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In recent years, policymakers and members of the media have raised concerns regarding access to behavioral health care for service members and veterans of the U.S. military and their families. Particular concern has been raised regarding the availability and accessibility of care to individuals covered by the U.S. Department of Defense Military Health System and the Veterans Health Administration. In this study, researchers analyzed the National Study of Drug Use and Health to examine utilization of behavioral health care among current or former wives of service members and veterans who are covered by either TRICARE or CHAMP-VA. Three findings of interest emerged from the analysis. First, relative to the comparison group, military wives were more likely to receive behavioral health services, but this pattern was exclusively due to use of prescription psychiatric medications. No difference was found for specialty behavioral health treatment. Second, residing in rural areas was negatively associated with behavioral health care service use for both groups. Third, contrary to expectations, military wives who live more than 30 minutes from a military treatment facility were more likely than military wives who lived closer to receive prescription psychiatric mediations but not other types of behavioral health services.

The dramatic evolution in information and communication technologies (ICTs) online and on smartphones has led to rapid innovations in behavioral health care. To assist the U.S. Air Force in developing a strategy for use of ICTs, the authors reviewed the scientific literature on their use to prevent and treat behavioral health conditions, such as major depression, posttraumatic stress disorder, and alcohol misuse. There is currently little scientific evidence supporting additional investment in ICT-based psychosocial programs for resilience or prevention of posttraumatic stress symptoms, depression, or anxiety. Instead, preventive interventions might prioritize problems of alcohol misuse and intimate partner violence. ICT applications that play a role in the treatment process may be used for patient education and activation, to improve decisionmaking by clinicians, to provide a therapy, to improve adherence to treatment, or to maintain treatment gains over time. However, partly due to the rapid pace of development of the technology, there is little or no evidence in the literature regarding the efficacy of the most recently developed types of ICTs, in particular those using smartphones. Despite the lack of solid research evidence to date, ICTs hold promise in addressing the challenges of mental health care. One promising avenue is development of reliable methods for patient-clinician communication between therapy sessions; another is Internet-based cognitive behavioral therapy. The authors recommend that the Air Force should take an incremental approach to adopting the use of ICTs—one that involves a program of measurement-based implementation and process and outcome monitoring rather than urgent dissemination.

Aim: The aim of this study is to investigate differences in the beliefs about the causes of schizophrenia between Aymara and non-Aymara patients with schizophrenia and their primary caregivers. Ethnic background plays an important role in the formation of beliefs regarding the causes of schizophrenia, and there have been no prior studies on such beliefs among the Aymara, an indigenous community with a population of about 2 million people living in the Andes. We focused on three systems of beliefs distinguished in the literature: biological, psychosocial and magical–religious. Methods: The sample comprised 253 patients ( n = 117 Aymara, and n = 136 non-Aymara) of public mental health centers in Chile (33.6%), Peru (33.6%) and Bolivia (32.8%) with a diagnosis of schizophrenia, and each patient's primary caregiver. We administered to patients and caregivers a questionnaire with scales assessing the perceived causes of schizophrenia. Linear regression models were fitted to compare differences in the levels of causal beliefs between Aymara and non-Aymara patients and caregivers, and to identify socio-demographic and clinical predictors of different types of beliefs about the causes of schizophrenia. Results: Adjusted for socio-demographic and clinical covariates, levels of psychosocial beliefs were significantly higher for Aymara caregivers (0.33, 95% confidence interval (CI) = 0.05, 0.62) than non-Aymara caregivers. Conclusions: Contrary to expectations, beliefs about the causes of schizophrenia among Aymara are not more magical–religious than those of their non-Aymara counterparts. It may be necessary for mental health staff members to evaluate beliefs about the disorder, especially in ethnic minorities, before applying a standard model of treatment.

This article reviews the scientific literature on the epidemiology, prevention, and treatment of problematic Internet use (PIU) with the goal of informing Air Force policies aimed at mitigating PIU's negative impact on operations and the mental health of Airmen. The study is motivated by a recent RAND study estimating that 6 percent of Airmen have PIU. Individuals with PIU, similar to people with substance addictions, suffer from excessive and compulsive online activities, symptoms of tolerance and withdrawal, and functional impairment. PIU is also strongly associated with other mental health problems including major depression. However, at present there is no single accepted definition of PIU, and no up-to-date estimates of the prevalence of PIU in the general U.S. population are available. A range of prevention and treatment approaches have been developed, but none has been rigorously tested in clinical trials. Prevention programs rely on workplace Internet policies and strategies to help individuals self-regulate their Internet use. Treatment approaches that have proven feasible and acceptable to patients with PIU include adaptations of cognitive-behavioral therapy, an evidence-based treatment for depression and anxiety, to the specific symptoms of PIU. Based on our findings, we recommend: (1) increasing awareness of PIU among organizational leadership and mental health professionals, (2) incorporating content related to PIU into existing trainings related to mental health, (3) providing support for self-regulation of Internet use on the job by incorporating PIU management principles into Internet use policies, and (4) continuing monitoring of the emerging scientific literature on PIU.

The Marine Corps Operational Stress Control and Readiness (OSCAR) program embeds mental health personnel within Marine Corps units and extends their reach by training officers and noncommissioned officers to recognize Marines showing signs of stress and intervene early. RAND Corporation researchers conducted an outcome evaluation of the OSCAR program that included four components: (1) a quasi-experimental study that compared Marines in OSCAR-trained and non–OSCAR-trained battalions on a wide array of stress-related outcomes before and after deployment, (2) a longitudinal pre- and postdeployment survey of perceptions of OSCAR among Marines who attended OSCAR training, (3) focus groups with Marines, and (4) semistructured interviews with commanding officers of battalions that had received OSCAR training. Results indicated that, after the authors adjust for a wide array of baseline characteristics and deployment experiences, Marines in OSCAR-trained battalions were more likely than those in non–OSCAR-trained battalions to report having sought help with stress problems from a peer, leader, or corpsman—behavior that is consistent with OSCAR goals. In addition, Marines considered OSCAR a valuable tool for enhancing combat and operational stress response and recovery efforts in the Marine Corps. However, this evaluation did not find evidence that OSCAR affected the key mental health outcomes it was designed to address. Thus, the results of this evaluation do not support the continuation of OSCAR in its current form. Based on lessons learned about OSCAR from this evaluation, other research, and best practices for program improvement and implementation, recommendations for improving combat and operational stress training in the Marine Corps are offered.

The dependent coverage expansion (DCE), a component of the Affordable Care Act, required private health insurance policies that cover dependents to offer coverage for policyholders' children through age 25. This review summarizes peer-reviewed research on the impact of the DCE on the chain of consequences through which it could affect public health. Specifically, we examine the impact of the DCE on insurance coverage, access to care, utilization of care, and health status. All studies find that the DCE increased insurance coverage, but evidence regarding downstream impacts is inconsistent. There is evidence that the DCE reduced high out-of-pocket expenditures and frequent emergency room visits and increased behavioral health treatment. Evidence regarding the impact of the DCE on health is sparse but suggestive of positive impacts on self-rated health and health behavior. Inferences regarding the public health impact of the DCE await studies with greater methodological diversity and longer follow-up periods.

Concerns about access to behavioral health care for military service members and their dependents living in geographically remote locations prompted research into how many in this population are remote and the effects of this distance on their use of behavioral health care. The authors conducted geospatial and longitudinal analyses to answer these questions and reviewed current policies and programs to determine barriers and possible solutions

With many service members now returning to the United States from the recent conflicts in Iraq and Afghanistan, concern over adequate access to behavioral health care (treatment for mental, behavioral, or addictive disorders) has risen. Yet data remain very sparse regarding how many service members (and their dependents) reside in locations remote from behavioral health providers, as well as the resulting effect on their access to and utilization of care. Little is also known about the effectiveness of existing policies and other efforts to improve access to services among this population. To help fill these gaps, a team of RAND researchers conducted a geospatial analysis using TRICARE and other data, finding that roughly 300,000 military service members and 1 million dependents are geographically distant from behavioral health care, and an analysis of claims data indicated that remoteness is associated with lower use of specialty behavioral health care. A review of existing policies and programs discovered guidelines for access to care, but no systematic monitoring of adherence to those guidelines, limiting their value. RAND researchers recommend implementing a geospatial data portal and monitoring system to track access to care in the military population and mark progress toward improvements in access to care. In addition, the RAND team highlighted two promising pathways for improving access to care among remote military populations: telehealth and collaborative care that integrates primary care with specialty behavioral care.

A new introduction to a timeless dynamic: how the movement of humans affects health everywhere. International migrants compose more than three percent of the world's population, and internal migrants—those migrating within countries—are more than triple that number. Population migration has long been, and remains today, one of the central demographic shifts shaping the world around us. The world's history—and its health—is shaped and colored by stories of migration patterns, the policies and political events that drive these movements, and narratives of individual migrants. Migration and Health offers the most expansive framework to date for understanding and reckoning with human migration's implications for public health and its determinants. It interrogates this complex relationship by considering not only the welfare of migrants, but also that of the source, destination, and ensuing-generation populations. The result is an elevated, interdisciplinary resource for understanding what is known—and the considerable territory of what is not known—at an intersection that promises to grow in importance and influence as the century unfolds