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Bradley SE, Heuer JN, Hahm B, Pettey K, Besterman-Dahan K. "Just Food doesn't Do It": Understanding Food Insecurity Among Rural Veterans in the United States. Ecol Food Nutr 2024; 63:564-584. [PMID: 39097942 DOI: 10.1080/03670244.2024.2387339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
Food security among rural veteran populations is an understudied subject. This study uses qualitative data from 106 semi-structured interviews conducted with staff from programs at the United States Department of Veterans Affairs (VA) and other federal agencies, staff from non-governmental organizations (NGOs), food security researchers, and food insecure veterans to identify the barriers to and facilitators for rural veteran food security. Barriers identified included external, structural barriers that exist in rural areas; internal barriers to using food assistance, such as feeling stigmatized; and barriers related to other social determinants of health, including a lack of education, employment, or housing stability.
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Affiliation(s)
- Sarah E Bradley
- Center for Healthcare Outcomes & Policy (CHOP) Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Research Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Jacquelyn N Heuer
- Research Service, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Bridget Hahm
- Research Service, Edward Hines, Jr. VA Hospital, Hines, Illinois, USA
| | - Kristin Pettey
- Office of Rural Health, Veterans Rural Health Resource Center, Salt Lake City, Utah, USA
| | - Karen Besterman-Dahan
- Mental Health, VISN 5 Mental Illness Research, Education and Clinical Center, Baltimore, Maryland, USA
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Somohano VC, Cameron D, Lewis MM, O’Neill A, Phillips R, Kaplan J, O’Neil ME. Predictors of evidence-based psychotherapy initiation among veterans with co-occurring PTSD and substance use disorder. Front Psychiatry 2024; 15:1432361. [PMID: 39220182 PMCID: PMC11363902 DOI: 10.3389/fpsyt.2024.1432361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/08/2024] [Indexed: 09/04/2024] Open
Abstract
Objective To compare initiation of PTSD evidence-based psychotherapy (EBP) between Veterans with and without a co-occurring substance use disorder (SUD), and identify factors associated with EBP initiation among Veterans with PTSD-SUD. Method A national sample of Veterans with PTSD (n = 301,872) and PTSD-SUD (n = 94,515) were identified from VA Electronic Health Record data. Treatment initiation was defined as having at least one mental health encounter associated with Cognitive Processing Therapy or Prolonged Exposure therapy. Generalized estimating equations were used to compare EBP initiation between Veterans with and without co-occurring SUD, and to identify patient- and facility characteristics associated with EBP initiation among Veterans with PTSD-SUD. Results The majority of Veterans were 30 - 44 years old, male sex, and Non-Hispanic White. No significant differences were observed in EBP initiation between Veterans with and without a co-occurring SUD (OR=1.00, p=0.985). Among Veterans with PTSD-SUD, co-occurring bipolar disorder (OR=0.83, p=.000), co-occurring psychotic disorder (OR=0.69, p=.000), service connection (OR=0.94, p=.001), female sex (OR=0.87, p=.000), and being 60 years or older (OR=0.57, p=.000) were associated with a reduced likelihood of initiating a PTSD EBP. Having a co-occurring anxiety disorder (OR=1.06, p=.020), MST history (OR=1.95, p=.000), and high risk for suicide (OR=1.15, p=.000) were associated with an increased likelihood of initiating EBP. Discussion These findings support VA provision of EBP for Veterans with PTSD regardless of the presence of co-occurring SUD. Identifying characteristics that increase or reduce the likelihood of EBP initiation may provide insight into treatment pathways and subgroups warranting augmented outreach.
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Affiliation(s)
- Vanessa C. Somohano
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, United States
| | - David Cameron
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, United States
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States
| | - Meaghan M. Lewis
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, United States
| | - Allison O’Neill
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, United States
| | - Rachel Phillips
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, United States
| | - Joshua Kaplan
- Integrative Neurology and Intraoperative Neuromonitoring, Oregon Health & Science University, Portland, OR, United States
| | - Maya E. O’Neil
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, United States
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States
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Cypel YS, DePhilippis D, Davey VJ. Substance Use in U.S. Vietnam War Era Veterans and Nonveterans: Results from the Vietnam Era Health Retrospective Observational Study. Subst Use Misuse 2023; 58:858-870. [PMID: 37096682 DOI: 10.1080/10826084.2023.2188427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Background: Substance use (SU) is associated with physical injury and mental health disorders in older persons, but recent research has scarcely examined SU in U.S. Vietnam-era veterans who are mostly in or near their eighth decade of life. Objectives: We compared the prevalence of self-reported lifetime and current SU and modeled current usage patterns in a nationally representative sample of veterans versus a matched nonveteran cohort. Methods: Cross-sectional, self-reported survey data were analyzed from the 2016-2017 Vietnam Era Health Retrospective Observational Study (VE-HEROeS) (n = 18,866 veterans, n = 4,530 nonveterans). We assessed lifetime and current alcohol and drug use disorders; lifetime and current use of cannabis, opioids, stimulants, sedatives, "other drugs" (psychedelics, prescription or over-the-counter drugs not prescribed/used as intended); and current SU patterns (alcohol-use-only, drug-use-only, dual-SU, no SU). Weighted descriptive, bivariable, and multivariable statistics were calculated. Covariates in multinomial modeling included sociodemographic characteristics, lifetime cigarette smoking, depression, potentially traumatic events (PTEs), and current pain (SF-8TM). Results: Prevalence of lifetime opioid and sedative use (p ≤ .01), drug and alcohol use disorders (p < .001), and current "other drug" use (p < .001) were higher in veterans versus nonveterans. Current use of alcohol and cannabis was high in both cohorts. In veterans, very severe/severe pain, depression, and PTEs were highly associated with drug-use-only (p < .001) and dual-SU (p < .01), but these associations were fewer for nonveterans. Conclusion: This research confirmed existing concerns over substance misuse in older individuals. Vietnam-era veterans may be at particular risk due to service-related experiences and later-life tribulations. Era veterans' unique perceptions toward healthcare assistance for SU may need greater provider focus to maximize self-efficacy and treatment.
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Affiliation(s)
- Yasmin S Cypel
- Epidemiology Program, Health Outcomes Military Exposures (HOME) (12POP5), Office of Patient Care Services, U.S. Department of Veterans Affairs, Washington, District of Columbia, USA
| | - D DePhilippis
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, U.S. Department of Veterans Affairs, Washington, District of Columbia, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - V J Davey
- Office of Research & Development (14RD), U.S. Department of Veterans Affairs, Washington, District of Columbia, USA
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Cypel Y, Schnurr PP, Schneiderman AI, Culpepper WJ, Akhtar FZ, Morley SW, Fried DA, Ishii EK, Davey VJ. The mental health of Vietnam theater veterans-the lasting effects of the war: 2016-2017 Vietnam Era Health Retrospective Observational Study. J Trauma Stress 2022; 35:605-618. [PMID: 35290689 PMCID: PMC9310606 DOI: 10.1002/jts.22775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 11/11/2022]
Abstract
Mental health data from the 2016-2017 Vietnam Era Health Retrospective Observational Study (VE-HEROeS) were analyzed by cohort, represented by United States Vietnam theater veterans (VTs) who served in Vietnam, Cambodia, and Laos; nontheater veterans (NTs) without theater service; and age- and sex-matched nonveterans (NVs) without military service. The exposure of interest was Vietnam theater service. Surveys mailed to random samples of veterans (n = 42,393) and nonveterans (n = 6,885) resulted in response rates of 45.0% for veterans (n = 6,735 VTs, Mage = 70.09, SE = 0.04; n = 12,131 NTs) and 67.0% for NVs (n = 4,530). We examined self-report data on four mental health outcomes: probable posttraumatic stress disorder (PTSD), depression, psychological distress, and overall mental health functioning. Weighted adjusted odds ratios (aORs) between each outcome and cohort were estimated, controlling for covariates in four models: cohort plus sociodemographic variables (Model 1), Model 1 plus physical health variables (Model 2), Model 2 plus potentially traumatic events (PTEs; Model 3), and Model 3 plus other military service variables (Model 4). Mental health outcome prevalence was highest for VTs versus other cohorts, with the largest aOR, 2.88, for PTSD, 95% CI [2.46, 3.37], p < .001 (Model 4, VT:NT). Physical health and PTEs contributed most to observed effects; other service variables contributed least to aORs overall. Mental health dysfunction persists among VTs years after the war's end. The present results reaffirm previous findings and highlight the need for continued mental health surveillance in VTs.
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Affiliation(s)
- Yasmin Cypel
- Epidemiology Program, Health Outcomes of Military Exposures (12POP5)U.S. Department of Veterans AffairsWashingtonD.C.USA
| | - Paula P. Schnurr
- National Center for PTSDU.S. Department of Veterans AffairsWhite River JunctionVermontUSA,Department of PsychiatryGeisel School of Medicine at DartmouthHanoverNew HampshireUSA
| | - Aaron I. Schneiderman
- Epidemiology Program, Health Outcomes of Military Exposures (12POP5)U.S. Department of Veterans AffairsWashingtonD.C.USA
| | - William J. Culpepper
- Epidemiology Program, Health Outcomes of Military Exposures (12POP5)U.S. Department of Veterans AffairsWashingtonD.C.USA
| | - Fatema Z. Akhtar
- Epidemiology Program, Health Outcomes of Military Exposures (12POP5)U.S. Department of Veterans AffairsWashingtonD.C.USA
| | - Sybil W. Morley
- VISN 2 Center of Excellence for Suicide PreventionU.S. Department of Veterans AffairsCanandaiguaNew YorkUSA
| | - Dennis A. Fried
- War Related Injury & Illness Study CenterU.S. Department of Veterans AffairsEast OrangeNew JerseyUSA
| | - Erick K. Ishii
- Population Health Services (10P4V)U.S. Department of Veterans AffairsWashingtonD.C.USA
| | - Victoria J. Davey
- Office of Research & Development (14RD)U.S. Department of Veterans AffairsWashingtonD.C.USA
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Karel MJ, Wray LO, Adler G, Hannum AOR, Luci K, Brady LA, McGuire MH. Mental Health Needs of Aging Veterans: Recent Evidence and Clinical Recommendations. Clin Gerontol 2022; 45:252-271. [PMID: 31971092 DOI: 10.1080/07317115.2020.1716910] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Large numbers of older Americans have a history of military service, which may be positively or negatively associated with mental health in late life. We reviewed literature with the aim of better understanding the mental health needs of older Veterans.Methods: Articles included those published in 2009-2018 and focused on prevalence/risk for mental illness and suicide among older Veterans; utilization of mental health services; effectiveness of evidence-based behavioral treatments; and pertinent care delivery models.Results: Older Veterans are generally resilient. A significant minority experience mental health concerns that are associated with poor outcomes including a substantial number of suicides. Most published research is based on the approximately one third of Veterans who use the Veterans Health Administration (VHA) for care. Older Veterans with mental health diagnoses are less likely to utilize mental health services compared to younger Veterans, but as likely to benefit once engaged. Integrated care models in primary and geriatric care settings are promising.Conclusions: Aging Veterans are a large subset of Americans whose mental health needs are complex and deserve attention.Clinical Implications: Clinicians should ask about history of military service (i.e., Veteran status) and utilize available resources when providing care for older Veterans.
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Affiliation(s)
- Michele J Karel
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs (VA) Central Office, Washington, DC, United States
| | - Laura O Wray
- VA Center for Integrated Healthcare, VA Western New York Health Care System, Buffalo, New York, United States.,Jacobs School of Medicine and Biomedical Sciences, SUNY University at Buffalo, Buffalo, New York, United States
| | - Geri Adler
- VA South Central Mental Illness Research, Education, and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, United States
| | - Alisa O' Riley Hannum
- Mental Health Service, VA Eastern Colorado Healthcare System, Colorado Springs, Colorado, United States
| | - Katherine Luci
- Center for Aging and Neurocognitive Services, Salem VA Medical Center, Salem, Virginia, United States.,Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Blacksburg, Virginia, United States
| | - Laura A Brady
- Jacobs School of Medicine and Biomedical Sciences, SUNY University at Buffalo, Buffalo, New York, United States
| | - Marsden H McGuire
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs (VA) Central Office, Washington, DC, United States
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Kutney-Lee A, Smith D, Griffin H, Kinder D, Carpenter J, Thorpe J, Murray A, Shreve S, Ersek M. Quality of end-of-life care for Vietnam-era Veterans: Implications for practice and policy. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2021; 9:100494. [PMID: 33992224 DOI: 10.1016/j.hjdsi.2020.100494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 09/04/2020] [Accepted: 10/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In federal response to the aging population of Vietnam-era Veterans, Congress directed the Department of Veterans Affairs (VA) to create a pilot program to identify and develop best practices for improving hospice care for this population. A first step in VA's response was to identify whether the end-of-life (EOL) care needs and outcomes of Vietnam-era Veterans differed from previous generations. METHODS Using medical records and bereaved family surveys, we examined clinical characteristics, healthcare utilization, and EOL quality indicators for Vietnam-era Veterans who died in VA inpatient settings between fiscal year 2013-2017. Contemporaneous comparisons were made with World War II/Korean War-era Veterans. RESULTS Compared to prior generations, higher percentages of Vietnam-era Veterans had mental health/substance use diagnoses and disability. Similar percentages of family members in both groups reported that overall EOL care was excellent; however, post-traumatic stress disorder management ratings by families of Vietnam-era Veterans were significantly lower. CONCLUSIONS Although current VA EOL practices are largely meeting the needs of Vietnam-era Veterans, greater focus on mental health comorbidity, including post-traumatic stress disorder, Agent Orange-related conditions, and ensuring access to quality EOL care in the community is warranted. IMPLICATIONS Policymakers and healthcare professionals should anticipate more physical and mental health comorbidities among Veterans at EOL as Vietnam-era Veterans continue to age. Findings are being used to inform the development of standardized EOL care protocols and training programs for non-VA healthcare providers that are tailored to the needs of this population.
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Affiliation(s)
- Ann Kutney-Lee
- Veteran Experience Center (VEC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Center for Health Equity Research and Promotion (CHERP), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; University of Pennsylvania, School of Nursing, Philadelphia, PA, USA.
| | - Dawn Smith
- Veteran Experience Center (VEC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Center for Health Equity Research and Promotion (CHERP), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Hilary Griffin
- Veteran Experience Center (VEC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
| | - Daniel Kinder
- Veteran Experience Center (VEC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Joan Carpenter
- Veteran Experience Center (VEC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
| | - Joshua Thorpe
- Veteran Experience Center (VEC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; University of North Carolina- Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, NC, USA; Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Andrew Murray
- Veteran Experience Center (VEC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
| | - Scott Shreve
- Hospice and Palliative Care Program, Department of Veterans Affairs, Lebanon VA Medical Center, Lebanon, PA, USA
| | - Mary Ersek
- Veteran Experience Center (VEC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Center for Health Equity Research and Promotion (CHERP), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; University of Pennsylvania, School of Nursing, Philadelphia, PA, USA; University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
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7
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Agha A, Kutney-Lee A, Kinder D, Shreve S, Keddem S. "That is Care That you Just can't fake!": Identifying Best Practices for the Care of Vietnam Veterans at End of Life. J Pain Symptom Manage 2021; 61:983-990. [PMID: 32976941 DOI: 10.1016/j.jpainsymman.2020.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
CONTEXT We reviewed the Veterans Health Administration Bereaved Family Survey's open-ended responses to understand end-of-life (EOL) care best practices for Vietnam and pre-Vietnam Veterans. OBJECTIVES To identify 1) recommendations for improved EOL care enhancements for older Veterans, 2) a model of best practices in EOL care for Veterans, and 3) any relevant differences in best practices between Vietnam and prior war eras. METHODS We examined five years of Bereaved Family Survey data (n = 2784), collected between 2013 and 2017, from bereaved family members of Veterans focusing on 2 open-ended questions: 1) Is there anything else you would like to share about the Veteran's care during his last month of life? 2) Is there anything else you would like to share about how the care could have been improved for the Veteran? Applied thematic analysis identified successes and challenges in the experience of the bereaved of Vietnam and pre-Vietnam era Veterans. RESULTS Regardless of war era and death venue, a patient-centered approach to EOL care with readily available staff who could 1) provide ongoing support, comfort, honor, and validation; 2) routinely adjust to the patient's changing needs; 3) and provide clear, honest, timely, compassionate communication was important to the bereaved. Consideration of the uniqueness of Vietnam Veterans is beneficial. CONCLUSIONS Patient-centered EOL care should include assigning a point of contact that follows the patient, educates the family on expectations, ensures the patient's changing needs are met, ensures the family has appropriate support, and communicates updates to the family throughout the patient's care continuum.
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Affiliation(s)
- Aneeza Agha
- Corporal Michael J. Crescenz VA Medical Center, VA Center for Health Equity Research and Promotion (CHERP), Philadelphia, Pennsylvania, USA.
| | - Ann Kutney-Lee
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Daniel Kinder
- Veteran Experience Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Scott Shreve
- Hospice and Palliative Care Program, Hospice and Palliative Care Unit Department of Veteran Affairs, Lebanon VA Medical Center, Lebanon, Pennsylvania, USA
| | - Shimrit Keddem
- Hospice and Palliative Care Program, Hospice and Palliative Care Unit Department of Veteran Affairs, Lebanon VA Medical Center, Lebanon, Pennsylvania, USA
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Decker SE, Pavlo A, Harper A, Herring Y, Black AC. Themes in experiences of PTSD symptoms and relationships among male veterans with risky sexual behavior. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2020; 12:678-686. [PMID: 32338947 PMCID: PMC8717835 DOI: 10.1037/tra0000569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
OBJECTIVE United States veterans with posttraumatic stress disorder (PTSD) symptoms are at elevated risk for high-risk sexual behavior (HRSB). Although quantitative research has examined relationships between PTSD symptoms and HRSB, qualitative research to understand the lived experiences of veterans with PTSD symptoms and HRSB has not been conducted. METHOD Qualitative interviews were conducted with N = 29 male veterans of Operation Enduring Freedom or Operation Iraqi Freedom who had PTSD symptoms and reported recent HRSB. The interviews were analyzed using a phenomenological framework. RESULTS Six themes emerged: (a) avoiding social contact due to feeling different since return from service; (b) effortful self-management; (c) supportive relationships; (d) sex as a means to an end; (e) sex, risk, and intimacy; and (f) responsibility and growth. CONCLUSION Male veterans with PTSD symptoms and HRSB reported engagement in significant self-management to reengage in life, and still reported high levels of difficulty in relationships. They described both wanting to avoid perceived risk associated with intimate relationships and wanting to take risks that caused them to feel alive. Implications for treatment include increased efforts to facilitate coping, to recognize and moderate risk-taking urges, and to build intimacy and trust. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Suzanne E Decker
- Veterans Affairs Mental Illness Research, Education, and Clinical Center
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Ingram PB, Tarescavage AM, Ben-Porath YS, Oehlert ME. Comparing MMPI-2-Restructured Form Scores by Service Era for Veterans Assessed Within the Veteran Affairs Healthcare System. J Clin Psychol Med Settings 2020; 27:366-375. [PMID: 31471846 PMCID: PMC7223335 DOI: 10.1007/s10880-019-09650-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study compares profiles of Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) scale scores from 1492 VA test-takers who served during the Vietnam or Gulf War service eras. The sample includes all such cases collected at any VA posttraumatic stress disorder Clinical Teams across the United States between January 1, 2008 and May 31, 2015 using the MMPI-2 or MMPI-2-RF (via the VA Mental Health Assistant suite). Associations between gender and score differences were also examined. In contrast to past research using the MMPI-2, results of this study suggest that veterans are generally homogeneous in their MMPI-2-RF profiles across different periods of service. Specifically, the magnitudes of mean differences are small and not clinically significant. Thus, responses on the MMPI-2-RF do not appear influenced by service era. Implications for the clinical use of, and research with, the MMPI-2-RF are discussed within the VA healthcare system.
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Affiliation(s)
- Paul B Ingram
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA.
- Dwight D. Eisenhower VAMC, Eastern Kansas Veteran Healthcare System, Leavenworth, KS, USA.
| | | | | | - Mary E Oehlert
- Dwight D. Eisenhower VAMC, Eastern Kansas Veteran Healthcare System, Leavenworth, KS, USA
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Desai MU, Bellamy C, Guy K, Costa M, O'Connell MJ, Davidson L. "If You Want to Know About the Book, Ask the Author": Enhancing Community Engagement Through Participatory Research in Clinical Mental Health Settings. Behav Med 2019; 45:177-187. [PMID: 31343967 DOI: 10.1080/08964289.2019.1587589] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Participatory research, in which people with lived experience of the study phenomenon are involved as collaborators, has been conducted for decades; however, these innovations have struggled to take hold in mental health settings-until recently. The slow uptake of community partnered research in mental health has been unfortunate, especially because this field already suffers from poor community relations, pervasive community mistrust, and racial and ethnic disparities. But now, people with lived experience of severe mental illness-long considered to be "incapable" of functioning as co-researchers-are beginning to be included on research teams. However, training and opportunities for conducting such work are still lacking. This report describes a two-year initiative to improve the quality and quantity of participatory research being conducted in a department of psychiatry at a large medical school, which culminated in an innovative training program for both researchers and patients, developed in direct collaboration with stakeholders. In addition to detailing this program, we also discuss the deep legacy of mental health mistrust and our own efforts to address issues of social justice and health equity.
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Affiliation(s)
- Miraj U Desai
- a Yale Program for Recovery and Community Health, Yale School of Medicine.,b Yale South Asian Studies Council
| | - Chyrell Bellamy
- a Yale Program for Recovery and Community Health, Yale School of Medicine
| | - Kimberly Guy
- a Yale Program for Recovery and Community Health, Yale School of Medicine
| | - Mark Costa
- a Yale Program for Recovery and Community Health, Yale School of Medicine
| | - Maria J O'Connell
- a Yale Program for Recovery and Community Health, Yale School of Medicine
| | - Larry Davidson
- a Yale Program for Recovery and Community Health, Yale School of Medicine
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11
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Cheney AM, Koenig CJ, Miller CJ, Zamora K, Wright P, Stanley R, Fortney J, Burgess JF, Pyne JM. Veteran-centered barriers to VA mental healthcare services use. BMC Health Serv Res 2018; 18:591. [PMID: 30064427 PMCID: PMC6069794 DOI: 10.1186/s12913-018-3346-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 07/02/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Some veterans face multiple barriers to VA mental healthcare service use. However, there is limited understanding of how veterans' experiences and meaning systems shape their perceptions of barriers to VA mental health service use. In 2015, a participatory, mixed-methods project was initiated to elicit veteran-centered barriers to using mental healthcare services among a diverse sample of US rural and urban veterans. We sought to identify veteran-centric barriers to mental healthcare to increase initial engagement and continuation with VA mental healthcare services. METHODS Cultural Domain Analysis, incorporated in a mixed methods approach, generated a cognitive map of veterans' barriers to care. The method involved: 1) free lists of barriers categorized through participant pile sorting; 2) multi-dimensional scaling and cluster analysis for item clusters in spatial dimensions; and 3) participant review, explanation, and interpretation for dimensions of the cultural domain. Item relations were synthesized within and across domain dimensions to contextualize mental health help-seeking behavior. RESULTS Participants determined five dimensions of barriers to VA mental healthcare services: concern about what others think; financial, personal, and physical obstacles; confidence in the VA healthcare system; navigating VA benefits and healthcare services; and privacy, security, and abuse of services. CONCLUSIONS These findings demonstrate the value of participatory methods in eliciting meaningful cultural insight into barriers of mental health utilization informed by military veteran culture. They also reinforce the importance of collaborations between the VA and Department of Defense to address the role of military institutional norms and stigmatizing attitudes in veterans' mental health-seeking behaviors.
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Affiliation(s)
- Ann M. Cheney
- Department of Social Medicine, Population, and Public Health, Center for Healthy Communities, School of Medicine, University of California, Riverside, 900 University Avenue, Riverside, CA 92521 USA
| | - Christopher J. Koenig
- Department of Communication Studies, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132 USA
| | - Christopher J. Miller
- The Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130 USA
- Department of Psychiatry, Harvard Medical School, 2 West, Room 305, 401 Park Drive, Boston, MA 02215 USA
| | - Kara Zamora
- San Francisco Veterans Affairs Health Care System, 4150 Clement Street, San Francisco, CA 94121 USA
| | - Patricia Wright
- School of Nursing, University of Arkansas for Medical Sciences, 220 Campus Dr, Little Rock, AR 72205 USA
| | - Regina Stanley
- HSR&D Center of Innovation, Central Arkansas VA Health Care System, 2200 Ft. Roots Drive Bldg. 58 152/NLR, North Little Rock, AR 72114 USA
| | - John Fortney
- Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, 1660 S. Columbian Way S-152, Seattle, WA 98108 USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St, Seattle, WA 98195-6560 USA
| | - James F. Burgess
- The Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130 USA
| | - Jeffrey M. Pyne
- HSR&D Center of Innovation, Central Arkansas VA Health Care System, 2200 Ft. Roots Drive Bldg. 58 152/NLR, North Little Rock, AR 72114 USA
- Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR 72205 USA
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12
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Siegel S, Dors S, Brants L, Schuy K, Rau H. Understanding health care avoidance and initial help-seeking behavior in German veterans: a theory of planned behavior. Psychol Res Behav Manag 2018; 11:243-248. [PMID: 30022863 PMCID: PMC6042492 DOI: 10.2147/prbm.s158876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To gain initial insights into salient beliefs of former German soldiers (veterans) about the use of mental health services. Data source Narrative interviews with former German soldiers (veterans) were conducted in 2016. Data collection/extraction method Forty-three interviews were transcribed and analyzed thematically based on the theoretical framework of the theory of planned behavior. From within the behavorial, normative, and control beliefs, the salient beliefs were identified. Principal findings Four groups of salient beliefs were identified, described, and named: "Autarky", "Ineffectiveness", "Heteronomy", and "Incapacity". Conclusion Interventions and campaigns addressing these four specific groups of beliefs may lead to higher health service use rates. However, as a result of methodological limitations of the study design, the conclusion remains tentative.
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Affiliation(s)
- Stefan Siegel
- Department for Psychiatry and Psychotherapy, Charite Universitatsmedizin Berlin, Berlin, Germany,
| | - Simone Dors
- Department for Psychiatry and Psychotherapy, Charite Universitatsmedizin Berlin, Berlin, Germany,
| | - Loni Brants
- Department for Psychiatry and Psychotherapy, Charite Universitatsmedizin Berlin, Berlin, Germany,
| | - Katrin Schuy
- Department for Psychiatry and Psychotherapy, Charite Universitatsmedizin Berlin, Berlin, Germany,
| | - Heinrich Rau
- Center for PTSD, Military Hospital Berlin, Berlin, Germany
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13
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Reengagement in PTSD psychotherapy: A case-control study. Gen Hosp Psychiatry 2017; 48:20-24. [PMID: 28917390 DOI: 10.1016/j.genhosppsych.2017.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/18/2017] [Accepted: 06/20/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study sought to identify patient characteristics and care processes related to reengagement in VA psychotherapy. METHODS Using national VA data, a retrospective cohort was constructed (N=24,492) of veterans who received a new PTSD diagnosis in FY08/FY09 and attended only one to five PTSD psychotherapy sessions. A nested case-control study was conducted comparing veterans who reengaged in psychotherapy (n=9649) in a 1:5 ratio with those who did not reengage by the end of FY12. Conditional logistic regression models were run to examine differences in sociodemographic, mental health, and service utilization factors between cases and controls. RESULTS Among veterans in the study cohort, 39.4% reengaged in psychotherapy. In adjusted analyses, all measured types of health system encounters (primary care [OR=1.61], primary care mental health [OR=1.61], non-PTSD psychotherapy [OR=1.76], other non-PTSD mental health care [OR=1.43], other non-psychotherapy PTSD care [OR=3.31], emergency room [OR=1.14], and psychiatric hospitalization [OR=1.56]) were related to greater odds of reengagement in PTSD psychotherapy. CONCLUSIONS Veterans' receipt of a broad range of care services may play an important role in reengagement in PCT psychotherapy, suggesting providers across care settings should be knowledgeable in how to support a Veteran's return to psychotherapy for PTSD.
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14
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Rozanova J, Noulas P, Smart K, Roy A, Southwick SM, Davidson L, Harpaz-Rotem I. "I'm Coming Home, Tell the World I'm Coming Home". The Long Homecoming and Mental Health Treatment of Iraq and Afghanistan War Veterans. Psychiatr Q 2016; 87:427-43. [PMID: 26566926 DOI: 10.1007/s11126-015-9398-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study explored the journey of American armed forces personnel from their decision to join the service, through their service in an active military conflict and how these factors may be associated with potential resistance for mental healthcare. The data came from qualitative interviews with 46 OIF/OEF/OND active-duty military, reservists, and discharged veterans of the average age of 25 years, who presented for a new episode of mental health treatment to a large Veterans Affairs Hospital (VAH) in Northeastern United States in 2011-2012. Qualitative analysis of veterans' perceptions revealed several major themes describing how a mental health diagnosis would negatively impact both their sense of identity and pragmatic career-building goals: enlisting as a career-building avenue, 'noble superhero' identity, escaping from hardship, and mental illness as a career-killer. Findings suggest that factors making young veterans resist mental healthcare may be reduced by partnering VAH psychiatrists with career counselors, and by enhancing military leadership's awareness and understanding about how to support soldiers with emotional and mental health needs, with a goal to eliminating stigma.
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Affiliation(s)
- Julia Rozanova
- Department of Internal Medicine, Yale School of Medicine, 135 College Street Suite 351, New Haven, CT, 06510, USA.
| | - Paraskevi Noulas
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Kathleen Smart
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Alicia Roy
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA.,United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Steven M Southwick
- United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, 950 Campbell Avenue, West Haven, CT, 06516, USA.,Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven, CT, 06511, USA
| | - Larry Davidson
- United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, 950 Campbell Avenue, West Haven, CT, 06516, USA.,Yale Program for Recovery and Community Health, 319 Peck Street, Building 1, New Haven, CT, 06513, USA
| | - Ilan Harpaz-Rotem
- United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, 950 Campbell Avenue, West Haven, CT, 06516, USA.,Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven, CT, 06511, USA
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15
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Tran LD, Grant D, Aydin M. California Veterans Receive Inadequate Treatment to Address their Mental Health Needs. ACTA ACUST UNITED AC 2016; 3:126-140. [PMID: 27570802 DOI: 10.22381/ajmr3220166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Data from the 2011 to 2013 California Health Interview Survey (CHIS) were pooled to estimate prevalence of mental health need (serious psychological distress and impairment in one or more life domains), minimally adequate treatment (having four or more visits with a health professional in the past 12 months and use of prescription medication for mental health problems in the past 12 months), and suicide ideation among veterans living in California. Numbers and percentages were weighted to the CA population using a large sample size (N=6,952), and for comparison purposes, veterans and nonveterans were standardized to the age and gender distribution of veterans in the sample. Although differences in mental health need were similar between veterans and nonveterans after adjustment, over three-quarters of veterans did not receive minimally adequate treatment needed to address their mental health needs. Suicide ideation was significantly higher among veterans than nonveterans. Male veterans at all ages were more vulnerable to thinking about suicide compared to their nonveteran counterparts.
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Affiliation(s)
- Linda Diem Tran
- UCLA Center for Health Policy Research, 10960 Wilshire Blvd, Suite 1550, Los Angeles, CA 90024, (310) 794-0909
| | - David Grant
- UCLA Center for Health Policy Research, 10960 Wilshire Blvd, Suite 1550, Los Angeles, CA 90024, (310) 794-0909,
| | - May Aydin
- National Science Foundation, National Center for Science and Engineering Statistics, 4201 Wilson Blvd, Suite 965, Arlington, VA 22230, (703) 292-4977,
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