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Shaw R, Pengelly C, Crinnin C, Amina E, Wutz AV, King PR. Scoping review of the role of social support in women veterans' psychosocial and health outcomes. J Women Aging 2024:1-25. [PMID: 39252402 DOI: 10.1080/08952841.2024.2395111] [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: 10/31/2023] [Revised: 06/04/2024] [Accepted: 07/16/2024] [Indexed: 09/11/2024]
Abstract
Women veterans are a steadily growing population and have unique military experiences (e.g., report high rates of sexual harassment and assault) that are impactful across the lifespan. High levels of positive social support have been linked to a range of positive outcomes in both civilian and military populations. However, research has not consistently explored social support and interpersonal functioning in women veterans, or as potential mechanisms of change within interventions for women veterans. This is a scoping review of peer-reviewed articles that evaluated social support. Articles with at least 10% women or formally evaluated sex or gender in reference to social support were included. A total of 69 studies evaluated social support in relation to women veterans' health outcomes. From a biopsychosocial perspective, social support is an important construct to examine relative to health care engagement and response. Limited research considered aging women veterans needs or focused on the intersectional identities of women veterans. Positive social support can have major physical and mental health benefits, yet limited research and disparate methodological approaches minimize the ability to draw conclusions on how social support can best be leveraged to support women veterans. Women veterans' roles and military experiences (e.g., increased likelihood of combat exposure) are changing and this population is aging. Research is needed to inform best practices for this growing segment of the veteran population.
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Affiliation(s)
- Rachael Shaw
- VA Center for Integrated Healthcare, Buffalo, New York, USA
- Department of Psychology, University at Buffalo, Buffalo, New York, USA
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Charlotte Crinnin
- VA Center for Integrated Healthcare, Buffalo, New York, USA
- School of Education & Human Services, Canisius College, Buffalo, New York, USA
| | - Evodie Amina
- VA Center for Integrated Healthcare, Buffalo, New York, USA
- School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | | | - Paul R King
- VA Center for Integrated Healthcare, Buffalo, New York, USA
- Department of Rehabilitation Science, University at Buffalo, Buffalo, New York, USA
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Mattocks KM, Shenette LL, Walker L, Maher N, Haskell S. Understanding Women's Transitions from Military to Department of Veterans Affairs Care. J Womens Health (Larchmt) 2024; 33:1185-1197. [PMID: 38836756 DOI: 10.1089/jwh.2024.0022] [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: 06/06/2024] Open
Abstract
Background: Over the past two decades, increasing numbers of women have served in the military, with women now comprising 17.3% of active-duty personnel and 21.4% of National Guard and reserves. During military service, women often incur painful musculoskeletal (MSK) injuries related to carrying heavy loads and wearing ill-fitting gear. While women may receive initial care for these injuries under the auspices of the Department of Defense (DoD), these injuries often linger and further treatment in required as women transition to Department of Veterans Affairs (VA) care. However, little is known about this transition process, and whether women are given adequate information and support regarding how to access VA care after their military service has ended. Research Design: To better understand these issues, we interviewed 65 women veterans with military service-related MSK injuries about their transition from DoD to VA care. Results: Six major themes emerged from the interviews. Those themes were: (1) Military injuries are often related to ill-fitting gear or carrying heavy loads; (2) Stigma/discrimination related to military injuries; (3) Limited assistance with transition between DoD and VA to manage ongoing injuries and pain; (4) Women have a difficult time managing perceptions and expectations of their weight after military service; (5) Childcare is a substantial burden for veterans in self-care; and (6) veterans desire peer-support services to help them stay healthy. Conclusions: Based on these findings, DoD and VA should continue to work together to develop programs to educate and support women as they transition from military to VA care. Furthermore, VA should consider developing peer support programs for women Veterans who may require additional support to maintain health, especially among Veteran mothers who have complex family responsibilities that may limit their ability to focus on their own health.
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Affiliation(s)
- Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Lisa L Shenette
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
| | - Lorrie Walker
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
| | - Nancy Maher
- Department of Veterans Affairs, Washington, District of Columbia, USA
| | - Sally Haskell
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Veterans Affairs, Washington, District of Columbia, USA
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Patel M, Jomy J, Couban RJ, Scelleur HL, Busse JW. Transition Needs Among Veterans Living With Chronic Pain: A Systematic Review. Mil Med 2024; 189:556-565. [PMID: 37675856 DOI: 10.1093/milmed/usad363] [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: 05/03/2023] [Revised: 08/07/2023] [Accepted: 09/01/2023] [Indexed: 09/08/2023] Open
Abstract
INTRODUCTION A third of Canadian Armed Forces veterans report difficulty adjusting to post-military life. Moreover, an estimated 40% of Canadian veterans live with chronic pain, which is likely associated with greater needs during the transition from military to civilian life. This review explores challenges and transition needs among military personnel living with chronic pain as they return to civilian life. METHODS We searched MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science from inception to July 2022, for qualitative, observational, and mixed-method studies exploring transition needs among military veterans released with chronic pain. Reviewers, working independently and in duplicate, conducted screening and used a standardized and pilot-tested data collection form to extract data from all included studies. Content analysis was used to create a coding template to identify patterns in challenges and unmet needs of veterans transitioning to civilian life, and we summarized our findings in a descriptive manner. RESULTS Of 10,532 unique citations, we identified 43 studies that reported transition challenges and needs of military personnel; however, none were specific to individuals released with chronic pain. Most studies (41 of 43; 95%) focused on military personnel in general, with one study enrolling individuals with traumatic brain injury and another including homeless veterans. We identified military-to-civilian challenges in seven areas: (1) identity, (2) interpersonal interactions/relationships, (3) employment, (4) education, (5) finances, (6) self-care and mental health, and (7) accessing services and care. CONCLUSIONS Military personnel who transition to civilian life report several important challenges; however, the generalizability to individuals released with chronic pain is uncertain. Further research is needed to better understand the transition experiences of veterans with chronic pain to best address their needs and enhance their well-being.
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Affiliation(s)
- Mansi Patel
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario L8S 4L8, Canada
- Michael G. DeGroote National Pain Centre, McMaster University, MDCL-2101, Hamilton, Ontario L8S 4L8, Canada
| | - Jane Jomy
- Temerty Faculty of Medicine, University of Torontor, Toronto, Ontario M5S 1A8, Canada
| | - Rachel J Couban
- Michael G. DeGroote National Pain Centre, McMaster University, MDCL-2101, Hamilton, Ontario L8S 4L8, Canada
| | - Hélène Le Scelleur
- Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario L8S 4L8, Canada
- Michael G. DeGroote National Pain Centre, McMaster University, MDCL-2101, Hamilton, Ontario L8S 4L8, Canada
- Department of Anesthesia, Faculty of Health Sciences, McMaster University, Hamilton, Ontario L8S 4L8, Canada
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Rohs CM, Albright KR, Monteith LL, Lane AD, Fehling KB. Perspectives of VA healthcare from rural women veterans not enrolled in or using VA healthcare. PLoS One 2023; 18:e0289885. [PMID: 37578986 PMCID: PMC10424869 DOI: 10.1371/journal.pone.0289885] [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: 01/12/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023] Open
Abstract
PURPOSE Women Veterans have unique healthcare needs and often experience comorbid health conditions. Despite this, many women Veterans are not enrolled in the Veterans Health Administration (VHA) and do not use VHA services. Underutilization of VHA services may be particularly prevalent among rural women Veterans, who may experience unique barriers to using VHA care. Nonetheless, knowledge of rural women Veterans and their experiences remains limited. We sought to understand rural women Veterans' perceptions and needs related to VHA healthcare, including barriers to enrolling in and using VHA services, and perspectives on how to communicate with rural women Veterans about VHA services. METHODS Rural women Veterans were recruited through community engagement with established partners and a mass mailing to rural women Veterans not enrolled in or using VHA healthcare. Ten virtual focus groups were conducted with a total of twenty-nine rural women Veterans (27 not enrolled in VHA care and 2 who had not used VHA care in the past 5 years) in 2021. A thematic inductive analytic approach was used to analyze focus group transcripts. FINDINGS Primary themes regarding rural women Veterans' perceptions of barriers to enrollment and use of VHA healthcare included: (1) poor communication about eligibility and the process of enrollment; (2) belief that VHA does not offer sufficient women's healthcare services; and (3) inconvenience of accessing VHA facilities. CONCLUSION Although VHA has substantially expanded healthcare services for women Veterans, awareness of such services and the nuances of eligibility and enrollment remains an impediment to enrolling in and using VHA healthcare among rural women Veterans. Recommended strategies include targeted communication with rural women Veterans not enrolled in VHA care to increase their awareness of the enrollment process, eligibility, and expansion of women's healthcare services. Creative strategies to address access and transportation barriers in rural locations are also needed.
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Affiliation(s)
- Carly M. Rohs
- Seattle-Denver Center for Innovation (COIN), Rocky Mountain Regional VA Medical Center, Aurora, Colorado, United States of America
- VA Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado, United States of America
| | - Karen R. Albright
- Seattle-Denver Center for Innovation (COIN), Rocky Mountain Regional VA Medical Center, Aurora, Colorado, United States of America
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Lindsey L. Monteith
- VA Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado, United States of America
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Amber D. Lane
- Seattle-Denver Center for Innovation (COIN), Rocky Mountain Regional VA Medical Center, Aurora, Colorado, United States of America
| | - Kelty B. Fehling
- Seattle-Denver Center for Innovation (COIN), Rocky Mountain Regional VA Medical Center, Aurora, Colorado, United States of America
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Glorieux V, Lo Bue S, Euwema M. Reintegration of crisis services employees: a systematic literature review. JOURNAL OF GLOBAL MOBILITY: THE HOME OF EXPATRIATE MANAGEMENT RESEARCH 2023. [DOI: 10.1108/jgm-06-2022-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
PurposeCrisis services personnel are frequently deployed around the globe under highly demanding conditions. This raises the need to better understand the deployment process and more especially, sustainable reintegration after deployment. Despite recent research efforts, the study of the post-deployment stage, more specifically the reintegration process, remains fragmented and limited. To address these limitations, this review aims at (1) describing how reintegration is conceptualised and measured in the existing literature, (2) identifying what dimensions are associated with the reintegration process and (3) identifying what we know about the process of reintegration in terms of timing and phases.Design/methodology/approachFollowing the preferred reporting items for systematic reviews and meta-analyses (PRISMA) protocol, the authors identified 5,859 documents across several scientific databases published between 1995 and 2021. Based on predefined eligibility criteria, 104 documents were yielded.FindingsResearch has primarily focused on descriptive studies of negative individual and interpersonal outcomes after deployment. However, this review indicates that reintegration is dynamic, multi-sector, multidimensional and dual. Each of its phases and dimensions is associated with distinct challenges.Originality/valueTo the authors’ knowledge, this is the first research that investigates reintegration among different crisis services and provides an integrative social-ecological framework that identifies the different dimensions and challenges of this process.
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Lake KN, Ferber L, Kilby DJ, Mourtada H, Pushpanadh S, Verdeli H. Qualitative Study Examining Perceived Stigma and Barriers to Mental Health Care Among Student Veterans. JOURNAL OF VETERANS STUDIES 2022. [DOI: 10.21061/jvs.v8i3.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Graham K, Murphy D, Hendrikx LJ. Exploring Barriers to Mental Health Treatment in the Female Veteran Population: A Qualitative Study. JOURNAL OF VETERANS STUDIES 2022. [DOI: 10.21061/jvs.v8i3.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Mattocks KM, Kroll-Desrosiers A, Marteeny V, Walker L, Vogt D, Iversen KM, Bastian L. Veterans' Perinatal Care and Mental Health Experiences During the COVID-19 Pandemic: An Examination of the Role of Prior Trauma and Pandemic-Related Stressors. J Womens Health (Larchmt) 2022; 31:1507-1517. [PMID: 35230179 DOI: 10.1089/jwh.2021.0209] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Many pregnant and postpartum Veterans have experienced multiple lifetime traumas, including military sexual trauma, intimate partner violence, and combat trauma. These women may be particularly vulnerable to increased post-traumatic stress disorder and other mental health problems following additional trauma exposures or stressful events, such as Coronavirus disease 2019 (COVID-19). This study sought to examine the impact of prior trauma exposures on the lived experience of pregnant and postpartum Veterans during the COVID-19 pandemic. Materials and Methods: Pregnant Veterans at 15 VA medical centers were surveyed at 20 weeks of pregnancy and 3 months postpartum asked about their COVID-19-related perinatal and mental health experiences, as well as the stressors that impacted them as a result of the COVID-19 pandemic. Results: Overall, 111 women Veterans completed both the pregnancy and postpartum surveys that included COVID-19 items. Sixty percent of our sample had experienced at least one potentially traumatic lifetime event, with 22% of our sample experiencing two or more of the included exposures. Women with a trauma history had 3.5 times increased odds of reporting their mental health as "much worse" compared to before the COVID-19 pandemic (95% confidence interval [CI]: 1.06-11.75) and were more likely to report that COVID-19 negatively affected their mental or emotional health "a lot" compared with women without a trauma history (odds ratio: 8.5; 95% CI: 1.93-37.48). Conclusions: COVID-19 has had a significant impact on pregnant and postpartum Veterans' mental health. Obstetricians should consider strategies to ensure women have access to mental health care during pregnancy, especially as the COVID-19 pandemic continues. Hospitals should also consider the importance of labor support companions during the COVID-19 pandemic and examine adjusting policies to allow for at least one labor support companion during labor and delivery.
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Affiliation(s)
- Kristin M Mattocks
- Department of Research, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
- UMass Chan Medical School, Department of Population and Quantitative Health Sciences (PQHS), Worcester, Massachusetts, USA
| | - Aimee Kroll-Desrosiers
- Department of Research, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
- UMass Chan Medical School, Department of Population and Quantitative Health Sciences (PQHS), Worcester, Massachusetts, USA
| | - Valerie Marteeny
- Department of Research, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
| | - Lorrie Walker
- Department of Research, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
| | - Dawne Vogt
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Jamaica Plains, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Katherine M Iversen
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Jamaica Plains, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lori Bastian
- Pain Research, Informatics, Multimorbidities, and Education (PRIME), VA Connecticut Healthcare System, West Haven, CT, USA
- Department of General Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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Holzhauer CG, Epstein EE, Bickar L, Ellis RA, Pole N, Sofuoglu M, Smelson DA, Mattocks K. Pilot examination of stress, heart rate variability, and alcohol craving and use among female veterans. Front Psychiatry 2022; 13:886801. [PMID: 36159929 PMCID: PMC9500469 DOI: 10.3389/fpsyt.2022.886801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Rates of alcohol use disorder (AUD) are increasing among civilian and veteran populations of women in the United States, and stress pathophysiology (i.e., abnormal acute and long-term change in physiological responses to stress) is central to the maintenance of alcohol misuse within this population. Heart rate variability (HRV) is one measure of stress regulation that may help to explain the association of stress with alcohol misuse among women. In the current analysis of pilot data, 20 women veterans attended an in-person laboratory session and completed 35 daily assessments of their alcohol use and craving. During the lab session, the effects of a stress induction procedure on self-reported alcohol craving and HRV were assessed. HRV was continuously measured and indexed in the time domain, using the root mean square of successive differences between normal heartbeats (RMSSD). Alcohol craving and use during the longitudinal 35-day study period were measured via self-report questionnaires sent to participants' phones. Results indicated that resting HRV in the lab was positively associated with odds of daily craving. Moreover, HRV during the stressor, as measured in lab, was positively associated with (1) overall alcohol craving in the lab (i.e., with resting and post-stress craving), and (2) number of daily drinks during the 35-day study period. This pilot study suggests the potential role of HRV in response to stressors in predicting alcohol craving and use among female veterans. It provides pilot data for research on stress-reactive HRV as a biomarker for alcohol misuse among women, and discusses directions for future research.
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Affiliation(s)
- Cathryn Glanton Holzhauer
- VA Central Western Massachusetts, Division of Research and Education, Leeds, MA, United States
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, United States
| | - Elizabeth E. Epstein
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, United States
| | - Laurel Bickar
- VA Central Western Massachusetts, Division of Research and Education, Leeds, MA, United States
| | - Robyn A. Ellis
- VA Central Western Massachusetts, Division of Research and Education, Leeds, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, United States
| | - Nnamdi Pole
- Department of Psychology, Smith College, Northampton, MA, United States
| | - Mehmet Sofuoglu
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, United States
- Department of Psychiatry, Yale University School of Medicine, West Haven, CT, United States
| | - David A. Smelson
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, United States
| | - Kristin Mattocks
- VA Central Western Massachusetts, Division of Research and Education, Leeds, MA, United States
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Bommersbach TJ, Rosenheck R, Rhee TG. Transgenerational Factors Associated With Military Service: Comparison of Children of Veterans and Nonveterans in a Nationally Representative Sample. J Am Acad Child Adolesc Psychiatry 2022; 61:1141-1154. [PMID: 35367608 DOI: 10.1016/j.jaac.2022.03.024] [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: 08/16/2021] [Revised: 12/13/2021] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE While the psychological effects of military service on the children of active-duty personnel have been studied extensively, little is known about the potential effects of military service for children of veterans after service has ended. METHOD Using nationally representative data from the 2018-2019 National Survey of Children's Health, school-age children of veteran families (n = 4,028) were compared with children of nonveteran families (n = 38,228). Owing to large sample sizes, effect sizes (relative risk and Cohen's d), rather than p values, were used to identify substantial differences in caregiver-reported sociodemographic, clinical, and school performance factors between children and caregivers in families with and without a veteran caregiver. Multivariate analyses were used to adjust for socioeconomic factors that could increase health service use. RESULTS Children of veteran families were more likely to have higher family incomes, health insurance, and married caregivers, but were also reported to have higher rates of clinically recognized externalizing behavioral conditions (attention-deficit disorder/attention-deficit/hyperactivity disorder or conduct disorder) (17.6% vs 12.7%; relative risk 1.42; 95% CI 1.21-1.66) and adverse childhood experiences; no substantial differences were reported in clinically recognized anxiety or depression. After adjustment for potentially confounding factors, children in veteran families were still more likely to be reported to have externalizing problems (odds ratio 1.34; 95% CI 1.02-1.77). CONCLUSION After adjustment for socioeconomic advantages that may increase health service use, children of veteran families demonstrate substantially higher rates of clinically recognized externalizing problems. While explanations for this require further study, service systems working with veterans may consider integrating child-focused screening/services.
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Affiliation(s)
| | - Robert Rosenheck
- Yale University School of Medicine, New Haven, Connecticut; US Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, Connecticut
| | - Taeho Greg Rhee
- Yale University School of Medicine, New Haven, Connecticut; US Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, Connecticut; University of Connecticut School of Medicine, Farmington, Connecticut
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Lopez CM, Gilmore AK, Brown WJ, Hahn CK, Muzzy W, Grubaugh A, Acierno R. Effects of Emotion Dysregulation on Post-treatment Post-traumatic Stress Disorder and Depressive Symptoms Among Women Veterans With Military Sexual Trauma. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP13143-NP13161. [PMID: 33775153 DOI: 10.1177/08862605211005134] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Military sexual trauma (MST), defined as sexual assault or repeated, threatening sexual harassment while in the military, is associated with increased risk of long-term mental and physical health problems, with the most common being symptoms of post-traumatic stress disorder (PTSD) and depression. In addition to PTSD and depression, MST is linked to difficulties in emotion regulation as well as poor treatment engagement. Thus, it is important to examine these correlates, and how they affect postintervention symptom reduction in this vulnerable population. The current study presents secondary data analyses from a randomized clinical trial comparing the efficacy of in-person versus telemedicine delivery of prolonged exposure therapy for female veterans with MST-related PTSD (n = 151). Results of the study found that changes in difficulties with emotion regulation predicted postintervention depressive symptoms but not postintervention PTSD symptoms. Neither postintervention depressive nor PTSD symptoms were affected by treatment dosing (i.e., number of sessions attended) nor treatment condition (i.e., in-person vs. telemedicine). Findings from the current study provide preliminary evidence that decreases in difficulties with emotion regulation during PTSD treatment are associated with decreases in depressive symptom severity.
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Affiliation(s)
| | | | | | | | - Wendy Muzzy
- Medical University of South Carolina, Charleston, SC, USA
| | - Anouk Grubaugh
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Ron Acierno
- University of Texas Health Sciences Center at Houston, TX, USA
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Creech SK, Kroll‐Desrosiers A, Benzer JK, Pulverman CS, Mattocks K. The impact of military sexual trauma on parent-infant bonding in a sample of perinatal women veterans. Depress Anxiety 2022; 39:201-210. [PMID: 34633137 PMCID: PMC9044465 DOI: 10.1002/da.23218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/23/2021] [Accepted: 09/25/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The experience of sexual assault and harassment during military service (military sexual trauma [MST]) is associated with increased risk for perinatal and reproductive health problems among women veterans. The objective of this study was to examine the associations between mothers' MST exposure and mother-infant bonding, as well as to examine whether there are any salient sociodemographic or military service characteristics among women veterans with greater impairment to mother-infant bonding, including stress during pregnancy and posttraumatic stress disorder (PTSD) diagnosis. METHODS This study was a secondary analysis of data collected from prospective, longitudinal study of women veterans using VHA maternity care benefits at 15 VHA medical centers across the US between January 2016 and February 2020. Participants were 697 pregnant veterans using VHA maternity care benefits. RESULTS MST was associated with higher maternal depression, and higher maternal depression was associated with poorer mother-infant bonding. The effect of MST on bonding was indirect through depression. PTSD diagnosis and life stressors during pregnancy also had significant indirect pathways with bonding through maternal depression. CONCLUSIONS Results underscore the need for access to high quality and trauma-informed perinatal mental health treatment for women veterans, for education on the unique risks conveyed by MST provided to civilian providers treating this population outside VA, and for further research to understand how to ameliorate the harmful effects of MST on perinatal women veterans and their children.
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Affiliation(s)
- Suzannah K. Creech
- VHA VISN 17 Center of Excellence for Research on Returning War Veterans and the Central Texas Veterans Health Care SystemWacoTexasUSA,Department of Psychiatry and Behavioral SciencesDell Medical School of the University of Texas at AustinAustinTexasUSA
| | - Aimee Kroll‐Desrosiers
- VA Central Western Massachusetts Healthcare SystemLeedsMassachusettsUSA,Departments of Population and Quantitative Health Sciences and PsychiatryUniversity of Massachusetts Medical SchoolWorcesterMassachusettsUSA
| | - Justin K. Benzer
- VHA VISN 17 Center of Excellence for Research on Returning War Veterans and the Central Texas Veterans Health Care SystemWacoTexasUSA,Department of Psychiatry and Behavioral SciencesDell Medical School of the University of Texas at AustinAustinTexasUSA
| | - Carey S. Pulverman
- VHA VISN 17 Center of Excellence for Research on Returning War Veterans and the Central Texas Veterans Health Care SystemWacoTexasUSA,Department of Psychiatry and Behavioral SciencesDell Medical School of the University of Texas at AustinAustinTexasUSA
| | - Kristin Mattocks
- VA Central Western Massachusetts Healthcare SystemLeedsMassachusettsUSA,Departments of Population and Quantitative Health Sciences and PsychiatryUniversity of Massachusetts Medical SchoolWorcesterMassachusettsUSA
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McBain SA, Garneau-Fournier J, Turchik JA. The Relationship Between Provider Gender Preferences and Perceptions of Providers Among Veterans Who Experienced Military Sexual Trauma. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP2868-NP2890. [PMID: 32741237 DOI: 10.1177/0886260520944536] [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: 06/11/2023]
Abstract
Previous research has demonstrated that most veterans who have experienced military sexual trauma (MST) have provider gender preferences. Although provider gender mismatch, defined as not receiving a provider of the gender of one's preference, may deter veterans from disclosing MST or seeking MST-related care, there is little research that has examined this issue. The current study aimed to explore how provider gender mismatch is related to veterans' comfort with providers, perception of their providers' competency, and their endorsement of perceived provider barriers when communicating about MST. The current study was conducted as part of a larger national survey of veterans' barriers to accessing MST-related care. Participants in the study were identified using Veterans Health Administration (VHA) administrative data. Criteria for inclusion in the overall study were being enrolled in VHA health care, having screened positive for MST, and having received at least one VHA outpatient service. A subset of eligible veterans who had endorsed MST, reported a provider gender preference, and endorsed discussing MST with a VHA provider (N = 1,591) were included in the current study. Results demonstrated that provider gender preference mismatch was associated with greater endorsement of perceived provider barriers, less comfort with providers, and lower perceived provider competency in women; and greater perceived provider barriers and less comfort with providers among men. The study demonstrates that provider gender preferences may affect care for veterans who have experienced MST, and that the impact may differ for men and women. These findings may be used to improve patient-centered care and inform future research regarding veterans' provider gender preferences.
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Affiliation(s)
- Sacha A McBain
- Palo Alto University, CA, USA
- VA Palo Alto Health Care System, Menlo Park, CA, USA
- University of Arkansas for Medical Sciences, Little Rock, USA
| | - Jade Garneau-Fournier
- Palo Alto University, CA, USA
- VA Palo Alto Health Care System, Menlo Park, CA, USA
- University of Central Florida, Orlando, USA
| | - Jessica A Turchik
- VA Palo Alto Health Care System, Menlo Park, CA, USA
- Stanford University, CA, USA
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14
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Trego LL, Wilson C. A Social Ecological Model for Military Women's Health. Womens Health Issues 2021; 31 Suppl 1:S11-S21. [DOI: 10.1016/j.whi.2020.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 12/08/2020] [Accepted: 12/23/2020] [Indexed: 11/30/2022]
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15
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McKenzie V, Anderson EH, Maydon A, Shivakumar G. Resiliency and Posttraumatic Growth Following Sexual Trauma in Women
Veterans of Iraq and Afghan Wars. JOURNAL OF VETERANS STUDIES 2021. [DOI: 10.21061/jvs.v7i2.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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16
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Buckley M. Empowering Female [Student] Veterans through Community Writing and
Experiential Learning in the Classroom. JOURNAL OF VETERANS STUDIES 2021. [DOI: 10.21061/jvs.v7i2.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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17
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Gaffey AE, Burg MM, Rosman L, Portnoy GA, Brandt CA, Cavanagh CE, Skanderson M, Dziura J, Mattocks KM, Bastian LA, Haskell SG. Baseline Characteristics from the Women Veterans Cohort Study: Gender Differences and Similarities in Health and Healthcare Utilization. J Womens Health (Larchmt) 2021; 30:944-955. [PMID: 33439756 PMCID: PMC8290312 DOI: 10.1089/jwh.2020.8732] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction: With the unprecedented expansion of women's roles in the U.S. military during recent (post-9/11) conflicts in Iraq and Afghanistan, the number of women seeking healthcare through the Veterans Health Administration (VHA) has increased substantially. Women Veterans often present as medically complex due to multiple medical, mental health, and psychosocial comorbidities, and consequently may be underserved. Thus, we conducted the nationwide Women Veterans Cohort Study (WVCS) to examine post-9/11 Veterans' unique healthcare needs and to identify potential disparities in health outcomes and care. Methods: We present baseline data from a comprehensive questionnaire battery that was administered from 2016 to 2019 to a national sample of post-9/11 men and women Veterans who enrolled in Veterans Affairs care (WVCS2). Data were analyzed for descriptives and to compare characteristics by gender, including demographics; health risk factors and symptoms of cardiovascular disease, chronic pain, and mental health; healthcare utilization, access, and insurance. Results: WVCS2 included 1,141 Veterans (51% women). Women were younger, more diverse, and with higher educational attainment than men. Women also endorsed lower traditional cardiovascular risk factors and comorbidities (e.g., weight, hypertension) and greater nontraditional cardiovascular risk factors (e.g., trauma, psychological symptoms). More women reported single-site pain (e.g., neck, stomach, pelvic) and multisite pain, but did not differ from men in posttraumatic stress disorder (PTSD) symptoms or treatment for PTSD. Women seek care at VHA medical centers more frequently, often combined with outside health services, but do not significantly differ from men in their insurance coverage. Conclusion: Overall, this investigation indicates substantial variation in risk factors, health outcomes, and healthcare utilization among post-9/11 men and women Veterans. Further research is needed to determine best practices for managing women Veterans in the VHA healthcare system.
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Affiliation(s)
- Allison E. Gaffey
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Internal Medicine (Cardiovascular Medicine), Yale School of Medicine, New Haven, Connecticut, USA
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Matthew M. Burg
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Internal Medicine (Cardiovascular Medicine), Yale School of Medicine, New Haven, Connecticut, USA
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lindsey Rosman
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Galina A. Portnoy
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Cynthia A. Brandt
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Casey E. Cavanagh
- Department of Psychiatry and Neurobehavioral Sciences, Charlottesville, Virginia, USA
| | | | - James Dziura
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kristin M. Mattocks
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Research and Development, VA Central Western Massachusetts and Department of Quantitative Health Science, University of Massachusetts Medical School, Leeds, Massachusetts, USA
| | - Lori A. Bastian
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Internal Medicine (General), Yale School of Medicine, New Haven, Connecticut, USA
| | - Sally G. Haskell
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Internal Medicine (General), Yale School of Medicine, New Haven, Connecticut, USA
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18
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Roche R, Manzi J, Bard K. A Patient-Centered Study Examining Self-Identification of Mental Health Challenges Among Female Military Officers. J Patient Cent Res Rev 2021; 8:134-139. [PMID: 33898646 PMCID: PMC8060039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Due to the expansion of leadership roles in the military for women, female military personnel now face stressors equal to, and yet unique from, their male counterparts. This pilot study surveyed 73 female U.S. Army officers regarding their experiences of leadership and mental wellness within the military. A mixed-methods survey was distributed via 2 private Facebook groups for female Army officers following an anonymized convenience sampling. This anonymous, patient-centered protocol was used to protect against known stigma surrounding disclosing mental health concerns in the military. Respondents were asked a series of questions including perceived mental health status and access to behavioral health services. Most respondents reported feelings of stress related to their roles as officers (86.6%). Self-reported feelings of anxiety (83.6%) and depression (65.7%) were high. In contrast, only 30.1% had ever received a formal diagnosis of anxiety or depression by a mental health professional. Our survey confirmed a large percentage, 65.7% of respondents, reported avoiding mental/behavioral health services. Female military officers are able to recognize their feelings as symptoms of anxiety and depression; however, many take active steps to hide these symptoms from their family members and senior officers and avoid seeking professional care.
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Affiliation(s)
- Rosellen Roche
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Cleveland, OH
| | - Joel Manzi
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Cleveland, OH
| | - Katelyn Bard
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Cleveland, OH
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Wilson SR, Hintz EA, MacDermid Wadsworth SM, Topp DB, Southwell KH, Spoont M. Female U.S. Military Veterans' (Non)Disclosure of Mental Health Issues with Family and Friends: Privacy Rules and Boundary Management. HEALTH COMMUNICATION 2021; 36:412-423. [PMID: 31752542 DOI: 10.1080/10410236.2019.1693128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Grounded in communication privacy management (CPM) theory, this study explores the criteria female U.S. military veterans rely on when creating privacy rules regarding (non)disclosure of their mental health information with others as well as how female veterans manage privacy boundaries. Interviews with a diverse sample of 78 female veterans recently diagnosed with PTSD revealed examples of all five criteria for privacy rules proposed by CPM theory and illustrate how factors such as military culture, trauma, and risk/benefit assessments are interconnected. Female veterans also altered their boundary linkages, permeability, and control in response to tensions between revealing and concealing mental health information. Findings suggest the potential utility of drawing connections between tensions that motivate concealing/revealing and boundary management operations and highlight the need to further develop and evaluate programs such as peer support counseling within the Department of Veteran Affairs where female veterans can serve as support resources for their peers.
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Affiliation(s)
| | | | - Shelley M MacDermid Wadsworth
- Department of Human Development and Family Studies, Purdue University
- Military Family Research Institute, Purdue University
| | - David B Topp
- Military Family Research Institute, Purdue University
- Research and Operations, Purdue University
| | | | - Michele Spoont
- Departments of Medicine and Psychiatry, University of Minnesota
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20
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Ghosh A, Niileksela CR, Janis R. Military Background and Gender Identity in Psychological Assessment Among College Students: Factorial Invariance of the Counseling Center Assessment of Psychological Symptoms-62 (CCAPS-62). Assessment 2021; 29:1045-1060. [PMID: 33733899 DOI: 10.1177/1073191121998768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to examine the factorial invariance of the Counseling Center Assessment of Psychological Symptoms-62 (CCAPS-62) across military background and gender identity. A sample of 2,208 military students and 2,208 nonmilitary students were chosen from a large database of university and college counseling centers. Using exploratory structural equation modeling, findings suggested the CCAPS-62 is mostly invariant across military background and gender identity. Only three item thresholds appeared to be noninvariant across groups. These results suggest comparisons of scores across military background and gender can be made. Latent mean differences across groups were also examined. After controlling for several background variables, there were some differences between males and females on subscales measuring depression, eating concerns, and generalized anxiety, but no differences between military and nonmilitary students. Implications for practice and future research are discussed.
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Affiliation(s)
| | | | - Rebecca Janis
- Pennsylvania State University, University Park, PA, USA
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21
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Bourke J. Military Sexual Trauma: Gender, Military Cultures, and the Medicalization of Abuse in Contemporary America. JOURNAL OF WAR & CULTURE STUDIES 2021; 15:86-105. [PMID: 35242217 PMCID: PMC8884252 DOI: 10.1080/17526272.2021.1884785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Sexual violence is a serious problem within armed services. This article explores intra-service rape in branches of the U.S. military from the 1990s to the present. The article begins by establishing the parameters of the crisis of sexual abuse within the U.S. armed services. Second, it explores systematic failures to recognize forms of suffering. Victim-survivors in the military are vulnerable to military-specific obstacles to reporting their abuse and being believed. Attention is paid to differences by gender and sexual orientation. Third, it analyses the medicalization of suffering in the modern military and its effects. What meanings are assigned to 'military sexual trauma' (MST) and how has that label affected victim-survivors of rape or sexual assault? The article concludes by arguing that the concept of 'trauma' as it is applied to victims of sexual abuse does a formidable amount of political and ideological work.
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22
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Adams RE, Hu Y, Figley CR, Urosevich TG, Hoffman SN, Kirchner HL, Dugan RJ, Boscarino JJ, Withey CA, Boscarino JA. Risk and protective factors associated with mental health among female military veterans: results from the veterans' health study. BMC WOMENS HEALTH 2021; 21:55. [PMID: 33557798 PMCID: PMC7869200 DOI: 10.1186/s12905-021-01181-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 01/13/2021] [Indexed: 11/10/2022]
Abstract
Background This study focuses on factors that may disproportionately affect female veterans’ mental health, compared to men, and is part of a larger study assessing the prevalence of mental health disorders and treatment seeking among formerly deployed US military service members. Methods We surveyed a random sample of 1,730 veterans who were patients in a large non-VA hospital system in the US. Based on previous research, women were hypothesized to be at higher risk for psychological problems. We adjusted our results for confounding factors, including history of trauma, childhood abuse, combat exposure, deployments, stressful life events, alcohol misuse, psychological resources, and social support. Results Among the veterans studied, 5% were female (n = 85), 96% were White (n = 1,161), 22.9% were Iraq/Afghanistan veterans (n = 398), and the mean age was 59 years old (SD = 12). Compared to males, female veterans were younger, unmarried, college graduates, had less combat exposure, but were more likely to have lifetime PTSD (29% vs. 12%.), depression (46% vs. 21%), suicidal ideation (27% vs. 11%), and lifetime mental health service use (67% vs. 47%). Females were also more likely to have low psychological resilience and to have used psychotropic medications in the past year. Using multivariate logistic regression analyses that controlled for risk and protective factors, female veterans had greater risk for lifetime PTSD, depression, suicidal thoughts, and for lifetime use of psychological services, compared to males. Since 95% of the population in this study were male and these results may have been statistically biased, we reran our analyses using propensity score matching. Results were consistent across these analyses. Conclusion Using a sample of post-deployment veterans receiving healthcare services from a large non-VA health system, we find that female veterans are at greater risk for lifetime psychological problems, compared to male veterans. We discuss these findings and their implications for service providers.
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Affiliation(s)
- Richard E Adams
- Department of Sociology, Kent State University, 215 Merrill Hall, 700 Hilltop Drive, Kent, OH, 44242-0001, USA
| | - Yirui Hu
- Department of Population Health Sciences, Geisinger Clinic, 100 N. Academy Avenue, MC 44-00, Danville, PA, 17822, USA
| | - Charles R Figley
- Tulane Traumatology Institute, Tulane University, 127 Elk Place, New Orleans, LA, 70112, USA
| | - Thomas G Urosevich
- Ophthalmology Service, Geisinger Clinic, 126 Market Way, Mount Pocono, PA, 18344, USA
| | - Stuart N Hoffman
- Department of Sleep Medicine, Geisinger Clinic, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - H Lester Kirchner
- Department of Population Health Sciences, Geisinger Clinic, 100 N. Academy Avenue, MC 44-00, Danville, PA, 17822, USA
| | - Ryan J Dugan
- Department of Population Health Sciences, Geisinger Clinic, 100 N. Academy Avenue, MC 44-00, Danville, PA, 17822, USA
| | - Joseph J Boscarino
- Clinical Psychology Department, William James College, 1 Wells Ave, Newton, MA, 02459, USA
| | - Carrie A Withey
- Department of Population Health Sciences, Geisinger Clinic, 100 N. Academy Avenue, MC 44-00, Danville, PA, 17822, USA
| | - Joseph A Boscarino
- Department of Population Health Sciences, Geisinger Clinic, 100 N. Academy Avenue, MC 44-00, Danville, PA, 17822, USA.
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Dyer KE, Hamilton AB, Yano EM, Moreau JL, Frayne SM, Carney DV, Golden RE, Klap R. Mobilizing embedded research and operations partnerships to address harassment of women Veterans at VA medical facilities. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2021; 8 Suppl 1:100513. [PMID: 33514498 DOI: 10.1016/j.hjdsi.2020.100513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 09/17/2020] [Accepted: 12/19/2020] [Indexed: 01/07/2023]
Abstract
Key insights: A: Addressing a complex problem like harassment in VA medical facilities requires committed, engaged collaboration at multiple levels of the organization. B: Timely feedback of initial research findings to operations partners enabled rapid and more responsive development of new programs and policies. C: Our research-clinical partnership has enabled us to pursue targeted change from the outset, while incorporating real-time findings from embedded researchers working to develop a comprehensive understanding of the problem.
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Affiliation(s)
- Karen E Dyer
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
| | - Alison B Hamilton
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Elizabeth M Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jessica L Moreau
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Susan M Frayne
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA; Division of Primary Care & Population Health, Stanford University, Stanford, CA, USA
| | - Diane V Carney
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Rachel E Golden
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Ruth Klap
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Roche R, Manzi J, Bard K. A Double Bind for the Ties that Bind: A Pilot Study of Mental Health Challenges among Female US Army Officers and Impact on Family Life. JOURNAL OF VETERANS STUDIES 2020. [DOI: 10.21061/jvs.v6i1.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Kroll-Desrosiers AR, Crawford SL, Moore Simas TA, Clark MA, Mattocks KM. Treatment and Management of Depression Symptoms in Pregnant Veterans: Varying Experiences of Mental Health Care in the Prenatal Period. Psychiatr Q 2020; 91:475-493. [PMID: 32008211 DOI: 10.1007/s11126-019-09676-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Depression screening is recommended for all pregnant veterans; however, little is known on how often symptomatic women receive care, how depression treatment presents in practice, and whether women veterans are utilizing treatment during the appreciable perinatal period. Our sample included 142 pregnant veterans from 15 Veterans Health Administration (VA) medical facilities with Edinburgh Postnatal Depression Scale (EPDS) scores ≥10. Sociodemographic characteristics, military service, health utilization, and pregnancy related factors were collected as part of a telephone survey. A majority of our sample (70%) had 1 or more mental health visits or antidepressant prescriptions during pregnancy. Women with a history of depression had more mental health visits and a higher percentage of antidepressant use before and during pregnancy than women without a history of depression. Pregnant women veterans without a history of depression may be less likely to receive care for depression during pregnancy. However, the majority of our veterans showing depression symptoms prenatally had at least one mental health visit or an antidepressant medication fill during their pregnancy window, suggesting that mental health care is readily available for women veterans.
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Affiliation(s)
- Aimee R Kroll-Desrosiers
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
- Research and Development, VA Central Western Massachusetts, Leeds, MA, USA.
| | - Sybil L Crawford
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA, USA
| | - Tiffany A Moore Simas
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
- Department of Obstetrics & Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, USA
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Melissa A Clark
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Kristin M Mattocks
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
- Research and Development, VA Central Western Massachusetts, Leeds, MA, USA
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Experiences of Perceived Gender-based Discrimination Among Women Veterans: Data From the ECUUN Study. Med Care 2020; 58:483-490. [PMID: 32000171 DOI: 10.1097/mlr.0000000000001304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Experiences of discrimination are associated with poor health behaviors and outcomes. Understanding discrimination in health care informs interventions to improve health care experiences. OBJECTIVE Describe the prevalence of, and variables associated with, perceived gender-based discrimination in the Veterans Affairs (VA) Healthcare System among women Veterans. DESIGN A cross-sectional, telephone-based survey of a random national sample of young female Veterans. PARTICIPANTS Female VA primary care patients aged 18-45 years. MAIN MEASURES The primary outcome was perceived gender-based discrimination in VA health care. Logistic and linear regression models were used to determine associations between any perceived discrimination and cumulative perceived discrimination with patient and health service characteristics. KEY RESULTS Among 2294 women Veterans, 33.7% perceived gender-based discrimination in VA. Perceiving gender-based discrimination was associated with medical illness [adjusted odds ratio (aOR)=1.67, 95% confidence interval (CI)=1.34, 2.08], mental illness (aOR=2.06, 95% CI=1.57, 2.69), and military sexual trauma (aOR=2.65, 95% CI=2.11, 3.32). Receiving most health care from the same VA provider (aOR=0.73, 95% CI=0.57, 0.94) and receiving care at a VA site with a women's health clinic (aOR=0.76, 95% CI=0.61, 0.95) were associated with reduced odds of any perceived gender-based discrimination. Among those who perceived gender-based discrimination (n=733), perceived discrimination scores were higher among women with increased age, medical illness, or history of military sexual trauma and lower among those who saw the same VA provider for most medical care. CONCLUSIONS One third of women Veterans perceived gender-based discrimination in VA. Obtaining most medical care from the same VA provider and having a women's health clinic at one's VA were associated with less perceived discrimination.
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Gross GM, Ronzitti S, Combellick JL, Decker SE, Mattocks KM, Hoff RA, Haskell SG, Brandt CA, Goulet JL. Sex Differences in Military Sexual Trauma and Severe Self-Directed Violence. Am J Prev Med 2020; 58:675-682. [PMID: 32037020 DOI: 10.1016/j.amepre.2019.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Previous research has demonstrated an association between military sexual trauma and risk for suicide; however, risk for self-directed violence such as suicide attempt or nonsuicidal self-injury following military sexual trauma is understudied. This study examines the relationship between military sexual trauma and serious self-directed violence resulting in hospitalization, as well as whether this relationship differs by sex. METHODS Participants were 750,176 Operations Enduring Freedom/Iraqi Freedom/New Dawn veterans who were enrolled in Veterans Health Administration care during the period of October 1, 2001-September 30, 2014 and who were screened for military sexual trauma. Data were analyzed in 2019. Bivariate analyses and Cox proportional hazards regression models were employed. RESULTS Women veterans were more likely to screen positive for military sexual trauma (21.33% vs 1.63%), and women and men were equally likely to experience serious self-directed violence (1.19% women vs 1.18% men). Controlling for demographic variables and psychiatric morbidity, military sexual trauma predicted serious self-directed violence for both men and women. Further, men with military sexual trauma were 15% less likely to experience self-directed violence compared with women with military sexual trauma (hazard ratio=0.85, 95% CI=0.74, 0.98). CONCLUSIONS Military sexual trauma is associated with risk for serious self-directed violence for both men and women veterans, and the relationship may be pronounced among women. Results underscore the importance of incorporating military sexual trauma into treatment and preventative efforts for self-directed violence.
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Affiliation(s)
- Georgina M Gross
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut.
| | - Silvia Ronzitti
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut
| | - Joan L Combellick
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut
| | - Suzanne E Decker
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut
| | - Kristin M Mattocks
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts
| | - Rani A Hoff
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut
| | - Sally G Haskell
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut
| | - Joseph L Goulet
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut
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28
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Cavanagh CE, Rosman L, Chui PW, Bastian L, Brandt C, Haskell S, Burg MM. Barriers to cardiovascular disease preventive behaviors among OEF/OIF/OND women and men veterans. Health Psychol 2020; 39:298-306. [PMID: 31999178 PMCID: PMC7078021 DOI: 10.1037/hea0000844] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE OEF/OIF/OND Veterans have an elevated risk for developing cardiovascular disease (CVD), but research suggests that engagement in CVD preventive behaviors is low even among at-risk individuals. It is critical to understand barriers to prevention engagement among Veterans to inform the development of tailored interventions addressing barriers and reducing CVD incidence. METHOD The Women Veterans Cohort Study survey of OEF/OIF/OND Veterans (586 women and 555 men) assessed patient, interpersonal, and systems level barriers to CVD risk prevention. Prevalence of barriers was determined, and chi-squares were conducted to examine sex differences. Multivariate logistic regressions were conducted to determine if sex differences remained when adjusting for demographic factors (age, marital status, education, employment status). RESULTS Despite a low response rate (11.5%), endorsement of barriers was high for both women and men, with most (56.8%) not perceiving themselves to be at CVD risk. More men preferred making no lifestyle change (40.9% vs. 29.1%). More women endorsed lack of confidence (42.4% vs. 36.1%), stress (36.9% vs. 27.8%) and depression (36.9% vs. 27.8%), and inadequate social support (26% vs. 20.9%), along with the belief that their clinician does not perceive them as at risk (57.8% vs. 32%) and has not explained CVD preventive behaviors (19% vs. 12.3%). Multivariate analyses reduced statistical significance of sex differences. CONCLUSIONS Given the low response rate, testing of efforts-for example, implementation science methods-to assess CVD risk reduction barriers in this population are needed, a task for which the Veterans Health Administration is well suited. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Casey E. Cavanagh
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Lindsey Rosman
- Department of Medicine - Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Philip W. Chui
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Lori Bastian
- VA Connecticut Healthcare System, West Haven, CT, USA
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Cynthia Brandt
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sally Haskell
- VA Connecticut Healthcare System, West Haven, CT, USA
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Matthew M. Burg
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
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Zungu D, Visagie N. All eyes on Sudan: The journey of female psychologists in the theatre of operation. SA JOURNAL OF INDUSTRIAL PSYCHOLOGY 2020. [DOI: 10.4102/sajip.v46i0.1739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Body weight status, perceived stress, and emotional eating among US Army Soldiers: A mediator model. Eat Behav 2020; 36:101367. [PMID: 32018191 DOI: 10.1016/j.eatbeh.2020.101367] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND In civilians, overweight and obesity are associated with emotional eating behaviors such as eating in response to stress, but this association has not been examined in Soldiers, a population with unique stressors. This cross-sectional study examined the relationship between perceived stress (PS), emotional eating (EE), and outcomes of body mass index (BMI), and failing Army body composition (BC) standards among Soldiers. METHODS Soldiers (N = 1460, 83% male, 23.5 ± 5.2 years old) completed validated surveys on PS, EE, and adherence with military BC standards. Conditional process models and mediation models tested gender as a moderator and EE as a mediator of associations between PS and BMI and PS and BC failure, respectively. RESULTS Higher PS was associated with more frequent self-reported EE behaviors (p < 0.001), higher BMI (p < 0.001), and BC failure (p < 0.001). BMI significantly increased with frequency of reported EE behaviors (p < 0.001). Gender was not a statistically significant moderator in the relationship between PS, EE, and, BMI (p = 0.83) or BC failure (p = 0.57). PS appears to affect BMI indirectly through EE behaviors (c' = 0.03, 95% CI: 0.02, 0.04). PS may affect BC failure directly (c' = 1.04, 95% CI: 1.01, 1.08) and indirectly (ab = 1.02, 95% CI: 1.01, 1.03) through EE as a mediator. CONCLUSIONS EE behaviors may mediate the positive association between PS, BMI, and BC failure. Prospective investigation is warranted to better understand the role of EE in health-related outcomes among Soldiers and populations in high stress professions.
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Military Sexual Trauma in Older Women Veterans: Prevalence and Comorbidities. J Gen Intern Med 2020; 35:207-213. [PMID: 31713042 PMCID: PMC6957619 DOI: 10.1007/s11606-019-05342-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 07/09/2019] [Accepted: 08/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Recent attention has highlighted the common occurrence and health consequences of military sexual trauma (MST) in younger women veterans. However, almost nothing is known about MST in older veterans. OBJECTIVE To describe MST among older women veterans, including prevalence and common comorbidities. DESIGN Cross-sectional observational study, using data from national Department of Veterans Affairs medical records. PARTICIPANTS Population-based sample of women Veterans aged 55+ with at least one documented MST screen response and at least one clinical encounter in fiscal years 2005-2015. MAIN MEASURES MST screen: medical diagnoses (diabetes, hypertension, hyperlipidemia, myocardial infarction, cerebrovascular disease, congestive heart failure, obesity, chronic pain conditions, back pain, dementia, insomnia, sleep apnea, menopause symptoms) and mental health diagnoses (anxiety, depression, posttraumatic stress disorder, tobacco use, alcohol use disorder, substance use disorder, opioid use disorder, suicidal ideation) from International Classification of Diseases, Ninth Revision Clinical Modification codes in the medical record. KEY RESULTS In this cohort of older women veterans (n = 70,864, mean age 65.8 ± 10.4 years), 13% had a positive MST screen. In multivariable regression analyses adjusted for age, race/ethnicity, and marital status, MST was strongly associated with most mental health diagnoses, particularly posttraumatic stress disorder (OR 7.25, 95% CI 6.84-7.68), depression (OR 2.39, 95% CI 2.28-2.50), and suicidal ideation (OR 2.42, 95% CI 2.08-2.82). MST was also associated with multiple medical conditions, particularly sleep disorders (insomnia OR 1.61, 95% CI 1.43-1.82; sleep apnea OR 1.48, 95% CI 1.37-1.61) and pain (chronic pain OR 1.58, 95% CI 1.50-1.67; back pain OR 1.40, 95% CI 1.34-1.47). CONCLUSIONS A history of MST is common among older women veterans and associated with a range of medical and mental health diagnoses. These findings call attention to the need for additional research in this understudied population, and the importance of trauma-informed care approaches for women across the lifespan.
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Abstract
Music therapy treatment is increasingly being used to promote health, enhance quality of life, and improve functioning in military personnel, but evidence on the use of music interventions with military service members is still emerging. The purpose of this scoping review was to synthesize the available literature regarding music therapy treatment with military personnel by identifying the types of information available, key characteristics, and gaps in the knowledge base. The review was completed using the methodological framework proposed by Arksey and O'Malley. A total of 27 publications met the criteria for review. The results included anecdotal reports, white papers/ briefs, case studies, historical reviews, clinical program descriptions, and research studies. Both active duty and veteran service members were represented in the literature, and post-traumatic stress disorder and traumatic brain injury were the most commonly listed conditions among those served. Music therapy services were offered in both group and individual formats, and drumming was the most common music intervention cited. Most publications accurately represented music therapy, and the historical reviews highlighted the connection between the development of the field of music therapy and the use of music with military personnel. Several gaps were identified, including a lack of specificity in reporting, low levels of evidence, and limited inclusion of women service members.
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Ronzitti S, Loree AM, Potenza MN, Decker SE, Wilson SM, Abel EA, Haskell SG, Brandt CA, Goulet JL. Gender Differences in Suicide and Self-Directed Violence Risk Among Veterans With Post-traumatic Stress and Substance Use Disorders. Womens Health Issues 2019; 29 Suppl 1:S94-S102. [PMID: 31253249 DOI: 10.1016/j.whi.2019.04.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 04/02/2019] [Accepted: 04/17/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Veterans have a high prevalence of both post-traumatic stress disorder (PTSD) and substance use disorders (SUDs), which are related to suicide risk. Exploring gender-related differences in suicidal behavior risk among this subgroup of veterans is important to improve prevention and treatment strategies. To date, few studies have explored these differences. METHODS The sample included 352,476 men and women veterans from the Women Veterans Cohort Study with a diagnosis of PTSD. First, we conducted analyses to assess gender-related differences in sociodemographic and clinical variables at baseline, as well as by suicidal behavior. Then, we conducted a series of Cox proportional hazards regression models to estimate the hazard ratios of engaging in self-directed violence (SDV) and dying by suicide by SUD status and gender, controlling for potential confounders. RESULTS Adjusted analyses showed that, among veterans with PTSD, the presence of a SUD significantly increased the risk of SDV and death by suicide. Women with PTSD had a decreased risk of dying by suicide compared with men. No gender-related difference was observed for SDV. SUD increased the risk of SDV behavior in both women and men but increased the risk of dying by suicide only among men. CONCLUSIONS Our findings revealed gender-related differences in SDV and suicide among veterans with a PTSD diagnosis with or without a SUD. Our study, along with the increasing numbers of women serving in the military, stresses the need to conduct gender-based analyses to help improve prevention and treatment strategies.
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Affiliation(s)
- Silvia Ronzitti
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale School of Medicine, New Haven, Connecticut.
| | - Amy M Loree
- VA Connecticut Healthcare System, West Haven, Connecticut; Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, Michigan
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut; Department of Neuroscience, Child Study Center, Connecticut Mental Health Center, New Haven, Connecticut; Connecticut Council on Problem Gambling, Yale School of Medicine, New Haven, Connecticut
| | | | - Sarah M Wilson
- VA Center for Health Services Research in Primary Care, Durham, North Carolina; Duke University School of Medicine, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Erica A Abel
- VA Connecticut Healthcare System, West Haven, Connecticut
| | | | | | - Joseph L Goulet
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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Mankowski M, Brennan-Ing M, Seidel L, Larson B, Karpiak S. Aging gay male veterans: a community-based study on their health and psychosocial needs. SOCIAL WORK IN HEALTH CARE 2019; 58:870-884. [PMID: 31634076 DOI: 10.1080/00981389.2019.1659906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/22/2019] [Accepted: 08/20/2019] [Indexed: 06/10/2023]
Abstract
Lesbian, gay, and bisexual persons have served in the military throughout history despite military policies that necessitated concealment of their sexual orientation. This secondary data analysis of research from a community-based study of sexual and gender minority (SGM) older adults sought to explore the unique needs of this growing "out" population and identify the future program, policy, and research goals. The sampling population for this study was drawn from a community-based study conducted initially by researchers from the ACRIA center. The SGM veterans in this pilot study were recruited from the Center on Halstead, the largest SGM community-based center in the Midwest. Twenty-six veterans' self-identified as gay men. Considering the minority stress model, data from this study identified a group of men with less social support - either formal or informal, less housing and economic security, and low service utilization. Interestingly, this group also self-reported as having a more positive mental and physical health outlook than previous research with this population. This study also identified a clear need for education, more extensive population-based mixed methods studies to help understand fully the needs of this previously "invisible" population of older military veterans.
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Affiliation(s)
- Mariann Mankowski
- Department of Social Work and Equitable Community Practice, The University of Saint Joseph , West Hartford , CT , USA
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, City University of New York , New York , NY , USA
| | - Liz Seidel
- Geriatrics Workforce Enhancement Program (GWEP), The Hartford Institute for Geriatric Nursing | NYU Rory Meyers College of Nursing , New York , NY , USA
| | | | - Stephen Karpiak
- ACRIA Center on HIV & Aging at GMHC,Gay Men's Health Crisis (GMHC),New York University College of Nursing , New York , NY , USA
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35
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Kotzias V, Engel CC, Ramchand R, Ayer L, Predmore Z, Ebener P, Haas GL, Kemp JE, Karras E. Mental Health Service Preferences and Utilization Among Women Veterans in Crisis: Perspectives of Veterans Crisis Line Responders. J Behav Health Serv Res 2019; 46:29-42. [PMID: 30298442 DOI: 10.1007/s11414-018-9635-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Women military veterans are at increased risk of suicide compared to non-veterans, but little is known about the mental health service preferences and needs of women veterans in crisis. This study used qualitative, secondary source key informant interviews to ascertain the experiences of women veterans in crisis from 54 responders working at the Veterans Crisis Line. Responders indicated that women veterans reported different experiences with Veterans Administration (VA) and non-VA care, though drivers of satisfaction or dissatisfaction were similar. Availability of specialty care, sensitivity to veterans' issues or Military Sexual Trauma, strong provider relationships, and continuity of care contributed to satisfaction; lengthy appointment wait times, limited service options, and insensitivity to veterans' issues contributed to dissatisfaction. Responders suggested that barriers limiting VA access for women veterans are perceived as similar to non-VA care. Findings suggest that caller experiences with providers drive satisfaction with VA and non-VA mental health services.
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Affiliation(s)
| | - Charles C Engel
- RAND Corporation, 20 Park Plaza, 9th Floor, Suite 920, Boston, MA, 02116, USA
| | - Rajeev Ramchand
- RAND Corporation, 1200 S. Hayes St., Arlington, VA, 22202, USA
| | - Lynsay Ayer
- RAND Corporation, 1200 S. Hayes St., Arlington, VA, 22202, USA
| | | | - Patricia Ebener
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401-3208, USA
| | - Gretchen L Haas
- VISN 4 MIRECC, Department of Veterans Affairs, 323 North Shore Drive, Suite 400, Pittsburgh, PA, 15212, USA
| | - Janet E Kemp
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, 400 Fort Hill Ave, Canandaigua, NY, 14424, USA
| | - Elizabeth Karras
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, 400 Fort Hill Ave, Canandaigua, NY, 14424, USA
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36
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Gross GM, Laws H, Park CL, Hoff R, Hoffmire CA. Meaning in life following deployment sexual trauma: Prediction of posttraumatic stress symptoms, depressive symptoms, and suicidal ideation. Psychiatry Res 2019; 278:78-85. [PMID: 31158725 DOI: 10.1016/j.psychres.2019.05.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 11/25/2022]
Abstract
Deployment sexual trauma (DST; i.e., sexual harassment or assault during deployment in the military) is associated with physical and mental health consequences, including posttraumatic stress disorder (PTSD), depression, and suicidal ideation (SI). Less attention has been placed on factors that may offer protection from deleterious mental health outcomes following DST. Global meaning in life (i.e., purpose, beliefs, goals, and subjective feelings) has been shown to be a protective factor against PTSD, depression, and SI following combat trauma; however, the extent to which meaning in life may affect outcomes following DST has not been investigated. Cross-sectional associations and Hayes mediation models were examined using baseline interview data from the Survey of Experiences of Returning Veterans sample (SERV; 850 recently returned veterans, 352 women). DST was associated with post-deployment posttraumatic stress symptoms (PTSS), depressive symptoms, and SI severity, and with decreased sense of meaning in life. Further, meaning in life was a significant mediator between DST and each of the three outcomes, even after controlling for demographic variables and combat experiences. The mediation models did not differ by gender. Findings suggest meaning in life may be an important clinical factor, both for the identification of risk and as a point of intervention.
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Affiliation(s)
- Georgina M Gross
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA.
| | - Holly Laws
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA; University of Massachusetts Amherst, Amherst, MA, USA
| | | | - Rani Hoff
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA
| | - Claire A Hoffmire
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Denver, CO, USA; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Battles AR, Kelley ML, Jinkerson JD, C Hamrick H, F Hollis B. Associations Among Exposure to Potentially Morally Injurious Experiences, Spiritual Injury, and Alcohol Use Among Combat Veterans. J Trauma Stress 2019; 32:405-413. [PMID: 31169954 DOI: 10.1002/jts.22404] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 11/08/2022]
Abstract
Potentially morally injurious experiences (PMIEs) are events that may violate deeply held values or belief systems. Combat engagement places service members at a heightened risk for PMIE exposure. Exposure to PMIEs may elicit internal conflict between moral beliefs and experiences and, if unresolved, conflict may manifest as feelings of guilt, shame, and spiritual or existential crisis. Further, distress caused by these experiences may promote harmful behaviors (e.g., excessive alcohol use), which may serve as attempts to cope with PMIEs veterans have witnessed or participated in. The present study examined a sequential mediation model in which combat exposure was associated with alcohol use (i.e., alcohol consumption, dependence symptoms, and alcohol-related problems) via PMIE exposure and spiritual injury (e.g., alienation from and/or anger towards respective higher power) in a community sample of 380 recent-era combat veterans. Multiple-group sequential mediation was then used to examine whether the model fit similarly across men and women. Exposure to PMIEs and spiritual injury sequentially mediated the association between combat and alcohol; higher levels of PMIE exposure and spiritual injury were associated with increased alcohol use, R2 = .17, f2 = 0.07. The multiple-group model showed that these associations significantly varied between genders such that the mediation was only significant among men. The results indicated that PMIEs and spiritual injury were associated with increased alcohol use, but these associations differed as a function of gender. Future research is needed to refine our understanding of moral and spiritual injury and explore possible risk and protective factors.
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Affiliation(s)
- Allison R Battles
- Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia, USA
| | - Michelle L Kelley
- Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia, USA.,Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
| | - Jeremy D Jinkerson
- Fielding Graduate University, School of Psychology, Santa Barbara, California, USA
| | - Hannah C Hamrick
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
| | - Brittany F Hollis
- Center for Health Equity Research and Promotion, Department of Veterans Affairs, Veterans Affairs Pittsburg Healthcare System, Pittsburgh, Pennsylvania, USA
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38
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Gawron LM, Mohanty AF, Kaiser JE, Gundlapalli AV. Impact of Deployment on Reproductive Health in U.S. Active-Duty Servicewomen and Veterans. Semin Reprod Med 2019; 36:361-370. [PMID: 31003251 DOI: 10.1055/s-0039-1678749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Reproductive-age women are a fast-growing component of active-duty military personnel who experience deployment and combat more frequently than previous service-era women Veterans. With the expansion of the number of women and their roles, the United States Departments of Defense and Veterans Affairs have prioritized development and integration of reproductive services into their health systems. Thus, understanding associations between deployments or combat exposures and short- or long-term adverse reproductive health outcomes is imperative for policy and programmatic development. Servicewomen and women Veterans may access reproductive services across civilian and military or Veteran systems and providers, increasing the need for awareness and communication regarding deployment experiences with a broad array of providers. An example is the high prevalence of military sexual trauma reported by women Veterans and the associated mental health diagnoses that may lead to a lifetime of high risk-coping behaviors that increase reproductive health risks, such as sexually transmitted infections, unintended pregnancies, and others. Care coordination models that integrate reproductive healthcare needs, especially during vulnerable times such as at the time of military separation and in the immediate postdeployment phase, may identify risk factors for early intervention with the potential to mitigate lifelong risks.
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Affiliation(s)
- Lori M Gawron
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | - April F Mohanty
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jennifer E Kaiser
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Adi V Gundlapalli
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.,Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah
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Monteith LL, Hoffmire CA, Holliday R, Park CL, Mazure CM, Hoff RA. Do unit and post-deployment social support influence the association between deployment sexual trauma and suicidal ideation? Psychiatry Res 2018; 270:673-681. [PMID: 30384288 DOI: 10.1016/j.psychres.2018.10.055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 10/21/2018] [Accepted: 10/23/2018] [Indexed: 11/15/2022]
Abstract
Deployment sexual trauma is associated with post-deployment suicidal ideation. No studies have examined the role of social support in this association. The present study examined if perceived unit support and post-deployment support influenced the association between deployment sexual trauma and suicidal ideation. 824 post-9/11 veterans (480 men, 344 women) from the Survey of Experiences of Returning Veterans completed the Deployment Risk and Resilience Inventory-2 and Columbia-Suicide Severity Rating Scale. Age, possible depression, posttraumatic stress disorder symptoms, and lifetime suicide attempt were covaried. Among men, post-deployment support moderated the association between deployment sexual trauma and suicidal ideation; deployment sexual trauma predicted suicidal ideation only for men reporting low post-deployment support. Among women, post-deployment support mediated the association between deployment sexual trauma and suicidal ideation. Unit support neither moderated nor mediated the association between deployment sexual trauma and suicidal ideation. Among men who experience deployment sexual trauma, those with low perceived post-deployment support may be at particularly elevated risk for suicidal ideation and may benefit from more intensive monitoring and interventions that bolster social support. Increasing perceived post-deployment support for women who experience deployment sexual trauma is also warranted. Determining optimal ways to strengthen post-deployment support for sexual trauma survivors is essential.
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Affiliation(s)
- Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center, 1700N. Wheeling St., Aurora, CO 80045, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Claire A Hoffmire
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center, 1700N. Wheeling St., Aurora, CO 80045, USA; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center, 1700N. Wheeling St., Aurora, CO 80045, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Carolyn M Mazure
- Women's Health Research at Yale, Yale School of Medicine, New Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Rani A Hoff
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA Northeast Program Evaluation Center, West Haven, CT, USA
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40
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Breeden NC, Welsh JA, Olson JR, Perkins DF. The Women's Experience: A Look at Risk and Protective Factors for Deployed Female Air Force Personnel. J Womens Health (Larchmt) 2018; 27:1449-1455. [DOI: 10.1089/jwh.2017.6835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nicole C. Breeden
- The Clearinghouse for Military Family Readiness at Penn State, The Pennsylvania State University, University Park, Pennsylvania
| | - Janet A. Welsh
- Edna Bennet Pierce Prevention Resource Center, The Pennsylvania State University, University Park, Pennsylvania
| | - Jonathan R. Olson
- School of Natural Health Arts and Sciences, Bastyr University, Kenmore, Washington
| | - Daniel F. Perkins
- The Clearinghouse for Military Family Readiness & Department of Agricultural Economics, Sociology and Education, The Pennsylvania State University, University Park, Pennsylvania
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Brownstone LM, Holliman BD, Gerber HR, Monteith LL. The Phenomenology of Military Sexual Trauma Among Women Veterans. PSYCHOLOGY OF WOMEN QUARTERLY 2018. [DOI: 10.1177/0361684318791154] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although researchers have examined health outcomes among survivors of military sexual trauma, knowledge regarding the phenomenology of military sexual trauma among women veterans remains limited. We used a qualitative, phenomenological approach to describe the experience, context, and perceived effects of military sexual trauma among women veterans. Thirty-two cisgender female military sexual trauma survivors participated in interviews, which we analyzed through thematic analysis. The following themes emerged: (1) sexual harassment: “expected,” “constant,” and “normal”; (2) silencing and disempowerment: “If you want a career, then shut up”; (3) changed attitudes toward the military: “I lost faith”; (4) loss of relational trust: “I can protect me if I’m not involved with someone”; (5) survivor internalization of messages conveyed by military sexual trauma: “If I looked different, none of this would have happened”; (6) coping by escape and avoidance: “I put my head in the sand and hoped it would go away”; and (7) a path to healing through validation and justice: “You’ll get through it.” Results suggest the importance of increasing stakeholders’ knowledge regarding military sexual trauma complexities and contexts. Military sexual trauma survivors should be heard, believed, and supported in pursuing justice. We also suggest cultural shifts and continued efforts to prevent military sexual trauma. Online slides for instructors who want to use this article for teaching are available on PWQ's website at http://journals.sagepub.com/page/pwq/suppl/index
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Affiliation(s)
- Lisa M. Brownstone
- Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Denver, CO, USA
| | - Brooke Dorsey Holliman
- Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Denver, CO, USA
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Holly R. Gerber
- Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Denver, CO, USA
| | - Lindsey L. Monteith
- Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Denver, CO, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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42
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Bannister JA, Lopez FG, Menefee DS, Norton PJ, Wanner J. Military and Premilitary Trauma, Attachment Orientations, and Posttraumatic Stress Disorder Severity Among Male and Female Veterans. J Trauma Stress 2018; 31:558-567. [PMID: 30091801 DOI: 10.1002/jts.22309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/14/2018] [Accepted: 04/23/2018] [Indexed: 11/08/2022]
Abstract
Samples in prior studies examining attachment theory in the military have been predominantly composed of male combat veterans. Given the rates of sexual trauma among female veterans and differences in the association between attachment and posttraumatic stress disorder (PTSD) severity for sexual trauma survivors, it was necessary to consider the attachment characteristics of veterans within a mixed-sex sample. Participants were a mixed-sex veteran sample seeking inpatient trauma-related treatment (N = 469). Using independent samples t tests, we examined sex differences in attachment. Consistent with our hypothesis, women reported a higher level of attachment anxiety than did men, t(351) = -2.12, p = .034. Women also reported a higher level of attachment avoidance, t(351) = -2.44, p = .015. Using hierarchical regression, we examined the contribution of attachment anxiety and avoidance to PTSD severity, partialing out variance accounted for by demographic variables and traumatic experiences. Consistent with our hypotheses, attachment avoidance predicted PTSD severity on the Clinician-Administered PTSD Scale for DSM-IV (CAPS), β = .20, p < .001, and the PTSD Checklist-Civilian Version (PCL-C), β = .18, p < .001. Attachment anxiety did not predict CAPS severity but did predict PCL-C severity, β = .11, p = .020. These results suggest the association between attachment avoidance and PTSD is not exclusive to combat trauma and may apply more generally to the larger veteran population. Higher levels of attachment anxiety and avoidance among female veterans potentially implicate the presence of greater attachment fearfulness among this particular subpopulation of veterans.
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Affiliation(s)
- Jenny A Bannister
- Michael E. DeBakey VA Medical Center (MEDVAMC), Houston, Texas.,Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, Texas
| | - Frederick G Lopez
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, Texas
| | - Deleene S Menefee
- Michael E. DeBakey VA Medical Center (MEDVAMC), Houston, Texas.,The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Peter J Norton
- School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Jill Wanner
- Michael E. DeBakey VA Medical Center (MEDVAMC), Houston, Texas.,The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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43
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Ross PT. Assessing Residents' Veteran-Centered Care Skills in the Clinical Setting. J Grad Med Educ 2018; 10:279-284. [PMID: 29946384 PMCID: PMC6008020 DOI: 10.4300/jgme-d-17-00700.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/15/2017] [Accepted: 02/13/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Despite their placement in Veterans Health Administration centers nationwide, residents' training and assessment in veteran-centered care is variable and often insufficient. OBJECTIVE We assessed residents' ability to recognize and address mental health issues that affect US military veterans. METHODS Two unannounced standardized patient (SP) cases were used to assess internal medicine residents' veteran-centered care skills from September 2014 to March 2016. Residents were assessed on 7 domains: military history taking, communication skills, assessment skills, mental health screening, triage, and professionalism, using a 36-item checklist. After each encounter, residents completed a questionnaire to assess their ability to recognize knowledge deficits. Residents' mean scores were compared across training levels, between the 2 cases, and by SP gender. We conducted analysis of variance (ANOVA) tests to analyze mean performance differences across training levels and descriptive statistics to analyze self-assessment questionnaire results. RESULTS Ninety-eight residents from 2 internal medicine programs completed the encounter and 53 completed the self-assessment questionnaire. Residents performed best on professionalism (0.92 ± 0.20, percentage of the maximal score) and triage (0.87 ± 0.17), and they scored lowest on posttraumatic stress disorder (0.52 ± 0.30) and military sexual trauma (0.33 ± 0.39). Few residents reported that they sought out training to enhance their knowledge and skills in the provision of services and support to military and veteran groups beyond their core curriculum. CONCLUSIONS This study suggests that additional education and assessment in veteran-centered care may be needed, particularly in the areas of posttraumatic stress disorder and military sexual trauma.
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Driscoll MA, Higgins D, Shamaskin-Garroway A, Burger A, Buta E, Goulet JL, Heapy A, Kerns RD, Brandt CA, Haskell SG. Examining Gender as a Correlate of Self-Reported Pain Treatment Use Among Recent Service Veterans with Deployment-Related Musculoskeletal Disorders. PAIN MEDICINE 2018; 18:1767-1777. [PMID: 28379576 DOI: 10.1093/pm/pnx023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective Women veterans with chronic pain utilize health care with greater frequency than their male counterparts. However, little is known about gender differences in the use of specialty pain care in this population. This investigation examined gender differences in self-reported use of opioids, interventional pain treatments, rehabilitation therapies, and complementary and integrative health (CIH) services for chronic pain treatment both within and outside of the Veterans Health Administration in a sample of veterans who served in support of recent conflicts. Methods Participants included 325 veterans (54% women) who completed a baseline survey as part of the Women Veterans Cohort Study and reported deployment-related musculoskeletal conditions and chronic pain. Measures included self-reported use of pain treatment modalities, pain severity, self-rated health, access to specialty care, disability status, and presence of a mental health condition. Results Men were more likely to report a persistent deployment-related musculoskeletal condition but were no more likely than women to report chronic pain. Overall, 21% of the sample reported using opioids, 27% used interventional strategies, 59% used rehabilitation therapies, and 57% used CIH services. No significant gender differences in use of any pain treatment modality were observed. Conclusions Use of pain specialty services was common among men and women, particularly rehabilitative and CIH services. There were no gender differences in the self-reported use of different modalities. These results are inconsistent with documented gender differences in pain care. They encourage further examination of gender differences in preferences and other individual difference variables as predictors of specialty pain care utilization.
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Affiliation(s)
- Mary A Driscoll
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME), A Health Services Research and Development Center of Innovation, West Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut
| | - Diana Higgins
- VA Boston Healthcare System, Jamaica Plain, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Andrea Shamaskin-Garroway
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME), A Health Services Research and Development Center of Innovation, West Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut
| | | | - Eugenia Buta
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME), A Health Services Research and Development Center of Innovation, West Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut
| | - Joseph L Goulet
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME), A Health Services Research and Development Center of Innovation, West Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut
| | - Alicia Heapy
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME), A Health Services Research and Development Center of Innovation, West Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut
| | - Robert D Kerns
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME), A Health Services Research and Development Center of Innovation, West Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME), A Health Services Research and Development Center of Innovation, West Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut
| | - Sally G Haskell
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME), A Health Services Research and Development Center of Innovation, West Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut
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45
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Dichter ME, Wagner C, True G. Women Veterans' Experiences of Intimate Partner Violence and Non-Partner Sexual Assault in the Context of Military Service: Implications for Supporting Women's Health and Well-Being. JOURNAL OF INTERPERSONAL VIOLENCE 2018; 33:843-864. [PMID: 27655865 DOI: 10.1177/0886260516669166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Women who have served in the military in the United States experience high rates of intimate partner violence (IPV) and non-partner sexual assault (SA). The military setting presents challenges and opportunities not experienced in other employment contexts that may compound the negative impacts of IPV/SA on women's lives. The purpose of this study was to explore the intersection of women's experiences of IPV/SA and military service through analysis of women veterans' narrative accounts. We conducted in-depth face-to-face qualitative interviews with 25 women veterans receiving primary care at a U.S. Veterans Affairs Medical Center. We draw upon Adler and Castro's (2013) Military Occupational Mental Health Model to frame our understanding of the impact of IPV/SA as a stressor in the military cultural context and to inform efforts to prevent, and support women service members who have experienced, these forms of violence. Our findings highlight the impact of IPV/SA on women's military careers, including options for entering and leaving military service, job performance, and opportunities for advancement. Women's narratives also reveal ways in which the military context constrains their options for responding to and coping with experiences of IPV/SA. These findings have implications for prevention of, and response to, intimate partner or sexual violence experienced by women serving in the military and underscore the need for both military and civilian communities to recognize and address the negative impact of such violence on women service members before, during, and after military service.
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Affiliation(s)
- Melissa E Dichter
- 1 U.S. Department of Veterans Affairs, Philadelphia, PA, USA
- 2 University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Clara Wagner
- 1 U.S. Department of Veterans Affairs, Philadelphia, PA, USA
| | - Gala True
- 3 U.S. Department of Veterans Affairs, New Orleans, LA, USA
- 4 Tulane University School of Medicine, New Orleans, LA, USA
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46
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Shamaskin-Garroway AM, Knobf MT, Adams LJ, Haskell SG. "I Think It's Pretty Much the Same, as It Should Be": Perspectives of Inpatient Care Among Women Veterans. QUALITATIVE HEALTH RESEARCH 2018; 28:600-609. [PMID: 29231129 DOI: 10.1177/1049732317746380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of this study was to gain a deeper understanding of the inpatient hospitalization experience for women veterans through in-depth interviews. Women veterans who were admitted for inpatient care on medical units within a university-affiliated VA hospital were invited to participate in a semistructured interview that inquired about their hospital experience, interactions with medical providers, and how being a woman veteran might affect this experience. Interviews were transcribed verbatim and analyzed using constant comparative method until thematic saturation was achieved ( n = 25). Three themes, (a) Being a woman and a veteran: Intersecting identities, (b) Expecting equality and equity, and (c) Defining woman-centered inpatient care described the unique perspective and context for Veterans Health Administration (VHA) health care of women veterans. These findings provide insight and guidance to clinical practice and care delivery for women veterans, including training and interpersonal approaches medical providers can take to improve the hospital experience for women.
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Affiliation(s)
- Andrea M Shamaskin-Garroway
- 1 School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
- 2 VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - M Tish Knobf
- 3 Yale School of Nursing, Orange, Connecticut, USA
| | - Lynette J Adams
- 2 VA Connecticut Healthcare System, West Haven, Connecticut, USA
- 4 Yale School of Medicine, New Haven, Connecticut, USA
| | - Sally G Haskell
- 2 VA Connecticut Healthcare System, West Haven, Connecticut, USA
- 4 Yale School of Medicine, New Haven, Connecticut, USA
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Lubens P, Bruckner TA. A Review of Military Health Research Using a Social–Ecological Framework. Am J Health Promot 2018; 32:1078-1090. [DOI: 10.1177/0890117117744849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective: We aim to contextualize the growing body of research on the sequelae of military service in the wars in Afghanistan and Iraq. We employ a social–ecological (SE) framework for the taxonomy of military health research and classify risk as arising from the individual, family, community, and the institutional levels. We intend for this review to inform enhanced health promotion efforts in military communities. Data Source: Articles reviewed were extracted from Web of Science, PubMed, and Scopus. Inclusion and Exclusion Criteria: Research focused on somatic and psychological sequelae of combat deployment published from 2001—the year the war in Afghanistan began—through the end of 2014. We excluded studies of non-US military personnel, other systematic reviews, meta-analyses, book chapters, and theoretical papers. Data Extraction: We examined and summarized the aims, participants, methods, study design, SE framework tier, risk factors, and health outcomes. Data Synthesis: Studies were categorized according to SE tier, whether they focused on somatic, behavioral, or psychological outcomes, and by risk factor. Results: Of the 352 peer-reviewed papers, 84% focused on war’s sequelae on the index military personnel, and 75% focused on mental or behavioral health outcomes—mostly on post-traumatic stress disorder. We find comparatively little research focusing on the family, community, or institutional tiers. Conclusions: We know relatively little about how family and community respond to the return of personnel from combat deployment; how family resources affect the health of returning military personnel; and how a war’s persistence presents challenges for federal, state, and local agencies to meet military health-care needs. Such work is especially salient as US troops return home from war—particularly in communities where there are substantial military populations.
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Affiliation(s)
- Pauline Lubens
- Program in Public Health, University of California, Irvine, CA, USA
| | - Tim A. Bruckner
- Program in Public Health, University of California, Irvine, CA, USA
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48
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Mota NP, Medved M, Hiebert-Murphy D, Whitney D, Sareen J. Negotiating home base: Narratives of psychological well-being among female military members. Health Place 2018; 50:105-111. [PMID: 29414421 DOI: 10.1016/j.healthplace.2018.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 12/12/2017] [Accepted: 01/23/2018] [Indexed: 10/18/2022]
Abstract
The current study aimed to understand how active duty service women with low levels of current psychological distress make sense of their military experiences in ways that might contribute to psychological well-being. Semi-structured interviews were conducted with active duty female members in the Canadian Forces and transcripts were analyzed using narrative analysis. A sense of belonging was found to be of utmost salience to the women, with several participants negotiating and constructing places that felt like home to them, and with different degrees of attachment to the military versus civilian world. The findings of this work are discussed within the context of focusing prevention and intervention efforts on increasing belongingness and a sense of home for female service members.
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49
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McCall JD, Tsai J. Characteristics and Health Needs of Veterans in Jails and Prisons: What We Know and Do Not Know about Incarcerated Women Veterans. Womens Health Issues 2017; 28:172-180. [PMID: 29217313 DOI: 10.1016/j.whi.2017.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 09/28/2017] [Accepted: 10/13/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE The majority of U.S. veterans in prisons and local jails are men, but incarcerated women veterans remain an important and understudied group. METHODS This study reported differences in sociodemographic, health, and criminal justice characteristics using Veterans Affairs (VA) administrative data on a national sample of 30,964 incarcerated veterans (30,440 men and 524 women) who received outreach from the VA Health Care for Reentry Veterans program between 2007 and 2011. Descriptive statistics and multivariable logistic regressions determined gender and racial differences in this population. RESULTS Compared with incarcerated veterans who were men, incarcerated women veterans were younger (d = 0.68), had significantly lower lifetime arrests (AOR, 0.65; p < .001; 99% CI, 0.49-0.87), and were less likely to have been incarcerated for a violent offense (AOR, 0.47; p < .001; 99% CI, 0.35-0.63). Notably, 58% of women were of reproductive age. Women were more likely to have reported eye problems, hypertension, chronic obstructive pulmonary disease, and seizure disorder, and were more likely to receive a preliminary diagnosis of mood disorder than men. Women were more likely to have received VA benefits, used VA health care before, and be willing to use VA services after release. A few important differences emerged when stratified by race. CONCLUSIONS These findings suggest that incarcerated women veterans are interested in VA health care services, but there is lack of information about women's health needs through the Health Care for Reentry Veterans program. The inclusion of Health Care for Reentry Veterans screening questions about women's health issues may support the VA's interests to better engage women veterans in care.
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Affiliation(s)
- Janice D McCall
- Carlow University, Department of Social Work, Pittsburgh, Pennsylvania; Veterans Affairs Healthcare System, Center for Health Equity Research and Promotion (CHERP), Pittsburgh, Pennsylvania
| | - Jack Tsai
- Veterans Affairs New England Mental Illness Research, Education, and Clinical Center (MIRECC), West Haven, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut; Veterans Affairs National Center on Homelessness Among Veterans, West Haven, Connecticut.
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50
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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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