Jennie Leskela

Minneapolis Veterans Affairs Hospital, Minneapolis, Minnesota, United States

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Publications (19)28.5 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Military personnel deployed to Iraq and Afghanistan often develop mental health difficulties, which may manifest as problematic driving behavior. Veterans may be more likely to engage in risky driving and to subsequently be involved in motor vehicle accidents and fatalities. This article reviews literature on driving difficulties among military veterans and evaluates available research on the potential pathways that underlie risky driving behavior. Current interventions for problematic driving behaviors are considered, and the necessity of modifying these interventions to address the unique difficulties encountered by military veterans is highlighted. The review concludes with a discussion of clinical implications of these findings and identification of possible avenues for future research and intervention.
    Military medicine. 06/2014; 179(6):633-639.
  • Lisa M James, Thad Q Strom, Jennie Leskela
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    ABSTRACT: Military personnel commonly experience post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI), both of which are associated with premature mortality. The present study examined two factors that may play a role in premature mortality-impulsivity and risk-taking behaviors-in a sample of 234 veterans screening positive for PTSD, mTBI, PTSD + mTBI, and controls. Analyses of variance demonstrated that veterans with PTSD, regardless of mTBI status, reported engaging in more frequent risky behaviors and reported a greater tendency to engage in impulsive behaviors when in a negative affective state. They also reported more premilitary delinquent behaviors and more suicide-related behaviors than controls. The present study highlights associations between impulsivity, risk-taking behaviors, and PTSD, and suggests continuity across the lifespan in terms of a predisposition to engage in impulsive and/or risky behaviors. Thorough evaluation of impulsivity and potentially risky behaviors is important in clinical settings to guide interventions and reduce the mortality and public health impact of high-risk behaviors in veterans.
    Military medicine. 04/2014; 179(4):357-63.
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    ABSTRACT: This column describes the potential of an enhanced electronic medical record (EMR) to advance best practices by displaying patient history, measuring progress, and facilitating clinical research. To create a graphical, single-page display of patient history, the authors examined data in the Minneapolis Department of Veterans Affairs EMR system, including 1.8 million encounters for 50,000 mental health patients. The prototype dashboard presents information on a patient's current and past providers, diagnoses, therapeutic interventions, prescriptions, dosages, and outcomes. To provide needed outcome data to monitor patient progress, the authors tested two questions with 212 patients. Patient and clinician responses to the questions provide reliable and clinically useful data that can be used in the EMR to track patient change over time. Use of EMRs can bridge gaps between science and practice to inform diagnosis and treatment decisions and permit more accurate prognoses.
    Psychiatric services (Washington, D.C.) 08/2013; · 2.81 Impact Factor
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    ABSTRACT: The present study examined the preliminary effects of an 8-session group cognitive-behavioral treatment (CBT) designed to reduce driving-related anger, aggression, and risky driving behaviors in veterans. Participants (N = 9) with self-reported aggressive and risky driving problems completed self-report measures at pretreatment, posttreatment, and 1-month follow-up. Of those completing the treatment, 89% demonstrated reliable change in driving-related aggression and 67% evidenced reliable change in driving-related anger. Similar changes were found for secondary treatment targets.
    Journal of Traumatic Stress 05/2013; · 2.72 Impact Factor
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    ABSTRACT: This study evaluated the impact of a course of prolonged exposure or cognitive processing therapy on mental health and medical service utilization and health care service costs provided by the Department of Veterans Affairs (VA). Data on VA health service utilization and health care costs were obtained from national VA databases for 70 veterans who completed prolonged exposure or cognitive processing therapy at a Midwestern VA medical center. Utilization of services and cost data were examined for the year before and after treatment. Results demonstrated a significant decrease in the use of individual and group psychotherapy. Direct costs associated with mental health care decreased by 39.4%. Primary care and emergency department services remained unchanged.
    Military medicine 01/2013; 178(1):95-9. · 0.77 Impact Factor
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    ABSTRACT: The present study conducted an exploratory examination of the relationship between self-reported symptoms of post-traumatic stress disorder and an expanded definition of risk-taking behaviors among 395 veterans at a large Midwestern Veterans Affairs Medical Center. Post-traumatic stress disorder symptoms were associated with elevated rates of substance use, thrill seeking, aggression, risky sexual practices, and firearm possession. Results indicated that suicidal ideation and aggressive driving behavior were among the most frequently reported. The present findings hold significant public health implications and highlight the need to attend to risk-taking behaviors in treatment planning.
    Military medicine 04/2012; 177(4):390-6. · 0.77 Impact Factor
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    ABSTRACT: Smoking prevalence among patients with posttraumatic stress disorder (PTSD) is over 40%. Baseline data from the VA Cooperative Studies Program trial of integrated versus usual care for smoking cessation in veterans with PTSD (N = 863) were used in multivariate analyses of PTSD and depression severity, and 4 measures of smoking intensity: cigarettes per day (CPD), Fagerström Test for Nicotine Dependence (FTND), time to first cigarette, and expired carbon monoxide. Multivariate regression analysis showed the following significant associations: CPD with race (B = -7.16), age (B = 0.11), and emotional numbing (B =0 .16); FTND with race (B = -0.94), education (B = -0.34), emotional numbing (B = 0.04), significant distress (B = -0.12), and PHQ-9 (B = 0.04); time to first cigarette with education (B = 0.41), emotional numbing (B = -0.03), significant distress (B = 0.09), and PHQ-9 (B = -0.03); and expired carbon monoxide with race (B = -9.40). Findings suggest that among veterans with PTSD, White race and emotional numbing were most consistently related to increased smoking intensity and had more explanatory power than total PTSD symptom score. Results suggest specific PTSD symptom clusters are important to understanding smoking behavior in patients with PTSD.
    Journal of Traumatic Stress 02/2012; 25(1):10-6. · 2.72 Impact Factor
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    ABSTRACT: An increasing number of predoctoral psychology interns are completing their internship within the Department of Veterans Affairs (VA) health care system. Individuals receiving mental health services in the VA constitute a distinct subculture with unique experiences reflected in their beliefs, norms, and language. Thus, interns need to increase their level of knowledge of military culture to effectively provide service to this population. The primary aim of the present article is to provide an overview of relevant cultural aspects associated with military service. A secondary aim is to describe and discuss several common ethical conflicts encountered by trainees working within the VA. Clinical vignettes will be used to illustrate common cultural issues faced by VA psychologists and interns. Finally, the article concludes by providing recommendations and suggested resources for VA psychology trainees and training directors.
    Training and Education in Professional Psychology 01/2012; 6(2):67-75. · 1.58 Impact Factor
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    ABSTRACT: Adult attachment style and post-traumatic stress disorder (PTSD) symptomatology were investigated in 107 former prisoner of war veterans. Those with secure attachment styles scored significantly lower on measures of PTSD than did those with insecure styles, and attachment style was a stronger predictor of PTSD symptom intensity than was trauma severity. The suggested association between attachment style and PTSD's development and persistence are discussed in relation to research and clinical practice.
    American Journal of Orthopsychiatry 03/2010; 71(3):374 - 378. · 1.60 Impact Factor
  • Christopher Erbes, Kyle Curry, Jennie Leskela
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    ABSTRACT: Reports an error in Treatment presentation and adherence of Iraq/Afghanistan era veterans in outpatient care for posttraumatic stress disorder by Christopher R. Erbes, Kyle T. Curry and Jennie Leskela (Psychological Services, 2009[Aug], Vol 6[3], 175-183). The copyright for the article was listed incorrectly. This article is in the Public Domain. The online version has been corrected. (The following abstract of the original article appeared in record 2009-12007-001.) The ongoing wars in Afghanistan (Operation Enduring Freedom or OEF) and Iraq (Operation Iraqi Freedom or OIF) make the development and application of effective postdeployment mental health treatment programs a high priority. There has been some concern that existing treatment programs for combat-related posttraumatic stress disorder (PTSD) may not fit well with OEF/OIF veterans confronted with acute mental health difficulties while reestablishing community, familial, and occupational connections after their deployment. This study utilized data gathered from a large outpatient Veterans Affairs Medical Center PTSD treatment clinic to examine differences in initial treatment presentation and treatment adherence (attendance and dropout) between a group of Vietnam era veterans (n = 54) and a group of OEF/OIF veterans (n = 106). OEF/OIF veterans reported lower levels of symptom distress on questionnaires assessing posttraumatic reexperiencing, avoidance, dissociation, and arousal symptoms but similar levels of anger and acting out behaviors and higher levels of alcohol problems. OEF/OIF veterans had significantly lower rates of session attendance and higher rates of treatment dropout than Vietnam veterans, and this difference was not accounted for by differences in treatment presentation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
    Psychological Services 01/2010; 7(3):125-125. · 1.08 Impact Factor
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    ABSTRACT: [Correction Notice: An erratum for this article was reported in Vol 7(3) of Psychological Services (see record 2010-17074-002). The copyright for the article was listed incorrectly. This article is in the Public Domain. The online version has been corrected.] The ongoing wars in Afghanistan (Operation Enduring Freedom or OEF) and Iraq (Operation Iraqi Freedom or OIF) make the development and application of effective postdeployment mental health treatment programs a high priority. There has been some concern that existing treatment programs for combat-related posttraumatic stress disorder (PTSD) may not fit well with OEF/OIF veterans confronted with acute mental health difficulties while reestablishing community, familial, and occupational connections after their deployment. This study utilized data gathered from a large outpatient Veterans Affairs Medical Center PTSD treatment clinic to examine differences in initial treatment presentation and treatment adherence (attendance and dropout) between a group of Vietnam era veterans (n = 54) and a group of OEF/OIF veterans (n = 106). OEF/OIF veterans reported lower levels of symptom distress on questionnaires assessing posttraumatic reexperiencing, avoidance, dissociation, and arousal symptoms but similar levels of anger and acting out behaviors and higher levels of alcohol problems. OEF/OIF veterans had significantly lower rates of session attendance and higher rates of treatment dropout than Vietnam veterans, and this difference was not accounted for by differences in treatment presentation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
    Psychological Services 07/2009; 6(3):175-183. · 1.08 Impact Factor
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    ABSTRACT: Patients with chronic psychiatric diagnoses have a prevalence of chronic hepatitis C (HCV) approximately 11 times higher than the general American population. Posttraumatic stress disorder (PTSD) is particularly common among HCV patients. The authors describe the effect of treatment with pegylated-interferon-alpha(2b) (IFN) and ribavirin for patients with HCV on their posttraumatic stress disorder (PTSD) symptoms. Sixteen patients with HCV and combat-related PTSD were followed for 24 weeks and assessed with self-report measures of PTSD, hostility, and depression. Depression and Resentment scores significantly increased in five patients treated with IFN and ribavirin, but no significant differences were found in PTSD scores when compared with 11 control patients. The results suggest that patients with PTSD and HCV can be safely treated with anti-viral therapies when they are given appropriate psychiatric care.
    Psychosomatics 01/2008; 49(3):225-9. · 1.73 Impact Factor
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    ABSTRACT: The objective of the present study was to compare three specialized treatment programs for post-traumatic stress disorder (PTSD) in different Veterans Affairs medical centers, in terms of the format of therapeutic services and the medications prescribed for PTSD. Chart review methods were used to examine medical records for 50 patients from each facility over a 6-month period. Results indicated that the medications prescribed were fairly consistent across sites, although they were not always consistent with treatment recommendations. Therapy formats for two of the facilities were quite different, with one offering more case management services and the other offering more intensive individual and group therapy services. Additional research is needed to broaden our knowledge of how PTSD is being treated currently and to study the effectiveness of the treatment strategies being used.
    Military medicine 05/2005; 170(4):305-8. · 0.77 Impact Factor
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    ABSTRACT: Although clinicians have patients interpret proverbs in mental status exams for psychosis, there are few empirical studies investigating the significance of proverb interpretation. In schizophrenia patients, we found abstraction positively correlated with overall intelligence but no symptom measures, concreteness negatively correlated with overall intelligence, executive functioning, attention, and memory, and bizarre-idiosyncratic responses associated with positive formal thought disorder but no cognitive functions.
    Schizophrenia Research 01/2004; 65(2-3):117-23. · 4.59 Impact Factor
  • Jennie Leskela, Michael Dieperink, Paul Thuras
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    ABSTRACT: Guilt about surviving a traumatic event is thought to be an associated feature of posttraumatic stress disorder (PTSD). Shame is an emotion closely related to guilt but is a distinct affective state. Little is known regarding the role of shame in PTSD and there are no studies of PTSD where shame and guilt are examined simultaneously. We used a measure of shame- and guilt-proneness in 107 community residing former prisoner of war veterans all of whom had been exposed to trauma. The measure of shame-proneness was positively correlated with PTSD symptom severity whereas guilt-proneness was not. This study provides the first empirical data regarding a possible role for shame in PTSD and may have important therapeutic and theoretical implications.
    Journal of Traumatic Stress 07/2002; 15(3):223-6. · 2.72 Impact Factor
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    ABSTRACT: Rape of men by other men is a form of sexual assault that is incompletely addressed in the literature. As a result, little is known about the treatment interventions that are most effective for this population. We designed and conducted an ongoing process-oriented psychotherapy group for male veterans who were raped while serving in the military and/or sexually assaulted in childhood. Our experience with this group provided us with a better understanding of the behavioral, cognitive, and emotional issues presented by sexually assaulted males. We suggest that group therapy is an effective modality in treating this population.
    Group 11/2001; 25(4):303-319.
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    ABSTRACT: Adult attachment style and post-traumatic stress disorder (PTSD) symptomatology were investigated in 107 former prisoner of war veterans. Those with secure attachment styles scored significantly lower on measures of PTSD than did those with insecure styles, and attachment style was a stronger predictor of PTSD symptom intensity than was trauma severity. The suggested association between attachment style and PTSD's development and persistence are discussed in relation to research and clinical practice.
    American Journal of Orthopsychiatry 08/2001; 71(3):374-8. · 1.60 Impact Factor
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    ABSTRACT: The present study explored relations among adult attachment styles, shame- and guilt-proneness, and several measures of relationship problem-solving attitudes and behaviors. Participants were 142 undergraduates (32 males, 110 females) who completed both categorical and continuous measures of adult attachment, as well as self-report measures of the other constructs under investigation. Most participants (93%) were currently involved in either exclusive or casual dating relationships at the time of the study. Controlling for respondents’dating status, results indicated that participants’attachment styles were significantly related to both shame-proneness and collaborative problem-solving, Preoccupied and fearful students were more shame-prone than were their secure and dismissive peers, and secure participants reported significantly higher collaboration scores relative to their fearful counterparts. As expected, shame and guilt scores were differentially related to collaborative problem-solving, and participants’attachment security significantly moderated observed shame-guilt correlations. Finally, respondents’guilt and shame scores partly mediated observed relations between adult attachment styles and collaborative problem-solving orientations.
    Personal Relationships 05/1997; 4(2):187 - 199. · 0.95 Impact Factor
  • Cynthia J. Kok, Jennie Leskela
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    ABSTRACT: Presents the authors' use of solution-focused brief therapy in an adult inpatient psychiatric hospital setting. It is suggested that a theoretical integration of the medical model and the solution-focused approach provides a useful treatment modality. A discussion of model implementation emphasizes assessment, treatment milieu, the role of staff, therapy, and discharge issues. The model's usefulness for training and supervision is described, and recommendations for future research are offered. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
    Journal of Marital and Family Therapy 06/1996; · 1.01 Impact Factor

Publication Stats

164 Citations
28.50 Total Impact Points

Institutions

  • 2002–2013
    • Minneapolis Veterans Affairs Hospital
      Minneapolis, Minnesota, United States
  • 2012
    • University of Minnesota Duluth
      • Medical School
      Duluth, Minnesota, United States
  • 2001
    • Calvin College
      Grand Rapids, Michigan, United States
  • 1996
    • Michigan State University
      East Lansing, Michigan, United States