Journal of Military, Veteran and Family Health最新文献

{"title":"An introduction to measurement-based care: Scientific literature and implementation in military and Veteran care systems.","authors":"Deniz Fikretoglu, Bryan Garber","doi":"10.3138/jmvfh-2025-0003","DOIUrl":"10.3138/jmvfh-2025-0003","url":null,"abstract":"<p><p>Measurement-based care (MBC) is an evidence-based practice in which patient-reported process and outcome data are routinely and systematically collected to track treatment progress. MBC uses such data to identify when patients are not progressing as expected. In this way, MBC supports clinicians in refining mental health treatment as needed. When implemented consistently, MBC improves patient outcomes. However, the uptake of MBC in military and Veteran mental health care systems has been less than optimal. The authors present their point of view that the challenges in successfully implementing MBC can be traced to two key issues, under-specification of MBC and limitations in implementation science, and they propose several solutions to address these issues in future research on MBC.</p>","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":"12 1","pages":"105-109"},"PeriodicalIF":0.8,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reimagining MAiD for psychiatric illness: Ethical dilemmas among Veterans, clinical realities, and the road ahead.","authors":"Gabrielle Dupuis, Rakesh Jetly, Stéphanie A H Bélanger, Jitender Sareen, Andrew A Nicholson","doi":"10.3138/jmvfh-2025-0034","DOIUrl":"10.3138/jmvfh-2025-0034","url":null,"abstract":"<p><strong>Introduction: </strong>The expansion of medical assistance in dying (MAiD) in Canada to include, as of Mar. 17, 2027, mental illness as a sole underlying medical condition (MI-SUMC) raises significant clinical, legal, and ethical concerns, particularly for Veterans, who are disproportionately affected by difficult-to-treat psychiatric conditions. Structural vulnerabilities, including poverty, discrimination, gender-based disparities, and poor access to care, compound psychiatric suffering and increase the risk of premature death among marginalized groups.</p><p><strong>Methods: </strong>The authors conducted a comprehensive review of clinical, legal, and ethical literature, including expert reports, case law, and systematic reviews. Key areas of analysis include terminology regarding difficult-to-treat conditions, limitations of current capacity assessments, structural vulnerability, and ethical tensions between suicide prevention and MAiD for MI-SUMC.</p><p><strong>Results: </strong>There is no consistent definition of difficult-to-treat conditions, with over 150 existing for major depressive disorder alone. Prognoses remain highly variable, weakening claims of irremediability. Current capacity assessments often overlook trauma, emotional states, and systemic barriers, introducing bias. Suicidality, a common symptom of psychiatric illness, complicates distinctions between autonomous MAiD requests and crisis responses. Last, evidence from jurisdictions like Belgium and the Netherlands demonstrates that structurally marginalized individuals are over-represented in psychiatric MAiD, raising concerns of systemic coercion.</p><p><strong>Discussion: </strong>Given the unresolved uncertainties around irremediability, suicidality, and access to care, a precautionary approach is warranted. Without equitable access to advanced, neuroscientifically informed treatments, some may request MAiD because of lack of alternatives. Safeguards such as longitudinal monitoring, inter-blinded assessments, and expanded access to care are essential to protect vulnerable groups, especially Veterans.</p>","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":"12 1","pages":"34-45"},"PeriodicalIF":0.8,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment-resistant PTSD and measurement-based care: A dual lens on psychiatric innovation toward better outcomes.","authors":"Susan Maureen Docherty-Skippen, Stéphanie A H Bélanger, Nicholas Held, Col Retd Rakesh Jetly","doi":"10.3138/jmvfh-2025-1106","DOIUrl":"https://doi.org/10.3138/jmvfh-2025-1106","url":null,"abstract":"","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":"12 1","pages":"1-2"},"PeriodicalIF":0.8,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Policy in implementation science: Considerations for measurement-based care in the Canadian Armed Forces.","authors":"Eva Guérin, Bryan Garber, Susan T Dowler","doi":"10.3138/jmvfh-2025-0002","DOIUrl":"10.3138/jmvfh-2025-0002","url":null,"abstract":"<p><p>Policy, an intricate and often-overlooked aspect of implementation science (IS), can be leveraged to facilitate the mobilization and uptake of evidence-based practices. However, there are varying conceptualizations of policy in research and practice, and multiple approaches to the policy-making process. This article brings together a selection of literature and current guidance on policy using an IS lens, focusing specifically on the use of policy as an implementation strategy or lever to increase the uptake of interventions and evidence-based practices. The article uses the Canadian Armed Forces' (CAF's) implementation of measurement-based care (MBC) as a case example to discuss IS implications regarding policy. The CAF adopted an MBC system in 2014, coinciding with the consistent evolution of its mental health system. Although MBC is mandatory within the parameters outlined in the current directive (policy), adherence has consistently fallen below target level. The authors provide a brief overview of early implementation milestones for MBC in the CAF and describe the guiding policy in its current form. The authors draw from the IS literature on policy development and implementation, including elements of contextual adaptation and stakeholder consultation, to frame a series of considerations for refining the policy approach to MBC in the CAF.</p>","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":"12 1","pages":"110-116"},"PeriodicalIF":0.8,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measurement-based care in a Canadian treatment program for first responders, military personnel, and Veterans: A case study.","authors":"Sarah Ahmed, Emily Rossi, Robert W Waterman, Kerry Manthenga, Shannon Remers","doi":"10.3138/jmvfh-2025-0006","DOIUrl":"10.3138/jmvfh-2025-0006","url":null,"abstract":"<p><strong>Introduction: </strong>The use of measurement-based care (MBC) can significantly improve outcomes for patients, including symptom reduction, improved functioning, and quality of life. However, existing barriers can lead to low implementation rates, especially among first responders, military personnel, and Veterans (FRMV). Overcoming barriers and identifying ways to measure implementation using aggregate data is the next step in integrating MBC into mental health care. This article outlines the current state of MBC implementation at a mental health and addictions hospital in Canada.</p><p><strong>Methods: </strong>Aggregate data provided by an online MBC platform were used to review clinical outcomes (Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, PTSD Checklist for DSM-5, and Working Alliance Inventory-6) and implementation rates (patient adoption and continuous engagement) of a Guardians program tailored for FRMV and compare these outcomes with benchmarks of Canadian and U.S. organizations.</p><p><strong>Results: </strong>Clinical outcomes and MBC implementation rates for the program exceeded national median benchmarks. Patient adoption and engagement increased between 2022 and 2023 and dropped in 2024.</p><p><strong>Discussion: </strong>Results suggest that the program was aligned with patients' clinical needs and addressed hospital needs for a MBC system because patient adoption and engagement exceeded national benchmarks. The consistent rise in patient participation since the implementation of MBC reflects the system's relative success, although barriers such as limited familiarity and staff capacity likely persist. Future work addressing barriers through organizational training and MBC champions may enhance implementation. The complex treatment needs of FRMV underline the importance of evaluating the integration of MBC into programming for this population.</p>","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":"12 1","pages":"76-85"},"PeriodicalIF":0.8,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"3MDR: From rehabilitation technology to a transformative trauma therapy for posttraumatic stress disorder.","authors":"Eric Vermetten, Rakesh Jetly, Michael J Roy, Pinata Sessoms, Mirjam J Nijdam, Lisa Burback, Suzette Brémault-Phillips","doi":"10.3138/jmvfh-2025-0014","DOIUrl":"10.3138/jmvfh-2025-0014","url":null,"abstract":"<p><p>Motion-assisted multi-modal memory desensitization and reconsolidation (3MDR) has emerged as a promising advancement in exposure-based therapies, particularly for treatment-resistant posttraumatic stress disorder (PTSD) and related disorders. Integrating treadmill-assisted movement with personalized trauma-related imagery and guided narrative processing, 3MDR promotes emotional engagement and supports memory reconsolidation in ways that traditional therapies often fail to achieve. This article reviews key developments in 3MDR's evolution, validation, and implementation. Randomized controlled trials in the Netherlands, the United Kingdom, the United States, and Canada have demonstrated significant reductions in PTSD symptoms, improved emotional processing, and strong patient adherence. Originating from the Computer-Assisted Rehabilitation Environment system - initially designed for physical rehabilitation - 3MDR was adapted to overcome avoidance and disengagement frequently seen in Veterans and other trauma-exposed groups. Technological improvements, including enhanced software usability, high-definition immersive visuals, and real-time customization, have strengthened its therapeutic impact. Recent expansions include pilot applications for adolescents, moral injury, and complex PTSD, supported by a structured international training framework requiring supervised cases and ongoing coaching through the International Consortium of 3MDR. Emerging innovations, such as HoloLens-based delivery, are also being explored. While acceptance among patients and clinicians is strong, broader adoption will require sustained investment in infrastructure and workforce training.</p>","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":"12 1","pages":"117-130"},"PeriodicalIF":0.8,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective report of a ketamine-augmented, transdiagnostic psychiatric outpatient psychotherapy program.","authors":"Ian Stefanuk, Kaitlin Chivers-Wilson, Rakesh Jetly, Atul Khullar, Robert Tanguay, Yanbo Zhang, Jennifer Swainson","doi":"10.3138/jmvfh-2025-0009","DOIUrl":"10.3138/jmvfh-2025-0009","url":null,"abstract":"<p><strong>Introduction: </strong>Comorbid conditions such as major depressive disorder, anxiety disorders, and posttraumatic stress disorder are common among Veterans, and the presence of multiple conditions requires innovative treatment approaches. The Newly Institute in Calgary, Alberta, Canada, has introduced a novel intervention combining sublingual ketamine therapy with a medically managed transdiagnostic intensive outpatient program (IOP) using evidence-based psychotherapies.</p><p><strong>Methods: </strong>A retrospective chart review was conducted of the first cohort of individuals (N = 56) who completed the Newly program between October 2021 and May 2022. This included four psychometric measures: the Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-Item Scale, PTSD Checklist for DSM-5, and World Health Organization Quality of Life - Brief (WHOQOL-BREF).</p><p><strong>Results: </strong>Preliminary findings reveal significant reductions in symptom severity post-treatment, with a notable proportion of patients experiencing clinically meaningful improvements in several symptom domains, particularly those with moderate to severe symptoms at baseline. In addition, WHOQOL-BREF scores increased with treatment, indicating both symptomatic and functional improvement.</p><p><strong>Discussion: </strong>The study underscores the potential of pairing ketamine with an IOP program; ketamine is thought to enhance neuroplasticity and emotional learning, and the IOP increases treatment engagement and long-term resiliency. Although limitations exist, including the lack of a control group, the study emphasizes the importance of exploring innovative transdiagnostic treatment modalities. Further research is needed to validate these findings and evaluate how this model may be adapted specifically for Veterans.</p>","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":"12 1","pages":"65-75"},"PeriodicalIF":0.8,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying and addressing cannabis withdrawal syndrome.","authors":"Paul Dhillon","doi":"10.3138/jmvfh-2025-0033","DOIUrl":"10.3138/jmvfh-2025-0033","url":null,"abstract":"","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":"12 1","pages":"13-16"},"PeriodicalIF":0.8,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward a definition of treatment-resistant posttraumatic stress disorder: A systematic review.","authors":"Huda F Al-Shamali, Shakila Meshkat, Reinhard Janssen-Aguilar, Harani Uthayakumar, Lisa Burback, Olga Winkler, Yanbo Zhang, Andrew Greenshaw, Murray W Enns, Andrew A Nicholson, Paul Frewen, Jitender Sareen, Eric Vermetten, Rakesh Jetly, Venkat Bhat","doi":"10.3138/jmvfh-2025-0015","DOIUrl":"10.3138/jmvfh-2025-0015","url":null,"abstract":"<p><strong>Introduction: </strong>Posttraumatic stress disorder (PTSD) is a complex disorder that often persists despite the use of evidence-based treatments. This systematic review aims to synthesize existing definitions of treatment-resistant PTSD (TR-PTSD) and examine the criteria used across studies to inform future research and clinical guidelines.</p><p><strong>Methods: </strong>A systematic search was conducted in four databases. Studies were included if they reported on adult participants with TR-PTSD, regardless of definition, or described non-response to one or more treatments. A narrative synthesis was used to categorize findings and suggest refinements to a working TR-PTSD definition.</p><p><strong>Results: </strong>Of 4,046 screened articles, 55 studies met the inclusion criteria. We found substantial variation in how TR-PTSD was defined across studies. Studies investigated pharmacological (n = 19), psychosocial (n = 16), psychedelic-assisted (n = 7), and emerging treatments (n = 13). Findings highlighted diverse intervention strategies. Some reduced PTSD symptoms significantly, and others showed mixed or limited efficacy.</p><p><strong>Discussion: </strong>This study consolidates existing research on TR-PTSD, revealing significant variability in its definitions across studies. The lack of standardized criteria underscores the need for a more consistent framework to guide research and clinical decision-making. The authors propose a dynamic reassessment of treatment resistance that considers adherence, treatment delivery, comorbidities, and mechanisms of action. Future research should incorporate a broader range of treatment response indicators, such as biomarkers and clinical subtypes, to establish a standardized model for TR-PTSD. A clearer definition will improve patient care, aid in therapy selection, and support the development of more effective treatments.</p>","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":"12 1","pages":"17-33"},"PeriodicalIF":0.8,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Augmenting evidence-based PTSD psychotherapy with neuroscientifically informed interventions: A mind-body-brain approach.","authors":"Rakesh Jetly, Paul Frewen, Jonathan M Lieberman, Breanne Kearney, Huda F Al-Shamali, Venkat Bhat, Ruth Lanius, Andrew A Nicholson","doi":"10.3138/jmvfh-2025-0024","DOIUrl":"10.3138/jmvfh-2025-0024","url":null,"abstract":"<p><strong>Introduction: </strong>Although clinical practice guidelines (CPG) emphasize several trauma-focused therapies for posttraumatic stress disorder (PTSD) as effective, many persons with PTSD do not experience full recovery, particularly among military and Veteran populations, leading to some individuals being labelled as having treatment-resistant PTSD (TR-PTSD). Recent advancements in neuroscience have enhanced the understanding of PTSD as a disorder driven by dynamic brain networks that contribute to core PTSD symptomatology, dissociation, moral injury, and systemic symptoms, thus highlighting the need for neuroscientifically informed interventions that address PTSD as it is expressed mentally, bodily, and neurally.</p><p><strong>Methods: </strong>This report reviews emerging PTSD interventions guided by neuroscientific advancements, specifically deep brain reorienting (DBR), virtual reality integrative therapy (VRIT), neurofeedback (NFB), and non-invasive brain stimulation (NIBS), as means to augment interventions recommended in CPG.</p><p><strong>Results: </strong>Each of DBR, VRIT, NFB, and NIBS show promise as neuroscience-informed therapies to augment outcomes of psychotherapies recommended in CPG by directly targeting some of the mind-body-brain mechanisms underlying PTSD symptoms.</p><p><strong>Discussion: </strong>The concept of TR-PTSD should be re-evaluated in light of new therapeutic approaches. Consistent with professional practice guidelines, neuroscientifically informed interventions such as DBR, VRIT, NFB, and NIBS offer a path toward more effective, individualized treatment by augmenting outcomes associated with CPG for PTSD by modulating mind-body-brain connections.</p>","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":"12 1","pages":"86-104"},"PeriodicalIF":0.8,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}