VISN 5 MIRECC researcher investigators have published numerous articles in peer reviewed scientific journals over the past year, a few of which, we are highlighting here.  Through our efforts, we support VA’s commitment to improve the whole health of Veterans in the context of mental health recovery.  This involves identifying and addressing the unique health needs experienced by Veterans who are diagnosed with mental health disorders and developing empowering interventions. The following summaries of VISN5 MIRECC projects, describe a group intervention to help decrease internalized mental health stigma, an innovative program promoting illness self-management, and findings on the relationship between chronic pain and mood with implications for Veterans’ efforts at pain management.

Ending Self Stigma: A team at the MIRECC¹ created a nine-session group called Ending Self Stigma to help people experiencing mental illness learn skills for reducing and dealing with internalized stigma – when people “absorb” common negative stereotypes about mental illness into how they think of themselves – and the harm it can cause. They then tested it in comparison to a general wellness education group of the same length, but which didn’t address stigma, randomly assigning 248 Veterans to attend one or the other.  Both groups experienced modest reductions in self-stigma and increases in a sense of belonging.  People experiencing psychosis who took part in Ending Self Stigma had greater reduction in internalized stigma compared to those who took part in the wellness control group.

Living Well: People with mental health conditions also have high rates of chronic medical conditions, like heart disease and diabetes. It can be a challenge for these individuals to manage both mental and medical conditions at the same time.  Researchers at the VISN 5 MIRECC designed a program called Living Well to help adults with mental health conditions manage their medical conditions. Living Well consisted of 12 group sessions where group members learned information and skills to better take care of their holistic health. In a large study they found that people who participated in Living Well became more proactive and confident about taking care of their medical conditions, and experienced improvements in quality of life. After publishing these exciting findings², VISN 5 MIRECC researchers wanted to find out more about how Living Well worked³. To do this, they looked at interviews from participants who described their experiences with Living Well. By conducting in-depth qualitative analyses with this interview data, they found that Living Well provided information and knowledge, opportunities for learning from others, and real-world practice, all in an interpersonally supportive environment. These active ingredients led to enhanced self-awareness, confidence, sense of control, and behavior and health status changes among participants. Now that they know more about how Living Well worked, they hope to work on implementing it successfully in more places.

Chronic Pain and Bipolar Disorder: Studies have found that individuals with bipolar disorder have higher rates of chronic pain (e.g., back pain, joint pain, headache, arthritis, fibromyalgia) relative to the general population. However, little information has been gathered about how chronic pain experiences differ across mood states (depression, mania) and how, together, chronic pain and mood disorders affect overall functioning and quality of life. To learn more about these experiences, Dr. Leticia Travaglini and colleagues⁴ interviewed 15 Veterans with bipolar disorder and chronic pain. First, Veterans endorsed a clear relationship between depression and pain. The relationship between mania and pain was less clear. When manic or hypomanic episodes were characterized by elevated mood and energy, Veterans had noticeable reductions in pain sensitivity and interference. When these episodes were characterized as more angry or irritable, Veterans reported increased pain severity. For almost all Veterans, pain and bipolar disorder symptoms affected quality of life and functioning, with many noting a cycling nature between pain impacting quality of life and in turn worsening depression. This study highlights the complexities with managing pain and mood symptoms and points to a greater need to assess chronic pain among Veterans with bipolar disorder, as changes in mood could have significant effects on general functioning and pain management.

You can read the full publications using the references below.

References:

1. Drapalski, A. L., Lucksted, A., Brown, C. H., & Fang, L. J. (2021). Outcomes of ending self-stigma, a group intervention to reduce internalized stigma, among individuals with serious mental illness. Psychiatric Services, 72(2), 136-142. Doi: 10.1176/appi.ps.201900296
2. Muralidharan, A., Brown, C. H., Peer, J., Klingaman, E., Hack, S., Li, L., Walsh, M. B., & Goldberg, R. W. (2019). Living Well: An Intervention to Improve Medical Illness Self-Management for Individuals with Serious Mental Illness. Psychiatric Services, 70 (1), 19-25.
3. Muralidharan, A., Peeples, A., & Lucksted, A. A. (2021). Health Behavior Change Processes Among Adults with Serious Mental Illness Engaged in Illness Self-Management. Qualitative Health Research. Advance online publication. doi:10.1177/1049732321992049
4. Travaglini, L. E., Kuykendall, L., Bennett, M. E., Abel, E. A., Lucksted, A. (2020). The relationship between chronic pain and mood states in veterans with bipolar disorder. Journal of Affective Disorders. 277, 765-771.