Amy M Kilbourne

Concordia University–Ann Arbor, Ann Arbor, Michigan, United States

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Publications (198)623.53 Total impact

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    ABSTRACT: Importance: Many Vietnam-era women veterans served in or near war zones and may have experienced stressful or traumatic events during their service. Although posttraumatic stress disorder (PTSD) is well studied among men who served in Vietnam, no major epidemiologic investigation of PTSD among women has been performed. Objectives: To assess (1) the onset and prevalence of lifetime and current PTSD for women who served during the Vietnam era, stratified by wartime location (Vietnam, near Vietnam, or the United States), and (2) the extent to which wartime location was associated with PTSD, with adjustment for demographics, service characteristics, and wartime exposures. Design, setting, and participants: Survey of 8742 women who were active-duty military personnel in the US Armed Forces at any time from July 4, 1965, through March 28, 1973, and alive as of survey receipt as part of Department of Veterans Affairs Cooperative Study 579, HealthVIEWS. Data were obtained from mailed and telephone surveys from May 16, 2011, through August 5, 2012, and analyzed from June 26, 2013, through July 30, 2015. Main outcomes and measures: Lifetime and current PTSD as measured by the PTSD module of the Composite International Diagnostic Interview, version 3.0; onset of PTSD; and wartime experiences as measured by the Women's Wartime Exposure Scale-Revised. Results: Among the 4219 women (48.3%) who completed the survey and a telephone interview, the weighted prevalence (95% CI) of lifetime PTSD was 20.1% (18.3%-21.8%), 11.5% (9.1%-13.9%), and 14.1% (12.4%-15.8%) for the Vietnam, near-Vietnam, and US cohorts, respectively. The weighted prevalence (95% CI) of current PTSD was 15.9% (14.3%-17.5%), 8.1% (6.0%-10.2%), and 9.1% (7.7%-10.5%) for the 3 cohorts, respectively. Few cases of PTSD among the Vietnam or near-Vietnam cohorts were attributable to premilitary onset (weighted prevalence, 2.9% [95% CI, 2.2%-3.7%] and 2.9% [95% CI, 1.7%-4.2%], respectively). Unadjusted models for lifetime and current PTSD indicated that women who served in Vietnam were more likely to meet PTSD criteria than women who mainly served in the United States (odds ratio [OR] for lifetime PTSD, 1.53 [95% CI, 1.28-1.83]; OR for current PTSD, 1.89 [95% CI, 1.53-2.33]). When we adjusted for wartime exposures, serving in Vietnam or near Vietnam did not increase the odds of having current PTSD (adjusted ORs, 1.05 [95% CI, 0.75-1.46] and 0.77 [95% CI, 0.52-1.14], respectively). Conclusions and relevance: The prevalence of PTSD for the Vietnam cohort was higher than previously documented. Vietnam service significantly increased the odds of PTSD relative to US service; this effect appears to be associated with wartime exposures, especially sexual discrimination or harassment and job performance pressures. Results suggest long-lasting mental health effects of Vietnam-era service among women veterans.
    JAMA Psychiatry 10/2015; DOI:10.1001/jamapsychiatry.2015.1786 · 12.01 Impact Factor
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    ABSTRACT: Background: The movement of evidence-based practices (EBPs) into routine clinical usage is not spontaneous, but requires focused efforts. The field of implementation science has developed to facilitate the spread of EBPs, including both psychosocial and medical interventions for mental and physical health concerns. Discussion: The authors aim to introduce implementation science principles to non-specialist investigators, administrators, and policymakers seeking to become familiar with this emerging field. This introduction is based on published literature and the authors' experience as researchers in the field, as well as extensive service as implementation science grant reviewers. Implementation science is "the scientific study of methods to promote the systematic uptake of research findings and other EBPs into routine practice, and, hence, to improve the quality and effectiveness of health services." Implementation science is distinct from, but shares characteristics with, both quality improvement and dissemination methods. Implementation studies can be either assess naturalistic variability or measure change in response to planned intervention. Implementation studies typically employ mixed quantitative-qualitative designs, identifying factors that impact uptake across multiple levels, including patient, provider, clinic, facility, organization, and often the broader community and policy environment. Accordingly, implementation science requires a solid grounding in theory and the involvement of trans-disciplinary research teams. The business case for implementation science is clear: As healthcare systems work under increasingly dynamic and resource-constrained conditions, evidence-based strategies are essential in order to ensure that research investments maximize healthcare value and improve public health. Implementation science plays a critical role in supporting these efforts.
    09/2015; 3(1):32. DOI:10.1186/s40359-015-0089-9
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    ABSTRACT: Background: Mood stabilizer medications (MSMs) can induce significant weight gain and other metabolic side effects. Research suggests that women are more susceptible to psychotropic medication-induced metabolic side effects than men. We examined gender differences in the likelihood of receiving an MSM with a lower liability for weight gain using data from the U.S. Department of Veterans Affairs (VA) healthcare system. Methods: We identified 3823 VA patients with a schizophrenia or bipolar disorder diagnosis who initiated treatment with a MSM between 10/2006 and 9/2011. We used multivariable logistic regression analysis to examine gender differences in the likelihood of incident prescription of MSMs with low versus medium/high metabolic risk, adjusting for fiscal year of prescribing and demographic, mental health, and physical health characteristics. Results: Overall, 47% of women were prescribed a low metabolic risk MSM compared to 26% of men (p<0.0001). In multivariable analysis, women were 2.19 times as likely as men to be prescribed a low metabolic risk MSM (95% CI: 1.84-2.60, p<0.0001). Several demographic and clinical covariates were also independently related to prescribing of MSMs by level of metabolic risk. Limitations: This study used retrospective administrative data collected from a VA healthcare system database, which does not allow us to understand the context in which MSM treatment decisions were made. Conclusions: Prescribing choices for MSMs by VA mental health prescribers and female Veterans may reflect a growing awareness of the potential adverse health consequences of these treatments in women.
    Journal of Affective Disorders 09/2015; 188:112-117. DOI:10.1016/j.jad.2015.08.065 · 3.38 Impact Factor
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    ABSTRACT: Study objective: To investigate the influence of SDB on weight loss in overweight/obese veterans. Design: Observational study. Setting: National Veterans Health Administration health system. Participants: Overweight/obese veterans enrolled in MOVE! from May 2008-February 2012 who had at least two MOVE! visits, baseline weight, and at least one follow-up weight (n = 84,770). Intervention: Nationally implemented behavioral weight management program (MOVE!). Measurements: SDB was defined by International Classification of Diseases, Ninth Revision, Clinical Modification codes. Primary outcome was weight change (lb) from MOVE! enrollment to 6- and 12-mo assessments. Weight change over time was modeled with repeated-measures analyses. Results: SDB was diagnosed in one-third of the cohort (n = 28,269). At baseline, veterans with SDB weighed 29[48] lb more than those without SDB (P < 0.001). On average, veterans attended eight MOVE! visits. Weight loss patterns over time were statistically different between veterans with and without SDB (P < 0.001); veterans with SDB lost less weight (-2.5[0.1] lb) compared to those without SDB (-3.3[0.1] lb; P = 0.001) at 6 months. At 12 mo, veterans with SDB continued to lose weight whereas veterans without SDB started to re-gain weight. Conclusion: Veterans with SDB had significantly less weight loss over time than veterans without SDB. SDB should be considered in the development and implementation of weight loss programs due to its high prevalence and negative effect on health.
    Sleep 09/2015; · 4.59 Impact Factor
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    ABSTRACT: Background: Few treatments are available to directly address employment or work functioning among individuals with bipolar disorder (BD) and currently available treatment models have not been evaluated to examine their impact employment outcomes. We examined impact of affective symptoms and health-related quality of life (HRQoL) on longitudinal employment outcomes in a community-based sample of individuals with bipolar disorder who completed the Life Goals-Collaborative Care (LG-CC) intervention. Methods: Participants (N=178) were assessed based on HRQoL, employment status, affective symptoms (depressive/manic), and work hours at baseline, 6-, 12- and 24-months after initiation of LG-CC. Frequency of LG-CC sessions and number of care-manager contacts also were ascertained. Results: At baseline, 21% were employed, 29.5% were unemployed, and 49.6% were on disability. Improvement in affective symptoms was seen over the 24-month period, but not in HRQoL. Lower depression symptoms, but not mania, at baseline predicted greater likelihood of employment status in 24-months. Degree of LG-CC participation was associated with a reduced likelihood of becoming disabled/unemployed and increased number of hours worked in 24-months. Limitations: The study was originally designed to compare implementation strategies and not the effectiveness of LG-CC on employment outcomes. Further, it was unclear whether improvement in work functioning were personal goals of the participants of this study. Conclusions: Fewer depressive symptoms were associated with positive employment outcomes over time. Collaborative Care Models that are already implemented by existing providers that focus on management of affective symptoms show promise in positively impacting employment outcomes.
    Journal of Affective Disorders 09/2015; 188. DOI:10.1016/j.jad.2015.08.052 · 3.38 Impact Factor
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    ABSTRACT: Because two-thirds of patients with Major Depressive Disorder do not achieve remission with their first antidepressant, we designed a trial of three "next-step" strategies: switching to another antidepressant (bupropion-SR) or augmenting the current antidepressant with either another antidepressant (bupropion-SR) or with an atypical antipsychotic (aripiprazole). The study will compare 12-week remission rates and, among those who have at least a partial response, relapse rates for up to 6 months of additional treatment. We review seven key efficacy/effectiveness design decisions in this mixed "efficacy-effectiveness" trial. Copyright © 2015. Published by Elsevier Ireland Ltd.
    08/2015; 229(3):PSYD1500402. DOI:10.1016/j.psychres.2015.08.005
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    Implementation Science 08/2015; 10(Suppl 1):A26. DOI:10.1186/1748-5908-10-S1-A26 · 4.12 Impact Factor
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    ABSTRACT: Background The mood stabilisers lithium and valproate might plausibly have differing associations with mortality because of differing effects on mental health and various physiological indicators. Aims To assess associations between lithium, valproate and non-suicide mortality. Method Intention-to-treat, propensity score-matched cohort study. Results Lithium was associated with significantly reduced non-suicide mortality in the intent-to-treat cohort over 0-90 days (hazard ratio (HR) = 0.67, 95% CI 0.51-0.87) but not longer. In secondary analyses, a sizeable reduction in mortality was observed during active treatment with lithium across all time periods studied (for example 365-day HR = 0.62, 95% CI 0.45-0.84), but significantly increased risks were observed among patients discontinuing lithium by 180 days (HR = 1.54, 95% CI 1.01-2.37). Conclusions Patients initiating lithium had lower non-suicide mortality over 0-90 days than patients initiating valproate and consistently lower non-suicide mortality among patients maintaining treatment, but elevated risk among patients discontinuing treatment by 180 days. Although residual confounding or selection effects cannot be excluded, this study suggests potential benefits to enhancing lithium treatment persistence and the monitoring of patients discontinuing lithium. There is a need for further research. © The Royal College of Psychiatrists 2015.
    The British journal of psychiatry: the journal of mental science 05/2015; 207(1). DOI:10.1192/bjp.bp.113.138685 · 7.99 Impact Factor
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    ABSTRACT: To examine gender differences in prescribing of antipsychotic medications (APMs) according to their liability for weight gain and other metabolic side effects. We identified 4510 patients with schizophrenia or bipolar disorders receiving usual care in a Veterans Affairs (VA) health care network in the U.S. mid-Atlantic region who initiated treatment with an APM between October 2006 and September 2011. We used multivariable logistic regression to examine gender differences in the likelihood of incident prescription of APMs with low versus medium/high metabolic risk, adjusting for fiscal year of prescribing and selected Veteran demographic, mental health and physical health characteristics. Overall, 58% of women were prescribed an APM with a low risk of metabolic side effects compared to 45% of men (P<.001). In multivariable analysis, women Veterans were 1.47 times as likely as men to be prescribed a low-metabolic-risk APM (95% confidence interval: 1.26-1.73, P<.001). Several demographic and clinical covariates were also independently related to prescribing of APMs by level of metabolic risk. The results may suggest that prescribing choices for APMs by VA mental health prescribers and female Veterans reflect a growing awareness of the potential adverse health consequences of these treatments in women. Copyright © 2015. Published by Elsevier Inc.
    General Hospital Psychiatry 04/2015; 37(4). DOI:10.1016/j.genhosppsych.2015.03.018 · 2.61 Impact Factor
  • Soham Rej · Martha Sajatovic · John Beyer · Amy M. Kilbourne ·

    American Journal of Geriatric Psychiatry 03/2015; 23(3):S30-S31. DOI:10.1016/j.jagp.2014.12.047 · 4.24 Impact Factor
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    ABSTRACT: This study compared effectiveness of an enhanced versus standard implementation strategy (Replicating Effective Programs [REP]) on site-level uptake of Re-Engage, a national program for veterans with serious mental illness. Mental health providers at 158 Veterans Affairs (VA) facilities were given REP-based manuals and training in Re-Engage, which involved identifying veterans who had not been seen in VA care for at least one year, documenting their clinical status, and coordinating further health care. After six months, facilities not responding to REP (N=88) were randomized to receive six months of facilitation (enhanced REP) or continued standard REP. Site-level uptake was defined as percentage of patients (N=1,531) with updated documentation or with whom contact was attempted. Rate of Re-Engage uptake was greater for enhanced REP sites compared with standard REP sites (41% versus 31%, p=.01). Total REP facilitation time was 7.3 hours per site for six months. Added facilitation improved short-term uptake of a national mental health program.
    Psychiatric services (Washington, D.C.) 01/2015; 66(1):90-3. DOI:10.1176/ · 2.41 Impact Factor

  • 01/2015; 13(1):85-93. DOI:10.1176/appi.focus.130114
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    ABSTRACT: Background Little is known about the demographic and clinical differences between early- and late-onset depressions (EOD and LOD, respectively) in Chinese patients. This study examined the demographic and clinical profile of EOD (<=25 years) compared to LOD (>25 years) in China. Methods A consecutively recruited sample of 1178 patients with MDD was assessed in 13 psychiatric hospitals or psychiatric units of general hospitals in China nationwide. The cross-sectional data of patients׳ demographic and clinical characteristics and prescriptions of psychotropic drugs including antidepressants, mood stabilizers, antipsychotics and benzodiazepines were recorded using a standardized protocol and data collection procedure. Results Two hundred and seventy five (23.3%) of the 1178 patients fulfilled criteria for EOD. In multiple logistic regression analyses, compared to LOD patients their EOD counterparts were more likely to be unmarried and unemployed, had more atypical and psychotic depressive episodes, had bipolar features, while they had more lifetime depressive episodes. Conclusions The demographic and more severe clinical features of EOD in Chinese patients were basically consistent with those found in Western populations. The association between socio-cultural factors and development of EOD warrants further studies.
    Journal of Affective Disorders 01/2015; 170:266–269. DOI:10.1016/j.jad.2014.09.008 · 3.38 Impact Factor
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    ABSTRACT: Background Few implementation strategies have been empirically tested for their effectiveness in improving uptake of evidence-based treatments or programs. This study compared the effectiveness of an immediate versus delayed enhanced implementation strategy (Enhanced Replicating Effective Programs (REP)) for providers at Veterans Health Administration (VA) outpatient facilities (sites) on improved uptake of an outreach program (Re-Engage) among sites not initially responding to a standard implementation strategy.Methods One mental health provider from each U.S. VA site (N¿=¿158) was initially given a REP-based package and training program in Re-Engage. The Re-Engage program involved giving each site provider a list of patients with serious mental illness who had not been seen at their facility for at least a year, requesting that providers contact these patients, assessing patient clinical status, and where appropriate, facilitating appointments to VA health services. At month 6, sites considered non-responsive (N¿=¿89, total of 3,075 patients), defined as providers updating documentation for less than <80% of patients on their list, were randomized to two adaptive implementation interventions: Enhanced REP (provider coaching; N¿=¿40 sites) for 6 months followed by Standard REP for 6 months; versus continued Standard REP (N¿=¿49 sites) for 6 months followed by 6 months of Enhanced REP for sites still not responding. Outcomes included patient-level Re-Engage implementation and utilization.ResultsPatients from sites that were randomized to receive Enhanced REP immediately compared to Standard REP were more likely to have a completed contact (adjusted OR¿=¿2.13; 95% CI: 1.09¿4.19, P¿=¿0.02). There were no differences in patient-level utilization between Enhanced and Standard REP sites.Conclusions Enhanced REP was associated with greater Re-Engage program uptake (completed contacts) among sites not responding to a standard implementation strategy. Further research is needed to determine whether national implementation of Facilitation results in tangible changes in patient-level outcomes.Trial registrationISRCTN: ISRCTN21059161.
    Implementation Science 12/2014; 9(1):778. DOI:10.1186/s13012-014-0163-3 · 4.12 Impact Factor
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    ABSTRACT: Background Lithium has been reported in some, but not all, studies to be associated with reduced risk of suicide death or suicidal behavior. The objective of this nonrandomized cohort study was to examine whether lithium was associated with reduced risk of suicide death in comparison to the commonly-used alternative treatment, valproate.MethodsA propensity score-matched cohort study was conducted of Veterans Health Administration patients (n¿=¿21,194/treatment) initiating lithium or valproate from 1999¿2008.ResultsMatching produced lithium and valproate treatment groups that were highly similar in all 934 propensity score covariates, including indicators of recent suicidal behavior, but recent suicidal ideation was not able to be included. In the few individuals with recently diagnosed suicidal ideation, a significant imbalance existed with suicidal ideation more prevalent at baseline among individuals initiating lithium than valproate (odds ratio (OR) 1.30, 95% CI 1.09, 1.54; p¿=¿0.003). No significant differences in suicide death were observed over 0¿365 days in A) the primary intent-to-treat analysis (lithium/valproate conditional odds ratio (cOR) 1.22, 95% CI 0.82, 1.81; p¿=¿0.32); B) during receipt of initial lithium or valproate treatment (cOR 0.86, 0.46, 1.61; p¿=¿0.63); or C) after such treatment had been discontinued/modified (OR 1.51, 95% CI 0.91, 2.50; p¿=¿0.11). Significantly increased risks of suicide death were observed after the discontinuation/modification of lithium, compared to valproate, treatment over the first 180 days (OR 2.72, 95% CI 1.21, 6.11; p¿=¿0.015).Conclusions In this somewhat distinct sample (a predominantly male Veteran sample with a broad range of psychiatric diagnoses), no significant differences in associations with suicide death were observed between lithium and valproate treatment over 365 days. The only significant difference was observed over 0¿180 days: an increased risk of suicide death, among individuals discontinuing or modifying lithium, compared to valproate, treatment. This difference could reflect risks either related to lithium discontinuation or higher baseline risks among lithium recipients (i.e., confounding) that became more evident when treatment stopped. Our findings therefore support educating patients and providers about possible suicide-related risks of discontinuing lithium even shortly after treatment initiation, and the close monitoring of patients after lithium discontinuation, if feasible. If our findings include residual confounding biasing against lithium, however, as suggested by the differences observed in diagnosed suicidal ideation, then the degree of beneficial reduction in suicide death risk associated with lithium treatment would be underestimated. Further research is urgently needed, given the lack of interventions against suicide and the uncertainties concerning the degree to which lithium may reduce suicide risk during active treatment, increase risk upon discontinuation, or both.
    BMC Psychiatry 12/2014; 14(1):357. DOI:10.1186/s12888-014-0357-x · 2.21 Impact Factor
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    ABSTRACT: Mood disorders represent the most expensive mental disorders for employer-based commercial health plans. Collaborative care models are effective in treating chronic physical and mental illnesses at little to no net healthcare cost, but to date have primarily been implemented by larger healthcare organizations in facility-based models. The majority of practices providing commercially insured care are far too small to implement such models. Health plan-level collaborative care treatment can address this unmet need. The goal of this study is to implement at the national commercial health plan level a collaborative care model to improve outcomes for persons with mood disorders. A randomized controlled trial of a collaborative care model versus usual care will be conducted among beneficiaries of a large national health plan from across the country seen by primary care or behavioral health practices. At discharge 344 patients identified by health plan claims as hospitalized for unipolar depression or bipolar disorder will be randomized to receive collaborative care (patient phone-based self-management support, care management, and guideline dissemination to practices delivered by a plan-level care manager) or usual care from their provider. Primary outcomes are changes in mood symptoms and mental health-related quality of life at 12 months. Secondary outcomes include rehospitalization, receipt of guideline-concordant care, and work productivity. This study will determine whether a collaborative care model for mood disorders delivered at the national health plan level improves outcomes compared to usual care, and will inform a business case for collaborative care models for these settings that can reach patients wherever they receive treatment. Identifier: NCT02041962; registered January 3, 2014.
    11/2014; 2(1):48. DOI:10.1186/s40359-014-0048-x
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    Amy M Kilbourne · David Atkins ·

    Journal of General Internal Medicine 10/2014; 29(4). DOI:10.1007/s11606-014-3050-3 · 3.45 Impact Factor
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    ABSTRACT: This randomized controlled implementation study compared the effectiveness of a standard versus enhanced version of the replicating effective programs (REP) implementation strategy to improve the uptake of the life goals-collaborative care model (LG-CC) for bipolar disorder. Seven community-based practices (384 patient participants) were randomized to standard (manual/training) or enhanced REP (customized manual/training/facilitation) to promote LG-CC implementation. Participants from enhanced REP sites had no significant changes in primary outcomes (improved quality of life, reduced functioning or mood symptoms) by 24 months. Further research is needed to determine whether implementation strategies can lead to sustained, improved participant outcomes in addition to program uptake.
    Administration and Policy in Mental Health and Mental Health Services Research 10/2014; 42(5). DOI:10.1007/s10488-014-0598-5 · 3.44 Impact Factor

Publication Stats

4k Citations
623.53 Total Impact Points


  • 2010-2015
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
    • University of Arkansas at Little Rock
      Little Rock, Arkansas, United States
  • 2007-2015
    • University of Michigan
      • Department of Psychiatry
      Ann Arbor, Michigan, United States
  • 2013
    • Duke University Medical Center
      • Department of Psychiatry and Behavioral Science
      Durham, North Carolina, United States
    • Harvard Medical School
      Boston, Massachusetts, United States
  • 2009-2012
    • Harvard University
      Cambridge, Massachusetts, United States
    • U.S. Department of Veterans Affairs
      Washington, Washington, D.C., United States
  • 2008
    • Alpert Medical School - Brown University
      Providence, Rhode Island, United States
  • 2001-2008
    • University of Pittsburgh
      • • Department of Psychiatry
      • • Department of Medicine
      • • Division of General Internal Medicine
      Pittsburgh, Pennsylvania, United States
  • 2006
    • Case Western Reserve University
      Cleveland, Ohio, United States