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General Mental Health

Kristine Sirevåg, Victoria Williamson, Viviana Wuthrich, David Berle / Kenneth Laidlaw (chair) Speaker

Chair: Kenneth Laidlaw

16:00 Physical exercise augmented cognitive behaviour therapy for older adults      
          with
generalised anxiety disorder (PEXACOG): Study protocol and feasibility
          results from a
randomised controlled trial
          Kristine Sirevåg, Silje Haukenes Stavestrand, Inger Hilde Nordhus, Ståle Pallesen, 
          Åsa Hammar, Anne Halmøy, Helene Hjelmervik, Anders Hovland, University of Bergen
         
Trond Sjøbø, Trygve Bruun Endal, Solli DPS, Norway
          Hans M. Nordahl, Norwegian University of Science and Technology  
          Egil W. Martinsen, University of Oslo  
          Eva Andersson, The Swedish School of Sport and Health Sciences
         
Jan Mohlman, William Paterson University, USA
          Julian F. Thayer, Ohio State University, USA        
        

16:15 The prevalence of mental health disorders in elderly military veterans: A
          meta-
analysis and systematic review
          Victoria Williamson, Sharon Stevelink, Karla Greenberg, Neil Greenberg,
          King's College London

16:30 The impact of military service later in life: A qualitative study
          Victoria Williamson, Sharon Stevelink, Karla Greenberg, Neil Greenberg,
          King's College London

16:45 The relationship between Perceived Injustice, Anger and Posttraumatic Stress
            Disorder (PTSD): Implications for treatment.
            David Berle, University of Technology Sydney & University of New South Wales
            Vladan Starcevic, Dominic Hilbrink, Ryan McMullan, Zachary Steel

 


17:00 Discussion


Abstracts:


1) Physical exercise augmented cognitive behaviour therapy for older adults with generalised anxiety disorder (PEXACOG): Study protocol and feasibility results from a randomised controlled trial

Kristine Sirevåg, University of Bergen, Faculty of Psychology, Bergen, Norway; Solli DPS, Norway; Silje Haukenes Stavestrand, University of Bergen, Faculty of Psychology, Bergen, Norway; Solli DPS, Norway; Inger Hilde Nordhus, University of Bergen, Faculty of Psychology, Bergen, Norway; University of Oslo, Faculty of Medicine, Oslo, Norway;Ståle Pallesen, University of Bergen, Faculty of Psychology, Bergen, Norway;Trond Sjøbø, Solli DPS, Norway; Trygve Bruun Endal , Solli DPS, Norway; Hans M. Nordahl, Norwegian University of Science and Technology, Department of Mental Health, Trondheim, Norway; St.Olavs Hospital HF, Nidaros DPS, Trondheim,Norway; Karsten Specht, University of Bergen, Faculty of Psychology, Bergen, Norway; Åsa Hammar, University of Bergen, Faculty of Psychology, Bergen, Norway; Anne Halmøy , K.G. Jebsen Centre for Neuropsychiatric Disorders, University of Bergen, Faculty of Medicine, Bergen, Norway; Kronstad DPS/ Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Egil W. Martinsen, University of Oslo, Faculty of Medicine, Oslo, Norway; Oslo University Hospital, Division of Mental Health and Addiction,Oslo, Norway; Eva Andersson, The Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden; Helene Hjelmervik, University of Bergen, Faculty of Psychology, Bergen, Norway; Jan Mohlman, William Paterson University, Department of Psychology, New Jersey, USA; Julian F. Thayer, Ohio State University, Department of Psychology, Ohio, USA; Anders Hovland, University of Bergen, Faculty of Psychology, Bergen, Norway; Solli DPS, Norway;

Background:
Generalised anxiety disorder (GAD) is prevalent among older adults. These patients exhibit impaired response to cognitive behaviour therapy (CBT), and physical exercise has been recommended as a potential add-on intervention to improve efficacy. The current study is a randomised clinical trial that will compare CBT augmented with physical exercise, or CBT combined with attention placebo, and the current study assessing the feasibility of testing procedures and the experimental combined treatment measures.
Methods:
4 participants were included in the feasibility study, and feasibility was assessed trough completion and attendance rates of testing and treatment sessions. Primary outcome measures were remission as assessed by an independent clinical rater using the Anxiety Disorders Interview Schedule for DSM-IV, and by symptom reduction on Penn State Worry Questionnaire. Manipulation check was assessed by physical tests of change in aerobic capacity and strength. Participants were measured on clinical, biological, physiological and neuropsychological tests at pre-, interim and post-treatment.
Results:
Completed treatment protocol for the RCT will be presented. 3 of 4 participants completed the full protocol including testing and the experimental augmented treatment. Participants completed 100% and 80% of CBT and physical exercise content, respectively. The three completers had large improvements on primary outcome and on manipulation checks.
Conclusion:
The testing procedures and experimental augmented treatment appear to be feasible. The preliminary findings indicate that this combined intervention can be efficacious.

2) The prevalence of mental health disorders in elderly military veterans: A meta-analysis and systematic review
Victoria Williamson; Sharon Stevelink; Karla Greenberg; Neil Greenberg, King's Centre for Military Health Research, King's College London, London UK

Objectives:
Older veterans may be vulnerable to mental health problems. Meta-analytic and systematic review methods sought to determine the prevalence rate of mental health disorders in older military veterans (≥65 years).
Methods:
Eleven studies were eligible and meta-analyses of veteran depression, substance abuse, post-traumatic stress disorder (PTSD), anxiety, dementia, bipolar disorder and schizophrenia were conducted.
Results:
Although conducted exclusively with US veterans, higher prevalence rates of substance (5.7%) and alcohol use disorders (5.4%) in older veterans were found compared to geriatric community populations. However, the prevalence of other mental health disorders, including PTSD and depression, in older veterans did not differ substantially from community estimates.
Conclusions:
The rates of disorder prevalence observed indicates a need for continued awareness of mental health difficulties in older veterans. In future, studies with non-US military samples using longitudinal design are required to further understand the prevalence of mental health disorders in geriatric veterans.  

 

3) The impact of military service later in life: A qualitative study
Victoria Williamson; Sharon Stevelink; Karla Greenberg, Neil Greenberg , King's Centre for Military Health Research, King's College London, London UK

The UK ex-service community is predominantly elderly, with 64% over the age of 65. Some research indicates that Armed Forces (AF) service may have implications for wellbeing later in life, although it remains unclear whether or not these health needs are a result of military service or a feature of ageing. This research aims to conduct a comprehensive, qualitative investigation of the impact of service on wellbeing.
Method:
35 older veterans and 25 non-veterans (≥ 65 years) were recruited. Measures of psychological adjustment were completed and the experience and impact of military/non-military occupations on wellbeing were assessed by semi-structured interviews. The symptom measures were used to describe the sample and interview data was analysed using Thematic Analysis.
Results:
Two key themes emerged. First, while military service was often a positive experience, several veteran participants reported ongoing mental health difficulties, including anxiety, depression and post-traumatic stress disorder (PTSD), as a result of military service and combat exposure. Nonetheless, both veteran and non-veteran participants reported psychological difficulties due to retirement from the workforce. Second, better physical health later in life was reported by veterans and attributed to the high volume of exercise undertaken in the AF. However, veterans also reported more physical health problems (e.g. hearing loss) due to a lack of protective equipment in the AF.
Conclusions:
These findings provide insight into the experiences and needs of older AF veterans and highlight the need for continued awareness of mental health difficulties in this age group.


4) The relationship between Perceived Injustice, Anger and Posttraumatic Stress Disorder (PTSD): Implications for treatment.
David Berle, Discipline of Clinical Psychology, University of Technology Sydney; School of Psychiatry, University of New South Wales; Vladan Starcevic, Discipline of Psychiatry, Sydney Medical School – Nepean, University of Sydney; Dominic Hilbrink, St John of God Health Care, Richmond Hospital; Ryan McMullan, Discipline of Clinical Psychology, University of Technology Sydney; Zachary Steel, School of Psychiatry, University of New South Wales; St John of God Health Care, Richmond Hospital

Introduction:
While the prominence of anger in many individuals with Posttraumatic Stress Disorder (PTSD) is well-recognised, the beliefs and cognitive appraisals associated with this have received little research attention. Perceived injustice (PI) surrounding: i) the trauma itself, or, ii) the response of communities and institutions to the events surrounding one’s trauma may contribute to both problematic anger and PTSD symptoms. We aimed to determine the relationships between perceived injustice and PTSD symptoms.
Methods:
We administered the 12-item Injustice Experiences Questionnaire of Sullivan et al., (2009) alongside measures of PTSD, anger and depression to an unselected online sample (N=261, 47.5% female, median age=34; Study 1) and to 49 individuals with PTSD (16.3% female, median age=46) attending a 4-week residential PTSD treatment program (Study 2).
Results:
In Study 1, latent class analysis suggested two distinct classes (AIC=7020.06; BIC=7365.82; Entropy=0.97): high and low perceived injustice. Regression analyses indicated that membership in the high perceived injustice group was associated with elevated levels of PTSD symptoms after controlling for trait anger, anxiety and depressive symptoms (95% CI: 6.74, 12.31). In Study 2, changes in perceived injustice, but not anger, predicted changes in PTSD symptoms across treatment and 3-month follow-up (β = 0.22, p < 0.05) after controlling for changes in depression and anxiety symptoms respectively.
Conclusion:
These findings highlight the clinical importance of perceived injustice as an independent contributor to PTSD symptoms and the potential benefit of addressing perceived injustice in treatment.