Ecological disasters highlight the importance of understanding natural disasters as they relate to a changing global climate. Such disasters often have a predictable pattern of evolving over time and anticipated psychological and behavioral problems and community disruptions. Various factors enhance transmission of these adverse effects beyond the geographic location of the ecological disaster, with certain populations being particularly vulnerable to these effects. Understanding the range and pattern of these effects can aid in optimizing interventions. The use of evidence-informed interventions can reduce distress, enhance well-being, and improve functioning for affected individuals and communities. Effective preparedness involves an understanding of these factors, incorporation of them at all stages of disaster management, and continuous education and training for disaster planners and responders.

The U.S. Department of Veterans Affairs (VA) and Department of Defense (DoD) worked together to revise the 2017 VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder. This article summarizes the 2023 clinical practice guideline (CPG) and its development process, focusing on assessments and treatments for which evidence was sufficient to support a recommendation for or against. Subject experts from both departments developed 12 key questions and reviewed the published literature after a systematic search using the PICOTS (population, intervention, comparator, outcomes, timing of outcomes measurement, and setting) method. The evidence was then evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method. Recommendations were made after consensus was reached; they were based on quality and strength of evidence and informed by other factors, including feasibility and patient perspectives. Once the draft was peer reviewed by an external group of experts and their inputs were incorporated, the final document was completed. The revised CPG includes 34 recommendations in the following 5 topic areas: assessment and diagnosis, prevention, treatment, treatment of nightmares, and treatment of posttraumatic stress disorder (PTSD) with co-occurring conditions. Six recommendations on PTSD treatment were rated as strong. The CPG recommends use of specific manualized psychotherapies over pharmacotherapy; prolonged exposure, cognitive processing therapy, or eye movement desensitization and reprocessing psychotherapy; paroxetine, sertraline, or venlafaxine; and secure video teleconferencing to deliver recommended psychotherapy when that therapy has been validated for use with video teleconferencing or when other options are unavailable. The CPG also recommends against use of benzodiazepines, cannabis, or cannabis-derived products. Providers are encouraged to use this guideline to support evidence-based, patient-centered care and shared decision making to optimize individuals' health outcomes and quality of life.

The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment

Moral injury is a relatively new, but increasingly studied, construct in the field of mental health, particularly in relation to current and ex-serving military personnel. Moral injury refers to the enduring psychosocial, spiritual or ethical harms that can result from exposure to high-stakes events that strongly clash with one’s moral beliefs. There is a pressing need for further research to advance understanding of the nature of moral injury; its relationship to mental disorders such as posttraumatic stress disorder and depression; triggering events and underpinning mechanisms; and prevalence, prevention and treatment. In the meantime, military leaders have an immediate need for guidance on how moral injury should be addressed and, where possible, prevented. Such guidance should be theoretically sound, evidence-informed and ethically responsible. Further, the implementation of any practice change based on the guidance should contribute to the advancement of science through robust evaluation. This paper draws together current research on moral injury, best-practice approaches in the adjacent field of psychological resilience, and principles of effective implementation and evaluation. This research is combined with the military and veteran mental health expertise of the authors to provide guidance on the design, implementation and evaluation of moral injury interventions in the military. The paper discusses relevant training in military ethical practice, as well as the key roles leaders have in creating cohesive teams and having frank discussions about the moral and ethical challenges that military personnel face.

Posttraumatic stress disorder (PTSD) is a potentially debilitating condition characterized by intrusive memories, avoidance, negative alterations in mood and cognition, and hyperarousal after exposure to a traumatic stressor. An estimated 70.4% of the adult population worldwide experiences a traumatic event in their lifetime.¹ Of those, approximately 6.8% develop PTSD over their lifetime,² with a prevalence rate of 3.6% over the past year.³ Changes in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) diagnostic criteria for PTSD⁴ indicate that work-related traumatic exposures are PTSD-qualifying events.⁵