Office of Research & Development

VA research on

Mental Health


Introduction

Mental health conditions are common in the United States. According to the National Institute of Mental Health, an estimated 43.4 million adults aged 18 or older had a mental illness in 2015, representing about 18 percent of all U.S. adults—and this figure did not include substance use disorders. More than 1.8 million Veterans received specialized mental health care from VA in fiscal year 2015.

VA offers a wide range of mental health services to Veterans. The goal of VA mental health care is to support recovery and enable Veterans who experience mental health problems to live meaningful lives in their communities and achieve their full potential.

The department aims to provide coordinated care for the whole person, not just for the person's mental illness. VA promotes the idea that having a healthy body, satisfying work, and supportive family and friends are integral to mental health. All Veterans who receive specialty mental health care have mental health treatment coordinators to help them define and work toward their overall mental health goals.

Mental health services are available in VA's mental health specialty clinics, primary care clinics, nursing homes, and residential care facilities. At most of VA's larger primary care venues, VA now integrates mental health staff into Patient Aligned Care Teams (PACTs), allowing those care teams to provide services for depression, anxiety, posttraumatic stress disorder (PTSD), and substance use without needing a separate consult with mental health providers outside of the PACT clinic area. Those with serious mental health problems may take part in specialized programs such as mental health intensive case management, day centers, work programs, and psychosocial rehabilitation.

Emergency mental health care is available 24 hours a day, seven days a week at VA medical centers. Facilities that do not have 24-hour emergency rooms must provide emergency services through a local non-VA hospital.

Veterans thinking about hurting or killing themselves or others, experiencing an emotional crisis, feeling hopeless, or engaging in self-destructive behavior such as drug abuse should call the Veterans Crisis Line at 1-800-273-TALK (8255). Press 1 for Veterans.

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Selected Major Accomplishments in VA Research

  • 1941: Set up a research lab at the Northport VA Medical Center, to conduct clinical and biomedical research in neuropsychiatric disorders
  • 1989: Created the National Center for PTSD to address the needs of Veterans and other trauma survivors with PTSD
  • 1997: Identified a gene associated with a major risk for schizophrenia
  • 2003: Determined that while atypical antipsychotic drugs vary in cost, there is limited evidence of differences in effectiveness
  • 2006: Developed, through VA's TIDES project, an evidence-based collaborative approach to depression management
  • 2013:
  • Determined an association between homelessness among Veterans and childhood problems such as abuse and family instability
  • Found that a loss of gray matter in three separate brain structures is common across a spectrum of psychiatric disorders widely perceived to be distinct
  • 2016: Found that the use of an injectable antipsychotic led to significant cost-savings related to inpatient admissions of patients with schizophrenia compared to oral atypical antipsychotics
  • 2017: Learned that compensatory cognitive training (CCT) can improve thinking ability, psychiatric symptoms, and quality of life in people with severe mental illnesses

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New, Ongoing, and Published Research

VA researchers are looking at potential new approaches for treating and preventing mental health disorders. They are also working on related projects such as developing and evaluating collaborative primary care models and improving access to services from rural and other remote areas by using the internet and other technologies.

Among the areas VA researchers are focusing on are mood disorders, such as depression and bipolar disorder; psychotic disorders, such as schizophrenia; PTSD and other anxiety conditions; and substance use disorders. VA investigators are highly organized in identifying, testing, and confirming new treatments for PTSD, especially focused on medications through the PTSD Psychopharmacology Initiative.

VA investigators are also looking at the co-occurrence of mental health issues and physical disorders—for instance, depression in those with spinal cord injury, or substance use disorder in patients with chronic pain.

The National Research Action Plan is a wide-reaching plan developed in 2013 by VA and the departments of Defense, Health and Human Services, and Education. The plan is designed to improve access to mental health services for Veterans, service members, and military families.

Implementation of the plan will improve scientific understanding of PTSD, traumatic brain injury (TBI), various co-occurring conditions, and suicide. Other goals of the plan include providing effective treatments for these diseases and reducing their occurrence.

VA's 15 Mental Illness Research, Education and Clinical Centers (MIRECCs) research the causes and treatments of mental disorders and use education to put new knowledge into routine clinical practice in VA. Specialized mental health centers of excellence are an essential part of VA's ability to meet Veterans' mental health needs.

VA's Center for Integrated Health Care, located in Canandaigua, New York, is dedicated to advancing research, education, and clinical consultation to enhance the integration of mental health and primary care services for Veterans. The Center of Excellence for Suicide Prevention, also located in Canandaigua, integrates surveillance with intervention development to inform the implementation of effective suicide prevention strategies for Veterans.

The Center of Excellence for Research on Returning War Veterans in Waco, Texas, supports state-of-the-art research on the effects of combat exposure on mental health. Center researchers focus on preventing mental illness in Iraq and Afghanistan Veterans and providing treatment and rehabilitation for those with mental illnesses.

The Center of Excellence for Stress and Mental Health, in San Diego, works to understand the neurobiological mechanisms of responses to trauma and, through this understanding, to develop and disseminate novel, effective treatments.

VA's National Center for PTSD is a VA group of research centers that focus entirely on the condition.

The department's Center for Mental Healthcare and Outcomes Research, in North Little Rock, Arkansas, conducts research to improve access to and engagement in evidence-based mental health and substance use care. The Brain Rehabilitation Research Center, in Gainesville, Florida, develops and tests treatments to substantially improve or restore motor, cognitive, and emotional functions that have been impaired by neurologic disease or injury. The Translational Research Center for TBI and Stress Disorders (TRACTS), in Boston, studies the complex changes in the brain, thinking, and psychological well-being that result from traumatic brain injury and PTSD.

Two of VA's 10 Collaborative Research to Enhance and Advance Transformation and Excellence (CREATE) programs address issues important to mental health. The primary goal of the Evidence-Based Therapies for PTSD CREATE is to improve Veterans' access to and engagement in evidence-based treatments for PTSD. The Improving Rural Veterans' Access/Engagement in Evidence-based Mental Healthcare CREATE aims to improve treatment engagement for Veterans living in rural settings who use mental health services at VA community-based outpatient clinics.

VA's Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, located in Little Rock, works to improve coordination, quality, equality, and outcomes of team-based care for Veterans with behavioral health conditions. This QUERI team is looking at ways to use measurements in mental health care—for example, having Veterans complete some kind of assessment of their mental health status each and every time they visit a VA mental health practitioner, to provide a score that can be tracked over time. The Virtual Specialty Care QUERI Program is comparing implementation strategies through telemedicine outreach for PTSD to increase Veterans' access to PTSD services.

For more information on Mental Health, visit our Depression, TBI, Suicide Prevention, Substance Use Disorders, PTSD, and Women's Health topic pages.

If you are interested in learning about joining a VA-sponsored clinical trial, visit our research study information page.

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➤Anxiety disorders

Anxiety is a normal biological reaction to a stressful event. For some people, however, their anxiety does not go away and may even worsen over time. They can experience symptoms such as nightmares, a racing pulse, and excessive worry or fear. In persistent cases, anxiety disorders such as PTSD, panic disorders, and phobias may develop.

Older Veterans no more likely to have anxiety than non-VeteransIn 2014, a team from the VA Palo Alto Health Care System and Stanford University School of Medicine examined data on 7,000 men age 50 or older, and found that Veterans were no more likely than non-Veterans to have depression or anxiety.

Because Veterans, especially those who served in combat, have generally experienced more stress and trauma in their lives than non-Veterans, the team had expected to see higher rates of depression among Veterans. Instead, they found just the opposite. Older Veterans actually scored better than non-Veterans in the same age group.

The team found 11 percent of Veterans reported elevated rates of depression, compared with 12.8 percent of non-Veterans. For anxiety, 9.9 percent of Veterans reported elevated levels, versus 12.3 percent for non-Veterans. These differences were not considered statistically significant.

Vietnam Veterans, however, were twice as likely to have elevated depression and anxiety, compared with World War II or Korean War Veterans in the study. The team said further studies are needed to explain this finding.

Anxiety sensitivity may link PTSD and suicide risk—Anxiety sensitivity is an exaggerated fear of experiencing symptoms related to anxiety, separate from the actual symptoms. In 2017, researchers at the Southeast Louisiana Veterans Health Care System found a significant association between the severity of PTSD in 60 male Veterans and a greater frequency of suicidal thoughts, plans, and impulses. They also found that cognitive anxiety sensitivity concerns may be responsible for this link—meaning that when people with PTSD worry that their personalities have changed or that they are not thinking normally, they may be at increased risk of suicidal behavior.

Relationship of PTSD and anxiety disorders to homelessnessResearchers from the VA New England MIRECC and the Yale School of Medicine found that 5.6 percent of more than 300,000 Veterans who were referred to anxiety or PTSD clinics experienced homelessness within the one-year time period of the study. The homelessness rate for the entire Veteran population is about 3.7 percent over a five-year period. Veterans who were unmarried or diagnosed with a drug use disorder were more than twice as likely to become homeless.

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➤ Depression

Depression is one of the most common and costly mental disorders. VA researchers are developing more effective drugs to treat depression by probing the biological roots of the condition. They are also exploring the benefits and risks of a wide variety of existing and potential new treatments.

Additional information on this topic can be found on our Depression topic page.

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➤ Interrelationship of mental health issues

Communality among psychiatric disordersA 2015 study by researchers at the VA Palo Alto Healthcare System and Stanford University identified a common pattern across a spectrum of psychiatric disorders widely perceived to be quite distinct.

The research team analyzed 193 peer-reviewed papers that contained magnetic resonance images of the brains of 7,381 patients diagnosed with schizophrenia, bipolar disorder, major depression, addiction, obsessive-compulsive disorder, and a cluster of related anxiety disorder.

They found a loss of gray matter (the darker tissue of the brain and spinal cord, consisting mainly of nerve cell bodies and branching dendrites) in three separate brain structures—the left and right anterior insula and the dorsal anterior cingulate.

These structures are part of a larger network in the brain associated with higher-level executive functions such as concentrating in the face of distractions, multitasking or task switching, planning and decision-making, and inhibition of counterproductive impulses.

Gray matter loss in the three brain structures was similar across patients with different psychiatric conditions, according to the researchers. The findings mirror those from a 2013 study that found shared genetic glitches across several categories of mental illness.

Access to clinicians' notes can build trustIn 2017, a team of researchers from the VA Portland Health Care System in Oregon looked at the value of giving patients who see mental health care providers access to the notes their clinicians write about their health care visits. They found the Veterans in the study appreciated seeing consistency between what had occurred during their appointments and what they later saw in the clinical notes, and felt respected and reported greater trust when the notes showed evidence that their clinicians had listened to and understood their personal stories and had taken note of their individual strengths. When the Veterans saw diagnoses that hadn't been discussed with them in the notes, their trust was significantly eroded.

Legal help has mental health benefits—Researchers with the VA New England MIRECC found, in 2017, that 148 Connecticut and New York Veterans who received help from legal non-profit groups embedded with medical teams at VA facilities had reduced levels of hostility, anxiety, and paranoia. The Veterans in the study were clients of two legal assistance groups that worked with medical teams at local VA hospitals and clinics to identify issues that might affect Veterans' health, such as evictions, disputes with landlords, divorces, or difficulty in obtaining benefits. While some of the mental health benefits were sustained over a year, other benefits, including reduction of symptoms of PTSD or depression did not show sustained improvement.

Precision medicine in mental health care—To achieve a remission from depression, patients and their health care providers must be persistent and try multiple treatments until they find one that is both tolerable and effective. Pharmacogenic testing is a type of genetic testing meant to predict a patient's likelihood to experience an adverse event from a given drug, or to not respond to that drug. In the last several years, such testing has become widespread for patients with depression as a means of implementing "precision medicine" (the tailoring of medical treatment to the individual characteristics of each patient).

Researchers with VA's Center for Health Equity Research and Promotion (CHERP) in Philadelphia are looking at the usefulness of pharmacogenic testing in treating major depressive disorder with or without concurrent PTSD. Patients and providers in the study will either be given the results of such testing immediately or after six months of treatment as usual. The study is scheduled to be completed in 2022.

PACT teams for seriously mentally ill VeteransPeople with serious mental illness die many years prematurely, with rates of premature mortality two to three times greater than the general public. Research has suggested that integrated care and medical care management can improve health care treatment and outcomes, and reduce treatment costs, in people with serious mental illnesses. VA now uses the Patient Aligned Care Team (PACT) model for primary care, a team-based approach that achieves coordinated care through collaboration among the patient, family members, caregivers, and health care professionals.

Researchers with VA's Center for the Study of Healthcare Innovation, Implementation, and Policy in Los Angeles are looking at whether a PACT team for Veterans with serious mental illness can improve treatment and outcomes, while reducing unnecessary use of emergency and hospital services. The study began in 2014 and is expected to conclude in 2018.

Maternal psychological disorder effects on children—A 2018 study that included a VA researcher found that prenatal exposure to maternal stress and depression could lead to psychological disorders in children. The researchers found that children born to mothers with PTSD, depression, or both together showed a pattern of gene expression not seen in children of mothers without psychological disorders. These changes in gene expression were similar to genetic biomarkers associated with autism spectrum disorder and schizophrenia. The results suggest that exposure to maternal psychological distress in utero may put children at risk for impaired psychological development.

Mental health and unintended pregnancy—Women Veterans with mental health disorders are more likely to have experienced unintended pregnancy than those without, found a 2018 study by VA Pittsburgh Health Care System researchers and colleagues. They surveyed almost 3,000 women Veterans by phone. Sixty percent of women with at least one mental health disorder reported having an unintended pregnancy, while 51 percent of women without a mental health disorder said they had had an unintended pregnancy. Mental health disorders were also connected to a greater number of unintended pregnancies. More research is need on how to improve reproductive health outcomes for women with mental health disorders, say the researchers.

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➤ PTSD

In recent years, VA investigators have made important strides in understanding PTSD, an anxiety disorder often linked with combat. PTSD also occurs after other types of trauma including sexual or physical abuse or assault; terrorist attacks; serious accidents, such as car wrecks; and natural disasters, such as fires, tornadoes, hurricanes, floods or earthquakes.

Symptoms of PTSD include reliving the event; avoiding of situations that remind those who have undergone trauma of the event; experiencing negative changes in beliefs and feelings; and feeling keyed up, also called hyperarousal.

Most people have some stress-related reactions after a traumatic event, but not everyone gets PTSD. Those whose reactions don't go away over time and disrupt their lives may have PTSD.

Additional information on this topic can be found on our PTSD topic page.

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➤ Schizophrenia and bipolar disorder

According to a 2016 study published in the American Journal of Public Health, over 1.1 million Veterans who were treated in a VA Patient Aligned Care Team (PACT) between 2010–2011 were diagnosed with at least one of five mental illnesses—depression, PTSD, substance use disorder, anxiety, and schizophrenia or bipolar disorder.

Schizophrenia is a chronic and severe psychiatric disorder affecting approximately 120,000 Veterans receiving VA health care, according to a 2014 study. People affected with the disorder may experience hallucinations, delusions, difficulty feeling pleasure, and trouble focusing or paying attention. The symptoms of schizophrenia typically surface between the ages of 16 to 30.

In 1997, a VA research team found that the difficulty many people with schizophrenia have in sorting out sounds, leading them to hear voices, has to do with a defective gene linked to mental illness. It was the first time a schizophrenia symptom was traced to a specific gene. Today, researchers have obtained genomic data that directly address the underlying nature of schizophrenia, which promises to provide further insight into the disorder.

Bipolar disorder, also called manic-depressive illness, is a brain disorder that causes people to swing between periods of elation and high energy levels to depression and feeling hopeless. There are four types of bipolar disorder: bipolar I disorder, bipolar II disorder, cyclothymic disorder, and other specified and unspecified bipolar and related disorders. During a manic episode, people may engage in risky behavior like using drugs, spending excessive amounts of money, or having reckless sex.

Gene locations in people with schizophreniaIn 2014, VA researchers took part in an international study that identified 108 genetic locations where the DNA of people with schizophrenia tends to differ from those without the disease. About three-quarters of the genetic locations identified in the study had not been previously reported.

The study analyzed DNA from nearly 37,000 people in Europe and Asia with schizophrenia, and more than 113,000 without the disease. While most of the genes implicated in the study are expressed in the brain, others appear to play a role in the body's immune system, supporting a link between the immune system and schizophrenia.

Results of the study may eventually lead to new ways to diagnose and treat the disease.

Recognizing facial emotions with schizophreniaMany patients with schizophrenia have difficulty recognizing others' facial emotions. A 2015 study led by researchers from the VA Greater Los Angeles Healthcare System tested an experimental device that delivers electrical current to specific parts of the brain on 36 Veterans with schizophrenia.

The team found that a single 20-minute session with the device, in which electrical current was applied to the outside of the prefrontal cortex, improved patients' ability to identify the emotion described in photographs of people displaying a variety of emotions. According to the researchers, this ability can be expected to last for an hour or two after the current is applied. The researchers are now looking into how such effects can be sustained long-term.

This treatment is different from electroconvulsive therapy, formerly known as shock therapy. ECT, which is performed under general anesthesia, induces a brief seizure via electrodes applied to the patient's scalp. It can be used to treat major depression that hasn't responded to traditional therapies.

Using oxytocin to boost social cognition in schizophreniaOxytocin is a naturally occurring hormone, produced in the brain, that has wide-reaching effects on social bonding, sexual reproduction, and childbirth. It is sometimes called the love hormone. One of the approved uses for Oxytocin is to help start or strengthen contractions in women who are giving birth.

Researchers are studying the use of oxytocin to help people with schizophrenia who have difficulties with social cognition. Social cognition refers to a set of skills that help people interact effectively with others. It includes aspects like social knowledge, empathy, and emotional processing.

A 2014 study by researchers with the VA Greater Los Angeles Healthcare System and the University of California suggests that giving oxytocin in a nasal spray may help patients with schizophrenia. The research team provided 27 men who had schizophrenia with either oxytocin or a placebo once a week for 12 weeks. All of the participants were also given training on social cognitive skills, including the ability to identify facial emotions, social perception, and empathy.

The team found that the group receiving oxytocin did significantly better than the group receiving a placebo in the area of "empathic accuracy"—understanding how others feel when they show emotion. They are now working to pinpoint the biochemical pathways oxytocin affects, and to see how much of an impact doses of oxytocin can have on the everyday lives of those with schizophrenia and autism.

However, in a 2018 study by VA San Diego Healthcare System researchers and their colleagues, oxytocin did not improve social cognition in patients with schizophrenia. The researchers prescribed schizophrenic patients oxytocin—a drug that has been shown to improve social cognition in the general population—over 24 weeks, along with cognitive behavioral training. Patients who took oxytocin showed no improvements in social cognition over the course of the study, compared with patients who took the placebo. The results add to growing literature suggesting that oxytocin may not be effective in this population.

Cognitive training can improve thinking and quality of lifeCompensatory cognitive training (CCT) can improve thinking ability, psychiatric symptoms, and quality of life in people with severe mental illnesses such as schizophrenia, bipolar disorder, and major depressive disorder, according to a 2017 study led by researchers with the VA San Diego Healthcare System. CCT is a program that teaches strategies to improve memory, attention, learning ability, and problem-solving skills. It helps those using it remember daily tasks, including those needed to succeed in the workplace.

The study, however, found that patients who received CCT fared no better at finding and keeping jobs, and received, on average, less money for their work. The study team hypothesized that more CCT treatments may result in better outcomes.

Injectable antipsychotics provide cost savings over oral antipsychoticsMost people with schizophrenia take oral drugs, usually in pill form once or twice a day. Not taking those drugs can undermine the effectiveness of treatments for the disease. Injectable antipsychotics, which are commonly administered once a month by a health professional, can improve adherence to treatment plans.

A 2016 VA database study found that Veterans with schizophrenia who use a long-acting injectable antipsychotic drug called paliperidone palmitate incur significantly lower health care costs than those who consumed oral antipsychotics, even though paliperidone palmitate is much more expensive. Although the pharmacy and outpatient costs of using the injected drug were higher, the average inpatient costs were lower because of the lower likelihood of inpatient hospitalizations for users of paliperidone palmitate.

Schizophrenia symptom management in the workplaceWhile schizophrenia can be severely disabling, some people with the illness can still succeed in the workplace. In 2017, a research team in Los Angeles, led by a VA researcher, interviewed 10 men and 10 women with schizophrenia who were either relatively steadily employed, full-time students, or responsible caretakers.

The research team found that successful patients achieved avoided behaviors or settings likely to set off symptoms; received support from others; stayed on their medication regimen; used strategies to talk themselves through stressful situations; controlled their environment to avoid disturbing thoughts and voices; found help through religion or meditation; focused on their well-being through diet or exercise; and went to work or attended school. The researchers believe patient perspectives like these are sorely needed in schizophrenia care.

Genetic markers predict lithium nonresponseLithium is the standard mood stabilizer used to treat bipolar disorder, but up to 30 percent of patients do not respond to the drug. In 2017, an international consortium, including several VA researchers, looked at the genomes of more than 2,000 patients with bipolar disorder. They found patients who had gene variations previously shown to predict schizophrenia also did not respond to lithium. The results can be used to predict how effective lithium treatment will be for individual patients.

Mortality rates for people with schizophrenia are not decreasingMortality rates for people with schizophrenia have not gone down in recent years despite a decline in mortality rates in the general population, according to a 2017 review by VA San Diego Healthcare System and University of California, San Diego researchers. People with schizophrenia tend to have a 15-20 year shorter life expectancy than those without. The researchers suggested that major changes in mental health stigma, health care, and economic policy are urgently needed to improve care for people with schizophrenia.

PRIME intervention for recent-onset schizophrenia—The PRIME program helped patients with recent-onset schizophrenia improve their mood and motivation, in a 2018 study by San Francisco VA Medical Center researchers. PRIME (Personalized Real-time Intervention for Motivational Enhancement) is a mobile digital health tool designed to improve motivation and quality of life. In PRIME, participants worked toward self-identified goals with the support of a virtual community of age-matched peers with schizophrenia-spectrum disorders, as well as motivation coaches.

After using PRIME for 12 weeks, participants had significant improvements in depression, defeatist beliefs, self-efficacy, and motivation, compared with schizophrenia patients not using the program. They also had significantly greater improvements in social motivation three months after the trial. The results suggest that PRIME could be an effective mobile-based intervention for young people with schizophrenia.

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➤ Stress

Stress is a state of mental or emotional strain or tension resulting from adverse or very demanding circumstances. It is a highly subjective phenomenon, experienced differently by every individual.

Normative Aging StudyIn 1963, VA began the Normative Aging Study, a longitudinal study that looks at the effects of aging on various health issues. Participants in the study undergo medical examinations every three to five years, and answer questions about behaviors affecting their health.

Using data from the study, a VA and Oregon State University team found in 2014 that the health of older men is particularly vulnerable to stressors, and that these stressors could contribute to a shorter life. Of the 1,293 men in the study, those whose daily life was significantly stressful were three times more likely to die between 1989 and 2004 than people who found their lives to be not very stressful or only moderately stressful.

Computer app helps control unpleasant thoughtsAn app called the Virtual Hope Box, built by a team at the Department of Defense, can help Veterans cope with stress and unpleasant thoughts, including those that could lead to suicide. A study published in 2017 by a team of VA and DoD researchers found that Veterans who used the app reported a much greater ability to cope with unpleasant emotions and thoughts after three and 12 weeks, compared with a control group of former military members. Those who used it also reported a greater likelihood to use it in the future, compared with written educational materials.

The Virtual Hope Box contains items that serve as reminders of positive life experiences or reasons for living, as well as simple tools to help with coping, relaxation, and distraction. Patients and their health care providers can collaborate to personalize by selecting audio, video, pictures, games, mind exercises, and inspirational quotes.

Coast Guardsmen also subject to stressVA researchers and researchers from other institutions assessed 241 active-duty Coast Guard members in 2017, and found rates of PTSD and depression comparable to those of the Army and other military services after deployment. The Coast Guardsmen in the study were all serving at boat stations, which carry out search and rescue operations. The overall rate of PTSD was 15 percent, and the rate of depression was 8 percent. The study is the largest to date to look at Coast Guardsmen's stress-related mental health problems.

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➤ Substance Use Disorders

VA supports a broad portfolio of research looking at risky substance use prevention, screening, and treatment. Additional information on substance use disorders can be found on our Substance Use Disorders topic page.

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➤ Suicide Prevention

According to the Centers for Disease Control and Prevention, in 2015, suicide was the 10th leading cause of death for all ages in the United States. There were 44,193 suicides in the United States in 2015, or 121 suicides each day. In 2014, about 18 percent of those who died by suicide were Veterans. As part of its efforts to address this problem, VA has established a toll-free, confidential Veterans Crisis Line at 1-800-273-8255 (1-800-273-TALK), staffed by mental health professionals 24 hours a day, seven days a week. VA also offers a texting service at #838255.

Veterans and their families can also chat online with trained counselors at www.VeteransCrisisLine.net. Registration with VA or enrollment in VA health care is not necessary. VA also has full-time suicide prevention coordinators at each of its 145 hospitals.

Additional information on this topic can be found on our Suicide Prevention topic page.

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More on our Website

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Selected Scientific Articles by Our Researchers

The association between mental health disorders and history of unintended pregnancy among women Veterans. Judge-Golden CP, Borrero S, Zhao X, Mor MK, Callegari LS. Women Veterans with mental health disorders are more likely to have experienced any and greater numbers of unintended pregnancies than Veterans without mental health disorders. J Gen Intern Med. 2018 Dec;33(12):2092-2099.

Gene expression in cord blood links genetic risk for neurodevelopmental disorders with maternal psychological distress and adverse childhood outcomes. Breen MS, Wingo AP, Koen N, Donald KA, Nicol M, Zar HJ, Ressler KJ, Buxbaum JD, Stein DJ. Prenatal exposure to maternal psychological distress induces neuronal, immunological, and behavioral abnormalities in affected offspring. Brain Behav Immun. 2018 Oct;73:320-330.

The effects of combined oxytocin and cognitive behavioral social skills training on social cognition in schizophrenia. Strauss GP, Granholm E, Holden JL, Ruiz I, Gold JM, Kelly DL, Buchanan RW. Findings suggest that combined cognitive-behavioral social skills training and oxytocin had minimal benefit for social cognition, adding to the growing literature indicating null effects of oxytocin in multi-dose trials. Psychol Med. 2018 Sep 5;1-9.

Effect of PRIME, a mobile app intervention designed to improve motivation in young people with schizophrenia. Schlosser DA, Campellone TR, Truong B, Etter K, Vergani S, Komaiko K, Vinogradov S. PRIME has the potential to be an effective mobile-based intervention for improving aspects of mood and motivation in young people with schizophrenia spectrum disorders. Schizophr Bull. 2018 Aug 20;44(5):1010-1020.

Medical-legal partnerships at Veterans Affairs medical centers improved housing and psychosocial outcomes for Vets. Tsai J, Middleton M, Villegas J, Johnson C, Retkin R, Seidman A, Sherman S, Rosenheck R. Medical-legal partnerships represent an opportunity to expand cross-sector, community-based partnerships in the VA health care system to address social determinants of mental health. Health Affairs. 2017 Dec;36(12):2195-2203.

Association of polygenic score for schizophrenia and HLA antigen and inflammation genes with response to lithium in bipolar affective disorder: a genome-wide association study. International Consortium on Lithium Genetics et al. There is a negative association between high genetic loading for schizophrenia and poor response to lithium in patients with bipolar affective disorder. JAMA Psychiatry. 2017 Nov 9. (Epub ahead of print.)

Posttraumatic stress disorder and suicidal ideation, plans, and impulses: the mediating role of anxiety sensitivity cognitive concerns among Veterans. Raines AM, Capron DW, Stentz LA, Walton JL, Allan NP, McManus ES, Uddo M, True G, Franklin CL. There is a significant association between PTSD symptom severity and higher suicidality, and anxiety sensitivity cognitive concerns mediated this association. J Affect Disord. 2017 Nov;222:57-62.

A widening longevity gap between people with schizophrenia and general population: a literature review and call for action. Lee EE, Liu J, Tu X, Palmer BW, Eyler LT, Jeste DV. Individuals with schizophrenia have higher mortality rates than the public at large, and major changes are urgently warranted to ensure this vulnerable segment of the population participates in the longevity revolution. Schizophr Res. 2017 Sep 27 (Epub ahead of print).

Stress-related mental health symptoms in Coast Guard: incidence, vulnerability, and neurocognitive performance. Servatius RJ, Handy JD, Doria MJ, Myers CE, Marx CE, Lipsky R, Ko N, Avcu P, Wright WG, Tsao JW. Rates of PTSD and major depressive disorder are comparable among Coast Guard personnel serving boat stations to those of larger military services after combat deployment. Front Psychol. 2017 Sep 14;8:1513.

Compensatory cognitive training for people with severe mental illnesses in supported employment: a randomized controlled trial. Twamley EW, Thomas KR, Burton CZ, Vella L, Jeste DV, Heaton RK, McGurk SR. CCT has the potential to improve cognitive performance, psychiatric symptom severity, and quality of life in people with severe mental illnesses, but did not result in better work outcomes. Schizophr Res. 2017 Aug 17. (Epub ahead of print.)

A qualitative analysis of how online access to mental health notes is changing clinician perceptions of power and the therapeutic relationship. Denneson, LM, Cromer R, Picciotta M, Williams H, Woods S Dobscha, SK. Ensuring consistency between what occurs during appointments and what appears in clinical notes, as well as highlighting patient individuality and strengths in notes, may help engender patient trust and avoid negative consequences in mental health care. J Med Internet Res. 2017 Jun;19(6):e208.

One-year incidence and predictors of homeless among 300,000 U.S. Veterans seen in specialty mental care. Tsai J, Hoff RA, Harpaz-Rotem I. A notable and important percentage of Veterans seen in VA specialty mental health clinics newly experience homelessness annually. Psychol Serv. 2017 May;14(2):203-207.

How occupationally high-achieving individuals with a diagnosis of schizophrenia manage their symptoms. Cohen AN, Hamilton AB, Saks ER, Glover DL, Glynn SM, Brekke JS, Marder SR. Use of strategies in a preventive fashion, the effectiveness of the identified strategies, and the comfort individuals expressed with using several different strategies helped individuals with schizophrenia to achieve their occupational goals. Psychiatr Serv. 2017 Apr 1;68(4):324-329.

A virtual hope box: randomized controlled trial of a smartphone app for emotional regulation and coping with distress. Bush NE, Smolenski DJ, Denneson LM, Williams HB, Thomas EK, Dobscha SK. The Virtual Hope Box is an easily accessible tool that can increase stress coping skills. Psychiatr Serv. 2017 Apr 1;68(4):330-336.

Impact of paliperidone palmitate versus oral atypical antipsychotics on health care resource use and costs in Veterans with schizophrenia. Young-Xu Y, Duh MS, Muser E, DerSarkissian M, Faust E, Kageleiry A, Bhak RH, Fu DJ, Lefebvre P, Shiner B. Paliperidone Palmitate treatment is associated with significantly lower total health care costs attributed to reduced inpatient admissions compared to oral atypical antipsychotics. J Clin Psychiatry. 2016 Oct;77(10).

Telephone smoking-cessation counseling for smokers in mental health clinics: a patient-randomized controlled trial. Rogers ES, Smelson DA, Gillespie CC, Elbel B, Poole S, Hagedorn HJ, Kalman D, Krebs P, Fang Y, Wang B, Sherman SE. A specialized counseling intervention was more effective at helping mental health patients quit smoking than transfer to a state quit-line. Am J Prev Med. 2016 Apr;50(4):518-527.

Psychotherapy for depression in older Veterans via telemedicine: a randomized, open-label, non-inferiority trial. Egede LE, Acierno R, Knapp RG, Lejuez C, Hernandez-Tejada M, Payne EH, Frueh BC. Telemedicine-delivered psychotherapy for older adults with major depression is not inferior to same-room treatment. Lancet Psychiatry, 2015 Aug;2(8):693-701.

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