McKenzie Lockett

All Publications

• Association Between Mental Illness and Risk of Severe Maternal Morbidity in Pregnant Veterans. Obstetrics and gynecology Panelli, D. M., Esmaeili, A., Joyce, V. R., Chan, C. S., Gujral, K., Schmitt, S. K., Murphy, N. F., Kimerling, R., Lockett, M., Leonard, S. A., Main, E. K., Shaw, J. G., Phibbs, C. S. 2025

  Abstract

  Mental illness is a leading cause of maternal mortality, yet population-level research is hindered by limited antenatal mental health data. The Veterans Health Administration, which offers universal outpatient mental health and substance use screening and resources, provides a unique opportunity to assess the effects of antenatal mental illness on severe maternal morbidity (SMM; a composite of life-threatening events around the time of childbirth).We conducted a population-level retrospective cohort study of births reimbursed by the Veterans Health Administration in fiscal years 2010-2020. The exposure was antenatal mental illness, identified by International Classification of Disease, Ninth or Tenth Revision, Clinical Modification codes for depression, anxiety, posttraumatic stress disorder, or other serious mental illness, categorized as "active" (coded 1 year or less before childbirth) or "historical" only (coded only more than 1 year before childbirth). The outcome was SMM, defined with the established Health Resources & Services Administration composite. Sequential multivariable Poisson regression models with robust standard errors were conducted, adjusted for sociodemographic confounders. A mediation analysis was conducted to assess the potential contribution of substance use disorders to the relationship between mental illness and SMM.Of 47,883 eligible births, 3.6% of veterans had historical mental illness and 17.4% had active antenatal mental illness. Compared with veterans with no prior mental illness, the risk of SMM was increased in veterans with active mental illness (2.0% vs 1.2%, adjusted risk ratio [aRR] 1.38, 95% CI, 1.15-1.67). There was no significant increase in risk among those with historical mental illness (aRR 0.87, 95% CI, 0.57-1.31). Substance use disorders were not found to be a significant mediator of the association between active mental illness and SMM.Active, but not historical, antenatal mental illness was independently associated with higher risk of SMM among pregnant veterans. These findings highlight a potential role for addressing mental health during pregnancy as part of broader efforts to reduce SMM.

  View details for DOI 10.1097/AOG.0000000000006107

  View details for PubMedID 41166709

• Protocol for a scoping review of PTSD and minority stress interventions for LGBTQIA + adults. Discover psychology Rosenfeld, E. A., Malek, N., Lockett, M., Edward, D., Hooper, V., Harper, K. L., Herbitter, C., Thompson, S. M., Ceja, A., Saty, M., Chang, C. J., Collazo, E. N., Ong, L., Stave, C., Cudd, A., O'Reilly, A., Livingston, N. A. 2025; 5 (1): 54

  Abstract

  LGBTQIA + people experience trauma and posttraumatic stress disorder (PTSD) at higher rates than cisgender heterosexual people, in addition to experiencing minority stress. There remains a dearth of research on appropriate PTSD interventions and minority stress interventions for LGBTQIA + people. However, the scope of the literature on neither PTSD interventions nor minority stress interventions for LGBTQIA + adults has ever been reviewed. Furthermore, research on PTSD-focused and minority stress-focused interventions remains relatively siloed, despite the link between minority stress and PTSD symptoms. The proposed scoping review aims to: (1) describe the scope of the current literature, chart available data, and synthesize findings, (2) collate information on existing PTSD and minority stress interventions for LGBTQIA + adults, and (3) identify gaps in the literature and directions for future research.Research produced since 2000 on psychological, psychotherapeutic, and behavioral interventions for PTSD, minority stress, or both within the LGBTQIA + adult population will be reviewed. This protocol follows the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR).The search yielded a total of 6818 results. Following deduplication, a total of 4945 results remained. Title/abstract screening will be followed by full-text review and data coding, charting, and mapping.This scoping review will be the first to describe the state of the literature and synthesize information on both PTSD and minority stress interventions for LGBTQIA + adults. Findings may also highlight promising interventions and treatment components. Information gleaned may inform future adaptations of existing interventions and development of new interventions for LGBTQIA + adults experiencing PTSD and/or minority stress.This paper discusses the planned steps for an ongoing scoping review. The scoping review will provide an overview of treatments for PTSD and for minority stress for LGBTQIA + adults.The online version contains supplementary material available at 10.1007/s44202-025-00355-2.

  View details for DOI 10.1007/s44202-025-00355-2

  View details for PubMedID 40688725

  View details for PubMedCentralID PMC12270952

• Mapping the gender gradient in posttraumatic stress disorder prevalence: A machine learning approach. Journal of traumatic stress Kimerling, R., Ward, R. N., Leder, S., Tamayo, G. C., Lockett, M. 2025

  Abstract

  The prevalence of posttraumatic stress disorder (PTSD) among women is over twice that of men, but the underlying mechanisms for these differences remain poorly understood. This study introduces a novel approach to examining gender and PTSD, moving beyond the binary group labels of male and female to explore the summative impact of gender-linked sociocultural factors. Using supervised machine learning, we modeled gender from theoretical and empirically selected predictors reflecting the roles, relationships, and institutional facets of gender. This model produced continuous gender scores reflecting the social circumstances typical of male (lower scores) or female (higher scores) individuals. We then examined how well these scores were associated with past-year PTSD among trauma-exposed men and women (N=23,936) and compared effects to those obtained using binary sex. The results revealed a clear dose-response relationship between the social circumstances typical of female gender and past-year PTSD. Main effects for gender scores, adjusted odds ratio (aOR)=4.03, 95% CI [2.64, 6.15], were substantially larger than main effects for binary sex, aOR=2.69, 95% CI [1.96, 3.68], z=2.30, p=.021, even after accounting for trauma exposure and other risk factors. This study highlights the importance of quantitative approaches that move beyond binary comparisons of male and female to better elucidate sociocultural determinants of traumatic stress.

  View details for DOI 10.1002/jts.23153

  View details for PubMedID 40312848

• Changes in healthcare engagement during the COVID-19 pandemic. Journal of patient-reported outcomes Lockett, M., Tamayo, G. C., Schalet, B. D., Reise, S. P., Kimerling, R. 2025; 9 (1): 21

  Abstract

  Healthcare engagement, defined as the self-efficacy to enact the behaviors needed to obtain optimal benefit from health services, is an important aspect of healthcare quality. Measuring changes to healthcare engagement is essential to informing current and ongoing adaptations to health service delivery. The objective of the present study was to explore the responsiveness of the recently developed PROMIS® Healthcare Engagement measure (PHE), a patient-reported outcome, through investigating the impact of COVID and COVID-related healthcare disruptions on healthcare engagement from pre- to peri-pandemic.Baseline data (2018-2019) were collected via a national mail survey of Veterans receiving VA care. For follow-up data, a subset of participants was randomly selected to be invited to a follow-up survey. Administrative data was used from the VA's Corporate Data Warehouse (CDW). We used mixed effects linear modeling to compare changes in healthcare engagement from baseline to follow-up between Veterans who reported healthcare disruptions and Veterans who did not report healthcare disruptions, adjusting for covariates.From baseline to follow-up, healthcare engagement scores increased on average by 2.84 points. Compared to Veterans who reported no disruptions, Veterans who experienced COVID-related healthcare disruptions demonstrated greater decreases to healthcare engagement (difference scores ≥ - 1.98, ps ≤ 0.002) Further, Veterans with more healthcare disruptions showed greater decreases in healthcare engagement relative to those with fewer healthcare disruptions, such that Veterans with 2 healthcare disruptions (difference score = -4.20) significantly differed from Veterans reporting only 1 healthcare disruption, and Veterans reporting 3 or more disruptions (difference score = -3.75) significantly differed from those with 2 disruptions.Our results provide preliminary evidence of the PHE's responsiveness through demonstrating that environmental factors, such as pandemic-related factors, influence healthcare engagement. The COVID-19 pandemic had a complex effect on healthcare engagement, with healthcare engagement scores increasing overall during the pandemic but Veterans reporting COVID-related healthcare disruptions showing decreased changes in healthcare engagement. These findings support the utility of the PHE as a measure of healthcare engagement.

  View details for DOI 10.1186/s41687-025-00850-z

  View details for PubMedID 39976772

  View details for PubMedCentralID 7821029