Readjustment of Urban Veterans: A Mental Health and Substance Use Profile of Iraq and Afghanistan Veterans in Higher Education

Chronic disease multimorbidity and substance use among African American men: veteran-non-veteran differences

OBJECTIVES

The purpose of the study was to explore the extent to which prior military service may moderate the relationship between chronic disease multimorbidity and substance use among African American men in the United States.

DESIGN

Data for this cross-sectional study was downloaded from the 2016 -2019 United States (US) National Survey on Drug Use and Health. We estimated three survey-weighted multivariable logistic regression models, where use of each of the following substances served as the dependent variables: illicit drugs, opioids, and tobacco. Differences in these outcomes were examined along two primary independent variables: veteran status and multimorbidity (and an interaction term for these variables). We also controlled for the following covariates: age, education, income, rurality, criminal behavior, and religiosity.

RESULTS

From the 37,203,237 (weighted N) African American men in the sample, approximately 17% reported prior military service. Veterans with ≥ 2 chronic diseases had higher rates of illicit drug use (aOR = 1.37, 95% CI = 1.01, 1.87; 32% vs. 28%) than non-veterans with ≥ 2 chronic diseases. Non-veterans with one chronic disease had higher rates of tobacco use (aOR = 0.80, 95% CI = 0.69, 0.93; 29% vs. 26%) and opioid misuse (aOR = 0.49, 95% CI = 0.36, 0.67; 29% vs. 18%) than veterans with one chronic disease.

DISCUSSION

Chronic disease multi-morbidity appears to be a context in which African American veterans may be at greater risk for certain undesirable health behaviors than African American non-veterans and at lower risk for others. This may be due to exposure to trauma, difficulty accessing care, socio-environmental factors, and co-occurring mental health conditions. These complex interactions may contribute to higher rates of SUDs among African American veterans compared to African American non-veterans.

Drug Use Difficulties and Academic Adjustment in Student Veterans With Disabilities: A Parallel Mediation Study

The attainment of postsecondary education is critical to leading a successful life. Substance abuse is one area that may negatively impact academic and, ultimately, employment outcomes in the student veteran population. We conducted a parallel mediation analysis to examine the relationship between substance use and academic outcomes in a sample of 129 college veterans with disabilities. We explored interpersonal problems, physical health problems, depression, and anxiety as possible mediators. Our results concluded that only interpersonal problems and anxiety mediated the relationship. Implications for practice and research are provided.

Creating a college adjustment index score for student veterans with and without disabilities

Higher education is a critical public health tool to achieve economic success, upward mobility, and improved quality of life. Yet, certain groups of students, including student veterans with and without disabilities (SVDs), are at high risk for course failure and dropout, partially due to challenges related to college adjustment. The purpose of this study is to develop a new college adjustment index score for SVDs. We had a total of 4 different research studies to examine the psychometric properties of our college adjustment index score. After conducting a series of psychometric analyses, we selected a total of 18-items. This 18-item tool may help clinicians and researchers conceptualize college adjustment among students through the lens of integrative Tinto's model and positive psychology approaches. Our psychometric analyses revealed that this index tool is brief, reliable, and valid tool to capture college adjustment in SVDs.

College Warrior Athlete Initiative and academic nursing

The College Warrior Athlete Initiative (CWAI) determined if a key element of military occupational culture, referred to as the "battle-buddy" concept of pairing college athletes with veterans, could be applied to Student Service Members/Veterans (SSM/V) health promotion. Participants: Fifty veterans of fifty-seven enrolled completed the program in seven separate cohorts between 2016 and 2017. Methods: The veteran-student athlete pairs or small groups exercised twice a week for 75 min under the supervision of a certified athletic trainer and attended wellness classes. Results: Of the data from 50 veterans, over 2/3rd of veterans lost weight during their 12-week program and reported increased overall health, mood, energy levels and social engagement. Conclusions: This exercise intervention program implemented at two university campuses indicates the benefits of engaging SSM/Vs and college students for physical exercise to improve health. Results provide a foundation for academic nursing in conjunction with other university departments to increase peer cohesion and a sense of community for SSM/Vs.

Psychometric validation of the PERMA-profiler as a well-being measure for student veterans

Objective: The current study aims to validate the PERMA-Profiler, a well-known well-being measure, among a sample of student veterans. Participants: A sample of 205 student veterans were recruited from universities across the United States. Method: Cross-sectional research design was used in this study. Measurement structure of the PERMA-Profiler was evaluated using exploratory factor analysis (EFA). Convergent, divergent, and criterion-related validity was tested using Pearson correlation coefficients and Kruskal-Wallis test. Results: The EFA results yielded a two-factor solution for student veterans. Factors are named as emotional character strengths and performance character strengths. Conclusions: The PERMA-Profiler is a multidimensional scale with good reliability and acceptable levels of convergent, divergent, and criterion-related validity. The PERMA-Profiler can help researchers and practitioners better gauge well-being in student veterans. Implications will be discussed.

Between- and within-person associations between opioid overdose risk and depression, suicidal ideation, pain severity, and pain interference

BACKGROUND

To better understand overdose (OD) risk and develop tailored overdose risk interventions, we surveyed 234 opioid-using veterans residing in New York City, 2014-2017. Our aim was to better understand how predictors of OD may be associated with physical and mental health challenges, including pain severity and interference, depression and suicidal ideation over time.

METHODS

Veterans completed monthly assessments of the Overdose Risk Behavior Scale (ORBS), pain severity and interference, suicidal ideation, and depression for up to two years and were assessed an average of 14 times over 611 days. To estimate between-person and within-person associations between time-varying covariates and opioid risk behavior, mixed-effects regression was used on the 145-person subsample of veterans completing the baseline and at least three follow-up assessments.

RESULTS

The level of each time-varying covariate at the average of study time (between-person effect) was positively related to ORBS for pain severity and interference, suicidal ideation, and depression. Deviations from individuals' personal trajectories (within-person effect) were positively related to ORBS for pain severity and interference, suicidal ideation, and depression.

CONCLUSIONS

US military veterans endure physical and mental health challenges elevating risk for opioid-related overdose. When pain severity, pain interference, suicidal ideation and depression were higher than usual, opioid risk behavior was higher. Conversely, when these health issues were less of a problem than usual, opioid risk behavior was lower. Assessing the physical and mental health of opioid-using veterans over time may support the development and implementation of interventions to reduce behaviors that increase the likelihood of overdose.

Military veterans' overdose risk behavior: Demographic and biopsychosocial influences

BACKGROUND

U.S. military veterans face many biopsychosocial (BPS) challenges post-service that may elevate risk for opioid-related overdose including physical pain, mental health concerns and social stressors. Some veterans use opioids to manage pain and cope with social readjustment. This study assessed associations between BPS factors and recent engagement in overdose risk behavior in a community sample of post-9/11 veterans who used opioids in New York City.

METHODS

Participants (n = 218) were recruited through convenience sampling and completed a baseline assessment including a validated Opioid Risk Behavior Scale (ORBS) that measured past-30-day engagement in 22 opioid-related overdose risk behaviors. Analyses examined associations between ORBS scores and hypothesized demographic, biological/physical, psychological and social predictors. Incident rate ratios estimated the expected relative difference in ORBS score associated with each predictor.

RESULTS

Participants reported an average of 4.72 overdose risk behaviors in the past 30 days. Significant independent predictors of higher ORBS score, after adjustment for demographics and current prescription medications, were past-30-day: depression symptoms; unsheltered or living in a homeless shelter (vs. private housing); history of mental health treatment; experiencing stressful life events; average pain severity; and pain interference.

CONCLUSION

Veterans face myriad BPS challenges and, while drug-related overdose risks are well understood, findings suggest that other factors-including mental health, pain and stressful life events-may also be associated with overdose risk among opioid-using veterans. The larger challenges veterans face should be considered in the context of BPS forms of pain management when tailoring and delivering overdose prevention interventions.

Life after loss: Comparing student service member/veteran and civilian mental health characteristics among individuals exposed to death by suicide

OBJECTIVE

This study evaluated the mental health characteristics and beliefs of student service members/veterans (SSM/Vs) who have been exposed to another's death by suicide.

PARTICIPANTS

A total of 39 SSM/Vs exposed to suicide and 32 SSM/Vs not exposed to suicide were sampled from a larger, epidemiological survey. An age- and gender-matched group of 39 civilian (C) students was drawn from a larger sample of individuals exposed to suicide.

METHODS

Data were collected as part of an Internet-based, campus needs survey that occurred in Fall 2014. Participants were asked to complete measures about suicide-related behaviors, suicide prevention, help-seeking, and demographics.

RESULTS

SSM/Vs exposed to suicide had more positive mental health/suicide prevention beliefs than SSM/Vs not exposed to suicide. Cs exposed to suicide were not significantly different from either group. Unique help-seeking patterns were also identified.

CONCLUSIONS

The current study identifies unique characteristics of SSM/Vs exposed to suicide that may inform prevention programming.