Jack Tsai's research while affiliated with University of Texas at San Antonio and other places

Publications (280)

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Justice-involved veterans are a high-risk, high-need subgroup serviced by behavioral health services within the Veterans Health Administration (VHA) system. Justice-involved veterans often have complex mental health and substance use difficulties, a myriad of case management needs, and a range of criminogenic needs that are difficult to treat with...
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The current study examined (a) how veteran status, race, and other individual characteristics are associated with any lifetime incarceration in the U.S. adult population; and (b) differences between veterans and other adults with any incarceration histories on sociodemographic, health, and psychosocial characteristics. Data from structured intervie...
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Objective: This study examined the descriptive terms used in referring to homeless populations. Methods: Data were from a 2020 national survey of 6,607 middle- and low-income U.S. adults with or without lived experiences of homelessness and a 2021 survey of a convenience sample of 354 U.S. researchers, homelessness service providers, and policy...
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Objective: This study was the first to examine the characteristics and referral outcomes for veterans calling the National Call Center for Homeless Veterans (NCCHV). Methods: The authors analyzed data from NCCHV and U.S. Department of Veterans Affairs (VA) health care records. Results: Between December 2018 and October 2020, the NCCHV received...
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Introduction: Erectile dysfunction (ED) is one of the most prevalent sexual dysfunctions in men and often co-occurs with physical and mental health issues. Military veterans are at elevated risk for many comorbid physical and mental health issues, including ED, although little research has examined the prevalence and health burden of ED in the gen...
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The objective of this study was to examine type of services U.S. veterans seek when they experience homelessness, characteristics associated with service use, and reasons for not using services. Data from a 2021 nationally representative survey of 1004 low-income U.S. veterans were analyzed with descriptive and multivariable analyses. One-quarter o...
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While social support has been linked to better health, most research has focused on the receipt of social support. In this study, we evaluated associations between provided support and mental health in a nationally representative cohort of 4069 US veterans. The majority (60–72%) of veterans reported providing support on a consistent basis. Veterans...
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Overuse of videoconferencing for work may contribute to what has been called "Zoom fatigue": feeling anxious, socially isolated, or emotionally exhausted due to lack of social connection. Given implications for employee well-being, this study investigated Zoom fatigue at work and its potential link to mental health symptoms. A national survey of me...
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U.S. Department of Veterans Affairs Office of Health Equity Information Brief (Non-print/Online materials)
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Objective: To: 1) identify sociodemographic and military differences between enlisted and commissioned U.S. military veterans; (2) examine sociodemographic, military, trauma, and mental health histories of enlisted and commissioned veterans; and (3) evaluate interactions between enlistment status and trauma exposures in relation to mental health....
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Background Dispositional gratitude has been implicated as a psychological characteristic that may modulate risk for mental health outcomes. Using a population-based sample of U.S. military veterans, this study evaluated the association between dispositional gratitude and the development of psychopathology and suicidal behaviors over a 7-year period...
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Loneliness was deemed a behavioral epidemic even prior to the COVID-19 pandemic. The COVID-19 pandemic and the subsequent social distancing policy measures have raised concerns about increased social isolation and loneliness, especially in vulnerable populations such as military veterans. However, little is known about the impact of the pandemic on...
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Background Homelessness is a major public health problem among U.S. military veterans. However, contemporary, population-based data on the prevalence, correlates, and mental health burden of homelessness among veterans are lacking. Methods Data were analyzed from the 2019–2020 National Health and Resilience in Veterans Study, a nationally repres...
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Accumulating research suggests unique patterns of suicide risk, homelessness, and criminal-justice involvement in younger (age < 40) relative to older (aged 40+) cohorts of Veterans. However, potential explanations for these differences remain unclear. To address this gap, we analyzed data from a nationally representative sample of more than 4,000...
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Background: Although the COVID-19 pandemic has not led to a uniform increase of mental health concerns among older adults, there is evidence to suggest that some older veterans did experience an exacerbation of pre-existing mental health conditions, and that mental health difficulties were associated with a lack of social support and increasing nu...
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For many years, suicide rates in U.S. general and veteran populations have steadily increased, stimulating research into suicide and nonfatal self-injury (NFSI). However, little research has examined community correlates of suicide and NFSI. This study used county data from New York State to identify community correlates of veteran and general popu...
Preprint
While social support has been linked to better health, most research has focused on the receipt of social support. In this study, we evaluated associations between provided support and mental health in a nationally representative cohort of 4,069 US veterans. The majority (60-72%) of veterans reported providing support consistently. Veterans who sco...
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Suicide among Veterans experiencing or at risk for homelessness remains a significant public health concern. Conducting research to understand and meet the needs of this at-risk population remains challenging due to myriad factors (e.g., clinical complexity including multimorbidity, difficulty monitoring risk across systems). To address this challe...
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This study provisionally examined the effects of the US eviction moratorium instituted in response to the Coronavirus Disease 2019 (COVID-19) pandemic. Three waves of data collected May 2020–April 2021 from a nationally representative sample of middle- and low-income US tenants (n = 3393 in Wave 1, n = 1311 in Wave 2, and 814 in Wave 3) were analyz...
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The accurate identification of persons at risk of exiting permanent supportive housing could help maximize client success and minimize attrition and premature exits from such housing. Thus, in the present study, we developed and tested multivariable prediction models of negative and positive exits from the U.S. Department of Housing and Urban Devel...
Preprint
BACKGROUND Although the pandemic has not led to a uniform increase of mental health concerns among older adults, there is evidence to suggest that some older veterans did experience an exacerbation of pre-existing mental health conditions, and that mental health difficulties were associated with a lack of social support and increasing numbers of pa...
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Background: To examine socioeconomic disparities in use of electroconvulsive therapy (ECT) among homeless or unstably housed (HUH) veterans with mental illness. Methods: National data from medical records in years 2000 to 2019 on 4 to 6 million veterans with mental illness, including 140 000 to 370 000 homeless veterans served annually from the...
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The U.S. Supreme Court ended the federal moratorium on evictions that was in effect from May 2020-August 2021 during the Coronavirus Disease 2019 (COVID-19) pandemic. The end of an unprecedented national eviction moratorium has public health implications for housing, health, and homelessness. Accumulation of eviction filings, unpaid rent, tenant mo...
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This study sought to examine the association between homelessness and receipt of electroconvulsive therapy (ECT) among older Medicare beneficiaries with homelessness. Among individuals with major depressive disorder who were older (age 65+) Medicare beneficiaries (2014–2015 data), we compared clinical and sociodemographic characteristics among thos...
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Objective This study conducted a pharmacoepidemiologic examination of antidepressant prescription patterns in homeless and unstably housed (HUH) populations. Methods Data were analyzed on over 2.6 million veterans from the U.S. Department of Veterans Affairs (VA), the largest provider of healthcare for HUH veterans and a system that does not requi...
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Objective: Psychiatric and substance use disorders are prevalent among U.S. military veterans, yet many veterans do not engage in treatment. The authors examined characteristics associated with use of mental health care in a nationally representative veteran sample. Methods: Using 2019-2020 data from the National Health and Resilience in Veteran...
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There has been insufficient research on gender, race, and ethnic differences in unmet needs of homeless populations. This study analyzed 5 years of data collected by Project Community Homelessness Assessment, Local Education, and Networking Groups (CHALENG) surveys from 2012 to 2016 to examine gender, race, and ethnic differences in "literally home...
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Introduction: Housing insecure veterans are aging, but the prevalence of Alzheimer's disease and related dementias (AD/ADRD) in the population is unknown. Methods: We calculated the prevalence of AD/ADRD diagnoses in 2018 among veterans that experienced homelessness, were at-risk for homelessness, or were stably housed. We determined acute care...
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A substantial proportion of U.S. military veterans experience mental health and/or substance use disorders. As public awareness of these difficulties rises, so too does interest in the relation between veteran behavioral health and high-risk events, namely suicide attempts, incarceration, and homelessness. Using latent class analysis and a large, n...
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Background: There is a lack of data-driven evidence about the burden of homelessness, and lack of a holistic measure of effectiveness for evaluating interventions targeting homelessness. Quality-adjusted life years (QALYs) can help holistically capture the burden of homelessness, and facilitate the valuation and comparison of interventions designe...
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This study examined the relationship between job loss and mental health during the pandemic among a nationally representative sample of middle- and low-income military veterans and civilians. Participants were recruited from Amazon Mechanical Turk in May to June 2020. Our sample was comparable to the U.S. population with respect to key demographics...
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Purpose: Millions of people are evicted from rental properties in the U.S. annually, but little is known about them and their mental health. This study followed a cohort of eviction court participants over time and assessed their housing and mental health outcomes. Methods: One hundred and twenty-one tenants were recruited from an eviction court...
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Rationale: The COVID-19 pandemic has had numerous negative effects globally, contributing to mortality, social restriction, and psychological distress. To date, however, the majority of research on the psychological impact of the COVID-19 pandemic has focused on negative psychological outcomes, such as depression, anxiety, and posttraumatic stress...
Preprint
In 2020, the Centers for Disease Control and Prevention (CDC) issued several agency orders that put into effect a national moratorium on evictions for over one year to limit transmission of Coronavirus Disease 2019 (COVID-19). Little is known about landlord and tenant behaviors during the eviction moratorium. The current study used three waves of d...
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Background The Coronavirus Aid, Relief, and Economic Security Act of 2020 provided ‘economic impact payments’ (EIPs) of $1200 to US adults with annual personal income of $75 000 or less. This study examined the prospective association between EIP receipt and mental health outcomes. Methods A nationally representative sample of 3169 middle-income a...
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Veterans are at increased risk of comorbid posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) relative to civilians. Few studies have explored the association between distinct PTSD symptoms and AUD in veterans, and existing findings are highly discrepant. This study aimed to address this gap and equivocal association by evaluating...
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Background: There are significant concerns about mental health problems occurring due to the coronavirus disease 2019 (COVID-19) pandemic. To date, there has been limited empirical investigation about thoughts of suicide and self-harm during the COVID-19 pandemic. Methods: A national survey was conducted May 2020 to investigate the association b...
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Objective: This study aimed to characterize the current prevalence of loneliness, and the relation between loneliness severity and psychiatric and physical health conditions, suicidality, and functional measures in a predominantly older sample of U.S. military veterans. Methods: This cross-sectional study used data from the National Health and Resi...
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Objective: Posttraumatic stress disorder (PTSD) and hazardous alcohol use are prevalent among trauma survivors. Despite higher rates of both PTSD and hazardous alcohol use among military combat veterans than civilians, scant research has examined whether military combat experience is associated with drinking alcohol to cope with PTSD symptoms. This...
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Objective: This study examined characteristics and planned expenses of U.S. adults who received the economic impact payment (EIP) during the COVID-19 pandemic. Methods: Using a nationally representative sample of 6,607 middle- and low-income U.S. adults, the authors examined the proportion and correlates of EIP receipt among eligible adults and...
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Objective: Despite the established efficacy of electroconvulsive therapy (ECT), negative perceptions and inaccurate knowledge about ECT in the United States and other countries persist. This study examined ECT perceptions and knowledge in the 3 most populous countries in the world. Methods: We recruited participants who screened positive for dep...
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Objective: Electroconvulsive therapy (ECT) is an effective treatment for major depressive disorder; yet, its use is confined to <1% of individuals with this disorder. The authors aimed to examine barriers to ECT from the perspective of the provider. Methods: Qualitative interviews were conducted with U.S.-based ECT providers to identify potentia...
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Background: To determine the incidence of homelessness among Veterans diagnosed with Alzheimer's disease and related dementias (ADRD). Methods: We used Veterans Affairs (VA) administrative records to identify Veterans with a new ADRD diagnosis anytime between 2010-2019. Among these Veterans, we calculated the incidence of homelessness, and estim...
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Sleep and posttraumatic stress disorder (PTSD) have a complex relationship, with some studies showing that disrupted sleep is associated with subsequent development of PTSD. The purpose of the current study was to examine the relationship between sleep quality and the development of probable PTSD in U.S. veterans surveyed as part of the National He...
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Background : Social anxiety disorder (SAD) is a chronic and disabling psychiatric disorder associated with low levels of help-seeking. To date, however, scarce research has examined the epidemiology of SAD in veterans. This study examined the prevalence, comorbidities and incremental burden of SAD in relation to suicidality and functioning in a rep...
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Compared with housed people, those experiencing homelessness have longer and more expensive inpatient stays as well as more frequent emergency department visits. Efforts to provide stable housing situations for people experiencing homelessness could reduce health care costs. Through the Supportive Services for Veteran Families program, the Departme...
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Objective: Intensive case management (ICM) is important in psychiatric rehabilitation but there is a need to "graduate" clients. The purpose of this research was to review the literature on criteria used and outcomes of graduating clients with severe mental illness from ICM programs. Method: A systematic review conducted in 2019 used keyword sea...
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This introduction describes the impetus and context for this special issue on multimorbidity in homeless populations. The guest editors begin the introduction by describing the problem of homelessness which has been exacerbated by the coronavirus disease 2019 (COVID-19) pandemic. The editors then describe the content of this special issue, which in...
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Background: Research indicates that adults with severe mental illness have lower income and employment than adults without severe mental illness. Further, mental illness has been identified as a risk factor for homelessness. However, little research has investigated the interrelationships between financial strain, mental illness, and homelessness....
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Purpose This study examined how exposure to events during the Coronavirus Disease-19 (COVID-19) era is linked to symptoms of major depressive disorder (MDD), generalized anxiety disorder (GAD), COVID-19 era-related stress (CS), alcohol use disorder (AUD), and suicidal ideation (SI) in low and middle-income U.S adults. Methods A national sample of...
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Rapid rehousing (RRH), a programmatic approach that seeks to help households currently experiencing homelessness quickly regain stable housing, has garnered increasing attention over the past decade in the United States and internationally. However, there has been no attempt to assess evidence of the effectiveness of RRH. We address this gap by con...
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The coronavirus disease 2019 (COVID-19) pandemic has negatively affected the mental health of the general population. However, less is known about its impact on vulnerable populations, such as veterans with pre-existing psychiatric conditions. Data were analyzed from the National Health and Resilience in Veterans Study, which surveyed a nationally...
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Background Varied longitudinal courses of suicidal ideation (SI) may be linked to unique sets of risk and protective factors. Method A national probability sample of 2291 U.S. veterans was followed over four assessments spanning 7 years to examine how a broad range of baseline risk and protective factors predict varying courses of SI. Results Mos...
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Objective: This study examined psychosocial and mental health characteristics associated with COVID-19 infection. Methods: An online survey that asked about COVID-19 status, social support, and mental health was used to recruit a national sample of 6,607 low- and middle-income adults; 354 reported a positive COVID-19 test, 1,819 reported a negat...
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Background The health concerns that spur care-seeking in emergency departments (EDs) among homeless populations are not well described. The Veterans Affairs (VA) comprehensive healthcare system does not require health insurance and thus offers a unique window into ED service use by homeless veterans. Objective This study examined the top 10 diagno...
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Importance: Temporary financial assistance (TFA) for housing-related expenses is a key component of interventions to prevent homelessness or to quickly house those who have become homeless. Through the US Department of Veterans Affairs (VA) Supportive Services for Veteran Families (SSVF) program, the department provides TFA to veterans in need of...
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Introduction There has been a decade-long federal commitment to prevent and end homelessness among U.S. military veterans. Substantial progress has been made; so, a question that stakeholders ask is: Is veteran homelessness still a problem? Methods To answer this question, 2 different data sources were analyzed in 2020: (1) a nationally representa...
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Objective: Exposure to traumatic life events is associated with increased risk of posttraumatic stress disorder (PTSD) and other mental health problems such as suicidal ideation (SI), alcohol use disorder (AUD), and decreased quality of life (QOL). Mindfulness, which involves attending to the present moment, may help individuals cope with traumati...
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Dispositional gratitude may be linked to positive mental health outcomes, yet population-based data on this association are lacking. Military veterans are an ideal population in which to examine this question given high rates of psychiatric morbidities and efforts to promote psychological resilience in this population. Data were analyzed from a nat...
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This study examined differences in public knowledge and attitudes about homelessness and posttraumatic stress disorder (PTSD) among US Veterans and other adults. A national online survey of 541 US adults from the general population was conducted in November 2016 about knowledge and attitudes about homelessness and PTSD both in reference to the gene...
Preprint
This study examined characteristics and planned expenses of U.S. adults who received the economic impact payment (EIP) during the coronavirus disease 2019 (COVID-19) pandemic. Using a nationally representative sample of 6,607 low and middle-income U.S. adults, this study examined the proportion and correlates of EIP receipt among eligible adults; a...
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United States (U.S.) veterans are substantially older than their non-veteran counterparts. However, nationally representative, population-based data on the unique health needs of this population are lacking. Such data are critical to informing the design of large-scale outreach initiatives, and to ensure the effectiveness of service care delivery b...
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Objective: Many homeless and unstably housed (HUH) adults have severe mental illnesses that are managed with antipsychotic medications. The US Department of Veterans Affairs (VA) is the largest provider of homeless services, but there has been little study of psychotropic medication prescriptions for HUH veterans. Methods: Using national VA admi...
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Background Military combat trauma is often associated with negative outcomes, including high rates of posttraumatic stress disorder (PTSD). Less is known, however, about whether military combat trauma may foster posttraumatic growth (PTG), which has been observed in relation to other trauma types, in representative samples of veterans. Methods We...
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Introduction Identifying patient populations most affected by adverse social determinants of health can direct epidemiologic investigation, guide development of tailored interventions, and improve clinical care and outcomes. This study explores how demographic characteristics are associated with specific types—and cumulative burden—of adverse socia...
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Objective: To assess sociodemographic, diagnostic, and services use factors associated with veterans' repeated, episodic use of Veterans Health Administration (VHA) Homeless Programs. Design: This retrospective cohort study used stepwise multivariate logistic regression to assess the odds of veterans being frequent episodic utilizers of VHA Home...
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Methods: Data from a nationally representative sample of 4,069 U.S. veterans in 2019-2020 were used to examine the prevalence of full and subthreshold PTSD in veterans with a history of homelessness; identify characteristics associated with PTSD; examine the proportion of veterans who reported homelessness as an index trauma event and screened pos...
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This study describes expert perspectives on service user transitions within and from homeless service programs. Semi-structured qualitative interviews were conducted with subject matter experts (SMEs) who had practice or research experience regarding transitional supports in homeless services. Interviews were analyzed using rapid assessment procedu...
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Moving On initiatives (MOIs) transition stable permanent supportive housing (PSH) residents into mainstream housing without embedded services. While this approach frees up PSH for homeless individuals in need, open questions remain regarding MOI recipients’ long‐term outcomes. This exploratory study examines how housing environment and residential...
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Objective: Homelessness is associated with increased risk of suicide attempts. This study examined whether suicide attempts typically precede or occur during episodes of homelessness in a representative national sample. Methods: Data from 36,127 adults in the National Epidemiologic Survey on Alcohol and Related Conditions-III were used to identi...
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Dissociative symptoms following trauma exposure, such as derealization (i.e., feeling that one’s experience is strange and unreal) and depersonalization (i.e., feeling detached from oneself) have been implicated in the development and maintenance of posttraumatic stress disorder (PTSD). In the current study, we analyzed data from a 3-year prospecti...
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Objective: The study aimed to examine the potential impact of job automation on veterans in the largest U.S. vocational rehabilitation program, the Compensated Work Therapy (CWT) program. Methods: Sixty-two CWT managers were surveyed about common jobs that veterans want and are placed in and about the anticipated impact of job automation on vete...