Larry D Pruitt

VA Puget Sound Health Care System · Mental Health Service

U.S. suicide rates have risen every year over the past two decades with self-directed firearm use as the method accounting for the highest proportion of deaths. This pattern is particularly pronounced among veterans and members of the U.S. Armed Forces. The numerical burden of firearm-related suicide accompanied by characteristics of self-directed...

Objective: The Recovery Engagement and Coordination for Health-Veterans Enhanced Treatment (REACH VET) program was launched in 2017 to identify Veterans at high risk for suicide and other adverse outcomes using predictive analytics. This quality improvement study evaluated the sustainment of the REACH VET program at a large Veterans Affairs health...

Background: The Veterans Health Administration (VHA) implemented REACH VET, which analyzes health records to identify veterans at statistically elevated risk for suicide and other adverse outcomes compared to other veterans in VHA. This project evaluated REACH VET program implementation at a large VA health care system by examining program fidelit...

Advances in artificial intelligence and machine learning have fueled growing interest in the application of predictive analytics to identify high-risk suicidal patients. Such application will require the aggregation of large-scale, sensitive patient data to help inform complex and potentially stigmatizing health care decisions. This paper provides...

Although veterans living in remote/rural areas are at elevated risk for suicide, there is very little research specific to treating suicidal veterans who present with barriers to in-person care. The current study aims to examine the delivery of brief cognitive-behavioral therapy for suicide prevention (BCBT-SP) via Clinical Video Telehealth (CVT) t...

Introduction The current model for treating behavioral health patients requires that providers and patients be in the same location for appointments. However, deploying warfighters present a challenge to this current model. Recent advances in technology make telehealth or virtual visits a viable option to replace the current model. This project lev...

In Reply Our systematic review¹ sought to provide a transparent and objective overview on the state of the science of suicide prediction models (SPMs). The findings demonstrate that current SPMs targeting suicide mortality cannot overcome the statistical challenge of predicting this relatively rare event. Our review focused on: (1) the positive pre...

Importance: Suicide prediction models have the potential to improve the identification of patients at heightened suicide risk by using predictive algorithms on large-scale data sources. Suicide prediction models are being developed for use across enterprise-level health care systems including the US Department of Defense, US Department of Veterans...

This paper presents data from the United States Department of Defense Suicide Event Report System for years 2012–2015 to detail descriptive, longitudinal rate data and risk factor profiles associated with military suicide. The annual findings were aggregated from all U.S. military suicide deaths and suicide attempts. Data elements included the most...

Financial stress has been frequently identified as a risk factor for suicidal behavior, both in military and civilian groups. However, it remains unclear to what degree financial stress may be associated independently with suicide behavior when accounting for other risk factors. This study examined data on suicide and suicide attempt cases in the D...

Rapid advances in health technologies require clinicians to have a general working knowledge of consumer technologies, specifically mobile health apps, and to understand how these tools are used for patient monitoring, education and treatment. The U.S. Department of Defense (DoD) Mobile Health Practice Guide offers an overview of mobile health and...

http://www.pdhealth.mil/news/blog/september-coming-soon-find-resources-your-military-suicide-prevention-month-activities

Introduction: Treatment engagement, adherence, cancellations and other patient-centric data are important predictors of treatment outcome. But often these data are only examined retrospectively. In this investigation, we analysed data from a clinical trial focused on innovative delivery of depression treatment to identify which patients are likely...

This report presents data from the United States (U.S.) Armed Forces on suicide mortality and on the incidence of attempted suicide between January 1, 2016 and December 31, 2016 (CY 2016). Each year the U.S. Air Force, Army, Marine Corps, and Navy must conduct an extensive data-collection effort—known as the Department of Defense Suicide Event Repo...

Mobile technologies may be able to provide service members and veterans with the knowledge necessary to transition to civilian life successfully in a cost-effective and accessible manner. Although a number of transition applications (apps) currently exist in the marketplace, to our knowledge, none of them has been evaluated for quality or effective...

Rapid advances in health technologies require clinicians to have a general working knowledge of consumer technologies, specifically mobile health apps, and to understand how these tools are used for patient monitoring, education and treatment. The U.S. Department of Defense (DoD) Mobile Health Practice Guide offers an overview of mobile health and...

MHSRS 2017

Objective: This study examined treatment response heterogeneity in a recent randomized controlled trial of treatment for depression using videoconferencing technology compared to traditional in-office care. Method: Growth mixture modeling was used to identify subgroups of individuals in the trial based on treatment response trajectories. Demogra...

US Army suicide rates increased significantly in the last decade and have remained high. To inform future research hypotheses, Army suicide surveillance data (2012-2014) were compared to similar Army data for suicides from 1975 to 1982. Preliminary data suggest that suicide rates increased across most demographic groups, but may have decreased amon...

Introduction: Home-based telebehavioural healthcare improves access to mental health care for patients restricted by travel burden. However, there is limited evidence assessing the economic value of home-based telebehavioural health care compared to in-person care. We sought to compare the economic impact of home-based telebehavioural health care...

Objective: Evidence of feasibility, safety, and effectiveness of home-based telebehavioral health (HBTBH) needs to be established before adoption of HBTBH in the military health system can occur. The purpose of this randomized controlled noninferiority trial was to compare the safety, feasibility, and effectiveness of HBTBH to care provided in the...

The effects of current posttraumatic stress disorder (PTSD) interventions on emotion regulation are relatively unknown. Many conceptualize PTSD as a disorder of emotion dysregulation, and clinicians often fear that emotion regulation impairments will not change with stand-alone PTSD treatments, particularly for individuals with pre-existing emotion...

This chapter addresses the barriers, solutions, and best practices for conducting patient assessments with clinical videoconferencing (CV) technologies. Specific attention is given to the benefits of CV assessment and recommendations for preparing, optimizing, and conducting clinical assessments over CV. Practical concerns such as the exchange of a...

Although home-based telemental health options have the potential to greatly expand the range of services available to U.S. military service members, there remains a need to demonstrate that home-based care is technically feasible, safe, and effective and meets the military health system's standards of care before widespread implementation can be ac...

Although there is growing empirical support for the clinical efficacy of telemental health (TMH) treatments, questions remain about how patient perceptions of the TMH treatment process may compare with those of traditional in-person psychotherapy treatments. Through a systematic review, we specifically examine measures of patient treatment satisfac...

The effective assessment and management of suicidal patients is an essential component of telehealth-based care. With this article, we describe how we have implemented procedures for the ongoing assessment and management of suicide risk in a clinical trial that compares in-office treatment to home-based treatment delivered via web-cam to U.S. milit...

Home-based telemental health (HBTMH) has several important benefits for both patients and clinical practitioners including improved access to services, convenience, flexibility, and potential cost savings. HBTMH also has the potential to offer additional clinical benefits that are not realized with traditional in-office alternatives. Through a revi...

Home-based telemental health (TMH) treatments have the potential to address current and future health needs of military service members, veterans, and their families, especially for those who live in rural or underserved areas. The use of home-based TMH treatments to address the behavioral health care needs of U.S. Military healthcare beneficiaries...

Objective: This study compared changes in emotion regulation and trait affect over the course of PTSD treatment with either prolonged exposure (PE) therapy or sertraline in adults with and without a history of childhood abuse (CA). Method: Two hundred adults with PTSD received 10 weeks of PE or sertraline. Emotion regulation and trait affect wer...

Fear, dysphoria, and distress are prominent components in the conceptualization of posttraumatic stress disorder (PTSD). However, because our diagnostic categories are open concepts, relying on observed patterns of symptoms for classification, it is unclear whether these components represent core or auxiliary features of the disorder. Convergence a...

The use and capabilities of telehealth technologies to conduct psychological assessments remotely are expanding. Clinical practitioners and researchers need to be aware of what influences the psychometric properties of telehealth-based assessments to assure optimal and competent assessments. The purpose of this review is to discuss the specific fac...

Despite the existence of effective treatment options for PTSD, these treatments are failing to reach those that stand to benefit from PTSD treatment. Understanding the processes underlying an individual's treatment seeking behavior holds the potential for reducing treatment-seeking barriers. The current study investigates the effects that positive...

Modern pharmacological treatments for anxiety disorders are safer and more tolerable than they were 30 years ago. Unfortunately, treatment efficacy and duration have not improved in most cases despite a greater understanding of the pathophysiology of anxiety. Moreover, innovative treatments have not reached the market despite billions of research d...

Distinct patterns of change in negative cognitions for pharmacotherapy vs. prolonged exposure therapy in PTSD

Beliefs underlying treatment preference: How providing testimonials impacts treatment choice for PTSD

Treatment Choice for PTSD; The role of positive testimonials.

Emotion regulation in the treatment of PTSD for childhood abuse and adult-onset trauma survivors with prolonged exposure and sertraline

Treating suicidal clients with borderline traits can be conducive to burnout. Dialectical behavior therapy (DBT) may assuage this burnout in counselors. As part of a DBT treatment outcome study, 6 counselors in training collected their own salivary cortisol samples and completed self-report measures of burnout and well-being for 1 year. Findings in...

In an attempted experimental manipulation of the future-oriented property of worry, a total of 174 college students were randomly assigned to one of five experimental conditions. After all participants viewed a distressing video, they were instructed to worry about a personally relevant topic while constraining their worry to outcomes that could oc...

Effective treatments for obsessive-compulsive disorder (OCD) exist, but additional treatment options are needed. The effectiveness of 8 sessions of acceptance and commitment therapy (ACT) for adult OCD was compared with progressive relaxation training (PRT). Seventy-nine adults (61% female) diagnosed with OCD (mean age = 37 years; 89% Caucasian) pa...

Psychotherapists often experience stress while providing psychotherapy, in particular when working with difficult presentations such as suicidality. As part of a larger study on the treatment of recently suicidal college students with borderline traits, 6 therapists in training collected their own salivary samples for alpha-amylase (AA) and cortiso...

Substance and Alcohol Use in a College Population With and Without GAD

Very little is known about what factors influence women's treatment preferences after a sexual assault. To learn more about these factors, data were collected from 273 women who read a standard "if this happened to you, what would you do" scenario describing a sexual assault and subsequent trauma-related psychiatric symptoms. After reading standard...

Recent meta-analytic studies suggest that social support plays an important role in regulating the severity of post-traumatic adjustment; however, few studies have manipulated potential underlying mechanisms. This analogue study examined how various social reactions, following trauma exposure, influenced subsequent anxiety, affect, and intrusive th...

Generalized anxiety disorder (GAD) involves excessive and uncontrollable worry as well as chronic somatic anxiety symptoms. The lifetime prevalence is estimated at 5.7%, suggesting that GAD is a pervasive problem in the United States. GAD disproportionately affects women compared to men. Worry typically involves verbal-linguistic thought instead of...

The future orientation of worry: final results

Associations between reported worry content by gender and generalized anxiety disorder (GAD) status

Exploring Temporal Features of Worry Phenomenology: Data Analysis and Conclusions.

Future Orientation of Worry: An Investigation of Temporal Elements.

Differences in reported worry content by GAD status and gender.