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Faculty Profiles

Karen Seal, MD
M_MED-VAMC-DGIM
Professor

4150 Clement St.
San Francisco, CA 94121
415-221-4810 ext. 4852
Karen.Seal@ucsf.edu

Dr. Karen Seal is a Professor of Medicine and Psychiatry at the University of California, San Francisco (UCSF). She is based at the San Francisco VA Health Care System (SFVAHCS) where she is the Director of the Integrated Care Clinic for Iraq and Afghanistan Veterans and Director of the Integrated Pain Team (IPT) Clinic. In these roles and as a practicing primary care internist and health services researcher, she has dedicated her career to developing and testing novel interventions to address comorbid mental and physical health problems, including chronic pain and opioid misuse in the context of PTSD and TBI among veterans. Dr. Seal serves as Chair of the SFVAHCS Integrative Health Advisory Committee to promote the development of Complimentary and Integrative Health (CIH) services for veteran patients and staff. In this capacity, Dr. Seal and her colleagues have been building Integrative Health capacity at SFVAHCS which includes system-wide training in VA Whole Health personalized health planning and coaching and mind body skills. She also actively mentors trainees, provides support for their research interests and seeks to involve them in one or more of the funded Research Projects listed below:
• Whole Health Pain Team for Chronic Pain (Funded by NIH, PI). This is a large pragmatic trial across 4 VA sites to develop the components of a Whole Health Team approach to chronic pain management in veterans and then test this in an RCT against a Usual primary care approach.
• COACH (Funded by VA HSR&D, PI): A multi-site randomized controlled trial (RCT) in Northern California and Louisiana to test telephone motivational coaching to enhance engagement in mental health treatment among rural veterans with untreated mental health concerns.
• OPTI (Funded by NIH, PI): A pilot RCT based at the San Francisco VA to decrease reliance on prescription opioids among veterans with chronic pain and higher risk opioid use.
• Pain Quality Improvement (QI) Research (Funded by VA HSR&D): A multi-faceted QI study of novel approaches to pain management based out of the San Francisco VA Health Care System, with a focus on evaluating the SFVAHCS Integrated Pain Team Clinic and Whole Health Coaching.
• VOICE: (Funded by PCORI, Co-PI): A pragmatic effectiveness trial across 9 VA sites of an integrated pain team approach (modeled after the SFVAHCS Integrated Pain Team Clinic) vs. telephone collaborative management to improve pain and decrease opioid use among veterans.
• Virtual Worlds Training in PTSD for Primary Care Providers (Funded by DoD, PI): This 4-year study involves first building a novel Virtual Worlds training for providers working in primary care settings on PTSD assessment and management and then conducting an RCT to compare it to an online training.

Education and Training

Location Degree or Training Specialty Date
University of California, San Francisco, Center for AIDS Prevention Studies Post-Doctoral Fellowship 05/2003
University of California, Berkeley MPH Epidemiology 05/1998
Stanford University School of Medicine MD Medicine 05/1994
Brown University BS Neuroscience 05/1985
University of California, San Francisco Residency Internal Medicine

Interests

behavioral health interventions, chronic pain, complimentary integrative health, opioid misuse, posttraumtic stress disorder, vulnerable populations

Awards and Honors
2016   Federal Employee of the Year for Research, VA, 2016
2010   UCSF Excellence in Teaching Award in Medical Education, UCSF, 2010
1991   Peninsula Community Scholar's Award for Community Service, Stanford University School of Medicine, 1991
1981   Sigma Xi, Brown University, 1981-1985

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In the News

Recent Articles (72)

Seal KH, Bertenthal D, Barnes DE, Byers AL, Gibson CJ, Yaffe K. Traumatic Brain Injury and Receipt of Prescription Opioid Therapy for Chronic Pain in Iraq and Afghanistan Veterans: Do Clinical Practice Guidelines Matter? J Pain. 2018 Mar 26.

Brailey K, Mills MA, Marx BP, Proctor SP, Seal KH, Spiro A, Ulloa EW, Vasterling JJ. Prospective Examination of Early Associations of Iraq War Zone Deployment, Combat Severity, and Posttraumatic Stress Disorder with New Incident Medical Diagnoses. J Trauma Stress. 2018 Feb; 31(1):102-113.

Samuelson KW, Abadjian L, Jordan JT, Bartel A, Vasterling J, Seal K. The Association Between PTSD and Functional Outcome Is Mediated by Perception of Cognitive Problems Rather Than Objective Neuropsychological Test Performance. J Trauma Stress. 2017 Oct; 30(5):521-530.

Purcell N, Zamora K, Tighe J, Li Y, Douraghi M, Seal K. The Integrated Pain Team: A Mixed-Methods Evaluation of the Impact of an Embedded Interdisciplinary Pain Care Intervention on Primary Care Team Satisfaction, Confidence, and Perceptions of Care Effectiveness. Pain Med. 2017 Oct 12.

Abraham TH, Koenig CJ, Zamora K, Hill C, Uddo M, Kelly AP, Hamilton MF, Curran GM, Pyne JM, Seal KH. Situating mental health work in place: Qualitative findings from interviews with Veterans in Southeastern Louisiana and Northern California. Health Place. 2017 Sep; 47:63-70.

Seal KH, Bertenthal D, Barnes DE, Byers AL, Strigo I, Yaffe K. Association of Traumatic Brain Injury With Chronic Pain in Iraq and Afghanistan Veterans: Effect of Comorbid Mental Health Conditions. Arch Phys Med Rehabil. 2017 08; 98(8):1636-1645.

Peralta CA, Frigaard M, Rubinsky AD, Rolon L, Lo L, Voora S, Seal K, Tuot D, Chao S, Lui K, Chiao P, Powe N, Shlipak M. Implementation of a pragmatic randomized trial of screening for chronic kidney disease to improve care among non-diabetic hypertensive veterans. BMC Nephrol. 2017 04 12; 18(1):132.

Metrik J, Jackson K, Bassett SS, Zvolensky MJ, Seal K, Borsari B. The mediating roles of coping, sleep, and anxiety motives in cannabis use and problems among returning veterans with PTSD and MDD. Psychol Addict Behav. 2016 Nov; 30(7):743-754.

Seal KH, Maguen S, Bertenthal D, Batki SL, Striebel J, Stein MB, Madden E, Neylan TC. Observational Evidence for Buprenorphine's Impact on Posttraumatic Stress Symptoms in Veterans With Chronic Pain and Opioid Use Disorder. J Clin Psychiatry. 2016 Sep; 77(9):1182-1188.

Koenig CJ, Abraham T, Zamora KA, Hill C, Kelly PA, Uddo M, Hamilton M, Pyne JM, Seal KH. Pre-Implementation Strategies to Adapt and Implement a Veteran Peer Coaching Intervention to Improve Mental Health Treatment Engagement Among Rural Veterans. J Rural Health. 2016 Sep; 32(4):418-428.

Breyer BN, Fang SC, Seal KH, Ranganathan G, Marx BP, Keane TM, Rosen RC. Sexual Health in Male and Female Iraq and Afghanistan U. S. War Veterans With and Without PTSD: Findings From the VALOR Cohort. J Trauma Stress. 2016 06; 29(3):229-36.

Lau KM, Madden E, Neylan TC, Seal KH, Maguen S. Assessing for mild TBI among Iraq and Afghanistan veterans: Outcomes of injury severity and neurological factors. Brain Inj. 2016; 30(3):287-94.

Seal KH, Bertenthal D, Samuelson K, Maguen S, Kumar S, Vasterling JJ. Association between mild traumatic brain injury and mental health problems and self-reported cognitive dysfunction in Iraq and Afghanistan Veterans. J Rehabil Res Dev. 2016; 53(2):185-98.

Koo KH, Hebenstreit CL, Madden E, Seal KH, Maguen S. Race/ethnicity and gender differences in mental health diagnoses among Iraq and Afghanistan veterans. Psychiatry Res. 2015 Oct 30; 229(3):724-31.

Maguen S, Madden E, Cohen BE, Bertenthal D, Neylan TC, Seal KH. Suicide risk in Iraq and Afghanistan veterans with mental health problems in VA care. J Psychiatr Res. 2015 Sep; 68:120-4.

Cohen BE, Shi Y, Neylan TC, Maguen S, Seal KH. Antipsychotic prescriptions in Iraq and Afghanistan veterans with posttraumatic stress disorder in Department of Veterans Affairs healthcare, 2007-2012. J Clin Psychiatry. 2015 Apr; 76(4):406-12.

Maguen S, Madden E, Neylan TC, Cohen BE, Bertenthal D, Seal KH. Timing of mental health treatment and PTSD Symptom improvement among Iraq and Afghanistan veterans. Psychiatr Serv. 2014 Dec 01; 65(12):1414-9.

Oliva EM, Midboe AM, Lewis ET, Henderson PT, Dalton AL, Im JJ, Seal K, Paik MC, Trafton JA. Sex differences in chronic pain management practices for patients receiving opioids from the Veterans Health Administration. Pain Med. 2015 Jan; 16(1):112-8.

O'Donovan A, Cohen BE, Seal KH, Bertenthal D, Margaretten M, Nishimi K, Neylan TC. Elevated risk for autoimmune disorders in iraq and afghanistan veterans with posttraumatic stress disorder. Biol Psychiatry. 2015 Feb 15; 77(4):365-74.

Koenig CJ, Maguen S, Monroy JD, Mayott L, Seal KH. Facilitating culture-centered communication between health care providers and veterans transitioning from military deployment to civilian life. Patient Educ Couns. 2014 Jun; 95(3):414-20.

Samuelson KW, Koenig CJ, McCamish N, Choucroun G, Tarasovsky G, Bertenthal D, Seal KH. Web-based PTSD training for primary care providers: a pilot study. Psychol Serv. 2014 May; 11(2):153-61.

Breyer BN, Cohen BE, Bertenthal D, Rosen RC, Neylan TC, Seal KH. Lower urinary tract dysfunction in male Iraq and Afghanistan war veterans: association with mental health disorders: a population-based cohort study. Urology. 2014 Feb; 83(2):312-9.

Grossbard JR, Hawkins EJ, Lapham GT, Williams EC, Rubinsky AD, Simpson TL, Seal KH, Kivlahan DR, Bradley KA. Follow-up care for alcohol misuse among OEF/OIF veterans with and without alcohol use disorders and posttraumatic stress disorder. J Subst Abuse Treat. 2013 Nov-Dec; 45(5):409-15.

Maguen S, Madden E, Lau KM, Seal KH. Service utilization among Iraq and Afghanistan veterans screening positive for traumatic brain injury. J Neurotrauma. 2013 Jul 01; 30(13):1123-8.

Maguen S, Madden E, Cohen B, Bertenthal D, Neylan T, Talbot L, Grunfeld C, Seal K. The relationship between body mass index and mental health among Iraq and Afghanistan veterans. J Gen Intern Med. 2013 Jul; 28 Suppl 2:S563-70.

Seal KH, Stein MB. Preventing the pain of PTSD. Sci Transl Med. 2013 Jun 05; 5(188):188fs22.

Grossbard JR, Lehavot K, Hoerster KD, Jakupcak M, Seal KH, Simpson TL. Relationships among veteran status, gender, and key health indicators in a national young adult sample. Psychiatr Serv. 2013 Jun; 64(6):547-53.

Breyer BN, Cohen BE, Bertenthal D, Rosen RC, Neylan TC, Seal KH. Sexual dysfunction in male Iraq and Afghanistan war veterans: association with posttraumatic stress disorder and other combat-related mental health disorders: a population-based cohort study. J Sex Med. 2014 Jan; 11(1):75-83.

Maguen S, Madden E, Cohen B, Bertenthal D, Seal K. Association of mental health problems with gastrointestinal disorders in Iraq and Afghanistan veterans. Depress Anxiety. 2014 Feb; 31(2):160-5.

Jakupcak M, Hoerster KD, Blais RK, Malte CA, Hunt S, Seal K. Readiness for change predicts VA Mental Healthcare utilization among Iraq and Afghanistan war veterans. J Trauma Stress. 2013 Feb; 26(1):165-8.

Maguen S, Madden E, Cohen BE, Bertenthal D, Seal KH. Time to treatment among veterans of conflicts in Iraq and Afghanistan with psychiatric diagnoses. Psychiatr Serv. 2012 Dec; 63(12):1206-12.

Cohen BE, Maguen S, Bertenthal D, Shi Y, Jacoby V, Seal KH. Reproductive and other health outcomes in Iraq and Afghanistan women veterans using VA health care: association with mental health diagnoses. Womens Health Issues. 2012 Sep; 22(5):e461-71.

Koenig CJ, Maguen S, Daley A, Cohen G, Seal KH. Passing the baton: a grounded practical theory of handoff communication between multidisciplinary providers in two Department of Veterans Affairs outpatient settings. J Gen Intern Med. 2013 Jan; 28(1):41-50.

Maguen S, Lau KM, Madden E, Seal K. Factors associated with completing comprehensive traumatic brain injury evaluation. Mil Med. 2012 Jul; 177(7):797-803.

Maguen S, Cohen B, Cohen G, Madden E, Bertenthal D, Seal K. Eating disorders and psychiatric comorbidity among Iraq and Afghanistan veterans. Womens Health Issues. 2012 Jul-Aug; 22(4):e403-6.

Spelman JF, Hunt SC, Seal KH, Burgo-Black AL. Post deployment care for returning combat veterans. J Gen Intern Med. 2012 Sep; 27(9):1200-9.

Seal KH, Abadjian L, McCamish N, Shi Y, Tarasovsky G, Weingardt K. A randomized controlled trial of telephone motivational interviewing to enhance mental health treatment engagement in Iraq and Afghanistan veterans. Gen Hosp Psychiatry. 2012 Sep-Oct; 34(5):450-9.

Seal KH, Shi Y, Cohen G, Cohen BE, Maguen S, Krebs EE, Neylan TC. Association of mental health disorders with prescription opioids and high-risk opioid use in US veterans of Iraq and Afghanistan. JAMA. 2012 Mar 07; 307(9):940-7.

Maguen S, Cohen B, Cohen G, Madden E, Bertenthal D, Seal K. Gender differences in health service utilization among Iraq and Afghanistan veterans with posttraumatic stress disorder. J Womens Health (Larchmt). 2012 Jun; 21(6):666-73.

Maguen S, Madden E, Lau KM, Seal K. The impact of head injury mechanism on mental health symptoms in veterans: do number and type of exposures matter? J Trauma Stress. 2012 Feb; 25(1):3-9.

Maguen S, Lau KM, Madden E, Seal K. Relationship of screen-based symptoms for mild traumatic brain injury and mental health problems in Iraq and Afghanistan veterans: Distinct or overlapping symptoms? J Rehabil Res Dev. 2012; 49(7):1115-26.

Maguen S, Cohen B, Ren L, Bosch J, Kimerling R, Seal K. Gender differences in military sexual trauma and mental health diagnoses among Iraq and Afghanistan veterans with posttraumatic stress disorder. Womens Health Issues. 2012 Jan-Feb; 22(1):e61-6.

Seal KH, Cohen G, Bertenthal D, Cohen BE, Maguen S, Daley A. Reducing barriers to mental health and social services for Iraq and Afghanistan veterans: outcomes of an integrated primary care clinic. J Gen Intern Med. 2011 Oct; 26(10):1160-7.

Seal KH, Cohen G, Waldrop A, Cohen BE, Maguen S, Ren L. Substance use disorders in Iraq and Afghanistan veterans in VA healthcare, 2001-2010: Implications for screening, diagnosis and treatment. Drug Alcohol Depend. 2011 Jul 01; 116(1-3):93-101.

Maguen S, Ren L, Bosch JO, Marmar CR, Seal KH. Gender differences in mental health diagnoses among Iraq and Afghanistan veterans enrolled in veterans affairs health care. Am J Public Health. 2010 Dec; 100(12):2450-6.

Maguen S, Lucenko BA, Reger MA, Gahm GA, Litz BT, Seal KH, Knight SJ, Marmar CR. The impact of reported direct and indirect killing on mental health symptoms in Iraq war veterans. J Trauma Stress. 2010 Feb; 23(1):86-90.

Seal KH, Maguen S, Cohen B, Gima KS, Metzler TJ, Ren L, Bertenthal D, Marmar CR. VA mental health services utilization in Iraq and Afghanistan veterans in the first year of receiving new mental health diagnoses. J Trauma Stress. 2010 Feb; 23(1):5-16.

Maguen S, Metzler TJ, Litz BT, Seal KH, Knight SJ, Marmar CR. The impact of killing in war on mental health symptoms and related functioning. J Trauma Stress. 2009 Oct; 22(5):435-43.

Cohen BE, Gima K, Bertenthal D, Kim S, Marmar CR, Seal KH. Mental health diagnoses and utilization of VA non-mental health medical services among returning Iraq and Afghanistan veterans. J Gen Intern Med. 2010 Jan; 25(1):18-24.

Cohen BE, Marmar C, Ren L, Bertenthal D, Seal KH. Association of cardiovascular risk factors with mental health diagnoses in Iraq and Afghanistan war veterans using VA health care. JAMA. 2009 Aug 05; 302(5):489-92.

Seal KH, Metzler TJ, Gima KS, Bertenthal D, Maguen S, Marmar CR. Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002-2008. Am J Public Health. 2009 Sep; 99(9):1651-8.

Tsui JI, Whooley MA, Monto A, Seal K, Tien PC, Shlipak M. Association of hepatitis C virus seropositivity with inflammatory markers and heart failure in persons with coronary heart disease: data from the Heart and Soul study. J Card Fail. 2009 Jun; 15(5):451-6.

Hu Y, Grau LE, Scott G, Seal KH, Marshall PA, Singer M, Heimer R. Economic evaluation of delivering hepatitis B vaccine to injection drug users. Am J Prev Med. 2008 Jul; 35(1):25-32.

Seal K, Mansell W, Mannion H. What lies between hypomania and bipolar disorder? A qualitative analysis of 12 non-treatment-seeking people with a history of hypomanic experiences and no history of major depression. Psychol Psychother. 2008 Mar; 81(Pt 1):33-53.

Seal KH, Bertenthal D, Maguen S, Gima K, Chu A, Marmar CR. Getting beyond "Don't ask; don't tell": an evaluation of US Veterans Administration postdeployment mental health screening of veterans returning from Iraq and Afghanistan. Am J Public Health. 2008 Apr; 98(4):714-20.

Seal KH, Monto A, Dove L, Shen H, Vittinghoff E, Tracy D, Miller E, Lau E, Wright TL. The association of human immunodeficiency virus infection with spontaneously resolved hepatitis C virus infection and level of viremia among injection drug users. Dig Dis Sci. 2007 Dec; 52(12):3423-30.

Seal KH, Bertenthal D, Miner CR, Sen S, Marmar C. Bringing the war back home: mental health disorders among 103,788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs facilities. Arch Intern Med. 2007 Mar 12; 167(5):476-82.

Seal KH, Currie SL, Shen H, Anand BS, Bini EJ, Brau N, Jeffers L, Wright TL. Hepatitis C treatment candidacy and outcomes among 4318 US veterans with chronic hepatitis C virus infection: does a history of injection drug use matter? J Clin Gastroenterol. 2007 Feb; 41(2):199-205.

Tsui JI, Pletcher MJ, Vittinghoff E, Seal K, Gonzales R. Hepatitis C and hospital outcomes in patients admitted with alcohol-related problems. J Hepatol. 2006 Feb; 44(2):262-6.

Seal KH, Thawley R, Gee L, Bamberger J, Kral AH, Ciccarone D, Downing M, Edlin BR. Naloxone distribution and cardiopulmonary resuscitation training for injection drug users to prevent heroin overdose death: a pilot intervention study. J Urban Health. 2005 Jun; 82(2):303-11.

Seal KH, Kral AH, Lorvick J, McNees A, Gee L, Edlin BR. A randomized controlled trial of monetary incentives vs. outreach to enhance adherence to the hepatitis B vaccine series among injection drug users. Drug Alcohol Depend. 2003 Aug 20; 71(2):127-31.

Pfeiffer RM, Tanaka Y, Yeo AE, Umemura T, Seal KH, Shih JW, Alter HJ, Edlin BR, O'Brien TR. Prevalence of SEN viruses among injection drug users in the San Francisco Bay area. J Infect Dis. 2003 Jul 01; 188(1):13-8.

Seal KH, Downing M, Kral AH, Singleton-Banks S, Hammond JP, Lorvick J, Ciccarone D, Edlin BR. Attitudes about prescribing take-home naloxone to injection drug users for the management of heroin overdose: a survey of street-recruited injectors in the San Francisco Bay Area. J Urban Health. 2003 Jun; 80(2):291-301.

Atkinson J, Edlin BR, Engels EA, Kral AH, Seal K, Gamache CJ, Whitby D, O'Brien TR. Seroprevalence of human herpesvirus 8 among injection drug users in San Francisco. J Infect Dis. 2003 Mar 15; 187(6):974-81.

Bluthenthal RN, Kral AH, Gee L, Lorvick J, Moore L, Seal K, Edlin BR. Trends in HIV seroprevalence and risk among gay and bisexual men who inject drugs in San Francisco, 1988 to 2000. J Acquir Immune Defic Syndr. 2001 Nov 01; 28(3):264-9.

Seal KH, Kral AH, Gee L, Moore LD, Bluthenthal RN, Lorvick J, Edlin BR. Predictors and prevention of nonfatal overdose among street-recruited injection heroin users in the San Francisco Bay Area, 1998-1999. Am J Public Health. 2001 Nov; 91(11):1842-6.

Edlin BR, Seal KH, Lorvick J, Kral AH, Ciccarone DH, Moore LD, Lo B. Is it justifiable to withhold treatment for hepatitis C from illicit-drug users? N Engl J Med. 2001 Jul 19; 345(3):211-5.

Ochoa KC, Hahn JA, Seal KH, Moss AR. Overdosing among young injection drug users in San Francisco. Addict Behav. 2001 May-Jun; 26(3):453-60.

Lorvick J, Kral AH, Seal K, Gee L, Edlin BR. Prevalence and duration of hepatitis C among injection drug users in San Francisco, Calif. Am J Public Health. 2001 Jan; 91(1):46-7.

Seal KH, Ochoa KC, Hahn JA, Tulsky JP, Edlin BR, Moss AR. Risk of hepatitis B infection among young injection drug users in San Francisco: opportunities for intervention. West J Med. 2000 Jan; 172(1):16-20.

Brailey, K, Mills, MA, Marx, BP, Proctor, SP, Seal, KH, Spiro, A, III, Ulloa, E. W., & Vasterling, J. J. . Prospective examination of early associations of Iraq warzone deployment, combat severity, and PTSD with new incident medical diagnoses. Journal of Traumatic Stress.

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