2016 defense centers of excellence for psychological ... · pdf file“medically ready...

2016 Defense Centers of Excellence for Psychological
Health and Traumatic Brain Injury
(DCoE) Summit
September 13 - 15, 2016
Medically Ready ForceReady Medical Force

Biography
Larry Pruitt is a licensed clinical psychologist in the research, outcomes, and investigations division of the National Center for Telehealth & Technology (T2). He earned his masters and doctoral degrees in clinical psychology at the University of Nevada, Reno, and completed a clinical internship at the Sierra Nevada Veterans Affairs Medical Center. Prior to joining the staff at T2, Pruitt completed a two-year fellowship at the University of Washington in the Department of Psychology as a faculty research associate. At T2, he serves as the program lead for the Department of Defense Suicide Event Reporting (DoDSER) system, and is the clinical research supervisor of the home telehealth program. He has authored numerous peer reviewed publications and book chapters in the areas of telemental health, PTSD treatment, suicide prevention, and the phenomenology of clinical anxiety.
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Learning Objectives
At the conclusion of this presentation the participants will be able to:
Discuss the rates and risk factors associated with Service members that die by suicide.
Interpret how the occurrence of suicide differs between the U.S. general population and the Services.
Assess risk and plan interventions based on current risk factors affecting the Service member population.
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The Incidence of Suicide in the US Armed Forces: Select Findings from the Department of Defense
Suicide Event Report (DoDSER)
Larry D. Pruitt, Ph.D. National Center for Telehealth and Technology
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Disclosure
Dr. Larry Pruitt has no relevant financial relationships to disclose.
The views expressed in this presentation are those of the author and do not necessarily reflect the official policy or position of the Department of Defense, nor the U.S. Government.
This continuing education activity is managed and accredited by Professional Education Services Group in cooperation with DCoE. PESG, as well as all accrediting organizations, do not support or endorse any product or service mentioned in this activity.
PESG and DCoE staff have no financial interest to disclose. Commercial support was not received for this activity.
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T2 & DCoE The National Center for Telehealth & Technology Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury DHA Healthcare Operations
Our Mission: To lead the innovation of health technology solutions for psychological health and traumatic brain injury, and deliver tested, valued health solutions that improve the lives of our nations warriors, veterans and their families.
Our vision is world-class health care and optimized health in the DoD through effective leveraging of behavioral science and technology.
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T2 Web Presence
afterdeployment.dcoe.mil
militarykidsconnect.dcoe.mil
dodser.t2.health.mil
startmovingforward.dcoe.mil
militaryparenting.dcoe.mil
familiesnearandfar.org Source: http://www.t2health.dcoe.mil
Medically Ready ForceReady Medical Force 7
http:http://www.t2health.dcoe.milhttp:familiesnearandfar.orghttp:militaryparenting.dcoe.milhttp:startmovingforward.dcoe.milhttp:dodser.t2.health.milhttp:militarykidsconnect.dcoe.milhttp:afterdeployment.dcoe.mil

T2 mobile Applications
Twenty T2 mobile applications as they appear on a mobile device Source: http://www.t2health.dcoe.mil
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http:http://www.t2health.dcoe.mil

A Day in the Life of T2 Applications
1,200 website visits
2,500 mobile apps downloaded
10,000 times mobile
apps used
Source: http://www.t2health.dcoe.mil Daily use of T2s mobile health products
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http:http://www.t2health.dcoe.mil

Research Endeavors
Telehealth Can tele-mental health be
delivered directly to the home? Can telehealth save money?
Mobile Health Can an app really collect
accurate psychological
screening information?
Can internet-based self-care solutions for PTSD actuallyreduce symptoms?
Emerging Technologies Is virtual reality exposure
therapy better than thestandard treatment for PTSD?
Suicide Can a smartphone app
improve clinical treatments for suicide behaviors?
Is mild TBI associated with military suicides?
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Source: http://www.t2health.dcoe.mil/programs/DoDSER Logo for DoD Suicide Event Report
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http://www.t2health.dcoe.mil/programs/DoDSER

Healthy Warrior Effect
U.S. Armed Forces suicide rates have traditionally been lower than the general population (Eaton et al., 2006)
Service Member Population:
- Is employed - Meets basic educational and
intellectual standards - Participates in routine physical
conditioning - Has access to health care services - Passes basic enlistment criteria
The General Population:
- Includes the unemployed and those without housing and other resources
- Includes those with severe psychiatric disorders
- Includes teens and elderly individuals
- Includes other cohorts with known risk profiles for suicide

Changing Landscape
Army suicide rates decreased significantly during WW I and II(Rothberg et al., 1987)
No evidence of an increase in suicide during Korean War or Vietnam War eras
Suicide rates among U.S. Service members have increased significantly between Vietnam era and Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) (Reger, et al., in press)
This increase during OEF/OIF has puzzled researchers Contrasts with Healthy Warrior Effect by violating expectations of
occurrence
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Unadjusted Suicide Rates 2008-2014 Su
icid
es p
er 1
00,0
00 S
ervi
ce m
embe
rs
Unadjusted Suicide Rates 2008-2014
Source: http://www.t2health.dcoe.mil/programs/DoDSER

Medically Ready ForceReady Medical ForceMedically Ready ForceReady Medical Force
Unadjusted Suicide Rates 2008-2014, by Service
Unadjusted Suicide Rates 2008-2014 Su
icid
es p
er 1
00,0
00 S
ervi
ce m
embe
rs
Source: http://www.t2health.dcoe.mil/programs/DoDSER
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A Need for Better Data
DoD Suicide Event Report (DoDSER) System: - A web-based application to collect standardized DoD suicide surveillance data.
DoDSER Annual Report: - A congressionally reviewed report that characterizes and contextualizes Service member suicide data to inform decision makers.
Source: https://dodser.t2.health.mil
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http:https://dodser.t2.health.mil

DoDSER Data Collection Process
DoDSER Data Collection Process
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Select Findings CY 2014 DoDSER Annual Report

CY 2014 Suicide Rates
438 deaths due to suicide 269 Active Component suicides 169 Reserve Component suicides Combined Active Component
Compared to Combined Reserves 80 deaths in the Reserves 89 deaths in the National Guard 2013 2014
23.4 21.9 19.9 18.7
Rat
es p
er 1
00,0
00
Combined Combined Active Reserves
Source: http://www.t2health.dcoe.mil/sites/default/files/CY-2014-DoDSER-Annual-Report.pdf

Active Component Demographic Risk Factors
Age Ethnicity Race Sex
Rate
Per
100
,000
SM
s
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http://www.t2health.dcoe.mil/sites/default/files/CY-2014-DoDSER-Annual-Report.pdf

Active Component Demographic Risk Factors
Marital Status
Rate
Per
100
,000
SM
s
Education Rank Source: http://www.t2health.dcoe.mil/sites/default/files/CY-2014-DoDSER-Annual-Report.pdf
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Method of Suicide
68.3% of SM suicides were due to injuries caused by firearms 92.2% of these firearms were personal possessions 7.3% of these firearms were military issued Firearm(s) present in the immediate environment of 63.1% of decedents
DoDSER 2014 Suicide Methods, by Service
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http://www.t2health.dcoe.mil/sites/default/files/CY-2014-DoDSER-Annual-Report.pdf

2016 defense centers of excellence for psychological ... · pdf file“medically ready...

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