Long-term disability associated with war-related experience among Vietnam veterans: retrospective cohort study. Med Care. 2015;53:401-408. [PMID: 25768060 PMCID: PMC4396733 DOI: 10.1097/mlr.0000000000000336]

Suicide Ideation, Plans, and Attempts Among Military Veterans vs Nonveterans With Disability

Importance

People with disability are at heightened risk for suicide ideation, planning, and attempt, with risk growing as the number of disabling limitations increases. Military veterans have higher rates of suicide deaths and disability relative to nonveterans.

Objective

To evaluate whether veteran status is associated with greater risk for suicide in those with disability.

Design, Setting, and Participants

This survey study used cross-sectional self-reported data from US adults who participated in the 2015-2020 National Survey on Drug Use and Health. Data were weighted to represent the population. Data analysis was conducted from July to August 2022.

Main Outcomes and Measures

Suicide ideation, planning, and attempt served as primary outcomes. Disability status (present or absent) and number of disabling limitations (1, 2, or ≥3) served as factors. Veteran status was determined based on self-report (veteran or nonveteran). Multivariable logistic regression examined suicide ideation, planning, and attempt as a function of veteran status and disability variables.

Results

Participants included 231 099 US veterans and nonveterans, representing 236 551 727 US adults, of whom 20.03% (weighted n = 47 397 876) reported a disabling limitation, 8.92% were veterans (weighted n = 21 111 727; 16.0% aged 35-49 years; 91.0% men; 6.7% Hispanic; 10.9% non-Hispanic Black; and 78.4% non-Hispanic White) and 91.08% were nonveterans (weighted n = 215 440 000; 25.4% aged 35-49 years; 44.0% male; 16.5% Hispanic; 11.7% non-Hispanic Black; and 63.3% non-Hispanic White). Overall, 4.39% reported suicide ideation, planning, or attempt (weighted n = 10 401 065). Among those with no disability, veteran status was associated with higher risk of suicide planning (adjusted odds ratio [AOR], 1.71; 95% CI, 1.17-2.49). Among those with 1 or 2 disabling limitations, being a veteran was associated with a lower risk of suicide planning (AOR, 0.57; 95% CI, 0.34-0.95) and history of attempt (AOR, 0.46; 95% CI, 0.24-0.88).

Conclusions and Relevance

In this study of how suicide risk differs as a function of disability and veteran status, risk for death by suicide was lower among veterans with disability relative to nonveterans with disability. Veteran status may mitigate risk for suicide given increased receipt of more disability-related care through the Department of Veterans Affairs. Further research would extend this line of inquiry by examining the cause and type of disability as well as perceptions of disability on self-worth. It is possible that physical wounds of war are protective because of the meaning and value of service to one's country.

Use of home care services by older Veterans and dependants in Melbourne, Australia, 2007-2016

LAY SUMMARY

Military service has an impact on health and well-being across the life course. However, there is little research on older Veterans and dependants who use home care to enable them to remain living in the community. The authors analysed data from a Melbourne, Australia, home care organization’s electronic care records to explore the differences between clients supported by the Department of Veterans’ Affairs and clients in the general home nursing population. Results showed the greater needs of and complexity of care utilized by Veterans and dependants. Funding structures and support services need to account for these needs in older age.

Low-level cognitive ability in young adulthood and other risk factors of depression in an observational cohort study among deployed Danish soldiers

PURPOSE

Evidence exists of an association between pre-morbid lower cognitive ability and higher risk of hospitalization for depressive disorder in civilian cohorts. The purpose of this study was to examine the relationship of cognitive ability at conscription with post-deployment depression and the influence of (1) baseline factors: age, gender, and pre-deployment educational level, (2) deployment-related factors: e.g., war-zone stress and social support, and (3) co-morbid PTSD.

METHODS

An observational cohort study linking conscription board registry data with post-deployment self-report data. The study population consisted of Danish Army military personnel deployed to different war zones from 1997 to 2015. The association between cognitive ability at conscription and post-deployment depression was analyzed using repeated-measure logistic regression models.

RESULTS

Study population totaled 9716 with a total of 13,371 deployments. Low-level cognitive ability at conscription was found to be weakly associated with post-deployment probable depression after adjustment for more important risk factors like gender, education, and deployment-related factors [odds ratio (OR) 0.93, 95% confidence interval (CI) 0.88-0.99]. The co-occurrence rate with PTSD was nearly 60%. When adding co-morbid PTSD as an independent variable, the association between cognitive ability and probable depression became insignificant, OR 0.95, CI 0.89-1.02.

CONCLUSIONS

Low cognitive ability at conscription is a risk factor for depression among returning military personnel, but unimportant compared to gender, education, and deployment-related factors. Part of this effect may be related to co-morbid PTSD. Use of cognitive ability score as an isolated selection tool cannot be recommended because of low predictive performance.

The health and wellbeing needs of veterans: a rapid review

BACKGROUND

For the majority of serving members, life in the military has a positive effect on wellbeing. However, the type, intensity and duration of service, along with the transition from fulltime military to civilian life, may have a negative effect on veterans' wellbeing. Such negative consequences, alongside the growing veteran population, indicate the need for greater exploration of veterans' physical, mental and social wellbeing.

METHODS

The current paper reports on the findings of a rapid review of the literature on the health and wellbeing needs of veterans, commissioned by the Australian Department of Veterans' Affairs to inform future programs and services. The databases Embase, Medline, Cinahl, PubMed, Web of Science and Cochrane Database were searched for systematic reviews reporting on veterans' physical, mental and social wellbeing published in English in peer-reviewed journals.

RESULTS

A total of 21 systematic reviews were included. The reviews reported on a range of mental, physical and social health problems affecting veterans. While there was limited information on prevalence rates of physical, mental and social health problems in veterans compared to civilian populations, the reviews demonstrated the interconnection between these domains and the effect of demographic and military service factors.

CONCLUSIONS

A key finding of the review is the interconnection of the mental, physical, and social health of veterans, highlighting the importance that an integrated approach to veterans' wellbeing is adopted. It is suggested that understanding key factors, such as demographic factors and factors relating to military service, can support improved service provision for veterans.

Enhancing health and independent living for veterans with disabilities by leveraging community-based resources

The number of US veterans with disabilities has increased in recent years as service members have returned home with extensive injuries and veterans from previous wars acquire functional limitations as a consequence of aging with chronic diseases. Veterans with severe disabilities need assistance and support to maintain independence at home and to avoid institutionalization. The US Department of Veterans Affairs (VA) strives to network with community organizations to achieve the best possible outcomes for veterans. Key community resources in the US for individuals with disabilities are Centers for Independent Living (CILs) that provide a wide range of services, promoting independent living and well-being for people across disabilities. The widespread availability and services of CILs nationwide suggest their potential as a community-based resource for veterans, particularly for those with limited access to VA care. In this article, we discuss long-term needs of veterans with disabilities, efforts to address veterans' rehabilitation needs at the VA and opportunities for leveraging the strengths of community-based organizations for veterans. More research is warranted to investigate CIL services and potential for CIL-VA partnerships.

Efficacy and safety of Jiuwei Xiaoyang soup vs nizatidine tablets in treatment of duodenal ulcer patients with spleen-stomach dampness-heat syndrome

AIM

To compare the efficacy and safety of Jiuwei Xiaoyang soup and nizatidine tablets in the treatment of duodenal ulcer patients with spleen-stomach dampness-heat syndrome.

METHODS

Eighty duodenal ulcer patients with spleen-stomach dampness-heat syndrome treated from January 2015 to May 2016 were randomly divided into either an experimental group to receive Jiuwei Xiaoyang soup (n = 40) or a control group to receive nizatidine tablets (n = 40). The treatment lasted six weeks in both groups. The rates of clinical improvement, gastroscopic improvement, and recurrence were compared between the two groups.

RESULTS

The rate of clinical improvement (e.g., dry mouth and body weight) was significantly higher in the experimental group than in the control group (P < 0.05). The rate of ulcer recurrence was significantly lower in the experimental group than the control group (P < 0.05). The rate of gastroscopic improvement did not differ significantly between the two groups (P > 0.05).

CONCLUSION

Jiuwei Xiaoyang soup is superior to nizatidine tablets in improving clinical symptoms and reducing ulcer recurrence in duodenal ulcer patients with spleen-stomach dampness-heat syndrome.

Disability and Mental Disorders in the Canadian Armed Forces

OBJECTIVES

The initial goal was to validate the use of a self-report measure of disability in the Canadian Armed Forces (CAF). The main goal was to document the extent of disability in personnel with and without mental disorders.

METHODS

Data were obtained from the 2013 Canadian Forces Mental Health Survey; the sample included 6700 Regular Forces personnel. Disability was measured with the 12-item version of the World Health Organization Disability Assessment Schedule (WHODAS-2); established cut points were used to demarcate severe, moderate, minimal, and no disability. The following recent (past-year) and remote (lifetime but not past-year) disorders were assessed with diagnostic interviews: posttraumatic stress disorder, major depressive episode, generalized anxiety disorder, panic disorder, and alcohol use disorder.

RESULTS

The WHODAS-2 showed good internal consistency (α = 0.89) and a 1-factor structure. Most personnel had no disability (59.2%) or minimal disability (30.8%). However, an important minority had moderate or severe disability (8.4% and 1.6%, respectively). Individuals with recent disorders reported greater disability than those without lifetime disorders, although many had minimal or no disability (41.2% and 24.7%, respectively). Disability increased with the number of recent disorders. Relative to those without lifetime disorders, individuals with remote disorders showed slightly greater disability, but most had no disabilty (57.1%) or minimal disability (35.0%).

CONCLUSIONS

The 12-item WHODAS-2 is a valid measure of disability in the CAF. Mental disorders may be important drivers of disability in this population, although limited residual disability is seen in individuals with remote disorders.