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Manietta L, McLaughlin S, MacArthur M, Landmann J, Kumbalatara C, Love M, McDaniel J. Exploring Veteran Mental Health Disparities: A Comparative Analysis of Rural and Urban Communities in the Midwest of the United States. J Community Health 2024:10.1007/s10900-024-01408-8. [PMID: 39367238 DOI: 10.1007/s10900-024-01408-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2024] [Indexed: 10/06/2024]
Abstract
Veterans face unique mental health challenges influenced by their service experiences and post-military transitions into civilian life. Geographic location also plays an integral role in impacting veterans' outcomes and access to proper care. The purpose of this case study is to examine disparities between rural and urban veterans in the Midwest using data collected from the 2022 Behavioral Risk Factor Surveillance System (BRFSS). Self-reported bad mental health days among veterans in rural and urban regions across twelve Midwestern states were analyzed through direct rate estimation and small area estimation techniques utilizing RStudio software. Higher rates of poor mental health days were ultimately observed among urban veterans in most states through both analyses. The results of the direct rate analysis revealed 13.5% of veterans reporting 14 + poor mental health days per month versus 9.5% in rural areas. Likewise, the results of the small area analysis demonstrated 12.2% of veterans reporting 14 + days of poor mental health days per month in urban areas versus 9.8% in rural areas. This highlights the significance of environmental stressors and social determinants of health in differentially impacting mental health outcomes. Thus, tailored interventions utilizing interdisciplinary teams are needed to meet the unique barriers for veterans in different geographic contexts. Despite the cross-sectional nature of the study and reliance on self-reported data, this case study provides valuable insights for mental health disparities among Midwest veterans. Creating a more equitable and accessible mental health landscape for veterans will require targeted and collaborative approaches.
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Affiliation(s)
- Luke Manietta
- Southern Illinois University School of Medicine, Springfield, IL, USA.
| | - Sarah McLaughlin
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Matthew MacArthur
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Jack Landmann
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Chesmi Kumbalatara
- College of Health and Human Sciences, Southern Illinois University, Carbondale, IL, USA
| | - Madeleine Love
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Justin McDaniel
- College of Health and Human Sciences, Southern Illinois University, Carbondale, IL, USA
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Robinson TD. Black Male Veterans' Mental Health: Exploring Their Lived Experiences. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:813-824. [PMID: 38769819 DOI: 10.1080/19371918.2024.2357084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
This study delves into the mental health experiences of Black male veterans, bridging their military service with the historical context of Black men's mental health. Amid limited literature on this demographic, qualitative methods, including focus groups, are utilized to gather nuanced insights. Themes such as mental health awareness gaps, diverse therapy encounters, familial and social stigmatization, and lacking support networks emerge. The study underscores the urgent need for heightened attention to this overlooked population within social work research, education, and practice. It advocates for an inclusive, culturally sensitive approach in social work, offering implications for practitioners, educators, and curriculum development tailored to the unique needs of Black male veterans. Despite constraints, this research provides vital perspectives, urging further inquiry and support initiatives to better comprehend and aid the mental well-being of Black male veterans.
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Affiliation(s)
- Tay D Robinson
- U.S. Department of Veteran Affairs, Indianapolis Vet Center, Indianapolis, Indiana, USA
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Good MK, Davila H, Ball D, O'Neill S, Healy H, Mengeling MA. Health and Health Care Use of American Indian/Alaska Native Women Veterans: A Scoping Review. Womens Health Issues 2024; 34:455-464. [PMID: 39191605 DOI: 10.1016/j.whi.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 06/27/2024] [Accepted: 07/22/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND American Indian/Alaska Native (AI/AN) women serve in the U.S. military, use Veterans Health Administration (VA) health care, and reside in rural areas at the highest rates compared with other women veterans. However, little is known about their unique health care needs, access, and health care use. OBJECTIVE We assessed the existing literature on the health and health care use of U.S. AI/AN women veterans. METHODS Online databases were searched to identify studies. Study characteristics extracted included health care topic, study design, overall sample size and number of AI/AN women veterans, and funding source. We screened 1,508 publications for inclusion; 28 publications were ultimately retained. RESULTS Health care access and use were the most common health care research topics (39%), followed by mental health (36%) and physical health (25%). Few studies considered the impact of rurality. Most studies found significant differences between AI/AN women veterans and other women veterans or AI/AN men veterans. Publication dates ranged from 1998 to 2023, with 71% published after 2010. The majority of studies (75%) were secondary analyses of extant health care data. More than three-quarters of studies (82%) were funded federally (e.g., VA). Many studies were based on VA administrative data, resulting in a gap in knowledge regarding AI/AN women veterans who are not eligible for, or choose not to use, VA health care. CONCLUSION Research to inform the health and health care of AI/AN women veterans is limited, especially in terms of known AI/AN and women veterans' prevalent health concerns (e.g., diabetes, hypertension), women's health and reproduction, and how AI/AN women veterans access, use, and confront barriers to health care. Moreover, there is scarce research specific to cultural, tribal, and regional factors that likely affect access and use of particular health care systems or that can affect perspectives on illness that impact long-term treatment adherence and patient outcomes.
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Affiliation(s)
- Mary K Good
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa; Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
| | - Heather Davila
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa; Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Daniel Ball
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa; Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Skye O'Neill
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa; Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Heather Healy
- Hardin Library for the Health Sciences, University of Iowa, Iowa City, Iowa
| | - Michelle A Mengeling
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa; Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Sharifian N, Kolaja CA, LeardMann CA, Castañeda SF, Carey FR, Seay JS, Carlton KN, Rull RP, Cohort Study Team FTM. Racial, Ethnic, and Sex Disparities in Mental Health Among US Service Members and Veterans: Findings From the Millennium Cohort Study. Am J Epidemiol 2024; 193:500-515. [PMID: 37968361 DOI: 10.1093/aje/kwad221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 11/02/2023] [Accepted: 11/13/2023] [Indexed: 11/17/2023] Open
Abstract
Although disparities in mental health occur within racially, ethnically, and sex-diverse civilian populations, it is unclear whether these disparities persist within US military populations. Using cross-sectional data from the Millennium Cohort Study (2014-2016; n = 103,184; 70.3% male; 75.7% non-Hispanic White), a series of logistic regression analyses were conducted to examine whether racial, ethnic, and/or sex disparities were found in mental health outcomes (posttraumatic stress disorder (PTSD), depression, anxiety, and problematic anger), hierarchically adjusting for sociodemographic, military, health-related, and social support factors. Compared with non-Hispanic White individuals, those who identified as American Indian/Alaska Native, non-Hispanic Black, Hispanic/Latino, or multiracial showed greater risk of PTSD, depression, anxiety, and problematic anger in unadjusted models. Racial and ethnic disparities in mental health were partially explained by health-related and social support factors. Women showed greater risk of depression and anxiety and lower risk of PTSD than men. Evidence of intersectionality emerged for problematic anger among Hispanic/Latino and Asian or Pacific Islander women. Overall, racial, ethnic, and sex disparities in mental health persisted among service members and veterans. Future research and interventions are recommended to reduce these disparities and improve the health and well-being of diverse service members and veterans.
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Gnall KE, Sacco SJ, Park CL, Mazure CM, Hoff RA. Life meaning and mental health in post-9/11 veterans: the mediating role of perceived stress. ANXIETY, STRESS, AND COPING 2023; 36:743-756. [PMID: 36542555 DOI: 10.1080/10615806.2022.2154341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 11/23/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Post-9/11 veterans frequently experience diminished mental health following military service. Life meaning is related to better mental health in veterans, yet its mechanism of action is unknown. A meaning-making model suggests that life meaning can reduce perceived stress, thus enhancing mental health. The present study tested this meaning-making model by predicting multiple dimensions of mental health (i.e., symptoms of posttraumatic stress disorder, anxiety, insomnia, and depression, and mental health quality of life) from life meaning as mediated by perceived stress. DESIGN AND METHODS The present study was a secondary analysis of a 12-month observational study of 367 post-9/11 veterans. Participants completed demographic and health surveys at baseline, 6-month, and 12-month follow-ups. A multivariate mediation model was created predicting changes in dimensions of mental health from 6 months to 12 months. RESULTS Higher life meaning at baseline predicted changes in all dimensions of mental health between 6 and 12 months, an effect mediated by changes in perceived stress between baseline and 6 months. CONCLUSIONS Across dimensions of mental health, the meaning-making model was supported. Understanding post-9/11 veteran mental health from this theoretical perspective may help better tailor healthcare efforts and enhance veteran health overall.
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Affiliation(s)
- Katherine E Gnall
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Shane J Sacco
- Department of Statistics, University of Connecticut, Storrs, CT, USA
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Carolyn M Mazure
- Department of Psychiatry, Women's Health Research at YaleYale School of Medicine, New Haven, CT, USA
| | - Rani A Hoff
- Northeast Program Evaluation Center (NEPEC), VA Connecticut Healthcare System, West Haven, CT, USA
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McKenzie A, Burdett H, Croak B, Rafferty L, Greenberg N, Stevelink SAM. Adjustment disorder in the Armed Forces: a systematic review. J Ment Health 2023; 32:962-984. [PMID: 36330797 DOI: 10.1080/09638237.2022.2140792] [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] [Received: 02/10/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND In the UK military, adjustment disorder (AjD) is reported as one of the most diagnosed mental disorders, alongside depression, in personnel presenting to mental health services. Despite this, little is understood about what may predict AjD, common treatment or outcomes for this population. AIM The systematic review aimed to summarise existing research for AjD in Armed Forces (AF) populations, including prevalence and risk factors, and to outline clinical and occupational outcomes. METHOD A literature search was conducted in December 2020 to identify research that investigated AjD within an AF population (serving or veteran) following the PRISMA guidelines. RESULTS Eighty-three studies were included in the review. The AjD prevalence estimates in AF populations with a mental disorder was considerably higher for serving AF personnel (34.9%) compared to veterans (12.8%). Childhood adversities were identified as a risk factor for AjD. AjD was found to increase the risk of suicidal ideation, with one study reporting a risk ratio of 4.70 (95% Confidence Interval: 3.50-6.20). Talking therapies were the most common treatment for AjD, however none reported on treatment effectiveness. CONCLUSION This review found that AjD was commonly reported across international AF. Despite heterogeneity in the results, the review identifies several literature gaps.
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Affiliation(s)
- Amber McKenzie
- King's Centre for Military Health Research, King's College London, London, United Kingdom
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Howard Burdett
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Bethany Croak
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Laura Rafferty
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Neil Greenberg
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Sharon A M Stevelink
- King's Centre for Military Health Research, King's College London, London, United Kingdom
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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Kusters IS, Amspoker AB, Frosio K, Day SC, Day G, Ecker A, Hogan J, Lindsay JA, Shore J. Rural-Urban Disparities in Video Telehealth Use During Rapid Mental Health Care Virtualization Among American Indian/Alaska Native Veterans. JAMA Psychiatry 2023; 80:1055-1060. [PMID: 37494050 PMCID: PMC10372753 DOI: 10.1001/jamapsychiatry.2023.2285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/15/2023] [Indexed: 07/27/2023]
Abstract
Importance American Indian/Alaska Native veterans experience a high risk for health inequities, including mental health (MH) care access. Rapid virtualization of MH care in response to the COVID-19 pandemic facilitated care continuity across the Veterans Health Administration (VHA), but the association between virtualization of care and health inequities among American Indian/Alaska Native veterans is unknown. Objective To examine differences in video telehealth (VTH) use for MH care between American Indian/Alaska Native and non-American Indian/Alaska Native veterans by rurality and urbanicity. Design, Setting, and Participants In this cohort study, VHA administrative data on VTH use among a veteran cohort that received MH care from October 1, 2019, to February 29, 2020 (prepandemic), and April 1 to December 31, 2020 (early pandemic), were examined. Exposures At least 1 outpatient MH encounter during the study period. Main Outcomes and Measures The main outcome was use of VTH among all study groups (ie, American Indian/Alaska Native, non-American Indian/Alaska Native, rural, or urban) before and during the early pandemic. American Indian/Alaska Native veteran status and rurality were examined as factors associated with VTH utilization through mixed models. Results Of 1 754 311 veterans (mean [SD] age, 54.89 [16.23] years; 85.21% male), 0.48% were rural American Indian/Alaska Native; 29.04%, rural non-American Indian/Alaska Native; 0.77%, urban American Indian/Alaska Native; and 69.71%, urban non-American Indian/Alaska Native. Before the pandemic, a lower percentage of urban (b = -0.91; SE, 0.02; 95% CI, -0.95 to -0.87; P < .001) and non-American Indian/Alaska Native (b = -0.29; SE, 0.09; 95% CI, -0.47 to -0.11; P < .001) veterans used VTH. During the early pandemic period, a greater percentage of urban (b = 1.37; SE, 0.05; 95% CI, 1.27-1.47; P < .001) and non-American Indian/Alaska Native (b = 0.55; SE, 0.19; 95% CI, 0.18-0.92; P = .003) veterans used VTH. There was a significant interaction between rurality and American Indian/Alaska Native status during the early pandemic (b = -1.49; SE, 0.39; 95% CI, -2.25 to -0.73; P < .001). Urban veterans used VTH more than rural veterans, especially American Indian/Alaska Native veterans (non-American Indian/Alaska Native: rurality b = 1.35 [SE, 0.05; 95% CI, 1.25-1.45; P < .001]; American Indian/Alaska Native: rurality b = 2.91 [SE, 0.38; 95% CI, 2.17-3.65; P < .001]). The mean (SE) increase in VTH was 20.34 (0.38) and 15.35 (0.49) percentage points for American Indian/Alaska Native urban and rural veterans, respectively (difference in differences [DID], 4.99 percentage points; SE, 0.62; 95% CI, 3.77-6.21; t = -7.999; df, 11 000; P < .001), and 12.97 (0.24) and 11.31 (0.44) percentage points for non-American Indian/Alaska Native urban and rural veterans, respectively (DID, 1.66; SE, 0.50; 95% CI, 0.68-2.64; t = -3.32; df, 15 000; P < .001). Conclusions and Relevance In this cohort study, although rapid virtualization of MH care was associated with greater VTH use in all veteran groups studied, a significant difference in VTH use was seen between rural and urban populations, especially among American Indian/Alaska Native veterans. The findings suggest that American Indian/Alaska Native veterans in rural areas may be at risk for VTH access disparities.
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Affiliation(s)
- Isabelle S. Kusters
- Department of Clinical, Health, and Applied Sciences, University of Houston–Clear Lake, Houston, Texas
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Amber B. Amspoker
- Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, Texas
| | - Kristen Frosio
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, Texas
- South Central Mental Illness Research, Education and Clinical Center, US Department of Veterans Affairs
| | - Stephanie C. Day
- Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, Texas
- South Central Mental Illness Research, Education and Clinical Center, US Department of Veterans Affairs
| | - Giselle Day
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, Texas
- South Central Mental Illness Research, Education and Clinical Center, US Department of Veterans Affairs
| | - Anthony Ecker
- Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, Texas
- South Central Mental Illness Research, Education and Clinical Center, US Department of Veterans Affairs
| | - Julianna Hogan
- Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, Texas
- South Central Mental Illness Research, Education and Clinical Center, US Department of Veterans Affairs
| | - Jan A. Lindsay
- Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, Texas
- South Central Mental Illness Research, Education and Clinical Center, US Department of Veterans Affairs
- Baker Institute for Public Policy, Rice University, Houston, Texas
| | - Jay Shore
- Veterans Rural Health Resource Center, Veterans Health Administration Office of Rural Health, Salt Lake City, Utah
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, Aurora
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Nillni YI, Horenstein A, McClendon J, Duke CC, Sawdy M, Galovski TE. The impact of perceived everyday discrimination and income on racial and ethnic disparities in PTSD, depression, and anxiety among veterans. PLoS One 2023; 18:e0291965. [PMID: 37751447 PMCID: PMC10521990 DOI: 10.1371/journal.pone.0291965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 09/05/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVES Black and Hispanic/Latinx individuals experience a greater burden of mental health symptoms as compared to White individuals in the general population. Examination of ethnoracial disparities and mechanisms explaining these disparities among veterans is still in its nascence. The current study examined perceived everyday discrimination and income as parallel mediators of the association between race/ethnicity and PTSD, depression, and general anxiety symptoms in a sample of White, Black, and Hispanic/Latinx veterans stratified by gender. METHODS A random sample of 3,060 veterans living across the U.S. (oversampled for veterans living in high crime communities) completed a mail-based survey. Veterans completed self-report measures of perceived discrimination via the Everyday Discrimination Scale, PTSD symptoms via the Posttraumatic Stress Disorder Checklist-5, depressive symptoms via the Patient Health Questionnaire, and anxiety symptoms via the Generalized Anxiety Disorder Questionnaire. RESULTS Models comparing Black vs. White veterans found that the significant effect of race on PTSD, depression, and anxiety symptoms was mediated by both perceived discrimination and income for both male and female veterans. Results were less consistent in models comparing Hispanic/Latinx vs. White veterans. Income, but not perceived discrimination, mediated the relationship between ethnicity/race and depression and anxiety symptoms, but only among women. CONCLUSIONS Results suggest that discrimination and socioeconomic status are important mechanisms through which marginalized social status negatively impacts mental health.
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Affiliation(s)
- Yael I. Nillni
- National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System, Boston, MA, United States of America
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
| | | | - Juliette McClendon
- National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System, Boston, MA, United States of America
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
| | | | - Molly Sawdy
- Suffolk University, Boston, MA, United States of America
| | - Tara E. Galovski
- National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System, Boston, MA, United States of America
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
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Lawson SC, Arif M, Hoopsick RA, Homish DL, Homish GG. Exploring Racial/Ethnic Disparities in Substance Dependence and Serious Psychological Distress among US Veterans. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01753-9. [PMID: 37603224 PMCID: PMC10879463 DOI: 10.1007/s40615-023-01753-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 08/03/2023] [Accepted: 08/06/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVES There are substantial racial/ethnic disparities in substance use and mental health among civilian populations, but few studies have examined these disparities in veterans using a nationally representative sample. Thus, we examined differences in substance dependence and serious psychological distress (SPD) by race/ethnicity among a national sample of US veterans. METHODS We pooled cross-sectional data from the 2015-2019 waves of the National Survey on Drug Use and Health (N = 7,653 veterans aged 18-64 years). Regression models were utilized to examine racial/ethnic differences in DSM-IV substance dependence and SPD with a Benjamini-Hochberg correction applied. RESULTS Compared to non-Hispanic White veterans: American Indian/Alaska Native veterans had significantly higher odds of past-year alcohol dependence (AOR = 2.55, 95% CI: 1.28, 5.08); Asian American veterans had significantly lower odds of past-year alcohol dependence (AOR = 0.12, 95% CI: 0.02, 0.62); non-Hispanic Black (AOR = 0.60, 95% CI: 0.48, 0.77), Hispanic (AOR = 0.47, 95% CI: 0.34, 0.65), and veterans of more than one race (AOR = 0.55, 95% CI: 0.36, 0.83) had significantly lower odds of past-month nicotine dependence; Asian American veterans had significantly lower odds of past-year illicit drug dependence (AOR = 0.05, 95% CI: 0.01, 0.35); and non-Hispanic Black veterans had significantly lower odds of past-year SPD (AOR = 0.69, 95% CI: 0.55, 0.85) after correction for multiple comparisons. CONCLUSION Overall, racial/ethnic disparities in substance dependence and SPD among veterans are not as stark as in civilian populations, but some disparities remain.
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Affiliation(s)
- Schuyler C Lawson
- Graduate Research Assistant, Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA.
| | - Mehreen Arif
- Graduate Research Assistant, Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Rachel A Hoopsick
- Assistant Professor, Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana-Champaign, Champaign, IL, USA
| | - D Lynn Homish
- Project Director, Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Gregory G Homish
- Professor and Chair, Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
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Beymer MR, Apostolou A, Smith CM, Paschane DM, Gomez SAQ, James TD, Bell AM, Santo T, Quartana PJ. Mental Health Outcomes Among American Indian and Alaska Native U.S. Army Soldiers: A Serial Cross-Sectional Analysis. Mil Med 2023; 188:e2292-e2299. [PMID: 36848142 DOI: 10.1093/milmed/usad049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/17/2022] [Accepted: 02/09/2023] [Indexed: 03/01/2023] Open
Abstract
INTRODUCTION American Indian and Alaska Native (AI/AN) individuals in the USA experience higher rates of mental illness and preventable death than the general population. Published research demonstrates that AI/AN veterans experience similar disparities to other minorities compared to non-minority veterans; few studies, however, have assessed mental health outcomes in AI/AN active duty military members. The objective of this study was to determine differences in depression, anxiety, hazardous alcohol consumption, and suicidal ideation among AI/AN soldiers compared to soldiers of other races during the Coronavirus Disease 2019 (COVID-19) pandemic. MATERIALS AND METHODS We conducted repeated cross-sectional electronic surveys to assess the mental health of active duty and activated reserve U.S. Army soldiers within three commands in the Northwestern Continental United States , Republic of Korea, and Germany during May-June 2020 (T1) and December 2020-January 2021 (T2). The primary exposure of interest in the present analysis was race and ethnicity, and the primary outcomes were probable depression with functional impairment (subsequently "depression"), probable anxiety with functional impairment (subsequently "anxiety"), hazardous alcohol use, and suicidal ideation. Multivariable logistic regression models were used to determine the association between demographics and COVID-19 concerns on mental health outcomes for each time point. RESULTS A total of 21,293 participants responded to the survey at T1 (participation rate = 28.0%), and 10,861 participants responded to the survey at T2 (participation rate = 14.7%). In the multivariable model, AI/AN participants had 1.36 higher adjusted odds of suicidal ideation (95% CI: 1.02-1.82) at T1 and 1.50 greater adjusted odds of suicidal ideation at T2 (95% CI: 1.00-2.24), when compared to non-Hispanic White participants. During T1, there was no significant difference detected between AI/AN and non-Hispanic White participants for anxiety (adjusted odds ratio: 1.21; 95% CI: 0.91-1.60) (Table IV). However, AI/AN participants had 1.82 greater adjusted odds of anxiety when compared to non-Hispanic White participants at T2 (adjusted odds ratio: 1.82; 95% CI: 1.29-2.57). There were no significant differences detected between AI/AN participants and non-Hispanic White participants in multivariable models for either depression or hazardous alcohol use at both time points. CONCLUSIONS Although we hypothesized that all adverse mental health outcomes would be higher for AI/AN service members at both time points, there were no significant differences at each of the time points analyzed for most of the outcomes analyzed. However, differences in suicidal ideation were found at both time points. Analyses and proposed interventions should account for diversity and heterogeneity of AI/AN populations.
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Affiliation(s)
- Matthew R Beymer
- U.S. Army Public Health Center, Aberdeen Proving Ground, MD 21010, USA
| | | | - Colin M Smith
- U.S. Indian Health Service, Rockville, MD 20852, USA
- Duke University School of Medicine, Durham, NC 27710, USA
| | | | | | | | - Amy Millikan Bell
- U.S. Army Public Health Center, Aberdeen Proving Ground, MD 21010, USA
| | - Theresa Santo
- U.S. Army Public Health Center, Aberdeen Proving Ground, MD 21010, USA
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11
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Salem K, Randles R, Sapre B, Finnegan A. Experiences of ethnic minority personnel in the armed forces: A systematic review. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2022. [DOI: 10.3138/jmvfh-2022-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
LAY SUMMARY An armed forces consisting of personnel from diverse and ethnic minority backgrounds offers considerable benefits, not just in terms of reflecting society but for improving the effectiveness of military operations. Many ethnic minority individuals serve for long periods, during which they experience personal growth and benefit from military service. However, little research has explored the impact these experiences might have on ethnic minority communities within the Armed Forces, who report higher levels of being bullying, harassment, and discrimination. Given the lack of empirical research into armed forces ethnic minority personnel, this systematic review aimed to provide insight into and understanding of existing international research, relevant reports, and policy. The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and included articles written in English since 2010. The review identified three themes — cultural identity, health status and health utilization, and trauma and discrimination — and indicated that ethnic minority personnel experience greater disadvantage than their native counterparts, both during and after service.
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Affiliation(s)
- Kate Salem
- Westminster Centre for Research in Veterans, University of Chester, Chester, United Kingdom
| | - Rebecca Randles
- Westminster Centre for Research in Veterans, University of Chester, Chester, United Kingdom
| | - Bhairavi Sapre
- Perinatal Mental Health Service, Cheshire and Wirral NHS Foundation Trust, Cheshire, United Kingdom
| | - Alan Finnegan
- Westminster Centre for Research in Veterans, University of Chester, Chester, United Kingdom
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12
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Manson SM, Buchwald DS. Aging and Health of American Indians and Alaska Natives: Contributions from the Native Investigator Development Program. J Aging Health 2021; 33:3S-9S. [PMID: 34167345 PMCID: PMC8627114 DOI: 10.1177/08982643211014399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: To describe recent advances in our knowledge regarding the health and illness of older American Indians and Alaska Natives, and factors underlying why this special population lives 5.5 years less than the 78.5 years of U.S. all races. Methods: The articles in this supplemental issue, authored by participants in a National Institutes of Health-sponsored early research career development program, examine high priority health concerns that contribute to the increased risk of Native elders for chronic disease and resulting impairment that compromise their life expectancy. Results: Important insights into the roles that racial discrimination, food security, hypertension, alcohol consumption, memory problems, and military service play in the health and well-being of older American Indians and Alaska Natives. Discussion: Early career faculty development programs focused on increasing the diversity of the scientific workforce not only promote greater racial and ethnic minority representation in the field of aging, but can simultaneously add to the knowledge base regarding the health status and function of often ignored, vulnerable older members of communities that suffer significant health disparities.
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Affiliation(s)
- Spero M. Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Dedra S. Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
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13
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Huyser KR, Locklear S, Sheehan C, Moore BL, Butler JS. Consistent Honor, Persistent Disadvantage: American Indian and Alaska Native Veteran Health in the National Survey of Veterans. J Aging Health 2021; 33:68S-81S. [PMID: 34167347 PMCID: PMC8236669 DOI: 10.1177/08982643211014034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: To examine self-rated health and activities of daily living (ADLs) limitations among American Indian and Alaska Native (AI/AN) veterans relative to white veterans. Methods: We use the 2010 National Survey of Veterans and limit the sample to veterans who identify as AI/AN or non-Hispanic white. We calculated descriptive statistics, confidence intervals, and used logistic regression. Results: AI/AN veterans are younger, have lower levels of income, and have higher levels of exposure to combat and environmental hazards compared to white veterans. We found that AI/AN veterans are significantly more likely to report fair/poor health controlling for socioeconomic status and experience an ADL controlling for age, health behaviors, socioeconomic status, and military factors. Discussion: The results indicate that AI/AN veterans are a disadvantaged population in terms of their health and disability compared to white veterans. AI/AN veterans may require additional support from family members and/or Veteran Affairs to address ADLs.
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Affiliation(s)
- Kimberly R Huyser
- Department of Sociology, 8166University of British Columbia, Vancouver, BC, Canada
| | - Sofia Locklear
- Department of Sociology, 170285University of New Mexico, Albuquerque, NM, USA
| | - Connor Sheehan
- School of Social and Family Dynamics, 7864Arizona State University, Tempe, AZ, USA
| | - Brenda L Moore
- Department of Sociology, 12292State University of New York at Buffalo, Buffalo, NY, USA
| | - John S Butler
- Department of Sociology and Management, 12330University of Texas at Austin, Austin, TX, USA
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14
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Ying D, Schmajuk G, Trupin L, Blanc PD. Inorganic Dust Exposure During Military Service as a Predictor of Rheumatoid Arthritis and Other Autoimmune Conditions. ACR Open Rheumatol 2021; 3:466-474. [PMID: 34085777 PMCID: PMC8281049 DOI: 10.1002/acr2.11273] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Rheumatoid arthritis (RA) and other autoimmune (AI) conditions are associated with inorganic dust exposure. Many military activities are likely to entail inorganic dust exposures. We wished to identify associations between prior military dust exposure and RA and other AI conditions. METHODS We studied persons from a roster of Army, Navy, Air Force, or Marine Corps personnel who had served in Operation Enduring Freedom and Operations Iraqi Freedom and New Dawn. We linked military occupational codes to a job exposure matrix assigning dust exposure likelihood. We used the Veterans Affairs Health Care System (VAHCS) electronic health care records to identify cases of RA, systemic lupus erythematosus (SLE), systemic sclerosis (SSc), vasculitis, and inflammatory myositis. Generalized estimating equations modeled risk of RA and other AI conditions associated with dust exposure, taking into account military service branch, age at first VAHCS encounter, sex, race/ethnicity, smoking status, and years of military service. RESULTS Of 438 086 veterans (68% ever-smokers), 44% were classified with likely or somewhat likely dust exposure. Cases included 1139 cases with RA, 467 cases with SLE, and 180 cases with other AI diseases (SSc, vasculitis, or inflammatory myositis). Military dust exposure was associated with increased odds of RA (odds ratio [OR] = 1.10; 95% confidence interval [CI] = 1.003-1.20) and increased odds of SSc, vasculitis, or inflammatory myositis (OR = 1.23; 95% CI = 1.14-1.34) but was protective for SLE (OR = 0.81; 95% CI = 0.76-0.88). CONCLUSION Dust exposure during past military service comprises an occupational and environmental risk factor for RA and other AI diseases. This is potentially relevant for prevention activities.
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Affiliation(s)
- David Ying
- San Francisco Veterans Affairs Health Care System, San Francisco, California, John Muir Health, Walnut Creek, California, and University of California at San Francisco
| | - Gabriela Schmajuk
- San Francisco Veterans Affairs Health Care System, San Francisco, California, and University of California at San Francisco
| | | | - Paul D. Blanc
- San Francisco Veterans Affairs Health Care System, San Francisco, California, and University of California at San Francisco
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15
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Walker LE, Watrous J, Poltavskiy E, Howard JT, Janak JC, Pettey WBP, Zarzabal LA, Sim A, Gundlapalli A, Stewart IJ. Longitudinal mental health outcomes of combat-injured service members. Brain Behav 2021; 11:e02088. [PMID: 33662185 PMCID: PMC8119815 DOI: 10.1002/brb3.2088] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/13/2021] [Accepted: 02/15/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The relationship between traumatic injury and subsequent mental health diagnoses is not well understood and may have significant implications for patient screening and clinical intervention. We sought to determine the adjusted association between traumatic injury and the subsequent development of post-traumatic stress disorder (PTSD), depression, and anxiety. METHODS Using Department of Defense and Veterans Affairs datasets between February 2002 and June 2016, we conducted a retrospective cohort study of 7,787 combat-injured United States service members matched 1:1 to combat-deployed, uninjured service members. The primary exposure was combat injury versus no combat injury. Outcomes were diagnoses of PTSD, depression, and anxiety, defined by International Classification of Diseases 9th and 10th Revision Clinical Modification codes. RESULTS Compared to noninjured service members, injured service members had higher observed incidence rates per 100 person-years for PTSD (17.1 vs. 5.8), depression (10.4 vs. 5.7), and anxiety (9.1 vs. 4.9). After adjustment, combat-injured patients were at increased risk of development of PTSD (HR 2.92, 95%CI 2.68-3.17), depression (HR 1.47, 95%CI 1.36-1.58), and anxiety (HR 1.34, 95%CI 1.24-1.45). CONCLUSIONS Traumatic injury is associated with subsequent development of PTSD, depression, and anxiety. These findings highlight the importance of increased screening, prevention, and intervention in patients with exposure to physical trauma.
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Affiliation(s)
| | | | | | | | | | - Warren B P Pettey
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lee Ann Zarzabal
- PEO Defense Healthcare Management Systems (DHMS), San Antonio, TX, USA
| | - Alan Sim
- PEO Defense Healthcare Management Systems (DHMS), San Antonio, TX, USA
| | - Adi Gundlapalli
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ian J Stewart
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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16
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Combining Natural Language Processing of Electronic Medical Notes With Administrative Data to Determine Racial/Ethnic Differences in the Disclosure and Documentation of Military Sexual Trauma in Veterans. Med Care 2020; 57 Suppl 6 Suppl 2:S149-S156. [PMID: 31095054 DOI: 10.1097/mlr.0000000000001031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Despite national screening efforts, military sexual trauma (MST) is underreported. Little is known of racial/ethnic differences in MST reporting in the Veterans Health Administration (VHA). OBJECTIVE This study aimed to compare patterns of MST disclosure in VHA by race/ethnicity. RESEARCH DESIGN Retrospective cohort study of MST disclosures in a national, random sample of Veterans who served in Afghanistan and Iraq and completed MST screens from October 2009 to 2014. We used natural language processing (NLP) to extract MST concepts from electronic medical notes in the year following Veterans' first MST screen. MEASURE(S) Any evidence of MST (positive MST screen or NLP concepts) and late MST disclosure (NLP concepts following a negative MST screen). Multivariable logistic regressions, stratified by sex, tested racial/ethnic differences in any MST evidence, and late disclosure. RESULTS Of 6618 male and 6716 female Veterans with MST screen results, 1473 had a positive screen (68 male, 1%; 1405 female, 21%). Of those with a negative screen, 257 evidenced late MST disclosure by NLP (44 male, 39%; 213 female, 13%). Late MST disclosure was usually documented during mental health visits. There were no significant racial/ethnic differences in MST disclosure among men. Among women, blacks were less likely than whites to have any MST evidence (adjusted odds ratio=0.75). In the subsample with any MST evidence, black and Hispanic women were more likely than whites to disclose MST late (adjusted odds ratio=1.89 and 1.59, respectively). CONCLUSIONS Combining NLP results with MST screen data facilitated the identification of under-reported sexual trauma experiences among men and racial/ethnic minority women.
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17
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Wischik DL, Magny-Normilus C, Whittemore R. Risk Factors of Obesity in Veterans of Recent Conflicts: Need for Diabetes Prevention. Curr Diab Rep 2019; 19:70. [PMID: 31368008 PMCID: PMC7530827 DOI: 10.1007/s11892-019-1191-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW To identify factors associated with obesity in veterans of the recent, Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) war conflicts. RECENT FINDINGS Over 44% OEF/OIF/OND veterans are obese (BMI > 30 kg/m2), which exceeds the national obesity prevalence rate of 39% in people younger than 45. Obesity increases morbidity, risk for type 2 diabetes (T2D), and mortality as well as decreases quality of life. A scoping review method was used to identify factors associated with obesity in young veterans. Military exposures, such as multiple deployments and exposure to combat, contribute to challenges in re-integration to civilian life in all veterans. Factors that contribute to increased risk for obesity include changes in eating patterns/eating disorders, changes in physical activity, physical disability, and psychological comorbidity. These conditions can contribute to a rapid weight gain trajectory, changes in metabolism, and obesity. Young veterans face considerable challenges related to obesity risk. Further research is needed to better understand young veterans' experiences and health needs in order to adapt or expand existing programs and improve access, engagement, and metabolic outcomes in this vulnerable population.
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Affiliation(s)
| | | | - Robin Whittemore
- Yale School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA
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18
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Shore JH, Goss CW, Dailey NK, Bair BD. Methodology for Evaluating Models of Telemental Health Delivery Against Population and Healthcare System Needs: Application to Telemental Healthcare for Rural Native Veterans. Telemed J E Health 2019; 25:628-637. [PMID: 30129880 DOI: 10.1089/tmj.2018.0084] [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: 10/28/2022] Open
Abstract
Background: Rural American Indian and Alaska Native (AI/AN) Veterans face exceptional barriers to receiving quality mental healthcare. We aimed to identify models of in-person and telemental health service delivery with promise for adaptation and wide dissemination to rural AI/AN Veterans. Methods: Our method for matching specific populations with models of care includes (1) selecting frameworks that represent the healthcare organization's goals, (2) identifying relevant service delivery models for the target population(s), (3) assessing models against the selected frameworks, and (4) summarizing findings across models. We applied this approach to rural AI/AN Veteran populations. Results: Searches identified 13 current models of service delivery for rural AI/AN Veteran, rural AI/AN, and general rural Veteran populations. These models were assessed against four frameworks-the U.S. Department of Veterans Affairs' Office of Rural Health's Promising Practices, Veterans Health Administration's Guide to Mental Health Services, the Institute for Healthcare Improvement's Triple Aim Framework, and the American Indian Telemental Health Clinic framework. Discussion: The one model used for service delivery for rural AI/AN Veterans increases access and is patient-centered but lacks operational feasibility. Models for rural AI/ANs also increase access and are patient-centered but generally lack effectiveness evaluations. Models for rural Veterans demonstrate beneficial effects on mental health outcomes but do not emphasize cultural adaptations to diverse populations. Conclusions: Our approach to selecting models of service delivery considers the needs of operational partners as well as target populations and emphasizes large-scale implementation alongside effectiveness. Pending further testing, this approach holds promise for wider application.
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Affiliation(s)
- Jay H Shore
- Veterans Rural Health Resource Center-Salt Lake City, Veterans Health Administration Office of Rural Health, Salt Lake City, Utah
| | - Cynthia W Goss
- Veterans Rural Health Resource Center-Salt Lake City, Veterans Health Administration Office of Rural Health, Salt Lake City, Utah
| | - Nancy K Dailey
- Veterans Rural Health Resource Center-Salt Lake City, Veterans Health Administration Office of Rural Health, Salt Lake City, Utah
| | - Byron D Bair
- Veterans Rural Health Resource Center-Salt Lake City, Veterans Health Administration Office of Rural Health, Salt Lake City, Utah
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19
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Lehavot K, Beckman KL, Chen JA, Simpson TL, Williams EC. Race/Ethnicity and Sexual Orientation Disparities in Mental Health, Sexism, and Social Support among Women Veterans. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2019; 6:347-358. [PMID: 31435497 PMCID: PMC6703561 DOI: 10.1037/sgd0000333] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To identify patterns of risk and resilience by the intersections of race/ethnicity and sexual orientation in mental health symptom severity, sexism, and social support among U.S. women veterans. METHODS A national sample of women veterans (n = 648, 38% sexual minority, 15% racial/ethnic minority) was recruited online in 2013 using social networking websites and listservs. Using cross-sectional survey data, we evaluated main and interactive associations between race/ethnicity and sexual orientation on depression, anxiety, posttraumatic stress, unhealthy alcohol use, sexism, and social support. Models were adjusted for other demographic characteristics. RESULTS Across depression, anxiety, and sexism, White heterosexual women reported the least distress and racial/ethnic minority heterosexual women the most distress (race/ethnicity x sexual orientation interactions p < .05). Among White women, sexual minority women reported greater levels of depression, anxiety, and sexism than heterosexual women. The effects were the opposite among racial/ethnic minority women, where heterosexual women reported similar or worse depression, anxiety, and sexism than sexual minority women. There were no race/ethnicity or sexual orientation interaction effects on posttraumatic stress symptoms or unhealthy alcohol use and marginally significant effects on social support. CONCLUSIONS Among women veterans, race/ethnicity and sexual orientation were associated with mental health and sexism, alone and in combination. Findings suggest that those who were both racial/ethnic and sexual minorities may develop resilience from their lived experience. On the other hand, women veterans with a minority race/ethnicity or a minority sexual orientation appeared more vulnerable to adverse outcomes and may need targeted care.
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Affiliation(s)
- Keren Lehavot
- Denver-Seattle Center of Innovation for Veteran-Centered Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System
- Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System
- Department of Psychiatry and Behavioral Sciences, University of Washington
- Department of Health Services, University of Washington
| | | | - Jessica A. Chen
- Denver-Seattle Center of Innovation for Veteran-Centered Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System
- Department of Health Services, University of Washington
| | - Tracy L. Simpson
- Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System
- Department of Psychiatry and Behavioral Sciences, University of Washington
- Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System
| | - Emily C. Williams
- Denver-Seattle Center of Innovation for Veteran-Centered Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System
- Department of Health Services, University of Washington
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20
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Luciano MT, McDevitt-Murphy ME, Acuff SF, Bellet BW, Tripp JC, Murphy JG. Posttraumatic stress disorder symptoms improve after an integrated brief alcohol intervention for OEF/OIF/OND veterans. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2018; 11:459-465. [PMID: 29939060 DOI: 10.1037/tra0000378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Although brief alcohol interventions (BAIs) that incorporate personalized feedback demonstrate efficacy for reducing the frequency and quantity of alcohol consumption in veteran samples, little research has explored the influence of BAIs in reducing symptoms of posttraumatic stress disorder (PTSD). The goal of this investigation was to understand whether PTSD symptom severity and diagnostic status changed after exposure to an intervention that targeted alcohol misuse and integrated feedback on PTSD. METHOD Sixty-eight combat veterans (8.8% female; 27.9% African American) who screened positive for hazardous drinking were recruited from a Veterans Affairs Medical Center. Participants received a 1-session brief intervention that primarily targeted alcohol misuse but also included personalized feedback and psychoeducation on PTSD symptoms and coping. Participants were randomized to receive personalized written feedback either with or without a motivational interview. RESULTS A mixed-model repeated measures analysis revealed that PTSD symptom severity was significantly lower at the 6-week (M = 41.47, SD = 28.94) and 6-month (M = 35.56 SD = 26.99) follow-up appointments relative to baseline (M = 51.22, SD = 26.67), F(2, 127.24) = 38.32, p < .001. Regression analyses demonstrate that the percent change in alcohol use was related to the change in PTSD severity. Further, results indicated that a motivational-interviewing-style counseling session accompanying the feedback was not significantly more efficacious than receiving feedback only. CONCLUSION A brief alcohol intervention that integrates information on PTSD has the potential to reduce PTSD severity. Personalized alcohol and PTSD feedback may be useful as an opportunistic intervention for OEF/OIF veterans. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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21
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Danan ER, Krebs EE, Ensrud K, Koeller E, MacDonald R, Velasquez T, Greer N, Wilt TJ. An Evidence Map of the Women Veterans' Health Research Literature (2008-2015). J Gen Intern Med 2017; 32:1359-1376. [PMID: 28913683 PMCID: PMC5698220 DOI: 10.1007/s11606-017-4152-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 06/08/2017] [Accepted: 07/27/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Women comprise a growing proportion of Veterans seeking care at Veterans Affairs (VA) healthcare facilities. VA initiatives have accelerated changes in services for female Veterans, yet the corresponding literature has not been systematically reviewed since 2008. In 2015, VA Women's Health Services and the VA Women's Health Research Network requested an updated literature review to facilitate policy and research planning. METHODS The Minneapolis VA Evidence-based Synthesis Program performed a systematic search of research related to female Veterans' health published from 2008 through 2015. We extracted study characteristics including healthcare topic, design, sample size and proportion female, research setting, and funding source. We created an evidence map by organizing and presenting results within and across healthcare topics, and describing patterns, strengths, and gaps. RESULTS We identified 2276 abstracts and assessed each for relevance. We excluded 1092 abstracts and reviewed 1184 full-text articles; 750 were excluded. Of 440 included articles, 208 (47%) were related to mental health, particularly post-traumatic stress disorder (71 articles), military sexual trauma (37 articles), and substance abuse (20 articles). The number of articles addressing VA priority topic areas increased over time, including reproductive health, healthcare organization and delivery, access and utilization, and post-deployment health. Three or fewer articles addressed each of the common chronic diseases: diabetes, hypertension, depression, or anxiety. Nearly 400 articles (90%) used an observational design. Eight articles (2%) described randomized trials. CONCLUSIONS Our evidence map summarizes patterns, progress, and growth in the female Veterans' health and healthcare literature. Observational studies in mental health make up the majority of research. A focus on primary care delivery over clinical topics in primary care and a lack of sex-specific results for studies that include men and women have contributed to research gaps in addressing common chronic diseases. Interventional research using randomized trials is needed.
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Affiliation(s)
- Elisheva R Danan
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA. .,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Erin E Krebs
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kristine Ensrud
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Eva Koeller
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Roderick MacDonald
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Tina Velasquez
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Nancy Greer
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Timothy J Wilt
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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22
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Posttraumatic Stress and Physical Health Functioning: Moderating Effects of Deployment and Postdeployment Social Support in OEF/OIF/OND Veterans. J Nerv Ment Dis 2017; 205:93-98. [PMID: 27660993 PMCID: PMC5272856 DOI: 10.1097/nmd.0000000000000571] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Research indicates that posttraumatic stress disorder (PTSD) is strongly associated with physical health difficulties, and that social support may be protective for both problems. Social support, however, is often broadly conceptualized. The present analysis explores how Veteran-specific social support (during military deployment and postdeployment) may moderate the relationship between PTSD and physical health functioning. Participants were recruited from a VA Medical Center. Self-report data were analyzed from 63 Veterans (17.46% female; 42.86% white) who had been deployed in support of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND). Data indicate that military deployment social support moderated the relationship between PTSD and pain (β = 0.02, p = 0.02) whereas postdeployment social support moderated the relationship between PTSD and general health perceptions (β = 0.03, p = 0.01). These findings may be used to better understand the role of support in influencing psychological and physiological processes.
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23
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Ramsey C, Dziura J, Justice AC, Altalib HH, Bathulapalli H, Burg M, Decker S, Driscoll M, Goulet J, Haskell S, Kulas J, Wang KH, Mattocks K, Brandt C. Incidence of Mental Health Diagnoses in Veterans of Operations Iraqi Freedom, Enduring Freedom, and New Dawn, 2001-2014. Am J Public Health 2016; 107:329-335. [PMID: 27997229 DOI: 10.2105/ajph.2016.303574] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate gender, age, and race/ethnicity as predictors of incident mental health diagnoses among Operations Iraqi Freedom, Enduring Freedom, and New Dawn veterans. METHODS We used US Veterans Health Administration (VHA) electronic health records from 2001 to 2014 to examine incidence rates and sociodemographic risk factors for mental health diagnoses among 888 142 veterans. RESULTS Posttraumatic stress disorder (PTSD) was the most frequently diagnosed mental health condition across gender and age groups. Incidence rates for all mental health diagnoses were highest at ages 18 to 29 years and declined thereafter, with the exceptions of major depressive disorder (MDD) in both genders, and PTSD among women. Risk of incident bipolar disorder and MDD diagnoses were greater among women; risk of incident schizophrenia, and alcohol- and drug-use disorders diagnoses were greater in men. Compared with Whites, risk incident PTSD, MDD, and alcohol-use disorder diagnoses were lower at ages 18 to 29 years and higher at ages 45 to 64 years for both Hispanics and African Americans. CONCLUSIONS Differentiating high-risk demographic and gender groups can lead to improved diagnosis and treatment of mental health diagnoses among veterans and other high-risk groups.
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Affiliation(s)
- Christine Ramsey
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - James Dziura
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Amy C Justice
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Hamada Hamid Altalib
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Harini Bathulapalli
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Matthew Burg
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Suzanne Decker
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Mary Driscoll
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Joseph Goulet
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Sally Haskell
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Joseph Kulas
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Karen H Wang
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Kristen Mattocks
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Cynthia Brandt
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
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Koo KH, Hebenstreit CL, Madden E, Maguen S. PTSD detection and symptom presentation: Racial/ethnic differences by gender among veterans with PTSD returning from Iraq and Afghanistan. J Affect Disord 2016; 189:10-6. [PMID: 26402342 DOI: 10.1016/j.jad.2015.08.038] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 08/13/2015] [Accepted: 08/17/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND To determine differences in positive PTSD screenings and symptom presentation by race/ethnicity and gender for Iraq and Afghanistan veterans diagnosed with PTSD. METHOD We conducted a retrospective analysis using existing records from Iraq and Afghanistan veterans who enrolled in VA care, received a post-deployment PTSD diagnosis, initiated mental health outpatient treatment between 10/01/07 and 12/31/11, and had a PTSD screen result at the start of treatment (N=79,938). PTSD outcomes were measured using the PC-PTSD and PCL. RESULTS At treatment initiation, differences in race/ethnicity and gender were found for PTSD screens and PTSD symptoms. Compared to their white counterparts, Asian/Pacific Islander (A/PI) women and black men were more likely to screen positive for PTSD (adjusted ORs=1.42 and 1.17, ps=.04 and <.0001, respectively) and endorse all measured symptoms (adjusted ORs=1.09 to 1.66, ps≤.000-.04) except avoidance for A/PI women and hyperarousal for black men; A/PI men were less likely to endorse hyperarousal (adjusted OR=.88, p=.04) and did not differ otherwise; and black women did not differ from their white counterparts. Additional differences in PTSD symptom presentation by race/ethnicity and gender were found. LIMITATIONS The current study utilized administrative data and was cross-sectional. The results may not be generalizable to veterans from other service eras. CONCLUSIONS PTSD screens differ by race/ethnicity and gender, and further by PTSD symptoms, which can influence initiation and planning of PTSD treatment. Awareness of such differences may aid in detecting PTSD to provide care for diverse veterans.
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Affiliation(s)
- Kelly H Koo
- San Francisco VA Health Care System, San Francisco, United States; University of California, San Francisco, United States.
| | - Claire L Hebenstreit
- San Francisco VA Health Care System, San Francisco, United States; University of California, San Francisco, United States
| | - Erin Madden
- San Francisco VA Health Care System, San Francisco, United States
| | - Shira Maguen
- San Francisco VA Health Care System, San Francisco, United States; University of California, San Francisco, United States
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