagnoses, and 100 (17.5%) received 4 or more diagnoses at intake. Most individuals diagnosed with PTSD (92.1%) had at least 1 comorbid diagnosis. The number of diagnoses (0-‐7) was positively correlated with symptom burden on the PTSD Checklist (PCL; r=.26; p<.001) and the Neurobehavioral Symptom Inventory (NSI; r=.28; p<.001). PCL scores were considerably higher in those with 2 diagnoses (d=0.53), 3 diagnoses (d=0.93) and 4 or more diagnoses (d=1.67) compared to those with a single diagnosis. A similar pattern was observed with NSI scores. In conclusion, multiple comorbidities were common in this cohort and were associated with higher symptom burden. Further research is needed to examine how comorbidity may affect treatment outcomes.
Poster Board #3 Stress Potentiation of the Brain’s Immune Response to Neurotoxic Exposure in the Field: An Animal Model Keyword: Biological/Medical Population Type: Military/Veterans Country/Region: USA Vashistha, Saurabh, MSc1; Russell, Lindsey, BSc1; Michalovicz, Lindsay, PhD2; Kelly, Kim A., PhD2; Vrana, Julie A., PhD2; Locker, Alicia R., PhD2; Barnes, Zach M., BSc3; Craddock, Travis JA, PhD4; Fletcher, Mary Ann, PhD3; Klimas, Nancy G., MD3; Miller, Diane, PhD2; O’Callaghan, James O., PhD2; Morris, Mariana, PhD3; Broderick, Gordon, PhD4
1University of Alberta, Edmonton, AB, Canada 2CDC – National Institute for Occupational Safety and Health (NIOSH), Morgantown, WV, USA 3Institute for Neuro-‐Immune Medicine, Nova Southeastern University, Ft Lauderdale, FL, USA 4College of Psychology Nova Southeastern University, Davie, FL, USA Stress is thought to be a major mediator of interactions between immune response in the central nervous system (CNS) and peripheral blood leading to increased susceptibility to neuro-‐inflammatory illnesses in the wake of toxic exposures. We propose that low-‐level exposure to neurotoxicants potentiated by war theater stressors may have led to Gulf War Illness (GWI), a complex multi-‐symptom disorder affecting as many as 1 in 3 veterans of the 1991 Persian Gulf conflict. We examine the interactions linking the expression of 12 cytokines in blood with the corresponding transcript abundance of 8 cytokines in the cortex and the hippocampus in mice responding to a lipopolysaccharide (LPS) induced immune challenge following a low-‐level exposure to the cholinesterase inhibitor nerve agent surrogate, diisopropyl fluorophosphate (DFP), potentiated by chronic exposure to corticosterone (Cort). We show that the stress hormone, Cort, increases the extent and persistence of signaling between the peripheral and neuro-‐immune systems. Cort “primed” DFP immune signaling was more diffuse in the brain with significant changes in the roles of TNFa, MIP-‐2, KC and IL-‐1 in blood. Moreover, the persistent inflammatory signatures produced in mouse blood approximates that found in the blood of afflicted veterans under physiological challenge, in particular those with a high Davidson Trauma score (DTS).
Poster Board #4 Increasing Resilience to Traumatic Events: Simulating the Protective Role of Well-‐Being Keyword: Biological/Medical Population Type: Military/Veterans Country/Region: USA Toole, J. Tory, MSc1; Rice, Jr., Mark A., BSc1; Nierenberg, Barry, PhD1; Craddock, Travis JA, PhD1; Fletcher, Mary Ann, PhD2; Klimas, Nancy G., MD2; Zysman, Joel, PhD3; Morris, Mariana, PhD2; Broderick, Gordon, PhD1
1College of Psychology Nova Southeastern University, Davie, FL, USA 2Institute for Neuro-‐Immune Medicine, Nova Southeastern University, Ft Lauderdale, FL, USA 3Center for Computational Science, University of Miami, Coral Gables, FL, USA The brain maintains physiological and behavioral homeostasis in part through a complicated network of feedback and feed forward mechanisms where neuro-‐chemicals and immune markers act as mediators. We propose that this neurotransmission network supports multiple regulatory regimes by design and that these give rise to self-‐sustaining psychological behaviors, both healthy and unhealthy. Moreover traumatic stress acts to facilitate divergence towards such chronic pathologic conditions. To explore this we model a basic neurotransmission and immune network as a discrete logic circuit. Analysis of this bio-‐behavioral circuitry showed that in addition to maintaining a normal healthy state, intense stress could redirect homeostasis towards a self-‐sustaining state of increased anxiety and depressed mood. Computer simulations mimicking the effects of behavioral therapy focused on well-‐being showed that this modality reduced the likelihood of the brain’s homeostatic drive reinforcing chronic anxiety in the wake of a traumatic event. This suggests not only that high levels of well-‐being can serve as a protective factor against chronic anxiety, but also that the regulation of bio-‐behavioral dynamics may be an important contributor to the mechanism of action through which positive psychological constructs, such as well-‐being, serve their protective function against negative affective states.
Poster Board #5 Client Perception of Care in a Canadian Operational Stress Injury Clinic Keyword: Clinical Practice Population Type: Military/Veterans Country/Region: Canada MacLeod, Jeffrey, PhD Candidate; Stewart, Melissa, PhD; Riendeau, Marney, BScN; Wong, May, PhD Carewest Operational Stress injury Clinic, Calgary, AB, Canada Client experience has increasingly been recognized as an important indicator of quality of healthcare services, and identified as a construct that is robustly related to other indicators of quality of service such as clinical effectiveness and client safety (e.g., Doyle, Lennox, & Bell, 2013). In the interest of gaining knowledge of client experience that may facilitate improvement in services, the Carewest Operational Stress Injury (OSI) Clinic in Calgary, AB is evaluating client perception of care using the Ontario Perception of Care Tool for Mental Health and Addictions (OPOC-‐MHA; Rush et al. 2013). The OPOC-‐MHA is being completed by the majority of clients accessing the clinic, providing a cross-‐section of clients in various stages of treatment (e.g., pre-‐treatment/assessment, stabilization, active trauma treatment, maintenance). The OPOC-‐MHA allows examination of client perception of care in various domains of treatment, including access/entry to services, services provided, therapists/staff, discharge, client rights, environment and overall experience. Overall clinic results on perception of care variables will be presented, along with relationships between perception of care variables and client variables (e.g., diagnosis, stage of treatment). The implications of the results for the clinic will be discussed, with particular consideration of the manner in which client perception of care data will be used to improve services provided by the clinic.
Poster Board #6 Preliminary Investigation of the Effectiveness of a Pre-‐Treatment Education Series in the Management of Operational Stress Injuries Keyword: Clinical Practice Population Type: Military/Veterans Country/Region: Canada Stewart, Melissa, PhD1; Riendeau, Marney, BScN1; Barnes, Pia, BN1; Curley, Gabrielle, RPsychN1; Hager, Alanna, PhD2 1Carewest Operational Stress Injury Clinic, Calgary, AB, Canada 2Metropolitan State University of Denver Counseling Center, Denver, CO, USA The current investigation presents preliminary findings from a recently implemented education series for military, veterans, and RCMP members referred for treatment services at an Operational Stress Injury (OSI) Clinic. Available both on site and via videoconferencing, the Stabilization Education Series is an open, 8-‐week series offered to clients at the Carewest OSI Clinic in Calgary, Alberta in preparation for their individual treatment. This series focuses on educating clients about OSIs, and providing information and instruction on relevant clinical topics and therapeutic skills that clients will build upon and utilize in their subsequent individual treatment at the clinic. Consisting of eight sessions, the Stabilization Education Series provides clients with psychoeducation on topics including sleep, managing strong emotions, unhelpful thinking, avoidance, pain, relationships, and resiliency. Pre-‐ and post-‐series assessments were conducted to evaluate the effectiveness of this educational series in managing overall distress levels, along with symptoms of depression, anxiety, and posttraumatic stress. Clients’ perceptions of the effectiveness of the series were also evaluated. Results of the current investigation have important implications for the treatment of Posttraumatic Stress Disorder and related mental health conditions in an OSI treatment setting.
Poster Board #7 The Relation between Dissociative Symptomatology and Immediate Memory Dysfunction in a Sample of Military Combat Exposed Individuals with and without PTSD Keyword: Clinical/Intervention Research Population Type: Military/Veterans Country/Region: Canada Boyd, Jenna, MSc1; Jetly, Rakesh, MD, FRCPC2; Richardson, J. Don, MD, FRCPC3; Frewen, Paul, PhD, CPsych3; McKinnon, Margaret, PhD, CPsych1; Lanius, Ruth, MD, PhD3 1McMaster University, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada 2Department of Research and Defense Canada, Toronto, ON, Canada 3University of Western Ontario, London, ON, Canada The core affective components of post-‐traumatic stress disorder (PTSD) are often accompanied by neurocognitive dysfunction across a range of domains. The mechanisms by which such cognitive deficits develop and are maintained remain poorly understood. We investigated the contribution of one potential mechanism, dissociative symptomatology, as well as other clinical characteristics, in a sample of twenty combat-‐trauma-‐exposed veterans with subthreshold post-‐traumatic stress symptoms or full PTSD. Symptoms of depression, anxiety, and dissociation as well as incidence of childhood traumatic experiences were assessed. Neuropsychological functioning was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (assesses domains of cognitive functioning including short-‐term memory, visuospatial abilities, language, attention, and delayed memory). Short-‐term memory performance was significantly correlated with dissociative symptoms, including overall dissociative symptoms (ρ = -‐0.48, P = 0.031), depersonalization/derealization (ρ = -‐0.56, P = 0.01), disengagement (ρ = -‐0.60, P = 0.005), and memory impairment (ρ = -‐0.47, P = 0.036). The results of the current study indicate that dissociative symptomatology may play a key role in the development and/or maintenance of short-‐term memory deficits in individuals with PTSD as a result of combat-‐related trauma.
Poster Board #8 Emotional Flexibility in Combat Veterans with Posttraumatic Stress Disorder and Depression Keyword: Biological/Medical Population Type: Military/Veterans Country/Region: USA Rodin, Rebecca, MSc1; Bonanno, George, PhD2; Rahman, Nadia, BA3; Kouri, Nicole, BA3; Bryant, Richard, PhD4; Marmar, Charles, MD3; Brown, Adam, PhD3
1Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada 2Columbia University, New York, NY, USA 3New York University Langone Medical Center, New York, NY, USA 4University of New South Wales, Sydney, NSW, Australia Background: A growing body of evidence suggests that the ability to flexibility express and suppress emotions supports successful adaptation to trauma and loss. However, studies have yet to examine whether individuals with posttraumatic stress disorder (PTSD) or depression exhibit alterations in such expressive flexibility (EF). The present study aims to test whether lower levels of EF are associated with PTSD and depression in combat-‐exposed veterans. Methods: Fifty-‐nine combat veterans with and without PTSD completed self-‐report measures assessing symptoms of depression, PTSD, and combat exposure. Participants also completed an EF task in which they were asked to either enhance or suppress their expressions of emotion while viewing affective images. EF was assessed by both expressive enhancement ability and expressive suppression ability. Results: Repeated measures ANOVA’s showed that both PTSD and depression were associated with lower levels of emotional enhancement ability. A series of linear regressions demonstrated that lower levels of emotional enhancement, but not suppression, ability were associated with greater symptom severity of PTSD and depression. Conclusions: Alterations in EF is a previously unrecognized affective mechanism associated with PTSD and depression. Clinical strategies aimed at enhancing emotional expression may aid in the treatment of these disorders.
Poster Board #9 Combat Stress Reactions through Veterans’ Eyes, 1916-‐1920 Keyword: Research Methodology Population Type: Military/Veterans Country/Region: Canada Bogaert, Kandace, PhD Laurier Centre for Military Strategic and Disarmament Studies, Waterloo, ON, Canada During the First World War, some 9600 Canadians were diagnosed with combat related psychiatric illnesses, often popularly referred to as “shell shock”. At this time few medical officers were experts in psychiatric illnesses, and there was still a deep-‐seated stigma and fear associated with such illnesses in Canadian society. In this poster, I explore the materials and methodology involved in re-‐constructing the illness experiences of Canadian Veterans of the First World War who were admitted to a military hospital specifically dedicated to the treatment of war related psychiatric illnesses, the Ontario Military Hospital at Cobourg, Ontario. Approximately 1742 soldiers and 18 nursing sisters were admitted to this hospital for treatment between November 1916 and April of 1920. Not all soldiers admitted to the hospital had served overseas, and there were a variety of illnesses listed in the hospital admission and discharge books, ranging from neurasthenia and shell shock to insanity. Using hospital admission and discharge records, in conjunction with the digitized pension files of Veterans Affairs Canada, I argue that it is possible to reconstruct patients’ illness narratives, which are a critical element in understanding psychiatric illness through Veterans’ eyes.
Poster Board #10 The impact of Operational Stress Injuries on the Mental Health and Well-‐being of Military and Veteran Families Keyword: Clinical/Intervention Research Population Type: Both Adult and Child/Adolescent Country/Region: Canada & USA Cramm, Heidi, PhD1; Norris, Deborah, PhD2; Eichler, Maya, PhD2; Tam-‐Seto, Linna, PhD (c)1; Smith-‐Evans, Kim, MA (candidate)2 1Queen’s University, Kingston, ON, Canada 2Mount Saint Vincent University, Halifax, NS, Canada Purpose. While attention to Operational Stress Injuries (OSI) among military members and veterans has increased, there has been much less focus on the impact OSI has on their families. Methods. First, a scoping review was completed to map the scholarly literature focusing on the family as a whole, as well as spouses/caregivers and children and youth more specifically. Second, an environmental scan of Canadian and international programs and services targeting OSI within military-‐connected families was done. Results. 506 potential sources were identified for the scoping review; 256 proceeded to full analytic extraction. There is growing evidence that OSI has negative impacts on the dynamics and relationships within the family. There is evidence that family members experience negative impacts, including more emotional, psychosocial, behavioural problems and a heightened vulnerability to neglect or abuse. There is a complex and potentially bidirectional set of mechanisms and factors at play across parental OSI, spousal mental health, and child developmental issues that may exacerbate difficulties yet increase the likelihood of treatment seeking. 66 programs were reviewed; they are usually embedded in a broader cadre of services that may dilute the efficacy for OSI. Physical location of programs impacts on a family’s ability to access programs. Implications. This study indicates the need for ongoing high quality research focused on the impact of OSIs on all family members, particularly in the Canadian context. OSI must be understood within a family context, necessitating family-‐centred approaches to addressing OSI.
Poster Board #11 Perceived Need for Mental HealthCare and Mental Health Service Use in the Canadian Armed Forces Keyword: Clinical/Intervention Research Population Type: Military/Veterans Country/Region: Canada Fikretoglu, Deniz, PhD1; Liu, Aihua, PhD2; Zamorski, Mark, MD3; Rusu, Corneliu, MD, PhD3; Jetly, Rakesh, MD3 1Defense Research and Development Canada – Toronto Research Center, Toronto, ON, Canada 2Contractor 3Department of National Defense, Ottawa, ON, Canada Introduction: Mental health service use (MHSU) is low among individuals with a mental disorder. Failure to perceive a need for care (PNC) is a leading barrier. This study captures the prevalence of PNC and MHSU in the Canadian Armed Forces (CAF) and Canadian civilians over the past decade and compares temporal changes in MHSU across these populations. Methodology: Data came from the 2013/2002 CAF and the 2012/2002 civilian mental health surveys, conducted by Statistics Canada, using almost identical methodology. The Regular Forces were included in the CAF samples. Civilian samples were restricted to make them comparable to the CAF. Prevalence rates for PNC and MHSU were calculated. Prevalence rate ratios (PRRs) were calculated using binary logistic regressions, controlling for sociodemographic and need-‐related variables. Results: After controlling for sociodemographic and need-‐related variables, PNC was higher in the CAF in 2013 vs. 2002 (PRR 1.24) and higher in the CAF in 2013 than in civilians in 2012 (PRR 2.16). MHSU was higher in CAF in 2013 vs. 2002 (e.g., psychiatrist: PRR 1.42) and, higher in CAF in 2013 than in civilians in 2012 (e.g., psychiatrist: PRR 3.65). Temporal changes in MHSU were greater in the CAF vs. civilians. Conclusions: Investments in workplace mental health, such as those implemented in the CAF, can lead to improvements in PNC and MHSU.
Poster Board #12 Combining Protocol-‐Based CBT with MDMA: The Case for MDMA-‐Facilitated Cognitive-‐Behavioral Conjoint Therapy for PTSD Keyword: Clinical/Intervention Research Population Type: Adults Country/Region: USA Wagner, Anne C., PhD1; Monson, Candice M., PhD1; Macdonald, Alexandra, PhD2; Mithoefer, Michael C., MD3; Mithoefer, Annie T., RN3 1Ryerson University, Toronto, ON, Canada 2The Citadel, Charleston, SC, USA 3Private Practice, Mt Pleasant, SC, USA Current gold-‐standard psychotherapies for PTSD result in symptom abatement for approximately half of participants, with military and veteran participants often showing poorer results. The need for novel, alternate therapies to address this gap is clear. The drug ±3,4-‐methylenedioxymethamphetamine (MDMA), which has significant impact on affiliation and emotional connection, has demonstrated significant effects as a standalone treatment for PTSD with supportive psychotherapy (e.g., Mithoefer et al., 2011; 2012). CBCT for PTSD, a protocol-‐based dyadic CBT intervention with the goals of both improving PTSD symptoms as well as relationship functioning, has also shown promising results treating PTSD (e.g., Monson et al., 2012). Therefore in an effort to maximize the potential benefits of each therapy, and provide an alternative for current therapies that may not address social factors as explicitly as the ones outlined here, the current study combines CBCT for PTSD with MDMA in a sample of 10 pilot cases. The current presentation will outline the evidence for each of these approaches, as well as the methodology behind combining the two treatments for purported maximum effect.
Poster Board #13 Using Client-‐Reported Outcomes Monitoring for Program Evaluation of Treatment Outcomes in Military Veterans and RCMP Members Suffering from Operational Stress Injuries Keyword: Clinical/Intervention Research Population Type: Military/Veterans Country/Region: Canada Palmer, Amy L., PhD Horizon Health, Fredericton, NB, Canada Nine Operational Stress Injury Clinics (OSICs) across Canada have been using the Client-‐Reported Outcomes Monitoring Information System (CROMIS) to regularly administer mental health questionnaires for 3 years. At each visit clients are asked to complete the 45-‐item version of the Outcome Questionnaire (OQ-‐45). The OSIC network has registered over 300 clients on this system, resulting in over 25,000 administrations of the OQ-‐45. Approximately 15,000 of these administrations were while clients were undergoing active treatment. Of these clients, 56% showed a significant improvement while 15% showed a significant deterioration. Although most clients show either a consistent improvement or deterioration, there is a subset who show an early change in the positive or negative direction and then go on to reverse their eventual outcome. This initial change appears very early in treatment and these clients tend to stay in treatment for the shortest amount of time. Furthermore, their frequency of treatment is at its highest when they show this early improvement, but then drops off near the end treatment when they show their eventual deterioration. Finally, it appears that those who show a steady improvement are also attending treatment sessions with the highest frequency than all other groups. This formative type of program evaluation will help inform evidence-‐based treatment plans.
Poster Board #14 Advances and Opportunities in Telemedicine-‐Enhanced Services: The Royal OSI Clinic Experience Keyword: Technology Population Type: Military/Veterans Country/Region: Canada Shlik, Jakov, MD, FRCPC, PhD; Hale, Shelley, BA, RSSW, RSW; Bhatla, Raj, MD, FRCPC, DABPN; Jansman-‐Hart, Erika, MSc The Royal, Ottawa, ON, Canada The Operational Stress Injury (OSI) Clinic at the Royal Ottawa Mental Health Centre (The Royal) is one of the Canadian OSI National Network Clinics funded by Veterans Affairs Canada and operated by The Royal. To date, the Royal OSI Clinic has provided specialized mental health care to over 1300 veteran and serving members of the Canadian Armed Forces and the Royal Canadian Mounted Police living with service-‐related OSIs, as well as their family members. The Royal OSI Clinic’s catchment area includes Eastern and Northeast Ontario, Western Quebec, and as far North as Nunavut. Telemedicine is a viable, and increasingly used, service delivery option aimed to increase access to services within this expansive region in a timely, flexible, and safe manner. All services, including assessment, individual therapy, consultation and follow-‐up are offered and delivered via Telemedicine. This presentation will highlight the growth of services delivered via Telemedicine, including a description of the types of services accessed and the interdisciplinary use of Telemedicine within the Royal OSI Clinic. The financial and clinical time savings of using Telemedicine in service delivery will also be discussed. Finally, client and clinician satisfaction with Telemedicine will be demonstrated through the results of a satisfaction survey administered to OSI Clinic clients and clinicians.
Poster Board #15 Cognitive Processing Therapy for PTSD: What Does the GRADEd Evidence Say? Keyword: Clinical/Intervention Research Population Type: Military/Veterans Country/Region: Canada Smith, Jeanette, MMus1; Kingsley, Lyn, MSW2; Garber, Bryan, MD2 1CADTH, Ottawa, ON, Canada 2Canadian Forces Health Services Group, Ottawa, ON, Canada The first priority in the Surgeon General’s 2013 five-‐year Mental Health Strategy for the Canadian Forces (CF) is the optimization of health outcomes for patients. The strategy points out that, while the Canadian military’s mental health system is strong, comprehensive, and evidence-‐based, it can be improved. To that end, the CF established a Mental Health Treatment Standardization Committee to develop policies and guidance on standardized, evidence-‐based care. A leading topic of interest to the Committee: Cognitive Processing Therapy (CPT), a “gold standard” intervention for post-‐traumatic stress disorder (PTSD). CADTH, a pan-‐Canadian agency responsible for providing healthcare decision-‐makers with objective evidence, conducted a systematic review of the clinical effectiveness of CPT for the CF. The review included Grading of Recommendations Assessment, Development and Evaluation (GRADE) tables, an approach that rates the strength of the evidence to aid in clinical practice guidance development. CADTH assisted with research translation, facilitating workshops at which the Committee learned how to apply GRADEd evidence to policy and guideline development. This poster outlines what the GRADEd evidence revealed about the effectiveness of CPT for PTSD, and the step-‐by-‐step processes used to translate and mobilize this research into standardized, evidence-‐based, front-‐line care.
Poster Board #16 Integrating Virtual Reality, Big Data Analytics and Tactile Garments for New Resilience Assessment and Development Approaches Keyword: Assessment/Diagnosis Population Type: Military/Veterans Country/Region: Canada McGregor, Carolyn, AM, PhD1; Bonnis, Brendan2; Stanfield, Brodie, BIT2; Stanfield, Michael2 1University of Ontario Institute of Technology, Ottawa, ON, Canada 2IF Tech Inventing Future Technology Inc., Oshawa, ON, Canada Introduction: Virtual reality is being used increasingly for tactical training. There is growing interest to structure tactical training so that core resilience skills are developed for dealing with traumatically stressful situations. Some current short comings are: 1) the training environment realism has been limited by only visual and auditory feedback; 2) physiological monitoring of trainees is limited to disconnected short burst monitoring and is not integrated with the virtual reality data; and 3) formalized resilience assessment analytics are not available in real-‐time. Methods: We present our innovative training platform for new approaches to resilience assessment and development that integrates virtual reality, big data analytics and a new form of haptic garment. The virtual reality component is ArmA 3, a first person shooter game. The Big Data analytics platform, Athena, built utilizing IBM InfoSphere streams provides an environment to synchronise virtual reality game data with the trainee’s physiological data. The haptic garment is ARAIG, a new multisensory garment containing muscle stimulation, vibration and localised sound enabling the trainee to feel what is happening during training. Conclusions: These new approaches to training can provide individualized information of the trainee’s stress impact and potentially risks for the onset of post-‐traumatic stress disorder.
Poster Board #17 Psychometric Validation of the English and French Versions of the Posttraumatic Stress Disorder Checklist for DSM-‐5 (PCL-‐5) Keyword: Assessment/Diagnosis Population Type: Adult Country/Region: Canada Houle-‐Johnson, Stephanie, BA (Hons)1; Ashbaugh, Andrea, PhD1; Herbert, Christophe, MA2; El-‐Hage, Wissam, MD, PhD3; Brunet, Alain, PhD2
1University of Ottawa, Ottawa, ON, Canada 2McGill University, Montreal, QC, Canada 3Université François Rabelais de Tours, Tours, France Objective: To assess the psychometric properties of a French version of the Posttraumatic Stress Disorder Checklist for DSM-‐5 (PCL-‐5), a self-‐report measure of posttraumatic stress disorder (PTSD) symptoms, and to further validate the existing English version of the measure. Method: Undergraduate students (n = 838 English, n = 262 French) completed the PCL-‐5 and other self-‐report measures of psychopathology online. Results: Total scores for both versions of the PCL-‐5 demonstrated excellent internal consistency (α = .95 English, α = .94 French, subscale α’s all > .79), good test-‐retest reliability (r = .91 English, r = .81 French), and strong convergent and divergent validity. Confirmatory factor analysis did not support the structural validity of the four-‐factor DSM-‐5 model. The seven-‐factor hybrid model best fit the data in each sample, only marginally surpassing the six-‐factor anhedonia model. Conclusion: The French PCL-‐5 exhibited the same psychometric quality as both the English version of the same measure and previous versions of the PCL. Thus clinicians serving French-‐speaking clients now have access to this highly used screening instrument. Additional research is needed to examine how the differentiation of the DSM-‐5 criterion groups may provide clinicians with additional information as to the symptomatology, diagnosis and treatment of PTSD.
Poster Board #18 Social Work on the Front-‐lines: Finding Protection in Workplace Social Support Keyword: Vicarious Trauma and Therapist Self Care Population Type: Mental Health Professionals Country/Region: Canada & USA Brend, Denise Michelle, BA, MSW, PhD Candidate McGill University, Montreal, QC, Canada A random sample of social workers in the U.S. were shown to suffer PTSD at a rate of 15% (Bride, 2007). Human service workers exposed to traumatic material through practice in the Intimate Partner Violence field have been found to have rates of PTSD between 21% (Choi, 2011b) and 47% (Slattery & Goodman, 2009). These prevalence rates are in contrast to the projected lifetime risk of PTSD in the U.S. of 8.7% (Kessler, Chiu, Demler, & Walters, 2005). In the empirical literature studying the impact of working with trauma in social work, workplace social support has been shown to be protective against traumatization for some workers (Boscarino, Figley, & Adams, 2004; Choi, 2011a; Ting, Jacobson, & Sanders, 2008). Upon careful examination of this scholarship, a clearly defined understanding of workplace social support amongst social workers dealing with the direct effects of exposure to traumatic material is lacking. My doctoral research asks how social workers, who are routinely exposed to trauma, specifically those working in the field of IPV, experience workplace social support. I hope to further understandings of workplace social support grounded in first-‐hand accounts with the aim of expanding or reformulating the construct and improving policy and practice. A comprehensive literature review and preliminary results will be presented.
Poster Board #19 Longitudinal Analysis of Quality of Life across the Trauma Spectrum Keyword: Culture/Diversity Population Type: Adult Country/Region: Canada Monson, Eva, PhD1; Brunet, Alain, PhD2; Caron, Jean, PhD2 1Concordia University, Montreal, QC, Canada 2McGill University, Montreal, QC, Canada This research aimed to provide an essential longitudinal examination of the effects of trauma and PTSD diagnosis on global as well as specific domains of quality of life in a representative Canadian sample.
Methods: Data was drawn from the initial two waves of Zone d’étude en épidémiologie sociale et psychiatrique du sud-ouest de Montréal (ZEPSOM), an epidemiological catchment area study based in southwest Montreal (N = 2,433 and 1,823). PTSD diagnosis, and global and subscale scores of quality of life outcomes were established by face-to-face structured interviews using standardized instruments. Outcomes were compared between three trauma/PTSD categories and healthy controls.
Results: Findings extended previous cross-sectional findings within the catchment area by demonstrating that the effects of current PTSD diagnosis on quality of life endure with time. Specifically, the negative impact of current diagnosis of PTSD on Wave 2 quality of life is expressed through its influence on Wave 1 quality of life. Subscale findings are discussed in depth.
Interpretation: Research needs to focus on understanding more than just global indices when it comes to the trauma spectrum. Additional research remains necessary to fully understand these complex relationships over time.
Poster Board #20 Silence in the Courtroom: A Review of Trauma-‐ and Stressor-‐related Symptoms in Jurors Keyword: Clinical/Intervention Research Population Type: Adult Country/Region: Canada & USA Lonergan, Michelle, MSc, CPhil; Leclerc, Marie-‐Eve, BA; Descamps, Melanie, PhD; Pigeon, Sereena, BA; Brunet, Alain, PhD Douglas Mental Health University Institute, Montreal, QC, Canada Background: Jury duty is an honorable, yet stressful, experience. Experts have argued that in some particularly complex cases, jurors may become vicariously traumatized and experience secondary traumatic stress symptoms. Understanding how jury duty affects mental health has significant socio-‐legal implications. Objectives: To summarize the literature examining trauma-‐related psychopathology stemming from jury duty. Method: A systematic search for articles was carried out using PsychInfo, ProQuest Dissertations, PubMed, Web of Science, Google Scholar, and HeinOnline. Inclusion criteria were: 1) reported original research; 2) reported a mental health outcome in former jurors. Data were extracted and summarized using a standard form. Results: 18 studies were included. Trauma-‐related pathology was found in as many as half of jurors, which persisted for weeks to months in a minority of individuals. Factors related to deliberations, trial complexity, and graphic evidence were identified as consistent sources of stress. Female gender and history of prior trauma was associated with post-‐trial pathology. Conclusion: A minority of jurors may be at increased risk for persistent secondary traumatic stress symptoms as a result of their service, especially in cases involving violent crime. However, methodological limitations found across studies highlight the need for caution in this interpretation and further empirical research in this area.
Poster Board #21 Recommendations for Providing Exemplary Care to Veterans and Military Families: Results from Focus Groups Conducted with Veterans, Military Families, and Social Work and Nursing Students Keyword: Clinical Practice Population Type: Military/Veterans Country/Region: USA Linn, Braden K., MCMP, MSW; Butler, Lisa D., PhD University at Buffalo, State University of New York, Buffalo, NY, USA Military service is associated with unique stressors and subsequent physical and mental health concerns for veterans. In the U. S., the national associations of social work and nursing have committed to providing quality care to veterans and their families. This poster presents a synthesis of two papers that examined the perceived needs and gaps from the perspective of female veterans and military families as well as training needs identified by social work and nursing students with experience providing care to veterans. We conducted six focus groups in total (n=45; two with male veterans, one each with female veterans, military family members, social work students, and nursing students) and analyzed the data using the qualitative content analysis process. Veterans and military families appreciated accessible and sustained care but noted that the system was overburdened, inflexible, and a challenge to navigate. Women veterans noted that they felt their contributions were devalued because of their gender. Students noted, among other things, that forming relationships with veterans was a challenge. Overall, data indicate that it is critical that healthcare providers and systems master a military/veteran cultural competence (including knowledge of characteristics of military life, and values to which service members subscribe), which may help improve outcomes for the population.
Poster Board #22 Religious Coping with Stress and Traditional Ways of Coping Keyword: Assessment/Diagnosis Population Type: Adult Country/Region: Middle East & North Africa Nassar Mohaisen, Khalaf, PhD United Arab Emirates University, Alain, UAE This paper is designed to construct a general coping with stress scale without including items related to religious coping; construct a religious coping scale; and to investigate if religious coping is an independent dimension of coping or loaded within the other coping strategies.. Three scales were utilized; the adapted Brief Arab Religious Coping Scale (BAECS); the Traditional Coping with Stress Scale and the General Health Questionnaire (GHQ). Data were collected from two samples selected from United Arab Emirates University students. The first sample was evaluated using the Brief Arab Religious Coping Scale (BARCS).The study assessed coping using a stress scale that comprised five factors, two of which were from the religious coping with stress scale.: The results support the importance of religious coping and emphasize the primary two methods of religious coping: (1) seeking support directly from God (Allah) through praying or practicing behaviors; and (2) looking for support from the religious environment and/or religious society. Both of these methods are similar because the first method has a social support element based on religious practicing behavior. However, the first method (seeking support directly from God) has an extra support because the person feels that he/she is anticipating extra rewards that will come from God (Allah). This wishful thinking by itself reduces stress and enables the person to cope or find a solution for his/her problem. Religious coping may not directly address the problems but may work as a “self-‐empowerment to cope with the current stress until adaptation takes place. The results showed that social-‐support can be used to predict general psychological health, specifically somatic and dysfunction. Social-‐support can decrease the consequences of stress through buffering the stress via social channels. The results did not show a significant correlation between the two factors of religious coping and any of the GHQ subscales, but this finding could be attributed to the nature of the sample. Because the sample was drawn from a normal population, they most likely have non-‐clinical problems and minor crises or catastrophes.
Poster Board #23 Attachment Styles and their Relationship to the Development of PTSD Keyword: Assessment/Diagnosis Population Type: Adult Country/Region: USA Chalet, Elias1; Meng, Xiangfei, PhD2; Brunet, Alain, PhD2 1McGill University, Montreal, QC, Canada 2Douglas Mental Health University Institute, Montreal, QC, Canada Background: Insecure attachment has been suggested as a predictor of increased susceptibility to developing post-‐traumatic stress disorder (PTSD). However, the work on investigating this relationship is scarce. Due to the important societal impact of PTSD, it is critical to have a better understanding of this relationship in a large, representative sample. Objectives: We aimed to 1) explore the relationship between adult attachment style and PTSD diagnosis, and 2) examine whether other covariates, i.e. comorbid mental disorders, could confound the relationship between attachment and PTSD. Methods: Data used in this study was from the National Comorbidity Survey Replication. We selected all participants (N = 5,647) with complete information on both attachment and PTSD. Descriptive analyses and multivariate logistic regressions were used to explore the relationship after adjusting for socio-‐demographic characteristics and other comorbid mental disorders. Results: The prevalence of PTSD was 10.5% in this survey. There were 61.3% of participants with secure attachment, and 31.0% with insecure attachment (26% insecure avoidant and 5% insecure anxious attachments). As expected, insecurely attached individuals were more likely to develop PTSD (odds ratio = 1.89, 95% CI 1.55-‐2.32), after controlling for socio-‐demographic characteristics and comorbid mental disorders.
Poster Board #24 The Theoretical ART of WAR vs Army Trash Talk UNFUCK Suggests Anti-‐War Propaganda and Tough Soldier Stance and Expectations, maybe a Required Changing Attitude towards PTSD Veterans’ Responsibilities Keyword: Clinical/Intervention Research Population Type: Military/Veterans Country/Region: Canada Kearns, Gertrude, ARCT Canadian WAR/MILITARY artist self-‐employed, Toronto, ON, Canada This is an Afghan War poster of Colonel Patrick Stogran who commanded a PPCLI battle group in Op Apollo in Kandahar, 2002, during which time the TARNAK FARM incident saw the death of 4 of his soldiers in a friendly fire incident. Later in 2007-‐10 he was Veteran’s Ombudsman, an unresolvedly frustrating job from which he was eventually fired. The portrait expresses that fine line between being a tough soldier, veterans’ advocate and PTSD sufferer. The general OSI (Operational Stress Injury) term includes the potent PTSD reference. The tan CADPAT stitched into Stogran’s forehead represents his total immersion in concerns for veterans; the blinker effect with the cutaway temperate green CADPAT, the Canadian uniform he wore as commander, suggests surviving with powerful and angry memories of his battlefield command. This image is currently in a series of 30 large format Afghan War posters (fine art Multiple Originals ltd ed) 2006-‐2015, about senior CF leadership in the Afghan War theatre. I attended an OSISS session in 2011 titled ‘PTSD: The Changing Attitude in the Treatment of PTSD in the CF’. A new attitude was emerging re a more soldierly responsibility about self and maintaining self-‐discipline eg. as in taking meds. PTSD maybe of necessity has evolved to mean Post Traumatic Stress Development. The PTSD poster delivers the above in a discordant, both POLITICAL and MEDICAL message. Potential for Audience Distress Only the word UNFUCK might shock a few people. However I have found that because it sidetracks into YOUR HEAD and THE SYSTEM, the purpose of the word use is clear and appreciated. The huge war print has been exhibited publicly for 3 ½ months at Fort York Visitor Centre, Toronto and will be shown in Calgary in a large show June-‐Nov 2016 at Founders’ Gallery, the Military Museums.
