2024
Prevalence, Correlates, and Burden of Subthreshold PTSD in US Veterans.
Fischer I, Na P, Harpaz-Rotem I, Marx B, Pietrzak R. Prevalence, Correlates, and Burden of Subthreshold PTSD in US Veterans. The Journal Of Clinical Psychiatry 2024, 85 PMID: 39480145, DOI: 10.4088/jcp.24m15465.Peer-Reviewed Original ResearchConceptsSubthreshold posttraumatic stress disorderPosttraumatic stress disorderPosttraumatic stress disorder symptom clustersLifetime psychiatric disordersUS veteransUS military veteransSymptom-related distressStress disorderPsychiatric disordersSymptom clustersTreating veteransCriterion AMilitary veteransTraumatic eventsCognitive functionWorking case definitionMental healthCriterion FFunctional impairmentVeteransNationally representative sampleFunctional correlatesDisordersElevated oddsGreater odds
2023
Racial and ethnic mental health disparities in U.S. Military Veterans: Results from the National Health and Resilience in Veterans Study
Merians A, Gross G, Spoont M, Bellamy C, Harpaz-Rotem I, Pietrzak R. Racial and ethnic mental health disparities in U.S. Military Veterans: Results from the National Health and Resilience in Veterans Study. Journal Of Psychiatric Research 2023, 161: 71-76. PMID: 36905842, DOI: 10.1016/j.jpsychires.2023.03.005.Peer-Reviewed Original ResearchMeSH KeywordsDepressive Disorder, MajorEthnicityFemaleHumansMental HealthMinority GroupsUnited StatesVeteransConceptsPsychiatric disordersWhite veteransNational HealthHispanic veteransMilitary veteransBlack veteransVeterans StudyLifetime major depressive disorderLifetime posttraumatic stress disorderHigh-risk subgroupsPopulation-based studyCurrent psychiatric disorderDrug use disordersMajor depressive disorderCommon psychiatric disordersEthnic differencesPopulation-based sampleCertain psychiatric disordersPopulation-based researchLower household incomeCurrent suicidal ideationPosttraumatic stress disorderRace/ethnicityU.S. military veteransMental health disparitiesClinical significance of novel 8-factor model of DSM-5 PTSD in national VA PTSD residential treatment data: Internally- v. externally-cued intrusions
Gross G, Spiller T, Duek O, Pietrzak R, Harpaz-Rotem I. Clinical significance of novel 8-factor model of DSM-5 PTSD in national VA PTSD residential treatment data: Internally- v. externally-cued intrusions. Journal Of Affective Disorders 2023, 328: 255-260. PMID: 36806596, DOI: 10.1016/j.jad.2023.02.046.Peer-Reviewed Original ResearchConceptsPosttraumatic stress disorderPTSD symptomsDysphoric arousalDSM-5 posttraumatic stress disorderDSM-5 PTSD symptomsDistinct underlying processesSelf-report measuresGeneralized anxiety symptomsSuperior model fitPhysical health functioningCore defining featuresStructural equation modelingWorse emotional functioningAnxious arousalSymptoms of depressionNegative affectIntrusion symptomsGreater avoidanceEmotional functioningStress disorderAnxiety symptomsPTSD ChecklistIntrusion factorCross-sectional designGeneralized anxietyUnderstanding veteran barriers to specialty outpatient PTSD clinical care
Rozek D, Steigerwald V, Baker S, Gross G, Maieritsch K, Hoff R, Harpaz-Rotem I, Smith N. Understanding veteran barriers to specialty outpatient PTSD clinical care. Journal Of Anxiety Disorders 2023, 95: 102675. PMID: 36854224, DOI: 10.1016/j.janxdis.2023.102675.Peer-Reviewed Original ResearchConceptsSpecialty outpatient clinicsPosttraumatic stress disorderOutpatient clinicPTSD specialty clinicClinical characteristicsMale sexPTSD symptom severitySpecialty clinicWhite raceClinical careClinical concernTreatment engagementSymptom severityStress disorderClinicGreater likelihoodVeteransSignificant minorityTreatmentImpact of demographicsMulti-faceted barriersCareFiscal year 2019DemographicsNational sample
2022
Treatment response trajectories in residential PTSD programs for veterans: A national cohort investigation
Grau P, Sripada R, Pietrzak R, Ganoczy D, Harpaz-Rotem I. Treatment response trajectories in residential PTSD programs for veterans: A national cohort investigation. Journal Of Anxiety Disorders 2022, 92: 102645. PMID: 36334317, DOI: 10.1016/j.janxdis.2022.102645.Peer-Reviewed Original ResearchMeSH KeywordsCohort StudiesHumansPsychotherapyResidential TreatmentStress Disorders, Post-TraumaticUnited StatesVeteransConceptsEvidence-based psychotherapiesThree-group trajectory modelTreatment outcomesTreatment responseTime of admissionPoor treatment outcomesPoor treatment responseNon-white raceResidential PTSD programsSubset of veteransPTSD treatment outcomesResidential PTSD treatmentPain severityCohort investigationPTSD careNational cohortFull cohortPTSD treatmentTherapeutic gainTreatment dropoutSymptom trajectoriesVeterans AffairsPTSD programTreatment response trajectoriesTreatment trajectoriesRisk for PTSD symptom worsening during new PTSD treatment episode in a nationally representative sample of treatment-seeking U.S. veterans with subthreshold PTSD
Gross GM, Pietrzak RH, Hoff RA, Katz IR, Harpaz-Rotem I. Risk for PTSD symptom worsening during new PTSD treatment episode in a nationally representative sample of treatment-seeking U.S. veterans with subthreshold PTSD. Journal Of Psychiatric Research 2022, 151: 304-310. PMID: 35526446, DOI: 10.1016/j.jpsychires.2022.04.040.Peer-Reviewed Original ResearchConceptsSymptom worseningRisk factorsSubthreshold PTSDPTSD symptom clustersSymptom clustersPTSD symptomsHealth care utilizationPTSD specialty clinicPoor treatment outcomesUnited States veteransBinary logistic regressionAdjusted analysisCare utilizationTreatment episodesRepresentative sampleSpecialty clinicSignificant symptomsTreatment outcomesSignificant worseningStates veteransSubthreshold symptomsEligible veteransNew episodesOutcome assessmentDiagnostic threshold
2021
Mental Health Care Use Among U.S. Military Veterans: Results From the 2019–2020 National Health and Resilience in Veterans Study
Kline AC, Panza KE, Nichter B, Tsai J, Harpaz-Rotem I, Norman SB, Pietrzak RH. Mental Health Care Use Among U.S. Military Veterans: Results From the 2019–2020 National Health and Resilience in Veterans Study. Psychiatric Services 2021, 73: 628-635. PMID: 34775790, DOI: 10.1176/appi.ps.202100112.Peer-Reviewed Original ResearchMeSH KeywordsHumansMental HealthPatient Acceptance of Health CarePrevalenceStress Disorders, Post-TraumaticUnited StatesVeteransConceptsMental health careMental health care utilizationHealth care utilizationSubstance use disordersCare utilizationU.S. military veteransMental dysfunctionNational HealthUse disordersHealth careVeterans StudyMental health care usePrimary health care providersHealth care useMilitary veteransHealth care providersUse of careHierarchical logistic regressionCare usePosttraumatic stress disorder (PTSD) symptom severitySleep disordersCare providersDisorder symptom severityU.S. veteransNeed factorsRacial Disparities in Clinical Outcomes of Veterans Affairs Residential PTSD Treatment Between Black and White Veterans
Gross GM, Smith N, Holliday R, Rozek DC, Hoff R, Harpaz-Rotem I. Racial Disparities in Clinical Outcomes of Veterans Affairs Residential PTSD Treatment Between Black and White Veterans. Psychiatric Services 2021, 73: 126-132. PMID: 34369806, DOI: 10.1176/appi.ps.202000783.Peer-Reviewed Original ResearchConceptsResidential Rehabilitation Treatment ProgramPosttraumatic stress disorderWhite veteransRacial disparitiesClinical outcomesBlack veteransSymptoms of PTSDPoor clinical outcomeRehabilitation treatment programRecurrence 4 monthsPoor treatment outcomesMental health treatmentPublic health issuePTSD symptom reductionResidential PTSD treatmentMental health researchTreatment outcomesPrevalence ratesSymptom reductionHealth treatmentHealth outcomesPTSD treatmentDemographic dataSymptom changeTreatment programMindfulness as a Mediator Between Trauma Exposure and Mental Health Outcomes: Results From the National Health and Resilience in Veterans Study
Kachadourian LK, Harpaz-Rotem I, Tsai J, Southwick S, Pietrzak RH. Mindfulness as a Mediator Between Trauma Exposure and Mental Health Outcomes: Results From the National Health and Resilience in Veterans Study. Psychological Trauma Theory Research Practice And Policy 2021, 13: 223-230. PMID: 33475404, PMCID: PMC8500672, DOI: 10.1037/tra0000995.Peer-Reviewed Original ResearchConceptsPosttraumatic stress disorderAlcohol use disorderLifetime traumaTrauma-related negative affectPresent momentVeterans StudyU.S. veteransTrauma-related experiencesSuicidal ideationTraumatic life eventsLifetime trauma burdenMental health outcomesQuality of lifeMental health problemsTrauma remindersNegative affectMindful attentionTrauma exposurePTSD symptomsMental health issuesTraumatic eventsCumulative traumaStress disorderNoncombat veteransLife eventsIn Their Own Words: Veteran Experiences with Evidence-Based Treatments for PTSD in the Veterans Health Administration
Doran JM, O’Shea M, Harpaz-Rotem I. In Their Own Words: Veteran Experiences with Evidence-Based Treatments for PTSD in the Veterans Health Administration. Psychiatric Quarterly 2021, 92: 961-980. PMID: 33409926, DOI: 10.1007/s11126-020-09861-z.Peer-Reviewed Original ResearchConceptsVeterans Affairs Healthcare SystemEvidence-based psychotherapiesVeterans Health AdministrationEvidence-based treatmentsOutpatient PTSD clinicVeterans' experiencesTreatment completionTreatment outcomesPTSD clinicTreatment protocolHealth AdministrationHealthcare systemTreatmentPTSDOutcomesVeteransVeterans' perceptionsMultiple barriersTreatment dropAssessment toolPresent study
2020
Early discontinuation of pharmacotherapy in U.S. veterans diagnosed with PTSD and the role of psychotherapy
Duek O, Pietrzak RH, Petrakis I, Hoff R, Harpaz-Rotem I. Early discontinuation of pharmacotherapy in U.S. veterans diagnosed with PTSD and the role of psychotherapy. Journal Of Psychiatric Research 2020, 132: 167-173. PMID: 33126010, DOI: 10.1016/j.jpsychires.2020.10.005.Peer-Reviewed Original ResearchConceptsPosttraumatic stress disorderRisk factorsEarly discontinuationMedication discontinuationPsychotropic medicationsPoor medication adherenceSimilar risk factorsStrong risk factorDeterminants of discontinuationKey risk factorsRole of psychotherapySingle medicationMedication adherenceMedication treatmentPsychiatric comorbidityAntipsychotic medicationPatient educationDiscontinuationOlder veteransMedicationsAdjunctive psychotherapyYounger veteransEarly interventionU.S. veteransVA treatmentDissociative Symptoms in a Nationally Representative Sample of Trauma-Exposed U.S. Military Veterans: Prevalence, Comorbidities, and Suicidality
Herzog S, Fogle BM, Harpaz-Rotem I, Tsai J, Pietrzak RH. Dissociative Symptoms in a Nationally Representative Sample of Trauma-Exposed U.S. Military Veterans: Prevalence, Comorbidities, and Suicidality. Journal Of Affective Disorders 2020, 272: 138-145. PMID: 32379605, DOI: 10.1016/j.jad.2020.03.177.Peer-Reviewed Original ResearchMeSH KeywordsCross-Sectional StudiesHumansPrevalenceQuality of LifeStress Disorders, Post-TraumaticSuicideUnited StatesVeteransConceptsQuality of lifeU.S. veteransDissociative symptomsPsychiatric comorbidityGreater likelihoodPoor mental health outcomesCurrent suicidal ideationNon-veteran populationsMental health outcomesPTSD diagnostic statusDirectionality of findingsLevel of functioningU.S. military veteransNationally Representative SampleClinical correlatesTrauma-exposed populationsRepresentative sampleRisk factorsSevere dissociative symptomsLifetime suicide attempt historySuicide attempt historyPsychiatric characteristicsComorbiditiesHealth outcomesSuicidal ideation
2019
Comparing the effectiveness of VA residential PTSD treatment for veterans who do and do not report a history of MST: A national investigation
Holliday R, Smith NB, Holder N, Gross GM, Monteith LL, Maguen S, Hoff RA, Harpaz-Rotem I. Comparing the effectiveness of VA residential PTSD treatment for veterans who do and do not report a history of MST: A national investigation. Journal Of Psychiatric Research 2019, 122: 42-47. PMID: 31923834, DOI: 10.1016/j.jpsychires.2019.12.012.Peer-Reviewed Original ResearchConceptsResidential Rehabilitation Treatment ProgramMilitary sexual traumaPosttraumatic stress disorderPTSD symptomsMST survivorsPTSD treatmentVeterans AffairsProgram completionRehabilitation treatment programSymptom severity scoresEffects of MSTExperience of MSTHistory of MSTPTSD symptom severity scoresPost-treatment gainsRace/ethnicityImpact of MSTSevere PTSD symptomsResidential PTSD treatmentAdjunctive servicesPsychiatric comorbiditySeverity scoreHealth sequelaeIncrease riskWomen veteransPosttraumatic stress symptom courses in U.S. military veterans: A seven-year, nationally representative, prospective cohort study
Mota NP, Cook JM, Smith NB, Tsai J, Harpaz-Rotem I, Krystal JH, Southwick SM, Pietrzak RH. Posttraumatic stress symptom courses in U.S. military veterans: A seven-year, nationally representative, prospective cohort study. Journal Of Psychiatric Research 2019, 119: 23-31. PMID: 31546045, DOI: 10.1016/j.jpsychires.2019.09.005.Peer-Reviewed Original ResearchConceptsPTSD symptom courseSymptom courseU.S. military veteransLatent growth mixture modelingProspective cohort studyMilitary veteransLifetime psychiatric historyMental health treatmentPhysical health difficultiesLifetime traumatic eventsTrauma-exposed veteransProtective psychosocial characteristicsCohort studyProspective cohortModerate symptomsModifiable correlatesNational HealthSymptomatic coursePsychiatric historyHealth treatmentU.S. veteransVeterans StudyPsychosocial characteristicsHigher symptomsHealth difficultiesApolipoprotein E gene polymorphism, posttraumatic stress disorder, and cognitive function in older U.S. veterans: Results from the National Health and Resilience in Veterans Study
Averill LA, Abdallah CG, Levey DF, Han S, Harpaz‐Rotem I, Kranzler HR, Southwick SM, Krystal JH, Gelernter J, Pietrzak RH. Apolipoprotein E gene polymorphism, posttraumatic stress disorder, and cognitive function in older U.S. veterans: Results from the National Health and Resilience in Veterans Study. Depression And Anxiety 2019, 36: 834-845. PMID: 31385647, DOI: 10.1002/da.22912.Peer-Reviewed Original ResearchConceptsPosttraumatic stress disorderExecutive functionCognitive functioningStress disorderΕ4 carrier statusΕ4 carriersVeterans StudyCognitive dysfunctionAttention/concentrationGreater cognitive difficultiesLower cognitive functioningOlder U.S. veteransΕ4 allele carrier statusPerseverative errorsCognitive difficultiesReplication sampleCarrier statusCognitive functionImportance of assessingNational HealthCognitive declinePredictive effectApolipoprotein E gene polymorphismE gene polymorphismΕ4 allele carriersRandomized Controlled Trial of Imagery Rehearsal for Posttraumatic Nightmares in Combat Veterans.
Harb GC, Cook JM, Phelps AJ, Gehrman PR, Forbes D, Localio R, Harpaz-Rotem I, Gur RC, Ross RJ. Randomized Controlled Trial of Imagery Rehearsal for Posttraumatic Nightmares in Combat Veterans. Journal Of Clinical Sleep Medicine 2019, 15: 757-767. PMID: 31053215, PMCID: PMC6510682, DOI: 10.5664/jcsm.7770.Peer-Reviewed Original ResearchConceptsCognitive behavioral therapyPosttraumatic stress disorderNightmare Distress QuestionnaireNightmare Frequency QuestionnaireBehavioral therapySevere posttraumatic stress disorderUnited States veteransOperation Enduring Freedom/Operation Iraqi Freedom veteransImagery rehearsalOperation Iraqi Freedom veteransSubgroups of veteransIraqi Freedom veteransFrequency questionnaireControlled TrialsPrimary outcomeLikelihood ratio chi-squareStates veteransDistress QuestionnaireStress disorderChi-squareRecurrent nightmaresConfidence intervalsMilitary veteransVeteransCombat veteransPosttraumatic Stress Disorder Symptoms, Functioning, and Suicidal Ideation in US Military Veterans: A Symptomics Approach.
Kachadourian LK, Harpaz-Rotem I, Tsai J, Southwick SM, Pietrzak RH. Posttraumatic Stress Disorder Symptoms, Functioning, and Suicidal Ideation in US Military Veterans: A Symptomics Approach. The Primary Care Companion For CNS Disorders 2019, 21 PMID: 31050228, DOI: 10.4088/pcc.18m02402.Peer-Reviewed Original ResearchMeSH KeywordsHumansQuality of LifeStress Disorders, Post-TraumaticSuicidal IdeationUnited StatesVeteransConceptsPosttraumatic stress disorderPositive affectMeasures of functioningCognitive functioningNegative thoughtsPTSD symptomsConcentration difficultiesSleep difficultiesTreatment of PTSDUS military veteransSeverity of PTSDPosttraumatic stress disorder (PTSD) symptomsSuicidal ideationDSM-5 PTSD symptomsMilitary veteransLifetime trauma burdenIrritability/aggressionHyperarousal symptomsDisorder symptomsStress disorderPsychogenic amnesiaPTSD diagnosisQuality of lifeMental functioningMost varianceAdoption by VA Residential Programs of Two Evidence-Based Psychotherapies for PTSD: Effect on Patient Outcomes
Cook JM, Schnurr PP, Simiola V, Thompson R, Hoff R, Harpaz-Rotem I. Adoption by VA Residential Programs of Two Evidence-Based Psychotherapies for PTSD: Effect on Patient Outcomes. Psychiatric Services 2019, 70: 553-560. PMID: 30966944, PMCID: PMC6690369, DOI: 10.1176/appi.ps.201800338.Peer-Reviewed Original ResearchMeSH KeywordsAdultCognitive Behavioral TherapyComorbidityDepressionFemaleHumansImplosive TherapyMaleMiddle AgedOutcome and Process Assessment, Health CarePsychological DistressResidential TreatmentStress Disorders, Post-TraumaticSubstance-Related DisordersUnited StatesUnited States Department of Veterans AffairsVeteransConceptsPosttraumatic stress disorderCognitive processing therapyEvidence-based psychotherapiesVeterans Affairs residential treatment programsAdoption groupsAlcohol useResidential treatment programSample of veteransGroup × time interactionPTSD symptomsStress disorderGroup formatProgram intakeResidential programs× time interactionDepression symptomsTreatment programPsychotherapyBasis of responsesPatient outcomesTime interactionProgram dischargeQualitative interviewsMonths postdischargeVeteransExamining the nonresponse phenomenon: Factors associated with treatment response in a national sample of veterans undergoing residential PTSD treatment
Sripada RK, Blow FC, Rauch SAM, Ganoczy D, Hoff R, Harpaz-Rotem I, Bohnert KM. Examining the nonresponse phenomenon: Factors associated with treatment response in a national sample of veterans undergoing residential PTSD treatment. Journal Of Anxiety Disorders 2019, 63: 18-25. PMID: 30785007, DOI: 10.1016/j.janxdis.2019.02.001.Peer-Reviewed Original ResearchConceptsResidential PTSD treatmentPTSD treatmentPTSD symptom changeTreatment-seeking veteransContextual protective factorsPhysical health resourcesNational sampleLarge national samplePsychological stateIndividual-level factorsLife eventsMultilevel modelingSymptom changeTreatment entryPoor treatment responseProtective factorsWorse treatment responsePersonality disorderPTSDBetter treatment responseTreatment responseCurrent studyGreater pain severityVeteransTheory of resources
2018
Protective correlates of suicidality among veterans with histories of posttraumatic stress disorder and major depressive disorder: Results from the National Health and Resilience in Veterans Study
Kachadourian LK, Tsai J, Harpaz-Rotem I, Southwick SM, Pietrzak RH. Protective correlates of suicidality among veterans with histories of posttraumatic stress disorder and major depressive disorder: Results from the National Health and Resilience in Veterans Study. Journal Of Affective Disorders 2018, 246: 731-737. PMID: 30616162, DOI: 10.1016/j.jad.2018.12.058.Peer-Reviewed Original ResearchMeSH KeywordsAdultCross-Sectional StudiesDepressive Disorder, MajorFemaleHumansLogistic ModelsMaleMiddle AgedMultivariate AnalysisOptimismPrevalenceProtective FactorsResilience, PsychologicalRisk FactorsStress Disorders, Post-TraumaticSuicidal IdeationSuicideSuicide, AttemptedSurveys and QuestionnairesUnited StatesVeteransYoung AdultConceptsMajor depressive disorderPosttraumatic stress disorderProtective correlatesSuicidal ideationSuicide attemptsProtective factorsDepressive disorderNational HealthVeterans StudyMultivariable logistic regression analysisSuicidal behaviorStress disorderHistory of PTSDLogistic regression analysisSample of veteransAssessment of suicidalityLifetime suicide attemptsRisk factorsHigh-risk sampleTreatment approachesU.S. veteransWeb-based surveyCross-sectional natureSuicide riskSelf-report items