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Webermann AR, Nester MS, Gianoli MO, Black AC, Rosen MI, Mattocks KM, Portnoy GA. Compensation and Pension Exams for Military Sexual Trauma-Related Posttraumatic Stress Disorder: Examiner Perspectives, Clinical Impacts on Veterans, and Strategies. Womens Health Issues 2023; 33:428-434. [PMID: 37003918 DOI: 10.1016/j.whi.2023.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/06/2023] [Accepted: 02/24/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND It is estimated that in one in three women veterans experience military sexual trauma (MST), which is strongly associated with posttraumatic stress disorder (PTSD). A 2018 report indicated the Veterans Benefits Administration (VBA) processed approximately 12,000 disability claims annually for PTSD related to MST, most of which are filed by women. Part of the VBA adjudication process involves reviewing information from a Compensation and Pension (C&P) exam, a forensic diagnostic evaluation that helps determine the relationship among military service, diagnoses, and current psychosocial functioning. The quality and outcome of these exams may affect veteran well-being and use of Veterans Health Administration (VHA) mental health care, but no work has looked at examiner perspectives of MST C&P exams and their potential clinical impacts on veteran claimants. METHODS Thirteen clinicians ("examiners") who conduct MST C&P exams through VHA were interviewed. Data were analyzed using rapid qualitative methods. RESULTS Examiners described MST exams as more clinically and diagnostically complex than non-MST PTSD exams. Examiners noted that assessing "markers" of MST (indication that MST occurred) could make veterans feel disbelieved; others raised concerns related to malingered PTSD symptoms. Examiners identified unique challenges for veterans who underreport MST (e.g., men and lesbian, gay, bisexual, transgender, and queer [LGBTQ+] veterans), and saw evaluations as a conduit to psychotherapy referrals and utilization of VHA mental health care. Last, examiners used strategies to convey respect and minimize retraumatization, including a standardized process and validating the difficulty of the process. CONCLUSIONS Examiners' responses offer insight into a process entered by thousands of veterans annually with PTSD. Strengthening the MST C&P process is a unique opportunity to enhance trust in the VBA claims process and increase likelihood of using VHA mental health care, especially for women veterans.
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Affiliation(s)
- Aliya R Webermann
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale School of Medicine, New Haven, Connecticut.
| | - M Shae Nester
- University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Mayumi O Gianoli
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale School of Medicine, New Haven, Connecticut; University of Connecticut School of Medicine, Farmington, Connecticut
| | - Anne C Black
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale School of Medicine, New Haven, Connecticut
| | - Marc I Rosen
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale School of Medicine, New Haven, Connecticut
| | - Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Galina A Portnoy
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale School of Medicine, New Haven, Connecticut
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2
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Elran-Barak R. The experience of claiming mental health disability benefits: A qualitative analysis of clients' perspectives. J Psychiatr Ment Health Nurs 2023. [PMID: 36633373 DOI: 10.1111/jpm.12896] [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] [Received: 04/12/2022] [Revised: 12/01/2022] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: The decision to apply for disability benefits may be an important breakthrough in the life of people with severe mental illness. The literature regarding the process of applying for mental health disability benefits is scarce. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study is, to the best of our knowledge, the first to fully describe the experience of submitting a claim for mental health disability benefits, as experienced by those diagnosed with severe mental illness. The process of applying for recognition of a mental health disability has three chronological stages-before the claim submission, during the claims process and after recognition. Clients approach the process without any prior knowledge, and therefore they need professional help when submitting their claim. A deterioration in clients' mental health prompts them to apply. A lack of trust in the system affects the application decision/process. The medical committee hearing is described as a complex and multifaceted experience. Clients reported being extensively preoccupied with stigma throughout the process. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Professional assistance throughout the claims process is a key factor with the potential to change clients' experience of the entire process. It is important to educate mental health nurses about the disability applicating process. Mental health professionals are encouraged to be mindful of the facilitating/hindering mechanisms that are dominant at each stage of the process. There is a need for liaising with relevant agencies that act as advocates for those diagnosed with a mental health illness. ABSTRACT INTRODUCTION: The decision to apply for disability benefits may be an important breakthrough in the life of those diagnosed with severe mental illness (SMI). Nevertheless, the literature regarding the application process is scarce. AIM The aim of the study was to explore how people who receive mental health disability benefits retrospectively perceive the process of applying for and receiving these benefits. METHODS Twenty-four in-depth qualitative interviews were conducted with people whose mental health disability was recognized in the past few years. RESULTS Analysis revealed three themes describing the process's chronological stages: Before submitting the claim (from deterioration to trust), during the claim process (from bureaucracy to understanding), after receiving recognition (from stigma to gratitude). Each stage includes facilitating factors (e.g. encouragement from professionals) and hindering factors (e.g. stigma, lack of knowledge and trust). DISCUSSION This is the first study to fully describe the experience of applying for mental health disability benefits, as experienced by clients. The decision to apply is perceived as complex and difficult. Although clients are extensively preoccupied with stigma throughout the process, they are able to express gratitude for the opportunities made available to them. IMPLICATIONS Professional assistance throughout the claim is a key factor with the potential to change clients' experience of the entire process.
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Affiliation(s)
- Roni Elran-Barak
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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3
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The “trauma pitch”: How stigma emerges for Iraq and Afghanistan veterans seeking disability compensation. PLoS One 2022; 17:e0267424. [PMID: 36044465 PMCID: PMC9432745 DOI: 10.1371/journal.pone.0267424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/16/2022] [Indexed: 11/21/2022] Open
Abstract
Posttraumatic Stress Disorder continues to be a highly stigmatized disease for the veteran population and stigma, experienced as a mark of discredit or shame, continues to be identified as the main deterrent in treatment seeking. Little attention has been paid to how the process of obtaining service-connected disability status can amplify veterans’ perceptions of being stigmatized. The following ethnographic study identified how combat veterans experienced stigma in processing through Veterans Affairs care and the effects of linking a Posttraumatic Stress Disorder diagnosis with disability compensation. Stigma was identified in two inter-related areas: 1) the structural level in the Veterans Affairs disability claims process and 2) the individual level in interactions with Veterans Affairs service providers. Findings based on veterans’ narratives suggest that the disability claims process, requiring multiple repetitions of personal trauma, coupled with perceptions of institutional stigmas of malingering, created bureaugenic effects: a worsening of symptoms caused by bureaucratic protocols intended to help veterans. This process influenced first time treatment users of the Veterans Affairs by deterring treatment-seeking behavior but was not found to affect veterans who had already initiated treatment. Despite the experience of stigma and commodification of their suffering through disability and diagnostic screening, veterans still sought disability compensation. Veterans viewed this compensation as acknowledgment of their loss and validation of their sacrifice.
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Bond GR, Al-Abdulmunem M, Ressler DR, Drake RE, Davis LL, Meyer T, Gade DM, Frueh BC, Dickman RB. Evaluation of an Employment Intervention for Veterans Transitioning From the Military: A Randomized Controlled Trial. J Nerv Ment Dis 2022; 210:321-329. [PMID: 34937846 DOI: 10.1097/nmd.0000000000001472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Military personnel face numerous challenges transitioning from military jobs to meaningful civilian employment. The Independence Project compared an innovative employment program (National Career Coach Program) with standard employment services (Local Community Resources) in a randomized controlled trial. Study participants were transitioning veterans with self-reported service-connected disabilities seeking permanent employment. The primary outcomes were paid employment and disability ratings over 1 year. Secondary outcomes included health and well-being. At 1-year follow-up, National Career Coach Program participants were significantly more likely to work, had significantly greater earnings, and reported significantly greater improvements in physical and mental health compared with participants assigned to Local Community Resources. Both groups increased in disability ratings over 12 months, with no difference between groups. Multifaceted supports delivered by the National Career Coach Program increased employment, earnings, mental health, and physical health over 1 year. These significant differences appeared even though control group participants achieved considerable employment success.
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Affiliation(s)
- Gary R Bond
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, Lebanon, New Hampshire
| | - Monirah Al-Abdulmunem
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, Lebanon, New Hampshire
| | - Daniel R Ressler
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, Lebanon, New Hampshire
| | - Robert E Drake
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, Lebanon, New Hampshire
| | | | - Thomas Meyer
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Daniel M Gade
- Department of Public Administration and Policy, American University, Washington, DC
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Johnson-Koenke R, Horton-Deutsch S, Pratt-Hopp F, Jones J, Oman KS. Stories of the Heart: Illness Narratives of Veterans Living With Heart Failure. Fed Pract 2022; 39:237-243. [PMID: 35935926 PMCID: PMC9351735 DOI: 10.12788/fp.0260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Illness narratives for veterans living with heart failure (HF) have been largely unexplored, yet HF is a significant and impactful illness affecting the lives of many veterans. METHODS This study used narrative inquiry to explore the domains of psychosocial adjustments using the model of adjustment to illness, including self-schema, world schema, and meaning. RESULTS Five illness narratives of veterans living with HF were cocreated and explored domains which were found across all the narratives explored in this study. Emergent themes included: uniqueness of the veteran experience and the social, historical, and cultural context of narrator and researcher. CONCLUSIONS Veterans living with HF are a unique population who experience changes in their self-schema, world schema, and meaning through their illness experience. These findings have important implications for interdisciplinary health care research and clinical practice, providing important insight into how people live with chronic illness.
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Affiliation(s)
- Rachel Johnson-Koenke
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Sara Horton-Deutsch
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora
- University of San Francisco, San Francisco, California
| | | | - Jacqueline Jones
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora
| | - Kathleen S. Oman
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora
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Spinola S, Fenton BT, Meshberg-Cohen S, Black AC, Rosen MI. Comparison of attitudes towards the service connection claims process among veterans filing for PTSD and veterans filing for musculoskeletal disorders. Medicine (Baltimore) 2021; 100:e27068. [PMID: 34477140 PMCID: PMC8415949 DOI: 10.1097/md.0000000000027068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/15/2021] [Accepted: 08/05/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Many veterans have negative views about the service connection claims process for posttraumatic stress disorder (PTSD), which likely impacts willingness to file service connection claims, re-file claims, and use Veterans Healthcare Administration care. Nevertheless, veterans have reported that PTSD claims are important to them for the financial benefits, validation of prior experience and harm, and self-other issues such as pleasing a significant other. It is unknown if reported attitudes are specific to PTSD claimants or if they would be similar to those submitting claims for other disorders, such as musculoskeletal disorders. Therefore, the purpose of this study was to compare attitudes and beliefs about service connection processes between veterans submitting service connection claims for PTSD and musculoskeletal disorders.Participants were Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans filing service connection claims for PTSD (n = 218) or musculoskeletal disorder (n = 257) who completed a modified Disability Application Appraisal Inventory. This secondary data analysis using multiple regression models tested the effect of demographics, clinical characteristics, and claim type on 5 Disability Application Appraisal Inventory subscales: Knowledge about service connection claims, Negative Expectations about the process, and importance of Financial Benefits, importance of Validation of veteran's experience/condition, and importance of Self-Other attitudes.The PTSD group assigned significantly less importance to financial benefits than the musculoskeletal disorder group. In addition, the subset of the PTSD group without depression had significantly more Negative Expectations than musculoskeletal disorder claimants without depression. Negative Expectations did not differ between the PTSD and musculoskeletal disorder groups with depression. Depression was significantly positively associated with Negative Expectations, importance of Financial Benefits, and importance of Validation.Most perceptions around seeking service connection are not specific to PTSD claimants. Depression is associated with having negative expectations about service connection claims and motivations to file claims. Addressing depression and negative expectations during the compensation and pension process might help veterans at this important point of contact with Veterans Healthcare Administration services.
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Affiliation(s)
- Suzanne Spinola
- VA Connecticut Healthcare System, West Haven, CT
- Yale University School of Medicine, Department of Psychiatry, CT
| | - Brenda T. Fenton
- VA Connecticut Healthcare System, West Haven, CT
- Yale University School of Medicine, Department of Neurology, CT
| | - Sarah Meshberg-Cohen
- VA Connecticut Healthcare System, West Haven, CT
- Yale University School of Medicine, Department of Psychiatry, CT
| | - Anne C. Black
- VA Connecticut Healthcare System, West Haven, CT
- Yale University School of Medicine, Department of Internal Medicine, CT
| | - Marc I. Rosen
- VA Connecticut Healthcare System, West Haven, CT
- Yale University School of Medicine, Department of Psychiatry, CT
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7
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Burdett H, Fear NT, Wessely S, Greenberg N, Rona RJ. Contribution of mental ill health during military service to postservice benefit claims in the UK. Occup Environ Med 2021; 78:643-647. [PMID: 33483458 DOI: 10.1136/oemed-2020-107050] [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: 09/14/2020] [Revised: 12/14/2020] [Accepted: 01/05/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES While most UK military personnel transition successfully into civilian life, some experience unemployment and disability, which may be partly attributable to in-service factors. This study aims to determine the degree to which in-service mental health problems impact on postservice benefit claims. METHODS Using data from a cohort of 5598 recent leavers from regular service in the UK Armed Forces linked with data from the Department for Work and Pensions, we assessed associations between in-service mental health and postservice benefit claims, and the population attributable fraction (PAF) of benefit claims related to in-service mental health. An analysis with postservice mental ill health as mediator was performed to determine the degree to which the observed effects were a consequence of persistent illness, as opposed to remitted. RESULTS Mental illness occurring in-service predicted both unemployment and disability claims, partly mediated by postservice health (23%-52% total effects mediated), but alcohol misuse did not. Common mental disorder (CMD) (PAF 0.07, 95% CI: 0.02 to 0.11) and probable post-traumatic stress disorder (PTSD) (PAF 0.05, 95% CI 0.01 to 0.09) contributed to unemployment claims. Probable PTSD was the largest contributor to disability claims (PAF 0.25, 95% CI 0.13 to 0.36), with a smaller contribution from CMD (PAF 0.16, 95% CI 0.03 to 0.27). CONCLUSIONS In-service mental ill health gives rise to benefit claims. These effects are only partly mediated by postservice mental health, implying that in-service (or pre-service) mental issues have carry-over effects into civilian life even if remitted. Better prevention and treatment of in-service PTSD symptoms may well reduce postservice disability claims.
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Affiliation(s)
- Howard Burdett
- King's Centre for Military Health Research, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Simon Wessely
- King's Centre for Military Health Research, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Neil Greenberg
- Academic Department of Military Mental Health, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Roberto J Rona
- King's Centre for Military Health Research, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
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8
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Maguen S, Holder N, Li Y, Madden E, Neylan TC, Seal KH, Lujan C, Patterson OV, DuVall SL, Shiner B. Factors associated with PTSD symptom improvement among Iraq and Afghanistan veterans receiving evidenced-based psychotherapy. J Affect Disord 2020; 273:1-7. [PMID: 32421589 DOI: 10.1016/j.jad.2020.04.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/02/2020] [Accepted: 04/24/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite availability of evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD), not all veterans who initiate EBPs experience benefit. Better understanding factors associated with clinically significant improvement can help ameliorate care. METHODS A cohort of Iraq and Afghanistan War veterans who initiated an EBP was identified (N = 32,780) with ≥1 post-deployment psychotherapy visit at the Veterans Health Administration from 10/2001-6/2017, a post-deployment PTSD diagnosis, and ≥2 PTSD symptom measures. We used random-effects logistic regression to assess whether patient-level, diagnostic, and treatment factors were associated with achieving symptom improvement. RESULTS Increased odds of PTSD symptom improvement were seen in women (OR = 1.19; 95% CI: 1.09--1.29), those who initiated EBP within a year of engaging in mental healthcare compared with the delayed EBP group (OR = 1.20; 95% CI: 1.14--1.28), those who completed at least 8 EBP sessions in 16 weeks (OR = 1.23; 95% CI:1.11--1.36), those who received PE only (vs. CPT or both; OR = 2.23; 95% CI: 1.86--2.68) or CPT individual therapy only (vs. CPT group or both; OR = 1.34; 95% CI: 1.22--1.48), and those with a drug dependence diagnosis (OR = 1.24; 95% CI: 1.11--1.39). Decreased odds of improvement were seen in Black veterans (OR=0.75; 95% CI: 0.69--0.81) and those with service-connected disability (OR = 0.61; 95% CI: 0.52--0.71). LIMITATIONS Diagnoses were from medical charts and not confirmed with gold standard assessment tools; we only included veterans with at least two PTSD measurements, which may cause bias. CONCLUSION Modifiable factors associated with PTSD improvement (timing, dose, and modality) can be used to improve EBP outcomes.
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Affiliation(s)
- Shira Maguen
- San Francisco Veterans Affairs Health Care System; Sierra Pacific Mental Illness Research, Education, and Clinical Center; University of California San Francisco School of Medicine.
| | - Nicholas Holder
- San Francisco Veterans Affairs Health Care System; Sierra Pacific Mental Illness Research, Education, and Clinical Center; University of California San Francisco School of Medicine
| | - Yongmei Li
- San Francisco Veterans Affairs Health Care System
| | - Erin Madden
- San Francisco Veterans Affairs Health Care System
| | - Thomas C Neylan
- San Francisco Veterans Affairs Health Care System; Sierra Pacific Mental Illness Research, Education, and Clinical Center; University of California San Francisco School of Medicine
| | - Karen H Seal
- San Francisco Veterans Affairs Health Care System; Sierra Pacific Mental Illness Research, Education, and Clinical Center
| | - Callan Lujan
- San Francisco Veterans Affairs Health Care System
| | - Olga V Patterson
- Department of Veterans Affairs Salt Lake City Health Care System; University of Utah School of Medicine
| | - Scott L DuVall
- Department of Veterans Affairs Salt Lake City Health Care System; University of Utah School of Medicine
| | - Brian Shiner
- White River Junction Veterans Affairs Medical Center; Geisel School of Medicine at Dartmouth; National Center for Posttraumatic Stress Disorder, Executive Division
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Redd AM, Gundlapalli AV, Suo Y, Pettey WBP, Brignone E, Chin DL, Walker LE, Poltavskiy EA, Janak JC, Howard JT, Sosnov JA, Stewart IJ. Exploring Disparities in Awarding VA Service-Connected Disability for Post-Traumatic Stress Disorder for Active Duty Military Service Members from Recent Conflicts in Iraq and Afghanistan. Mil Med 2020; 185:296-302. [PMID: 32074380 DOI: 10.1093/milmed/usz208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION We explore disparities in awarding post-traumatic stress disorder (PTSD) service-connected disability benefits (SCDB) to veterans based on gender, race/ethnicity, and misconduct separation. METHODS Department of Defense data on service members who separated from October 1, 2001 to May 2017 were linked to Veterans Administration (VA) administrative data. Using adjusted logistic regression models, we determined the odds of receiving a PTSD SCDB conditional on a VA diagnosis of PTSD. RESULTS A total of 1,558,449 (79% of separating service members) had at least one encounter in VA during the study period (12% female, 4.5% misconduct separations). Females (OR 0.72) and Blacks (OR 0.93) were less likely to receive a PTSD award and were nearly equally likely to receive a PTSD diagnosis (OR 0.97, 1.01). Other racial/ethnic minorities were more likely to receive an award and diagnosis, as were those with misconduct separations (award OR 1.3, diagnosis 2.17). CONCLUSIONS Despite being diagnosed with PTSD at similar rates to their referent categories, females and Black veterans are less likely to receive PTSD disability awards. Other racial/ethnic minorities and those with misconduct separations were more likely to receive PTSD diagnoses and awards. Further study is merited to explore variation in awarding SCDB.
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Affiliation(s)
- Andrew M Redd
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System, 500 Foothill Dr, Salt Lake City, UT 84148.,Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132
| | - Adi V Gundlapalli
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System, 500 Foothill Dr, Salt Lake City, UT 84148.,Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132
| | - Ying Suo
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System, 500 Foothill Dr, Salt Lake City, UT 84148.,Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132
| | - Warren B P Pettey
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System, 500 Foothill Dr, Salt Lake City, UT 84148.,Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132
| | - Emily Brignone
- VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA 15240
| | - David L Chin
- Department of Health Promotion and Policy, School of Public Health, University of Massachusetts Amherst, 715 N Pleasant St, Amherst, MA 01003
| | - Lauren E Walker
- David Grant USAF Medical Center, Clinical Investigation Facility, 101 Bodin Circle, Travis AFB, CA 94535
| | - Eduard A Poltavskiy
- David Grant USAF Medical Center, Clinical Investigation Facility, 101 Bodin Circle, Travis AFB, CA 94535
| | - Jud C Janak
- Department of Defense Joint Trauma System, Defense Health Agency, Joint Base San Antonio-Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234
| | - Jeffrey T Howard
- Department of Kinesiology, Health and Nutrition, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249
| | - Jonathan A Sosnov
- 375th Medical Group, Scott AFB, IL 62225.,Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814
| | - Ian J Stewart
- David Grant USAF Medical Center, Clinical Investigation Facility, 101 Bodin Circle, Travis AFB, CA 94535.,Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814
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Maynard C, Trivedi R, Nelson K, Fihn SD. Disability Rating, Age at Death, and Cause of Death in U.S. Veterans with Service-Connected Conditions. Mil Med 2019; 183:e371-e376. [PMID: 29590473 DOI: 10.1093/milmed/usy040] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/26/2018] [Indexed: 11/14/2022] Open
Abstract
Introduction The association between disability and cause of death in Veterans with service-connected disabilities has not been studied. The objective of this study was to compare age at death, military service and disability characteristics, including disability rating, and cause of death by year of birth. We also examined cause of death for specific service-connected conditions. Materials and methods This study used information from the VETSNET file, which is a snapshot of selected items from the Veterans Benefits Administration corporate database. We also used the National Death Index (NDI) for Veterans which is part of the VA Suicide Data Repository. In VETSNET, there were 758,324 Veterans who had a service-connected condition and died between the years 2004 and 2014. Using the scrambled social security number to link the two files resulted in 605,493 (80%) deceased Veterans. Age at death, sex, and underlying cause of death were obtained from the NDI for Veterans and military service characteristics and types of disability were acquired from VETSNET. We constructed age categories corresponding to period of service; birth years 1938 and earlier corresponded to Korea and World War II ("oldest"), birth years 1939-1957 to the Vietnam era ("middle"), and birth years 1958 and later to post Vietnam, Gulf War, and the more recent conflicts in Iraq and Afghanistan ("youngest"). Results Sixty-two percent were in the oldest age category, 34% in the middle group, and 4% in the youngest one. The overall age at death was 75 ± 13 yr. Only 1.6% of decedents were women; among women 25% were in the youngest age group, while among men only 4% were in the youngest group. Most decedents were enlisted personnel, and 60% served in the U.S. Army. Nearly 61% had a disability rating of >50% and for the middle age group 54% had a disability rating of 100%. The most common service-connected conditions were tinnitus, hearing loss, and post-traumatic stress disorder (PTSD). In the oldest group, nearly half of deaths were due to cancer or cardiovascular conditions and <2% were due to external causes. In the youngest group, cardiovascular disease and cancer accounted for about 1/3 of deaths, whereas external causes or deaths due to accidents, suicide, or assault accounted for nearly 33% of deaths. For Veterans with service-connected PTSD or major depression; 6.5% of deaths were due to external causes whereas for Veterans without these conditions, only 3.1% were due to external causes. Conclusion The finding of premature death due to external causes in the youngest age group as well as the finding of higher proportions of external causes in those with PTSD or major depression should be of great concern to those who care for Veterans.
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Affiliation(s)
- Charles Maynard
- Department of Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way Seattle, WA.,Department of Health Services, University of Washington, 1959 Pacific ST Seattle, WA
| | - Ranak Trivedi
- Department of Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152-MPD) Building 324, Menlo Park, CA.,Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry RD, Stanford, CA
| | - Karin Nelson
- Department of Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way Seattle, WA.,Department of Health Services, University of Washington, 1959 Pacific ST Seattle, WA.,Department of Medicine, University of Washington, 1959 Pacific ST Seattle, WA
| | - Stephan D Fihn
- Department of Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way Seattle, WA.,Department of Health Services, University of Washington, 1959 Pacific ST Seattle, WA.,Department of Medicine, University of Washington, 1959 Pacific ST Seattle, WA.,Department of Veterans Affairs Office of Clinical System Development and Evaluation, 915 2nd Avenue Seattle, WA
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11
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Fried DA, Passannante M, Helmer D, Holland BK, Halperin WE. The Health and Social Isolation of American Veterans Denied Veterans Affairs Disability Compensation. HEALTH & SOCIAL WORK 2017; 42:7-14. [PMID: 28395067 DOI: 10.1093/hsw/hlw051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 01/11/2016] [Indexed: 06/07/2023]
Abstract
Authors comparatively analyzed health and social isolation between U.S. military veterans denied Veterans Affairs (VA) disability compensation and veterans awarded VA disability compensation. The 2001 National Survey of Veterans was used to create a sample of 4,522 veterans denied or awarded VA disability compensation. Using the Andersen health services utilization model as a conceptual framework, multivariate logistic regression was applied to assess relationships between VA disability compensation award status, three separate domains of health, and correlates of social isolation. Results indicate that denied applicants were more likely than those awarded to have poor overall health (odds ratio [OR] = 1.45, 95% confidence interval [CI]: 1.23, 1.70), and limitations in activities of daily living (OR = 1.12, 95% CI: 1.03, 1.21). Denied applicants' physical functioning (40.3) and mental functioning (41.2) composite summary scores were not clinically different from those of awarded applicants (39.0 and 40.1, respectively), indicating that both were comparably impaired. Veterans denied VA disability compensation had poor health and functional impairments. They also experienced poverty and isolation, suggesting that they may be in need of additional supportive services. Connecting veterans to community resources could be a vital service to provide to all veterans applying for disability compensation.
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Affiliation(s)
- Dennis Adrian Fried
- Postdoctoral fellow, War Related Injury and Illness Study Center (WRIISC), U.S. Department of Veterans Affairs (VA), East Orange, NJ, USA
| | - Marian Passannante
- Professor, New Jersey Medical School, Rutgers, State University of New Jersey, Newark, USA
| | | | - Bart K Holland
- Professor, New Jersey Medical School, State University of New Jersey, Newark, USA
| | - William E Halperin
- professor, School of Public Health, Rutgers, State University of New Jersey, Newark, USA
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Vermetten E, Baker DG, Jetly R, McFarlane AC. Concerns Over Divergent Approaches in the Diagnostics of Posttraumatic Stress Disorder. Psychiatr Ann 2016. [DOI: 10.3928/00485713-20160728-02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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"I Want to Come Home": Vietnam-Era Veterans' Presenting for Mental Health Care, Roughly 40 Years After Vietnam. Psychiatr Q 2016; 87:229-39. [PMID: 26156261 DOI: 10.1007/s11126-015-9382-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There continues to be an increase in the number of Vietnam-era veterans receiving a diagnosis of PTSD in the Veterans Health Administration, nearly four decades after Vietnam. In the present study, our aim was to better understand what prompts Vietnam-era veterans to present to a VHA mental health clinic, and to determine the meaning of this experience for them. Participants were interviewed regarding the experiences that prompted their visit to the mental health clinic at a VA medical center. Ensuing narratives were analyzed via phenomenological qualitative methods. Findings revealed that veterans did not hold a clear and determinate understanding of "PTSD" prior to attending the mental health clinic. Their engagement was instead the culmination of a long process wherein trusted others (e.g., family, other veterans, primary care doctors) suggested that their difficulties may be indicative of a problematic pattern that required attention beyond the everyday ways of dealing with them. In general, veterans suffered from a longstanding experience of social rejection, abandonment, and even betrayal following the war, including pervasive stigmatizations and perceived "weaknesses," and their own preferences for self-reliance over inattentive social and governmental institutions. Many veterans were newly focused on renewing meaning and purpose in their lives. The findings suggest the need to build stronger bridges between the VA and veterans' community supports, who greatly influenced veterans' care seeking. Further efforts to welcome Vietnam-era veterans home, validate their experiences of rejection and abandonment, and respectfully process their ensuing pain and anger are warranted.
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Rosen MI, Ablondi K, Black AC, Mueller L, Serowik KL, Martino S, Mobo BH, Rosenheck RA. Work outcomes after benefits counseling among veterans applying for service connection for a psychiatric condition. Psychiatr Serv 2014; 65:1426-32. [PMID: 25082304 PMCID: PMC4713007 DOI: 10.1176/appi.ps.201300478] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study's objective was to determine the efficacy of benefits counseling in a clinical trial. There has been concern that disability payments for psychiatric disorders reduce incentives for employment and rehabilitation. Benefits counseling, with education about opportunities to work and the financial implications of work on receipt of disability benefits, may counter these disincentives. METHODS This single-blind, six-month randomized clinical trial enrolled 84 veterans who had applied for service-connected compensation for a psychiatric condition. Veterans were randomly assigned to either four sessions of benefits counseling or of a control condition involving orientation to the U.S Department of Veterans Affairs health care system and services. Days of paid work and work-related activities were assessed at follow-up visits by using a timeline follow-back calendar. RESULTS Veterans assigned to benefits counseling worked for pay for significantly more days than did veterans in the control group (effect size=.69, p<.05), reflecting an average of three more days of paid employment during the 28 days preceding the six-month follow-up. Benefits counseling was associated with increased use of mental health services, but this correlation did not mediate the effect of benefits counseling on working. CONCLUSIONS Barriers to employment associated with disability payments are remediable with basic counseling. More research is needed to understand the active ingredient of this counseling and to strengthen the intervention.
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Affiliation(s)
- Marc I Rosen
- Dr. Rosen, Ms. Ablondi, Dr. Black, Ms. Serowik, and Dr. Martino are with the Department of Psychiatry, Yale University School of Medicine, New Haven, and with the Department of Psychiatry, U.S. Department of Veterans Affairs (VA) Connecticut Healthcare System, West Haven (e-mail: ). Dr. Rosenheck is with the Department of Psychiatry, Yale University School of Medicine, and with the Mental Illness Research, Education and Clinical Center, VA New England Healthcare System, where Dr. Mueller is affiliated. Dr. Mueller is also with the Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts. Dr. Mobo is with the Christiana Care Health System, Newark, Delaware
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15
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Fisher MP. PTSD in the U.S. military, and the politics of prevalence. Soc Sci Med 2014; 115:1-9. [PMID: 24930003 DOI: 10.1016/j.socscimed.2014.05.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 05/27/2014] [Accepted: 05/29/2014] [Indexed: 10/25/2022]
Abstract
Despite the long-standing codification of posttraumatic stress disorder (PTSD) as a mental disorder, the diagnosis is a controversial one whose legitimacy is at times disputed, particularly in U.S. military contexts (e.g., McNally and Frueh 2013; McNally, 2003, 2007). These disputes often manifest in a struggle over prevalence rates. Utilizing data from in-depth interviews and relying on situational analysis methodology (Clarke, 2005), I highlight this struggle in the wake of a decade of U.S.-led war in Afghanistan and Iraq. I focus on the objects of contestation employed by public officials, veterans' advocates, and researchers to make or refute claims about PTSD prevalence. These objects of contestation include the diagnostic category and criteria; screening tools, procedures, or systems; and the individuals who express symptoms of the disorder. Based on these claims, I make two key interrelated assertions. First, PTSD is viewed by some public officials as an overly generalized or invalid diagnostic category that is often induced in or falsified by veterans or servicemembers. As such, PTSD is perceived by these stakeholders to be over-diagnosed. Compounding these perceptions are beliefs that PTSD is costly and negatively impacts military duty performance, and thus overall manpower. Second, there exist perceptions, largely on the part of veterans' advocates but also some public officials, that many servicemembers and veterans are not seeking treatment (and thus, a diagnosis) when they experience symptoms of PTSD. Thus, PTSD is perceived by these stakeholders to be under-diagnosed. Paradoxically, some public officials make both claims: that PTSD is over-diagnosed and under-diagnosed. I conclude by exploring the implications of these findings.
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Affiliation(s)
- Michael P Fisher
- University of California, San Francisco, Department of Social and Behavioral Sciences, 3333 California Street, Suite 455, San Francisco, CA 94118, USA.
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16
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Meshberg-Cohen S, Reid-Quiñones K, Black AC, Rosen MI. Veterans' attitudes toward work and disability compensation: associations with substance abuse. Addict Behav 2014; 39:445-8. [PMID: 24090622 DOI: 10.1016/j.addbeh.2013.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 08/18/2013] [Accepted: 09/03/2013] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Veterans deemed disabled for conditions resulting from, or aggravated by, their service in the military are eligible for service-connected disability payments. Despite many positive effects of disability payments, one concern is that Veterans with psychiatric conditions who receive disability payments are less likely to be employed compared to those who are denied benefits. Little is known about the attitudes of substance using Veterans, for whom work is a particularly important part of recovery, toward work and disability compensation. METHODS This study compared the responses of Veterans with (n=33) and without substance use problems (n=51) to questions about work's significance and its relationship to disability payments. T- and chi-square tests were conducted to determine if Veterans with substance use problems differed from the others on work-related attitudes and perceptions of the relation between work and Veterans' benefits. RESULTS Veterans endorsed high levels of agreement with statements that working would lead to loss of benefits. Veterans with substance use agreed more strongly that they would rather turn down a job offer than lose financial benefits. CONCLUSIONS The greater preference for disability payments among substance-using Veterans may reflect a realistic concern that they are particularly likely to have difficulty maintaining employment. The widespread concern among Veterans that work will lead to loss of VA disability payments is striking given the ambiguity about how likely loss of benefits actually is, and should be addressed during the service-connection application process.
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Affiliation(s)
- Sarah Meshberg-Cohen
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychiatry Department, 116A, West Haven, CT 06516, United States; Yale University School of Medicine, Department of Psychiatry, United States.
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Sayer NA, Spoont M, Murdoch M, Parker LE, Hintz S, Rosenheck R. A qualitative study of U.S. veterans' reasons for seeking Department of Veterans Affairs disability benefits for posttraumatic stress disorder. J Trauma Stress 2011; 24:699-707. [PMID: 22109077 DOI: 10.1002/jts.20693] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Posttraumatic stress disorder (PTSD) is the most prevalent compensable mental disorder within the U.S. Department of Veterans Affairs disability system and the number of veterans with PTSD service-connected disability has increased steadily over the past decade. An understanding of the reasons veterans apply for PTSD disability status may inform interpretation of this increase and policies and interventions to assist veterans with military-related PTSD. The authors conducted an exploratory qualitative study to describe the reasons veterans seek PTSD disability benefits and explored differences between those who served in different military service eras. They gathered data through in-depth interviews with 44 purposefully selected U.S. veterans, and conducted content analysis of transcribed interviews using inductive and deductive analysis with constant comparison. Participants described 5 interrelated categories of reasons for seeking PTSD disability benefits, including 3 internal factors (tangible need, need for problem identification or clarification, beliefs that justify/legitimize PTSD disability status) and 2 external factors (encouragement from trusted others and professional assistance). There were no major differences by service era. Findings may help policy makers, providers, and researchers understand what veterans hope to achieve through PTSD disability and the instrumental role of social networks and government systems in promoting the pursuit of PTSD disability status.
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Affiliation(s)
- Nina A Sayer
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, Minnesota 55417, USA.
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18
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Tal-Katz P, Araten-Bergman T, Rimmerman A. Israeli policy toward veterans with disabilities: a snapshot and insights of the proposed reform. JOURNAL OF SOCIAL WORK IN DISABILITY & REHABILITATION 2011; 10:232-46. [PMID: 22126141 DOI: 10.1080/1536710x.2011.622967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
The policy toward Israeli veterans with disabilities is based on the Invalids Law (Benefits and Rehabilitation) of 1949 . This legislation has served as the foundation for an intricate disability policy, providing benefits and psychosocial services for veterans with disabilities. Sixty two years later, in light of the emergence of a new social model and disability rights conceptualization, there is a need to reevaluate the current legislation and policy. In this article the authors present the essence of the current Israeli disability policy and explore the applications of a proposed reform aimed at adapting the disability policy and services to the new principles of the social model of disability.
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Affiliation(s)
- Patricia Tal-Katz
- The School of Social Work, Ariel University Center of Samaria, Israel
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McFarlane AC, Van Hooff M. Impact of childhood exposure to a natural disaster on adult mental health: 20-year longitudinal follow-up study. Br J Psychiatry 2009; 195:142-8. [PMID: 19648546 DOI: 10.1192/bjp.bp.108.054270] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Studies examining the impact of childhood disaster exposure on the development of adult psychopathology report increased rates of post-traumatic stress disorder (PTSD) and other psychopathology. AIMS To examine the rates of PTSD and other lifetime DSM-IV disorders in adults exposed to an Australian bushfire disaster as children in 1983 using a matched control sample recruited at the time of the original study. METHOD A total of 1011 adults recruited from an original sample of 1531 were assessed 20 years following the fires using the Composite International Diagnostic Interview (CIDI-2.1). RESULTS Results showed only a small direct impact of the fires on adult psychiatric morbidity. A higher proportion of bushfire survivors met criteria for 'any DSM-IV disorder' and ;any anxiety'. CONCLUSIONS Findings suggest that the long-term impact of a prominent trauma in childhood should be assessed in the context of other lifetime trauma in order to provide a more accurate account of PTSD prevalence rates.
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Affiliation(s)
- Alexander C McFarlane
- Dip Psychother, Centre for Military and Veterans' Health, Adelaide, South Australia 5000, Australia.
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Sayer NA, Spoont M, Nelson DB, Clothier B, Murdoch M. Changes in psychiatric status and service use associated with continued compensation seeking after claim determinations for posttraumatic stress disorder. J Trauma Stress 2008; 21:40-8. [PMID: 18302170 DOI: 10.1002/jts.20309] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study examined changes in psychiatric status and use of VA mental health services after the adjudication of Department of Veterans Affairs (VA) disability claims for posttraumatic stress disorder (PTSD) in a sample of 101 veteran claimants. Hypotheses were based on the premise that the claims process may create incentives for veterans to demonstrate illness. After the PTSD claim determination, half the sample had filed or planned to file a claim for a rating increase or an appeal and thus remained compensation seeking. Contradicting the authors' hypotheses, psychiatric status did not improve and treatment drop-out rates did not increase among veterans who were no longer compensation seeking after the claim determination. Results have implications for the design and direction of future research.
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Affiliation(s)
- Nina A Sayer
- Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, MN 55417, USA.
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21
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Frueh BC, Grubaugh AL, Elhai JD, Buckley TC. US Department of Veterans Affairs disability policies for posttraumatic stress disorder: administrative trends and implications for treatment, rehabilitation, and research. Am J Public Health 2007; 97:2143-5. [PMID: 17971542 DOI: 10.2105/ajph.2007.115436] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
An accumulating body of empirical data suggests that current Department of Veterans Affairs (VA) psychiatric disability and rehabilitation policies for combat-related posttraumatic stress disorder (PTSD) are problematic. In combination, recent administrative trends and data from epidemiological and clinical studies suggest theses policies are countertherapeutic and hinder research efforts to advance our knowledge regarding PTSD. Current VA disability policies require fundamental reform to bring them into line with modern science and medicine, including current empirically supported concepts of resilience and psychiatric rehabilitation.
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Sayer NA, Clothier B, Spoont M, Nelson DB. Use of mental health treatment among veterans filing claims for posttraumatic stress disorder. J Trauma Stress 2007; 20:15-25. [PMID: 17345650 DOI: 10.1002/jts.20182] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study examines predictors of current mental health service use in a sample of 154 veterans filing claims for Veterans Affairs (VA) disability benefits based on Posttraumatic Stress Disorder (PTSD). Our conceptual framework was the behavioral model that classifies predictors of service utilization into predisposing (background), enabling (e.g., insurance) and need (e.g., symptoms) factors. Slightly more than half of the PTSD claimants were receiving mental health treatment at the time of claim initiation. Mean symptom levels were clinically significant in both users and nonusers of mental health treatment. In a multivariate logistic regression analysis, mental health treatment use was associated with younger age, marriage, and dependence on public insurance. Implications for future research are discussed.
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Affiliation(s)
- Nina A Sayer
- Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, MN 55417, USA.
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Benyamini Y, Solomon Z. Combat stress reactions, posttraumatic stress disorder, cumulative life stress, and physical health among Israeli veterans twenty years after exposure to combat. Soc Sci Med 2005; 61:1267-77. [PMID: 15970236 DOI: 10.1016/j.socscimed.2005.01.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2004] [Accepted: 01/25/2005] [Indexed: 10/25/2022]
Abstract
This study examined the association of initial combat stress reaction (CSR), chronic post-traumatic stress disorder (PTSD) and cumulative life stress on physical health 20 years after the 1982 war with Lebanon, in a sample of 504 Israeli veterans of the war. Two groups were assessed: male veterans who fought and suffered from CSR and a matched group of male veterans from the same units who did not exhibit such reactions. Twenty years following the war, participants were asked to rate their general physical health status, report health complaints and risk behaviors, and were screened for PTSD. CSR and, to a greater extent, PTSD, were found to be associated with general self-rated health, chronic diseases and physical symptoms, and greater engagement in risk behaviors. CSR and PTSD were also related to greater cumulative life stress since the war. Both negative and positive life events were independently related to most of the physical health measures but did not account for the associations of CSR and PTSD with poorer health. Tests of the interactions between CSR, PTSD and life stress in their association with physical health and risk behaviors showed that PTSD suppressed the effects of additional life stress (negative life events had a weaker effect on health among participants with PTSD).
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Affiliation(s)
- Yael Benyamini
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv 69978, Israel.
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Sayer NA, Spoont M, Nelson DB, Nugent S. Development and psychometric properties of the disability application appraisal inventory. Psychol Assess 2004; 16:192-6. [PMID: 15222816 DOI: 10.1037/1040-3590.16.2.192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article describes the development and psychometric properties of an inventory to assess cognitive appraisal of the Department of Veterans Affairs (VA) disability application process, the Disability Application Appraisal Inventory (DAAI). Participants were 439 veterans seeking disability status for posttraumatic stress disorder through the VA and subgroups from that sample. The 3 DAAI scales assess (a) understanding of the disability application process (Knowledge scale) (b) expectations specific to the process (Negative Expectations scale) and (c) investment in obtaining disability status (Importance scale). The scales are internally consistent and largely uncorrelated. Test-retest correlations are adequate for the Negative Expectations and Importance scales. Evidence of factorial and construct validity is presented.
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Affiliation(s)
- Nina A Sayer
- Center for Chronic Disease Outcomes Research, Veterans Affairs (VA) Medical Center, Minneapolis, MN, USA.
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