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Lesnewich LM, Hyde JK, McFarlin ML, Bolton RE, Bayley PJ, Chandler HK, Helmer DA, Phillips LA, Reinhard MJ, Santos SL, Stewart RS, McAndrew LM. 'She thought the same way I that I thought:' a qualitative study of patient-provider concordance among Gulf War Veterans with Gulf War Illness. Psychol Health 2023:1-19. [PMID: 37654203 DOI: 10.1080/08870446.2023.2248481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 07/15/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023]
Abstract
Objective: Medically unexplained symptoms (MUS), such as chronic fatigue syndrome, irritable bowel syndrome, and Gulf War Illness (GWI), are difficult to treat. Concordance-shared understanding between patient and provider about illness causes, course, and treatment-is an essential component of high-quality care for people with MUS. This qualitative paper focuses on the experiences of United States military Veterans living with GWI who have endured unique healthcare challenges. Methods & Measures: Qualitative interviews were conducted with 31 Veterans with GWI to explore factors that contribute to and detract from concordance with their Veteran Affairs (VA) healthcare providers. In addition to being seen by VA primary care, over half of participants also sought care at a War Related Illness and Injury Study Center, which specializes in post-deployment health. Deductive and inductive codes were used to organize the data, and themes were identified through iterative review of coded data. Results: Major themes associated with patient-provider concordance included validation of illness experiences, perceived provider expertise in GWI/MUS, and trust in providers. Invalidation, low provider expertise, and distrust detracted from concordance. Conclusion: These findings suggest providers can foster concordance with MUS patients by legitimizing patients' experiences, communicating knowledge about MUS, and establishing trust.
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Affiliation(s)
- Laura M Lesnewich
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
| | - Justeen K Hyde
- Department of Medicine, Section General Internal Medicine, Boston University, Boston, MA, USA
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Bedford Healthcare System, Bedford, MA, USA
| | | | - Rendelle E Bolton
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Bedford Healthcare System, Bedford, MA, USA
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Peter J Bayley
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Helena K Chandler
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness & Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - L Alison Phillips
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
- Department of Psychology, Iowa State University, IA, USA
| | - Matthew J Reinhard
- War Related Illness and Injury Study Center (WRIISC), Washington DC Veterans Affairs Medical Center, Washington, DC, USA high-quality
| | - Susan L Santos
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
| | - Rachel S Stewart
- War Related Illness and Injury Study Center (WRIISC), Washington DC Veterans Affairs Medical Center, Washington, DC, USA high-quality
| | - Lisa M McAndrew
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
- University at Albany, State University of New York (SUNY), Albany, NY, USA
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Mazo GE, Neznanov NG, Rukavishnikov GV. [Psychosomatic medicine: old resources and new technologies]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:14-19. [PMID: 37141124 DOI: 10.17116/jnevro202312304214] [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: 05/05/2023]
Abstract
Two primary research directions closely coexist in psychosomatic medicine. One is the most traditional, associated with an assessment of the psychological aspects of the connection, interconnection and mutual impact of mental and somatic pathology. The second, based on the rapid development of biological medicine in the last decade, studies causal associations and looks for shared mechanisms. In our review, we consider the previous main stages in the psychosomatic medicine and the prospective approaches to its further study. Evaluation of the etiopathogenesis of the entire set of mental and somatic symptoms in their interaction and dynamics can help identify individual subpopulations of patients with shared pathobiochemical and neurophysiological disorders. The recent interpretation of the biopsychosocial model is mainly related to the etiology and pathogenesis of mental disorders and also provides a good perspective for research on these issues. Today, there are sufficient opportunities to study all three domains of the model. Productive study of the biological, personal and social domains is also possible on the base of evidence-based design using modern research technologies.
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Affiliation(s)
- G E Mazo
- Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russia
| | - N G Neznanov
- Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russia
- Pavlov First Saint-Petersburg State Medical University, St. Petersburg, Russia
| | - G V Rukavishnikov
- Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russia
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Blakey SM, Halverson TF, Evans MK, Patel TA, Hair LP, Meyer EC, DeBeer BB, Beckham JC, Pugh MJ, Calhoun PS, Kimbrel NA. Experiential avoidance is associated with medical and mental health diagnoses in a national sample of deployed Gulf War veterans. J Psychiatr Res 2021; 142:17-24. [PMID: 34314990 PMCID: PMC8429252 DOI: 10.1016/j.jpsychires.2021.07.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/17/2021] [Accepted: 07/21/2021] [Indexed: 12/14/2022]
Abstract
A substantial minority of deployed Gulf War veterans developed posttraumatic stress disorder (PTSD), depression, and several chronic illnesses. Although military combat and exposure to certain nuclear, biological, and chemical agents (NBCs) increase risk for post-deployment health problems, they do not fully explain many Gulf War veteran health diagnoses and are not viable treatment targets. Experiential avoidance (EA; one's unwillingness to remain in contact with unpleasant internal experiences) is a modifiable psychosocial risk factor associated with PTSD and depression in veterans as well as pain and gastrointestinal diseases in the general population. In this study, we recruited a national sample of deployed Gulf War veterans (N = 454) to test the hypothesis that greater EA would be significantly associated with higher lifetime odds of PTSD, depression, "Gulf War Illness" (GWI/CMI), and other chronic illnesses common in this veteran cohort. Participants completed a self-report battery assessing demographic, military-related, and health-related information. Multivariate analyses showed that after adjusting for age, sex, race, combat exposure, and NBC exposure, worse EA was associated with higher lifetime odds of PTSD, depression GWI/CMI, gastrointestinal problems, irritable bowel syndrome, arthritis, fibromyalgia, and chronic fatigue syndrome (ORs ranged 1.25 to 2.89; effect sizes ranged small to large), but not asthma or chronic obstructive pulmonary disease. Our findings suggest medical and mental health providers alike should assess for EA and potentially target EA as part of a comprehensive, biopsychosocial approach to improving Gulf War veterans' health and wellbeing. Study limitations and future research directions are also discussed.
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Affiliation(s)
- Shannon M Blakey
- Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, 3022 Croasdaile Dr., Durham, NC, 27705, USA.
| | - Tate F Halverson
- Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.
| | - Mariah K Evans
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, DUMC 3625, Durham, NC, 27710, USA.
| | - Tapan A Patel
- Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.
| | - Lauren P Hair
- Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA; Duke University School of Medicine Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, DUMC 3625, Durham, NC, 27710, USA.
| | - Eric C Meyer
- University of Pittsburgh Department of Rehabilitation Science and Technology, 4028 Forbes Tower, Pittsburgh, PA, 15260, USA.
| | - Bryann B DeBeer
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center, 1700 N Wheeling St, G-3-116M, Aurora, CO, 80045, USA; Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, 12631 E 17th Ave, Aurora, CO, 80045, USA.
| | - Jean C Beckham
- Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, 3022 Croasdaile Dr., Durham, NC, 27705, USA; Duke University School of Medicine Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, DUMC 3625, Durham, NC, 27710, USA.
| | - Mary J Pugh
- VA Salt Lake City Healthcare System, 500 Foothill Dr, Salt Lake City, UT, 84148, USA; University of Utah School of Medicine Department of Medicine, 30 N. 1900 E, Salt Lake City, UT, 84132, USA.
| | - Patrick S Calhoun
- Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, 3022 Croasdaile Dr., Durham, NC, 27705, USA; Duke University School of Medicine Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, DUMC 3625, Durham, NC, 27710, USA.
| | - Nathan A Kimbrel
- Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, 3022 Croasdaile Dr., Durham, NC, 27705, USA; Duke University School of Medicine Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, DUMC 3625, Durham, NC, 27710, USA.
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