Prazosin, like many of our most effective treatments for PTSD, seems to be significantly more effective for some individuals than others. We have hypothesized that this is because prazosin works to compensate for increased noradrenergic signaling, which is a primary driver of symptoms in some, but not all, individuals with PTSD. If we could identify individuals where increased or inappropriate noradrenergic signaling is driving PTSD symptoms, it would not only help us match individuals with treatments that will work well for them, but would also help us identify new treatment options.
The PREDICT study is a 5-year clinical trial designed to (1) test whether clinically-relevant biomarkers can predict in advance who is most likely to benefit from prazosin for PTSD; and (2) test a working model of how pre-synaptic and post-synaptic changes in the regulation of noradrenaline may combine together to produce the symptoms of PTSD.
LGBT Veterans have faced a long history of stigma, discrimination, and exclusionary policies that were intended to exclude them from military service. Despite recent shifts in policy and increased staff trainings, existing evidence suggests that this group is at high risk for health disparities, particularly with respect to mental health and health risk behaviors. While informative, the research to date has been limited in several respects: cross-sectional designs, collapsing LGBT subgroups, severe lack of data on some subgroups, problems with identifying a comparison group, and lack of data on risk and protective factors and care experiences. This prospective cohort study will fill these gaps, recruiting and conducting surveys online with 1,600 Veterans to identify health disparities, test a conceptual model of prospective risk and protective factors, and assess VA utilization, barriers to care, and treatment preferences. Data from this study will inform future intervention efforts to achieve health equity for LGBT Veterans.
This pilot study will leverage Veteran expertise to inform user-centered design improvements and will pilot the effectiveness of a computerized intervention targeting anxiety sensitivity among this patient population.
This pragmatic trial will study a DVD- and coaching-based weight loss intervention among Veterans, relative to VA usual care.
This Hybrid Type 1 Trial will test the effectiveness of MOVE!+UP, a behavioral weight management intervention tailored to address PTSD-based weight loss barriers. The trial will compare MOVE!+UP to VA’s standard weight loss program on weight and PTSD symptom changes. The study also will identify implementation barriers and facilitators to help understand effectiveness findings and inform future implementation.
Alzheimer’s disease and related dementias (ADRD) affect more than 10% of
adults who are age 65 and older, but the toll of ADRD is most devastating among
older African Americans. COVID-19 widened these disparities; in addition to
being more susceptible to COVID-19 infection and fatalities, older African
Americans are more likely to experience digital and technical inequities. This puts
them at risk for the development/worsening of depression, anxiety, cognitive
impairment and sleep disturbances.
This project will evaluate several traditional and mobile health tools for
remotely monitoring the effects of social isolation on cognition and mental
health in older African Americans with baseline cognitive complaints. By
testing three different strategies, we will identify the most effective,
feasible and subject-preferred approach to collecting cognitive and mental
health data which will help address brain health disparities.
More than a million people in the US sustain a mild traumatic brain injury
(mTBI) every year, and many report difficulties with attention, memory and
other thinking abilities months and even years following their injury. A promising
treatment option is cognitive rehabilitation, but the full-length (20 hours),
in-person intervention is not feasible for many people due to time and
financial constraints.
This study will evaluate a brief (6 hours), virtual cognitive rehabilitation
intervention developed for individuals with persisting cognitive difficulties
after mTBI. We will evaluate several outcomes related to improving patient care
including treatment satisfaction, feasibility of this intervention when using
telehealth and preliminary effectiveness. The proposed treatment aims to
provide the same clinical impact of traditional cognitive rehabilitation while
reducing burden and increasing access.
We will analyze Veterans Health Administration electronic medical record data to determine the effects of medical marijuana laws (MML) and recreational marijuana laws (RML) on cannabis (use and cannabis use disorder); opioids (prescriptions, fatal and non-fatal overdoses, opioid use disorders); and psychotropic medication prescriptions, providing important information on MML and RML effects in VA patients and in others with similar vulnerability factors to researchers, policy makers, health professionals and the public.
To evaluate the use of an existing selective suicide prevention intervention, Preventing Addiction Related Suicide (PARS), for use with Veterans by: 1) adapting and tailoring content to Veteran populations and 2) conducting an open trial within a VA substance use disorder intensive outpatient program.
The Stepped Care for Opioid Use Disorder Train-the-Trainer (SCOUTT) program is a national VA initiative which aims to improve access to treatment medications for opioid use disorder (OUD) in primary care, pain management, and mental health clinics. The Seattle CESATE is conducting ongoing evaluations of SCOUTT to understand providers’ perspectives on the initiative and the outcomes for Veteran participants. Project aims also include to: assess patient retention in and compliance with SCOUTT, assess changes in number of waivered and prescribing providers, retention in and compliance with stepped care, and identify barriers and facilitators to implementing, sustaining and spreading OUD care.
