Charles W Hoge

Walter Reed Army Institute of Research, Silver Spring, Maryland, United States

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Publications (170)1535.1 Total impact

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    ABSTRACT: Background: Inconsistent findings between studies of gender differences in mental health outcomes in military samples have left open questions of differential prevalence in posttraumatic stress disorder (PTSD) among all United States Army soldiers and in differential psychosocial and comorbid risk and protective factor profiles and their association with receipt of treatment. Methods: This study assesses the prevalence and risk factors of screening positive for PTSD for men and women based on two large, population-based Army samples obtained as part of the 2005 and 2008 U.S. Department of Defense Surveys of Health Related Behaviors among Active Duty Military Personnel. Results: The study showed that overall rates of PTSD, as measured by several cutoffs of the PTSD Checklist, are similar between active duty men and women, with rates increasing in both men and women between the two study time points. Depression and problem alcohol use were strongly associated with a positive PTSD screen in both genders, and combat exposure was significantly associated with a positive PTSD screen in men. Overall, active duty men and women who met criteria for PTSD were equally likely to receive mental health counseling or treatment, though gender differences in treatment receipt varied by age, race, social support (presence of spouse at duty station), history of sexual abuse, illness, depression, alcohol use, and combat exposure. Conclusions: The study demonstrates that the prevalence of PTSD as well as the overall utilization of mental health services is similar for active duty men compared with women. However, there are significant gender differences in predictors of positive PTSD screens and receipt of PTSD treatment.
    Journal of Women's Health 11/2015; DOI:10.1089/jwh.2014.5078 · 2.05 Impact Factor
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    ABSTRACT: The cumulative strain of 14 years of war on service members, veterans, and their families, together with continuing global threats and the unique stresses of military service, are likely to be felt for years to come. Scientific as well as political factors have influenced how the military has addressed the mental health needs resulting from these wars. Two important differences between mental health care delivered during the Iraq and Afghanistan wars and previous wars are the degree to which research has directly informed care and the consolidated management of services. The U.S. Army Medical Command implemented programmatic changes to ensure delivery of high-quality standardized mental health services, including centralized workload management; consolidation of psychiatry, psychology, psychiatric nursing, and social work services under integrated behavioral health departments; creation of satellite mental health clinics embedded within brigade work areas; incorporation of mental health providers into primary care; routine mental health screening throughout soldiers' careers; standardization of clinical outcome measures; and improved services for family members. This transformation has been accompanied by reduction in psychiatric hospitalizations and improved continuity of care. Challenges remain, however, including continued underutilization of services by those most in need, problems with treatment of substance use disorders, overuse of opioid medications, concerns with the structure of care for chronic postdeployment (including postconcussion) symptoms, and ongoing questions concerning the causes of historically high suicide rates, efficacy of resilience training initiatives, and research priorities. It is critical to ensure that remaining gaps are addressed and that knowledge gained during these wars is retained and further evolved.
    American Journal of Psychiatry 11/2015; DOI:10.1176/appi.ajp.2015.15040553 · 12.30 Impact Factor
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    Maria M Steenkamp · Brett T Litz · Charles W Hoge · Charles R Marmar ·
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    ABSTRACT: Posttraumatic stress disorder (PTSD) is a disabling psychiatric disorder common among military personnel and veterans. First-line psychotherapies most often recommended for PTSD consist mainly of "trauma-focused" psychotherapies that involve focusing on details of the trauma or associated cognitive and emotional effects. To examine the effectiveness of psychotherapies for PTSD in military and veteran populations. PubMed, PsycINFO, and PILOTS were searched for randomized clinical trials (RCTs) of individual and group psychotherapies for PTSD in military personnel and veterans, published from January 1980 to March 1, 2015. We also searched reference lists of articles, selected reviews, and meta-analyses. Of 891 publications initially identified, 36 were included. Two trauma-focused therapies, cognitive processing therapy (CPT) and prolonged exposure, have been the most frequently studied psychotherapies for military-related PTSD. Five RCTs of CPT (that included 481 patients) and 4 RCTs of prolonged exposure (that included 402 patients) met inclusion criteria. Focusing on intent-to-treat outcomes, within-group posttreatment effect sizes for CPT and prolonged exposure were large (Cohen d range, 0.78-1.10). CPT and prolonged exposure also outperformed waitlist and treatment-as-usual control conditions. Forty-nine percent to 70% of participants receiving CPT and prolonged exposure attained clinically meaningful symptom improvement (defined as a 10- to 12-point decrease in interviewer-assessed or self-reported symptoms). However, mean posttreatment scores for CPT and prolonged exposure remained at or above clinical criteria for PTSD, and approximately two-thirds of patients receiving CPT or prolonged exposure retained their PTSD diagnosis after treatment (range, 60%-72%). CPT and prolonged exposure were marginally superior compared with non-trauma-focused psychotherapy comparison conditions. In military and veteran populations, trials of the first-line trauma-focused interventions CPT and prolonged exposure have shown clinically meaningful improvements for many patients with PTSD. However, nonresponse rates have been high, many patients continue to have symptoms, and trauma-focused interventions show marginally superior results compared with active control conditions. There is a need for improvement in existing PTSD treatments and for development and testing of novel evidence-based treatments, both trauma-focused and non-trauma-focused.
    JAMA The Journal of the American Medical Association 08/2015; 314(5):489-500. DOI:10.1001/jama.2015.8370 · 35.29 Impact Factor
  • Charles W Hoge · Colleen B Rye ·

    The Lancet Psychiatry 08/2015; 2(8):668-9. DOI:10.1016/S2215-0366(15)00226-6
  • Charles W Hoge ·

    JAMA Psychiatry 07/2015; 72(9). DOI:10.1001/jamapsychiatry.2015.1066 · 12.01 Impact Factor
  • Charles W Hoge · Wayne B Jonas ·

    JAMA Internal Medicine 07/2015; 175(7):1241. DOI:10.1001/jamainternmed.2015.1051 · 13.12 Impact Factor
  • Christopher G Ivany · Charles W Hoge ·

    JAMA Psychiatry 03/2015; 72(3):296. DOI:10.1001/jamapsychiatry.2014.2474 · 12.01 Impact Factor
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    Charles W Hoge · Christopher H Warner ·
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    ABSTRACT: Having an accurate estimate of the prevalence of posttraumatic stress disorder (PTSD) is critically important for projecting health care needs for veterans now and in coming years. However, prevalence studies in US veterans have produced widely varying estimates, due in large part to lack of representative samples of the entire population, including those who deployed to war zones as well as the large proportion with service not involving war zone deployment. The article by Wisco et al in this issue of the Journal of Clinical Psychiatry provides the most comprehensive estimate to date of PTSD prevalence in a national veteran sample, as well as other important findings on trauma exposure, risk factors, and comorbidities useful to clinicians, researchers, and health care administrators. © Copyright 2014 Physicians Postgraduate Press, Inc.
    The Journal of Clinical Psychiatry 12/2014; 75(12):e1439-41. DOI:10.4088/JCP.14com09616 · 5.50 Impact Factor
  • Phillip J Quartana · Joshua E Wilk · Thomas J Balkin · Charles W Hoge ·
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    ABSTRACT: To characterize the indirect associations of combat exposure with post-deployment physical symptoms through shared associations with post-traumatic stress disorder (PTSD), depression and insomnia symptoms. Surveys were administered to a sample of U.S. soldiers (N=587) three months after a 15-month deployment to Iraq. A multiple indirect effects model was used to characterize direct and indirect associations between combat exposure and physical symptoms. Despite a zero-order correlation between combat exposure and physical symptoms, the multiple indirect effects analysis did not provide evidence of a direct association between these variables. Evidence for a significant indirect association of combat exposure and physical symptoms was observed through PTSD, depression, and insomnia symptoms. In fact, 92% of the total effect of combat exposure on physical symptoms scores was indirect. These findings were evident even after adjusting for the physical injury and relevant demographics. This is the first empirical study to suggest that PTSD, depression and insomnia collectively and independently contribute to the association between combat exposure and post-deployment physical symptoms. Limitations, future research directions, and potential policy implications are discussed. Published by Elsevier Inc.
    Journal of Psychosomatic Research 11/2014; 78(5). DOI:10.1016/j.jpsychores.2014.11.017 · 2.74 Impact Factor
  • Charles W Hoge · Wayne B Jonas ·

    JAMA Internal Medicine 11/2014; 175(1). DOI:10.1001/jamainternmed.2014.3375 · 13.12 Impact Factor
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    ABSTRACT: Objective: The goal of this study was to identify factors affecting timely, quality mental health and substance abuse treatment for service members and characterize patients at the greatest risk of having problems accessing treatment. Methods: An electronic survey was emailed to 2,310 Army mental healthcare providers. After providers with undeliverable emails and who self-reported not being behavioral health providers were excluded, 543 (26%) of the remaining 2,104 providers responded. This represented approximately a quarter of all Army behavioral health providers at the time of the survey. Of these 543 providers, 399 (73%) reported treating at least one service member during their last typical work week and provided clinically detailed data on one systematically selected service member. Results: The majority of the clinicians reported being able to spend sufficient time with patients (91.8%) and schedule encounters to meet patients' needs (82.4%). The clinicians also identified services where treatment access was more limited and patient subgroups with an unmet need for additional clinical care or services. Specifically, a significant proportion of clinicians reported that they were "never, rarely, or sometimes" able to provide or arrange for mental health treatment for the sampled service member's children (52.0%), provide or arrange for marriage and family therapy (40.1%), coordinate care effectively with primary care (36.7%), provide or arrange for care/case management (28.3%), or provide or arrange for substance abuse treatment (24.9%). Patients with more severe symptoms and diagnostic and clinical complexity had higher rates of problems with treatment access. Conclusions: Our findings highlight opportunities to improve access to timely, quality treatment for service members and their families.
    Journal of Psychiatric Practice 11/2014; 20(6):448-59. DOI:10.1097/01.pra.0000456593.58739.61 · 1.34 Impact Factor
  • R.K. Herrell · J.E. Wilk · C.W. Hoge ·

  • Charles W Hoge · Carl A Castro ·

    JAMA The Journal of the American Medical Association 10/2014; 312(16):1685-6. DOI:10.1001/jama.2014.6670 · 35.29 Impact Factor
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    ABSTRACT: The definition of post-traumatic stress disorder (PTSD) underwent substantial changes in the 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). How this will affect estimates of prevalence, whether clinical utility has been improved, and how many individuals who meet symptom criteria according to the previous definition will not meet new criteria is unknown. Updated screening instruments, including the PTSD checklist (PCL), have not been compared with previously validated methods through head-to-head comparisons.
    The Lancet Psychiatry 09/2014; 1(4). DOI:10.1016/S2215-0366(14)70235-4
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    Daniel J Lee · Christopher H Warner · Charles W Hoge ·
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    ABSTRACT: As the longest war in American history draws to a close, an unprecedented number of service members and veterans are seeking care for health challenges related to transitioning home and to civilian life. Congressionally mandated screening for mental health concerns in the Department of Defense (DoD), as well as screening efforts Veterans Affairs (VA) facilities, has been established with the goal of decreasing stigma and ensuring service members and veterans with depression and posttraumatic stress disorder (PTSD) receive needed treatment. Both the DoD and VA have also developed integrated behavioral health in primary-care based initiatives, which emphasize PTSD screening, treatment, and care coordination. This article discusses the rationale for population-level deployment-related mental health screening, recent changes to screening frequency, commonly used screening instruments such as the primary care PTSD screen (PC-PTSD), PTSD checklist (PCL), and Davidson Trauma Scale (DTS); as well as the strengths/limitations of each, and recommended cut-off scores based on expected PTSD prevalence.
    Current Psychiatry Reports 09/2014; 16(9):467. DOI:10.1007/s11920-014-0467-7 · 3.24 Impact Factor
  • Charles W Hoge · Christopher H Warner · Carl A Castro ·

    JAMA Psychiatry 08/2014; 71(8):965-966. DOI:10.1001/jamapsychiatry.2014.689 · 12.01 Impact Factor
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    ABSTRACT: Measurement of functional impairment is a priority for the military and other professional work groups routinely exposed to stressful traumatic events as part of their occupation. Standard measures of impairment used in general or chronically ill populations contain many items not suitable for these populations, and include mental health symptoms items that are not true measures of functioning. We created a new, 14-item scale-the Walter Reed Functional Impairment Scale-to assess functioning in 4 domains (physical, occupational, social, and personal). We asked 3,380 soldiers how much difficulty they currently have in each of the 4 domains on a 5-point scale. Behaviorally based psychosocial and occupational performance measures and general health questions were used to validate the scale. The utility of the scale was assessed against clinical measures of psychopathology and physical health (depression, posttraumatic stress disorder [PTSD], general health, generalized physical symptoms). We utilized Cronbach's alpha, item response theory, and the score test for trend to establish consistency of items and the validity of the scale. The scale exhibited excellent reliability (Cronbach's α= 0.92) and validity. The individual items and quartiles of sum scores were strongly correlated with negative occupational and social performance, and the utility of the scale was demonstrated by strong correlations with depression, PTSD, and high levels of generalized physical symptoms. This scale exhibits excellent psychometric properties in this sample of U.S. soldiers and, pending future research, is likely to have utility for other healthy occupational groups. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Psychological Services 08/2014; 11(3):254-64. DOI:10.1037/a0037347 · 1.08 Impact Factor
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    ABSTRACT: Objectives: We characterized trends in mental health services utilization and stigma over the course of the Afghanistan and Iraq wars among active-component US soldiers. Methods: We evaluated trends in mental health services utilization and stigma using US Army data from the Health-Related Behavior (HRB) surveys from 2002, 2005, and 2008 (n = 12,835) and the Land Combat Study (LCS) surveys administered to soldiers annually from 2003 to 2009 and again in 2011 (n = 22,627). Results: HRB and LCS data suggested increased mental health services utilization and decreased stigma in US soldiers between 2002 and 2011. These trends were evident in soldiers with and without posttraumatic stress disorder (PTSD), major depressive disorder (MDD), or PTSD and MDD. Despite the improving trends, more than half of soldiers with mental health problems did not report seeking care. Conclusions: Mental health services utilization increased and stigma decreased over the course of the wars in Iraq and Afghanistan. Although promising, these findings indicate that a significant proportion of US soldiers meeting criteria for PTSD or MDD do not utilize mental health services, and stigma remains a pervasive problem requiring further attention.
    American Journal of Public Health 07/2014; 104(9):e1-e9. DOI:10.2105/AJPH.2014.301971 · 4.55 Impact Factor

  • JAMA Internal Medicine 06/2014; 174(8). DOI:10.1001/jamainternmed.2014.2726 · 13.12 Impact Factor

Publication Stats

10k Citations
1,535.10 Total Impact Points


  • 1996-2015
    • Walter Reed Army Institute of Research
      • Center for Military Psychiatry and Neuroscience Research
      Silver Spring, Maryland, United States
  • 2002-2010
    • Uniformed Services University of the Health Sciences
      • Department of Psychiatry
      Bethesda, MD, United States
    • Walter Reed National Military Medical Center
      Washington, Washington, D.C., United States
  • 2009
    • George Washington University
      Washington, Washington, D.C., United States
  • 1992-1996
    • Armed Forces Research Institute of Medical Sciences
      • Department of Enteric Diseases
      Siayuthia, Bangkok, Thailand
  • 1990
    • University of Maryland, Baltimore
      • Division of Geographic Medicine
      Baltimore, Maryland, United States