Steve Martino’s research while affiliated with Yale-New Haven Hospital and other places

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Publications (173)


To Adopt or Adapt: A Scoping Review of Dialectical Behaviour Therapy With Patients With Minoritised Identity Constructs
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February 2025

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42 Reads

Counselling and Psychotherapy Research

Frances M. Aunon

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Polly Ingram

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Suzanne E. Decker

Objective Dialectical behaviour therapy (DBT) is an evidence‐based psychological intervention (EBP) for reducing suicide behaviour. While DBT, like many EBPs, was developed and first evaluated in largely white samples in Western contexts, it is now broadly applied. This review assessed how DBT has been adopted or adapted when used with patient populations with minoritised identity constructs. Methods We conducted a PRISMA‐guided scoping review of articles using DBT with a minoritised patient population. We used an implementation science framework, Framework for Reporting Adaptations and Modifications‐Enhanced, to characterise adaptations to the content and context of DBT application. Through PubMed, Embase and PsycINFO, we identified 273 articles where the title or abstract mentioned DBT and described a minoritised adult patient population. Principle Findings We found 83.5% (228/273) articles reviewed reported adaptations to DBT content. Specifically, 66.3% (181/273), 44.6% (122/273) and 39.6% (108/273) of articles described reducing, expanding or changing DBT content, respectively. We found that 42.1% of articles (115/273) reported adaptations to the DBT context. Moreover, 57.5% of content adaptations and 65.3% of context adaptations did not specify a reason for adaptation. Conclusions This scoping review indicates that the majority of articles of studies using DBT with patients with minoritised identity constructs made adaptations to DBT, but few provided justification for these adaptations. We encourage clinicians and clinical administrators, researchers and policymakers to document adaptations and justifications thereof, and evaluate clinical and implementation outcomes.




The Promise of a Retreat: Perspectives of U.S. Women Veterans and Interdisciplinary Experts on the Development of a Retreat-Based Suicide Prevention Program for Violence-Exposed Women Veterans

January 2025

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8 Reads

To supplement the mental health programming offered to women veterans within the Veterans Health Administration, a retreat-based suicide prevention program could foster healing through social connection and holistic health. However, no study has investigated retreat-based suicide prevention program components relevant for violence-exposed women veterans. To address this gap, we conducted focus groups with women veterans and semi-structured interviews with interdisciplinary subject matter experts to examine perceptions, beliefs, concerns, and preferences related to a retreat-based suicide prevention program for women veterans. Emergent themes included interest and appeal, concerns about program execution, and program preferences. Findings suggest that both women veterans and experts agree that a retreat-based suicide prevention program for women veterans is a promising and welcomed prevention strategy that may reduce suicide risk. Both interest groups emphasized that programming should be trauma-informed with training for program facilitators and attention to group dynamics.


Mean Evidence and Context ORCA Subscale Scores - By Site and Overall. The Organizational Readiness to Change Assessment (ORCA; Helfrich, Sharp, & Sales, 2009) included items from the three domains of the original Promoting Action on Research in Health Services (PARIHS; Kitson, Harvey, & McCormack, 1998) assessing the strength of evidence for the innovation, quality of the context for implementation, and capacity to facilitate the implementation. This study used the ORCA evidence and context subscales. All quantitative items are scored as 1=Strongly Disagree | 2=Disagree | 3=Neither Agree nor Disagree | 4=Agree | 5=Strongly Agree.
Mixed-methods formative evaluation of implementing an adapted suicide prevention treatment: Dialectical Behavior Therapy Skills Groups in the Veterans Health Administration
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  • Full-text available

November 2024

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37 Reads

Background Preventing veteran suicide requires addressing mechanisms driving suicidal behavior, such as emotion dysregulation. Dialectical Behavior Therapy Skills Groups (DBT-SG) are well established for reducing emotion dysregulation, improving coping skills, and in some studies, reducing suicide attempt, but will require implementation support to deliver DBT-SG and to test its effectiveness within the Veterans Health Administration (VHA). Methods We conducted a mixed-method developmental formative evaluation of DBT-SG at four VHA medical centers, guided by the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, as part of a hybrid effectiveness-implementation trial (Clinical trials ID, NCT05000749). Results Quantitative Organizational Reasons for Change Assessment data (n = 30 VHA staff) and qualitative data (n = 35 VHA staff) were merged, compared, and triangulated. Quantitative and qualitative data largely converged, showing favorable views of evidence supporting DBT-SG and strong enthusiasm for its potential to reduce veteran suicide attempt. Staff noted DBT-SG’s broad applicability to veterans. Staff were less optimistic about the inner context supporting DBT-SG implementation, commenting on how limited staffing could be a barrier despite leadership wanting to support suicide prevention. Conclusions Implementation barriers to DBT-SG at VHA include limited staffing, despite staff enthusiasm. The next phase of this project will evaluate DBT-SG effectiveness in a randomized controlled trial. Clinical trials registration https://clinicaltrials.gov/study/NCT05000749, identifier NCT05000749.

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Impact of the COVID-19 pandemic on participants in pragmatic clinical trials for chronic pain: implications for trial outcomes and beyond

November 2024

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1 Read

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2 Citations

Pain Medicine

Objective The COVID-19 pandemic had profound effects on society, including those living with chronic pain. This study sought to examine pandemic impacts on individuals enrolled in pragmatic clinical trials focused on nonpharmacological treatments for chronic pain. Methods We evaluated responses to a questionnaire on COVID-19 impacts that had been administered to participants (n=2024) during study enrollment in 3 pragmatic clinical trials for chronic pain treatment. All trials were part of the National Institutes of Health (NIH)–Department of Veterans Affairs (VA)–Department of Defense (DOD) Pain Management Collaboratory. COVID-19–related impacts on access to health care, mental health, finances, ability to meet basic needs, and social support were assessed. Results Pandemic impacts were found in all domains assessed, including access to health care, mental and emotional health, ability to meet basic needs, finances, and social support. Impacts varied by demographic and clinical characteristics. The participants most negatively impacted by the pandemic were younger, Black or Latino, female, more educated, and unemployed and had screened positive for depression. No impact differences were found with regard to alcohol use disorder screenings or a prior history of COVID-19. Higher levels of pain were associated with worse pandemic impacts, and negative impacts declined over time. Conclusions Negative impacts of the pandemic on individuals living with chronic pain cut across aspects of life that are also central to effective pain management, including access to health care, social support, and mental and emotional health, with differential impacts found across key demographic and clinical factors. These findings should yield consideration of pandemic impacts in clinical practice and as moderating effects of treatment outcomes in clinical trials conducted during the pandemic.


Screening, brief intervention, and referral to treatment for pain management for veterans separating from military service: study protocol of a hybrid type 2 study testing implementation facilitation versus training-as-usual

November 2024

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8 Reads

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1 Citation

Pain Medicine

Background Veterans transitioning to civilian life often have chronic pain from service-related musculoskeletal disorders (MSD) with higher risk for substance misuse. Many seek VA (Department of Veterans Affairs) compensation for MSD. Use of Screening, Brief Intervention, and Referral to Treatment for Pain Management (SBIRT-PM) by VA Post-9/11 Military2VA (M2VA) case managers presents an opportunity to engage these veterans in VA pain care and address substance misuse. Implementation facilitation might help case managers use SBIRT-PM and engage veterans in services to improve outcomes. Design This study is a 2-cohort multisite cluster-randomized hybrid type 2 effectiveness-implementation trial. Within 2 separate cohorts of 14 VA sites each, sites will be allocated to receive an implementation strategy through the use of a constrained randomization procedure: virtual implementation facilitation or training-as-usual. Sites and M2VA case managers will receive the assigned implementation strategy to support use of SBIRT-PM. Recently discharged veterans (n = 1848) claiming service-connected MSD will be recruited, with case managers blind to veterans’ study enrollment. The proportion of participants who receive any SBIRT-PM will be the primary implementation outcome. Veteran participants will complete baseline, 12-week, and 36-week assessments, irrespective of whether case managers conduct SBIRT-PM with them (intent-to-treat). Pain intensity and interference will be the primary clinical outcomes. The study emphasizes pragmatic over explanatory methodological features. Summary This pragmatic trial will examine implementation facilitation versus training-as-usual in implementing SBIRT-PM to promote veteran engagement in nonpharmacological pain services. Using innovative methods to train and support VA case managers in SBIRT-PM, study outcomes could have broad implications for case management systems of care across the VA.



The IMB Model of Health Behavior Change Applied to Alcohol Use and Polypharmacy
The contents of the Information, Motivation and Behavioral Skills boxes correspond to the specific elements that are addressed and enhanced in the pilot intervention to change alcohol and polypharmacy behavior
Resource Core Domains on the Foundation of Patient Context and Culture
Data captured in HARP
The Feasibility and Acceptability of a Clinical Pharmacist-delivered Intervention to Reduce Bothersome Health Symptoms from Polypharmacy and Alcohol Use and Communicate Risk among People with HIV: Pilot Study Protocol

October 2024

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22 Reads

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1 Citation

AIDS and Behavior

Among persons with HIV (PWH), unhealthy alcohol use and polypharmacy contribute to bothersome symptoms (e.g., fatigue, dizziness, memory loss). However, effective risk communication targeting these associations is challenging. The HIV and Alcohol Research center focused on Polypharmacy (HARP) is conducting a pilot study that will generate feasibility and acceptability data on a clinical pharmacist-delivered counseling intervention targeting the modification of unhealthy alcohol use and polypharmacy in PWH. Counseling is guided by the Information-Motivation-Behavioral Skills-Motivational Interviewing (IMB-MI) model. Herein, we describe the study protocol. This pilot uses a one-group pre-test/post-test design. We will recruit 50 participants from those who participated in the consented cohort of the Veterans Aging Cohort Study. Participants must be prescribed ≥ 5 long-term medications, have a self-reported Alcohol Use Disorders Identification Test score > 0, and be living with HIV. We will exclude those with moderate-severe alcohol use disorder as identified by an Alcohol Symptom Checklist score ≥ 4. Data are collected using three self-administered surveys (baseline, immediately after booster intervention, and 30-days post-intervention), two PEth blood tests (baseline, 30 days post-intervention), and medication data from the electronic health record (baseline). The intervention includes a 60-minute IMB-MI-based counseling session followed by a booster session 2 weeks later. Some participants will also be asked to participate in a qualitative interview to provide feedback on the intervention. The pilot investigates the impact of an intervention on alcohol consumption and the use of multiple medications among PWH, exploring how best to reduce bothersome symptoms, communicate risk, and support behavior change in this population.



Citations (61)


... Some sites offered additional, non-mandated modalities (e.g., mindfulness-based stress reduction). Although VOICE services continued throughout the COVID-19 pandemic, the pandemic negatively affected access to VA pain services 29 and may have limited VOICE participants' access to ancillary and CIH services recommended in their VOICE care plans. (When VA sites are unable to provide timely access to mandated services, VA pays for care in the community, but community care access varies and was also impacted by the pandemic. ...

Reference:

What Makes for a Positive Patient Experience in Chronic Pain Care? A Qualitative Evaluation of Factors Affecting Veteran Patient Satisfaction Across Two Individualized Pain Care Interventions in VA Primary Care
Impact of the COVID-19 pandemic on participants in pragmatic clinical trials for chronic pain: implications for trial outcomes and beyond
  • Citing Article
  • November 2024

Pain Medicine

... However, the effectiveness and safety of these treatments vary widely and depend on individual factors such as the type, intensity, duration, and cause of pain, as well as the patient's preferences, expectations, and adherence [18,20]. Moreover, some treatments, especially opioids, have serious adverse effects and risks of misuse, addiction, and overdose, leading to the opioid crisis that has claimed thousands of lives and harmed countless others [20][21][22]. ...

Integrating the Management of Pain and Addiction via Collaborative Treatment (IMPACT): A randomized clinical trial of a digital cognitive behavioral treatment (Preprint)

JMIR Research Protocols

... Thus, healthcare providers have a unique opportunity to identify individuals who use IPV, provide referrals, and follow patients over time (Penti et al., 2018). Moreover, when patients across clinical settings are asked about their IPV use, they do in fact disclose their use of violence during healthcare visits, particularly during mental health appointments (Chang et al., 2011;Gerlock et al., 2011b;Portnoy et al., 2023). Over the past decade, a number of brief IPV use screening instruments have been developed (Ernst et al., 2012;Kraanen et al., 2013;Portnoy et al., 2018), many with strong reliability and validity (Davis & Padilla-Medina, 2021). ...

Screening for Intimate Partner Violence Experience and Use in the Veterans Health Administration

JAMA Network Open

... Due to the compulsive nature of substance use, individuals may substitute substances with unhealthy foods, such as those with a sweet taste, known as an addictive switch [48]. This addicitive switch can cause excessive weight gain, which may become even more severe in patients receiving methadone as their OAT medication, which eight out of the twelve participants in our study did [49,50]. Since this can lead to adverse health outcomes like obesity, it is essential to incorporate a nutritional component into OAT [51]. ...

Weight change in a national cohort of U.S. Military Veterans engaged in medication treatment for opioid use disorder
  • Citing Article
  • October 2023

Journal of Psychiatric Research

... For pregnant persons with preexisting chronic pain, pain caused by the normal course of pregnancy may be intensified owing to the exacerbation of existing conditions and/or changes to treatment strategies in the perinatal period. Our recent work among a sample of 1,100 veterans enrolled in Veterans Health Administration (VHA) care demonstrated that nearly 15% were diagnosed with a painful musculoskeletal condition in the year before their pregnancy (Kroll-Desrosiers et al., 2023). In general, women veterans are at higher risk of chronic pain compared with women in the general population (Cypel et al., 2023) and with their male veteran counterparts (Higgins et al., 2017). ...

Musculoskeletal Pain During Pregnancy Among Veterans: Associations With Health and Health Care Utilization
  • Citing Article
  • August 2023

Women s Health Issues

... Patients who use violence in relationships present for care in a range of clinical healthcare settings, including emergency rooms, primary care, mental health, and substance use clinics (Coben & Friedman, 2002;Gerlock et al., 2011b;Relyea et al., 2023;Singh et al., 2014). Thus, healthcare providers have a unique opportunity to identify individuals who use IPV, provide referrals, and follow patients over time (Penti et al., 2018). ...

Understanding Veterans' intimate partner violence use and patterns of healthcare utilization
  • Citing Article
  • July 2023

Health Services Research

... Celecoxib inhibits CYP2D6 and is metabolized by CYP2C9, interacting with enzyme inhibitors. 77,78 Esmethadone N-methyl-D-aspartate (NMDA) receptor antagonist 71 TRD 70 Oral, 25-50mg daily 70 Methadone has previously been observed to contribute to weight gain. 71 Further evaluation of esmethadone on weight gain should be observed. ...

Weight change among patients engaged in medication treatment for opioid use disorder: a scoping review
  • Citing Article
  • May 2023

... The impact of the COVID-19 pandemic on the understanding of safety knowledge in military settings is evident, as it presents new challenges and obstacles for healthcare professionals and workers. The working conditions at military hospitals have undergone changes, including increased infection risks, inadequate staffing, and excessive workloads, all of which can influence safety knowledge and practices (Midboe et al, 2023). External influences on safety knowledge and decision making have a significant impact on the military's decision to deploy during the pandemic (Dietrich et al, 2023). ...

Impact of COVID-19 pandemic on nonpharmacological pain management trials in military and veteran healthcare settings: an evaluation informed by implementation science

Translational Behavioral Medicine

... One potential barrier to PTSD improvement among women veterans who have experienced MST is institutional betrayal, which is the failure of institutions (e.g., Department of Defense [DoD], Department of Veterans Affairs [VA]) to prevent harm and/or institutions responding in ways that exacerbate harm . The culture of one's military unit can create or perpetuate environments in which MST is more or less likely to occur, and institutional culture in both the DoD and the VA can promote more or less supportive environments in response to MST and its disclosure (Reinhardt et al., 2016;Webermann et al., 2023). For instance, a qualitative study indicated that half of women veterans with an MST history experienced retaliation for disclosure, and those who disclosed to fellow service members felt fear regarding potential consequences relative to those who disclosed to a non-service member (Dardis et al., 2018). ...

The Role of Unit and Interpersonal Support in Military Sexual Trauma and Posttraumatic Stress Disorder Symptoms

... The comorbidity of problematic drinking and alcohol use disorder (AUD) with weight problems and obesity presents a complex challenge for individuals, clinicians, and researchers. 33,34 This article reviews the effectiveness of anti-obesity medications (AOMs) in reducing alcohol consumption among people struggling with significant drinking issues, which are defined here as both problematic drinking and AUD, essentially referring to the same conditions. 35,36 These conditions are characterized by an individual's inability to control their alcohol intake despite facing adverse consequences. ...

Co-occurring alcohol use disorder and obesity in U.S. military veterans: Prevalence, risk factors, and clinical features
  • Citing Article
  • March 2022

Journal of Psychiatric Research