Robert A Rosenheck

Yale-New Haven Hospital, New Haven, Connecticut, United States

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Publications (612)2331.66 Total impact

  • Jack Tsai, Robert A Rosenheck
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    ABSTRACT: Homelessness among US veterans has been a focus of research for over 3 decades. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this is the first systematic review to summarize research on risk factors for homelessness among US veterans and to evaluate the evidence for these risk factors. Thirty-one studies published from 1987 to 2014 were divided into 3 categories: more rigorous studies, less rigorous studies, and studies comparing homeless veterans with homeless nonveterans. The strongest and most consistent risk factors were substance use disorders and mental illness, followed by low income and other income-related factors. There was some evidence that social isolation, adverse childhood experiences, and past incarceration were also important risk factors. Veterans, especially those who served since the advent of the all-volunteer force, were at greater risk for homelessness than other adults. Homeless veterans were generally older, better educated, and more likely to be male, married/have been married, and to have health insurance coverage than other homeless adults. More studies simultaneously addressing premilitary, military, and postmilitary risk factors for veteran homelessness are needed. This review identifies substance use disorders, mental illness, and low income as targets for policies and programs in efforts to end homelessness among veterans. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.
    Epidemiologic Reviews 01/2015; · 7.33 Impact Factor
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    ABSTRACT: Lack of insight into illness has long been recognized as a central characteristic of schizophrenia. Although recent theories have emphasized neurocognitive dysfunction as a central impairment in schizophrenia it remains unclear whether the lack of insight in schizophrenia is more strongly associated with measures of symptom severity or neuropsychological dysfunction. Seventy-four consecutive inpatients with chronic schizophrenia were enrolled in a cross-sectional study. All subjects were assessed with the Positive and Negative Syndrome Scale (PANSS, five-factor model), the Insight and Treatment Attitudes Questionnaire (ITAQ), and the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB). Bivariate association and multiple linear regression analyses were used to investigate the relationship between insight and both symptoms and neurocognition. On bivariate correlation, the positive, negative, disorganized and excited factors of the PANSS showed a negative correlation with insight but there was no significant association between the MCCB total score or any component subscale and insight. Multiple regression analysis showed that positive symptoms, disorganized/concrete symptoms and excited symptoms contributed to awareness of mental illness; positive and disorganized/concrete symptoms were significant contributors to awareness of the need for treatment; but there were no significant associations with the MCCB. Insight in this sample of patients with chronic schizophrenia is significantly associated with clinical symptoms but not with neuropsychological functioning. Copyright © 2014 Elsevier B.V. All rights reserved.
    Schizophrenia Research 12/2014; · 4.43 Impact Factor
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    ABSTRACT: Three of the most common trauma-related mental disorders—posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD)—are highly comorbid and share common transdiagnostic symptom dimensions of threat (i.e., fear) and loss (i.e., dysphoria) symptomatology. However, empirical evaluation of the dimensional structure of component aspects of these disorders is lacking.Methods Using structured clinical interview data from U.S. military veterans with chronic military-related PTSD, we evaluated the transdiagnostic dimensional structure of PTSD, MDD, and GAD symptoms. We then examined the relationship between the best-fitting transdiagnostic model of these symptoms, and measures of physical and mental functioning, and life satisfaction and well-being.ResultsExploratory factor analysis revealed that a 3-factor transdiagnostic model comprised of loss (i.e., dysphoria), threat (i.e., anxious arousal, re-experiencing, and avoidance symptoms), and somatic anxiety (i.e., physiological manifestations of anxiety) symptoms provided the best representation of trauma-related PTSD, MDD, and GAD symptoms. Somatic anxiety symptoms were independently associated with physical functioning, while loss symptoms were independently associated with mental functioning and life satisfaction and well-being.LimitationsEvaluation of study aims in a relatively homogeneous sample of veterans with chronic, military-related PTSD.Conclusions Results of this study suggest that a 3-factor transdiagnostic model best characterizes the dimensional structure of PTSD, MDD, and GAD symptoms in military veterans with chronic military-related PTSD. This model evidenced external validity in demonstrating differential associations with measures of physical and mental functioning, and life satisfaction and well-being. Results provide support for emerging contemporary models of psychopathology, which emphasize transdiagnostic and dimensional conceptualizations of mental disorders. Such models may have utility in understanding the functional status of trauma survivors.
    Journal of Affective Disorders 10/2014; · 3.71 Impact Factor
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    ABSTRACT: The fact that individuals with schizophrenia have high cardiovascular morbidity and mortality is well established. However, risk status and moderators or mediators in the earliest stages of illness are less clear.
    JAMA Psychiatry 10/2014; · 12.01 Impact Factor
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    Denis Rybin, Gheorghe Doros, Robert Rosenheck, Robert Lew
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    ABSTRACT: Missing data pose a serious challenge to the integrity of randomized clinical trials, especially of treatments for prolonged illnesses such as schizophrenia, in which long-term impact assessment is of great importance, but the follow-up rates are often no more than 50%. Sensitivity analysis using Bayesian modeling for missing data offers a systematic approach to assessing the sensitivity of the inferences made on the basis of observed data. This paper uses data from an 18-month study of veterans with schizophrenia to demonstrate this approach. Data were obtained from a randomized clinical trial involving 369 patients diagnosed with schizophrenia that compared long-acting injectable risperidone with a psychiatrist's choice of oral treatment. Bayesian analysis utilizing a pattern-mixture modeling approach was used to validate the reported results by detecting bias due to non-random patterns of missing data. The analysis was applied to several outcomes including standard measures of schizophrenia symptoms, quality of life, alcohol use, and global mental status. The original study results for several measures were confirmed against a wide range of patterns of non-random missingness. Robustness of the conclusions was assessed using sensitivity parameters. The missing data in the trial did not likely threaten the validity of previously reported results. Copyright © 2014 John Wiley & Sons, Ltd.
    Pharmaceutical Statistics 10/2014; · 0.99 Impact Factor
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    ABSTRACT: The 30-item Positive and Negative Syndrome Scale (PANSS) is used worldwide in the assessment of symptom severity in schizophrenia. The present study uses confirmatory factor analysis (CFA) to compare three different factorial models and to evaluate the best-fitting representation of schizophrenia symptom structure on the (PANSS) across four samples of patients diagnosed with schizophrenia from the U.S. (the CATIE schizophrenia trial), São Paulo, Brazil, and from Beijing and Changsha, China. We examine the goodness of fit of several previously proposed models. The traditional trifactorial model for the PANSS and two 5-factor models were evaluated using absolute and incremental indices. Single group CFA found that the 5-factor model proposed by NIMH researchers on the basis of an extensive literature review demonstrates the best fit in each of the 4 samples. This model used 20 of the 30 PANSS item grouped into five factors: positive, negative, disorganized, excited, and depressed symptoms. Subgroups defined by age, gender, nationality, hospitalization status, and severity of illness also did not differ in overall symptom structure as assessed by several standard indices. Our findings suggest that five factor NIMH model showed the best representation among all four samples from different countries and potentially contrasting cultures.
    Psychiatry Research 10/2014; · 2.68 Impact Factor
  • Eric Hermes, Alan Fontana, Robert Rosenheck
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    ABSTRACT: Although 40 years have passed since the Vietnam War, demand for treatment of posttraumatic stress disorder (PTSD) among veterans from this conflict has increased steadily. This study investigates the extent to which two factors, delayed onset or awareness of PTSD symptoms, may influence this demand. Using data from two studies of Vietnam Veterans in outpatient (n = 353) and inpatient (n = 721) PTSD treatment, this analysis examines retrospective perceptions of the time of symptom onset and awareness of the connection between symptoms and war-zone stress. The association of these two constructs with pre-war, wartime, and post-war clinical variables are analyzed. Delay in onset of symptoms was reported by 50 % of outpatients and 35 % of inpatients. Delay in awareness was reported by 60 % of outpatients and 65 % of inpatients. Onset of symptoms occurred within six years and onset of awareness within 20 years in 90 % of individuals. Reported delays in onset and awareness were associated with more numerous negative life events after military service and before the onset of symptoms. Findings suggest that providers, administrators, and policy makers should be aware of the potential for protracted treatment demand among veterans from current conflicts, due in part by delay in onset and awareness of symptoms.
    The Psychiatric quarterly. 08/2014;
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    ABSTRACT: This study's objective was to determine the efficacy of benefits counseling in a clinical trial. There has been concern that disability payments for psychiatric disorders reduce incentives for employment and rehabilitation. Benefits counseling, with education about opportunities to work and the financial implications of work on receipt of disability benefits, may counter these disincentives.
    Psychiatric services (Washington, D.C.) 08/2014; · 2.81 Impact Factor
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    ABSTRACT: Background Many studies have shown that more severe symptoms and poorer insight are associated with poor treatment compliance in schizophrenia while severe symptoms may result in higher medication dosages. Since pharmacologic side effects that may accompany greater medication compliance and higher medication dosage, the relationship between symptoms, insight and side effects deserves study. Methods In this study, 174 inpatients diagnosed with schizophrenia were assessed during the week before hospital discharge from a large psychiatric hospital in Guangzhou, China. Symptoms were measured by the Positive and Negative Syndrome Scale for Schizophrenia (PANSS). Insight was assessed by the Insight and Treatment Attitudes Questionnaire (ITAQ). Pharmacologic side effects were assessed by the Treatment Emergent Symptoms Scale (TESS). Bivariate and multivariate regression models were used to examine the relationship of symptoms, insight and the interaction between the two, to the severity of side effects. Results As expected, the PANSS total score was significantly associated with poorer ITAQ scores and with more severe side effects, and on multivariate analysis both higher PANSS and lower ITAQ scores were associated with more severe side effects. Stepwise multiple linear regression analysis showed that the model with the PANSS total score alone explained 3.4% of the variance in side-effect scores, while adding the ITAQ increased the explained variance to 11.8%. Analysis of the interaction of symptoms and insight showed that patients with both more severe symptoms and high insight had the most severe side effects (B = .006, p = .008, R2 = 15.4%). Conclusion More severe symptoms and greater insight among schizophrenic inpatients were both significantly if modestly associated with more severe pharmacologic side effects, the former presumably because of the need for higher doses of medication and the latter because of greater medication compliance. In addition, patients with both more severe symptoms and greater insight were even more prone to pharmacologic side effects than others presumably reflecting higher doses and higher compliance. Clinicians treating highly symptomatic but insightful patients, i.e. those most likely to need and to adhere to prescribed medications, may need to be especially vigilant about side effects.
    Comprehensive Psychiatry 07/2014; · 2.26 Impact Factor
  • Dolores Vojvoda, Elina Stefanovics, Robert A Rosenheck
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    ABSTRACT: Recent military conflicts have generated significantly more demand for treatment of posttraumatic stress disorder (PTSD) as well as concerns about the adverse effects of stigma associated with specialty mental health care. This study examined the extent to which veterans diagnosed as having PTSD received treatment exclusively in primary care settings.
    Psychiatric services (Washington, D.C.) 07/2014; · 2.81 Impact Factor
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    ABSTRACT: The authors surveyed attitudes towards mental illness among Nigerian medical personnel at three different levels of training and experience: medical students who had not completed their psychiatry rotation, medical students who had competed their psychiatry rotation, and graduate physicians.
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    ABSTRACT: Most psychiatric inpatients in China are involuntarily admitted by their families, resulting in relatively long admissions and relatively low readmission rates. However, this pattern may change after implementation of China's new national mental health law (promulgated in 2013), which restricts involuntary psychiatric admissions to the small proportion of mentally ill individuals who are a danger to self or others.
    Shanghai archives of psychiatry. 06/2014; 26(3):138-148.
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    ABSTRACT: Long-acting injectable antipsychotics are used to reduce medication nonadherence and relapse in schizophrenia-spectrum disorders. The relative effectiveness of long-acting injectable versions of second-generation and older antipsychotics has not been assessed.
    JAMA The Journal of the American Medical Association 05/2014; 311(19):1978-87. · 29.98 Impact Factor
  • Eric D.A. Hermes, Robert A. Rosenheck
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    ABSTRACT: Objective There is little information on diagnostic rates or treatment correlates of insomnia in real-world practice. Study objectives were to identify the 1-year prevalence, psychotropic pharmacotherapy, and clinical correlates of diagnosed insomnia, nationally in the Veterans Health Administration (VHA). Method The study utilized national administrative data on all individuals receiving VHA care in 2010. Receipt of insomnia in addition to comorbid diagnoses were identified using relevant ICD-9 diagnostic codes. The adjusted mean number of psychotropic prescription fills and comorbid conditions associated with insomnia were identified using bivariate and multivariable regression models. Results Of the 5,531,379 individuals receiving VHA care in 2010, 190,378 (3.4%) received an insomnia diagnosis. Controlling for clinical characteristics, the presence of an insomnia diagnosis was associated with an average of four additional psychotropic prescription fills over the year. Among demographic characteristics, deployment to recent conflicts in Iraq/Afghanistan (Adjusted Odds Ratio [AOR]=1.62) displayed the strongest independent association, while age, unexpectedly, did not display any association with insomnia. Among diagnostic variables, anxiety disorders other than posttraumatic stress (AOR=2.12) and depressive disorders other than major depression (AOR=2.05) displayed the strongest independent associations with insomnia. Conclusion The diagnosis of insomnia is associated with the filling of more psychotropic prescriptions, net of the presence of psychiatric comorbidity in national VHA administrative data, and the prevalence of diagnosed insomnia is lower than that found in systematic surveys of the general population, a potential impediment to optimal treatment.
    Sleep Medicine 05/2014; · 3.10 Impact Factor
  • Ellen L. Edens, Jack Tsai, Robert A. Rosenheck
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    ABSTRACT: Background Recent research suggests low-demand housing (ie, not contingent upon abstinence) is effective in helping people exit homelessness, even among recent active substance users. Whether active users of illicit drugs and stimulants have worse housing outcomes than primary alcohol users, however, is unknown.MethodsA total of 149 participants in a multisite supportive housing program who reported high levels of active substance use at program entry were classified as either (1) predominantly “Alcohol Use” (>10 of 30 days alcohol, but not >10 days of drug use) or (2) “Illicit Drug Use” (>10 of 30 days any single illicit drug use with or without alcohol use). Sub-analysis of the “Illicit Drug Use” group compared participants reporting high levels of “Stimulant Use” (>10 days cocaine, crack, or methamphetamine use) to those with high levels of “Non-stimulant Use” (>10 days marijuana or other non-stimulant drug use). Group differences in housing outcomes were examined with mixed model multivariate regression.ResultsDuring 24-month follow-up, days housed increased dramatically for both the “Alcohol Use” and the “Illicit Drug Use” groups without significant differences. Sub-analysis of illicit drug users showed stimulant use was associated with fewer days housed (p = .01) and more days homeless (p = .02) over time.Conclusions Among illicit drug users, stimulant users have somewhat less successful housing outcomes than other active drug and alcohol users, though both groups maintained substantial housing improvements in low-demand housing. (Am J Addict 2014;23:243–248)†
    American Journal on Addictions 05/2014; 23(3). · 1.74 Impact Factor
  • Eric D A Hermes, Rani Hoff, Robert A Rosenheck
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    ABSTRACT: OBJECTIVE Correlates of the sharp increase in Vietnam era veterans diagnosed as having posttraumatic stress disorder (PTSD) in the Veterans Health Administration (VHA) were examined. METHODS Analyses compared receipt of a PTSD diagnosis and service-connected disability compensation in 2004-2006 and 2007-2009. RESULTS Among Vietnam era veterans, the percentage with a PTSD diagnosis in 2007-2009 was 22.2% higher than the percentage with PTSD in 2004-2006; the percentage without PTSD was 6.2% higher than in 2004-2006. Of those with PTSD in 2007-2009, 22.6% were previous VHA service users newly diagnosed ("conversions"); only 12.8% were entirely new to VHA ("recents"). Rates of disability compensation among recents and conversions were almost two and three times higher, respectively, than among those without PTSD. CONCLUSIONS The increase in Vietnam era veterans with PTSD is associated with more frequent "conversion" to PTSD among previous VHA users and receipt of disability compensation.
    Psychiatric services (Washington, D.C.) 04/2014; · 2.81 Impact Factor
  • Jack Tsai, Robert A Rosenheck, Vincent Kane
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    ABSTRACT: As more women serve in the U.S. military, the proportion of females among homeless veterans is increasing. The current study compares the individual characteristics and 1-year outcomes of homeless female and male veterans in the Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program nationally. Administrative data on 43,853 veterans (10.69% females; 89.31% males) referred to HUD-VASH were analyzed for gender differences at baseline and over a 1-year period. Homeless female veterans were younger, had shorter homeless and incarceration histories, and were less likely to have substance use disorders than men. However, despite being less likely to report combat exposure, female veterans were more likely to have posttraumatic stress disorder. Homeless female veterans were also much more likely to have dependent children with them and to plan to live with family members in supported housing. Once admitted to HUD-VASH, there were no gender differences in attrition or main housing outcomes. Case managers were faster to admit female veterans to the program, reported better working alliances, and provided more services related to employment and income than male veterans. These findings suggest homeless female veterans may have certain strengths, including being younger, less involved in the criminal justice system, and more adept at relating to professional and natural supports; but special attention to noncombat trauma and family-oriented services may be needed. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Psychological Services 04/2014; · 1.08 Impact Factor
  • Jack Tsai, Anne Klee, Robert A Rosenheck, Laurie Harkness
    Psychiatric services (Washington, D.C.) 04/2014; 65(4):564-5. · 2.81 Impact Factor
  • Meaghan Leddy, Elina Stefanovics, Robert Rosenheck
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    ABSTRACT: Supported employment, specifically individual placement and support (IPS), improves competitive employment (CE) rates for individuals with serious mental illness, but has not shown greater improvement in non-vocational outcomes than other rehabilitation approaches. The Department of Veterans Affairs offers two types of vocational services, IPS and transitional work experience (TWE), but no study has compared the effectiveness of these approaches. This secondary analysis of data from a study of homeless veterans compared 6 mo improvement in diverse outcomes for five employment patterns: never worked, worked only in TWE, worked in TWE followed by CE, worked in CE without IPS, and worked in CE with IPS referral. Veterans referred to IPS were more likely to be competitively employed. Those who worked in CE (whether following TWE or with or without IPS referral) showed the greatest increase in days worked, employment income, and total income and the greatest decrease in public support income when compared with those who worked only in TWE or not at all. Veterans in TWE showed the greatest increase in residential treatment days, but there were no other differences in non-vocational outcomes between groups. There are multiple paths to CE, but few differences in non-vocational outcomes across employment experiences.
    The Journal of Rehabilitation Research and Development 04/2014; 51(1):161-75. · 1.69 Impact Factor
  • Jack Tsai, Elina Stefanovics, Robert A Rosenheck
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    ABSTRACT: Objective: To examine the frequency and predictors of group attendance in a new group-intensive peer support (GIPS) model of case management for the Veterans Affairs supported housing program. Methods: Administrative data and group attendance records from 1 GIPS program were analyzed using bivariate and regression analyses. Results: Of 295 clients, 42% attended at least 1 group and attended an average of 3 groups per month. There were no significant differences in any demographic, psychosocial, or clinical characteristics at baseline between group attenders and nongroup attenders. However, among group attenders, those who entered the program with more days homeless in the past month and more mental health symptoms attended groups more frequently. Conclusions and Implications for Practice: These results provide support for group-based models of care in supported housing and suggest those with more extensive housing and mental health problems may be more receptive to attending groups. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Psychiatric Rehabilitation Journal 03/2014; · 0.75 Impact Factor

Publication Stats

16k Citations
2,331.66 Total Impact Points


  • 1998–2014
    • Yale-New Haven Hospital
      • Department of Laboratory Medicine
      New Haven, Connecticut, United States
  • 1992–2014
    • Yale University
      • Department of Psychiatry
      New Haven, Connecticut, United States
  • 2013
    • Robert Wood Johnson Foundation
      Princeton, New Jersey, United States
    • Boston University
      Boston, Massachusetts, United States
    • Neuropsychiatric Research Institute
      Fargo, North Dakota, United States
  • 2012
    • Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
      • Departamento de Psiquiatria
      São Paulo, Estado de Sao Paulo, Brazil
  • 2009–2012
    • Penn State Hershey Medical Center and Penn State College of Medicine
      • Public Health Sciences
      Hershey, Pennsylvania, United States
    • Rogers Memorial Hospital
      Oconomowoc, Wisconsin, United States
  • 2011
    • University of South Florida
      Tampa, Florida, United States
    • The University of Calgary
      • Department of Psychiatry
      Calgary, Alberta, Canada
    • Hospital of the University of Pennsylvania
      • Department of Psychiatry
      Philadelphia, Pennsylvania, United States
    • University of São Paulo
      • Institute of Psychiatry
      San Paulo, São Paulo, Brazil
  • 2010–2011
    • University of Massachusetts Boston
      • Gerontology Institute
      Boston, MA, United States
  • 2008–2011
    • The Ohio State University
      • College of Social Work
      Columbus, OH, United States
    • University of California, San Diego
      • Department of Psychiatry
      San Diego, CA, United States
    • Johns Hopkins Medicine
      • Welch Center for Prevention, Epidemiology and Clinical Research
      Baltimore, MD, United States
    • University of California, Los Angeles
      • Department of Psychiatry and Biobehavioural Sciences
      Los Angeles, CA, United States
    • Medical University of South Carolina
      Charleston, South Carolina, United States
  • 2005–2011
    • Columbia University
      • • Department of Psychiatry
      • • Department of Economics
      New York City, New York, United States
  • 2000–2011
    • U.S. Department of Veterans Affairs
      • Mental Illness Research, Education and Clinical Centers - MIRECC
      Washington, Washington, D.C., United States
  • 2005–2010
    • West Haven University
      West Haven, Connecticut, United States
  • 2004–2009
    • University of Wisconsin, Madison
      • Center for Tobacco Research and Intervention
      Madison, MS, United States
    • National Center for PTSD
      Washington, Washington, D.C., United States
    • Edward Hines, Jr. VA Hospital
      Hines, Oregon, United States
    • Hospital Nuestra Señora del Rosario
      Madrid, Madrid, Spain
  • 2006–2008
    • University of Iowa
      Iowa City, Iowa, United States
    • University of North Carolina at Chapel Hill
      • • Department of Medicine
      • • Department of Psychiatry
      Chapel Hill, NC, United States
    • State University of New York Downstate Medical Center
      • Department of Psychiatry and Behavioral Sciences
      Brooklyn, NY, United States
  • 2005–2008
    • Brown University
      Providence, Rhode Island, United States
    • Duke University Medical Center
      • Department of Psychiatry and Behavioral Science
      Durham, NC, United States
  • 2001–2008
    • University of Illinois at Chicago
      • Department of Psychiatry (Chicago)
      Chicago, Illinois, United States
    • Boston College, USA
      Boston, Massachusetts, United States
  • 2007
    • Emory University
      Atlanta, Georgia, United States
  • 2006–2007
    • Mount Sinai School of Medicine
      • Department of Psychiatry
      Manhattan, NY, United States
  • 2004–2006
    • University of Southern California
      • Marshall School of Business
      Los Angeles, California, United States
  • 2001–2005
    • University of Massachusetts Amherst
      • Department of Sociology
      Amherst Center, MA, United States
  • 2002
    • University of Toronto
      • Institute of Health Policy, Management and Evaluation
      Toronto, Ontario, Canada
    • Oregon Health and Science University
      • School of Dentistry
      Portland, OR, United States
    • University of Maryland, Baltimore
      • Department of Medicine
      Baltimore, MD, United States
  • 1999–2000
    • Wesleyan University
      • Department of Psychology
      Middletown, CT, United States
    • VA Puget Sound Health Care System
      Washington, Washington, D.C., United States