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Muñoz-Reyes JA, Torrico-Bazoberry D, Polo P, Figueroa O, Guzmán-Lavín E, Fajardo G, Valenzuela N, Belinchón M, Rodríguez-Sickert C, Pita M. Evidence of the active participation of women in the intergroup conflict based on the use of aggression and cooperation. Sci Rep 2023; 13:17742. [PMID: 37853104 PMCID: PMC10584941 DOI: 10.1038/s41598-023-45012-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/14/2023] [Indexed: 10/20/2023] Open
Abstract
Intergroup conflict has been a persistent aspect of human societies since the emergence of our species. Various researchers have proposed that competition between groups has acted as a key selective force throughout human evolutionary history. Such intergroup competition for limited resources exacerbated the expression of intergroup aggression and intragroup cooperation. Furthermore, it would have a sexual dimorphism, with men demonstrating increased sensitivity to conflict threats-in order to maximize reproductive opportunities-, while women generally reject from active engagement in intergroup conflict. In the present study, we conducted behavioral experiments under controlled laboratory conditions to measure cooperation and aggression from using virtual games, specifically the Public Good Games and the Point Subtraction Aggression Paradigm, in a sample of 541 participants. We created control and experimental intergroup competition scenarios, where aggression and cooperation were necessary to increase monetary rewards. Our results shows that men modulate aggression and cooperation in the presence of intergroup conflict. In addition, our data also reveals that women cooperate more than men and display heightened levels of cooperation and aggression when confronted with intergroup conflict. These findings prompt a reevaluation of current functional theoretical models concerning the role of women in intergroup conflict and suggest that the dynamics of human aggression and cooperation may be more nuanced than previously believed.
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Affiliation(s)
- José Antonio Muñoz-Reyes
- Laboratorio de Comportamiento Animal y Humano, Centro de Investigación en Complejidad Social, Facultad de Gobierno, Universidad del Desarrollo, Santiago, Chile.
| | - Daniel Torrico-Bazoberry
- Laboratorio de Comportamiento Animal y Humano, Centro de Investigación en Complejidad Social, Facultad de Gobierno, Universidad del Desarrollo, Santiago, Chile
| | - Pablo Polo
- Laboratorio de Comportamiento Animal y Humano, Centro de Investigación en Complejidad Social, Facultad de Gobierno, Universidad del Desarrollo, Santiago, Chile
| | - Oriana Figueroa
- Laboratorio de Comportamiento Animal y Humano, Centro de Investigación en Complejidad Social, Facultad de Gobierno, Universidad del Desarrollo, Santiago, Chile
| | - Eugenio Guzmán-Lavín
- Laboratorio de Comportamiento Animal y Humano, Centro de Investigación en Complejidad Social, Facultad de Gobierno, Universidad del Desarrollo, Santiago, Chile
| | - Gabriela Fajardo
- Facultad de Administración y Economía, Universidad de Santiago, Santiago, Chile
| | - Nohelia Valenzuela
- Laboratorio de Comportamiento Animal y Humano, Centro de Investigación en Complejidad Social, Facultad de Gobierno, Universidad del Desarrollo, Santiago, Chile
| | - Montserrat Belinchón
- Laboratorio de Comportamiento Animal y Humano, Centro de Investigación en Complejidad Social, Facultad de Gobierno, Universidad del Desarrollo, Santiago, Chile
| | - Carlos Rodríguez-Sickert
- Laboratorio de Comportamiento Animal y Humano, Centro de Investigación en Complejidad Social, Facultad de Gobierno, Universidad del Desarrollo, Santiago, Chile
| | - Miguel Pita
- Departamento de Biología, Universidad Autónoma de Madrid, Madrid, Spain
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2
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Ebrahimi R, Yano EM, Alvarez CA, Dennis PA, Shroyer AL, Beckham JC, Sumner JA. Trends in Cardiovascular Disease Mortality in US Women Veterans vs Civilians. JAMA Netw Open 2023; 6:e2340242. [PMID: 37902755 PMCID: PMC10616720 DOI: 10.1001/jamanetworkopen.2023.40242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/17/2023] [Indexed: 10/31/2023] Open
Abstract
Importance Cardiovascular disease (CVD) remains the leading cause of death in the US. Women veterans have higher rates of CVD compared with civilian US women; however, analyses of recent trends in mortality from cardiac disease for women veterans are lacking. Objective To investigate trends in cardiac disease mortality among women veterans over approximately the past 2 decades and compare rates with those for civilian women. Design, Setting, and Participants In this retrospective longitudinal cohort study, US Veterans Health Administration (VHA) electronic health record data, linked with the National Death Index, were analyzed for CVD trends and rates of cardiac disease mortality among women veterans (aged 18 years or older) with VHA health care encounters from January 1, 2000, to December 31, 2017. These data were compared with a national cohort of civilian women (aged 15 years or older) in the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, which provides cause-of-death data using death certificates for all US residents. The data analysis was performed between March 10, 2021, and November 28, 2022. Exposure Cardiac disease mortality among women veterans and civilian women. Main Outcomes and Measures Cardiac disease mortality was based on International Classification of Diseases, Tenth Revision diagnostic codes (I00-I09, I11, I13, and I20-I51 as defined by CDC WONDER). For women veterans and civilian women, crude and age-adjusted cardiac disease mortality rates (per 100 000 life-years) and 95% CIs were calculated, with the 2000 US general population as the reference for age-adjusted rates. Results From 2000 to 2017, 817 912 women veterans engaged with VHA health care (mean [SD] age, 45.7 [17.1] years), and 19 022 cardiac disease deaths were identified (22.4% of total deaths). The crude and age-adjusted cardiac disease mortality rates, respectively, per 100 000 life-years were 200.2 (95% CI, 181.0-221.0) and 197.6 (95% CI, 175.2-222.0) in 2000 and 196.0 (95% CI, 186.1-206.4) and 208.1 (95% CI, 196.4-220.4) in 2017, reflecting stable crude rates and a 5.3% increase in age-adjusted rates. For civilian women, the crude and age-adjusted rates decreased over time from 320.7 (95% CI, 319.7-321.8) and 268.1 (95% CI, 267.3-269.0) in 2000 to 220.9 (95% CI, 220.1-221.7) and 164.7 (95% CI, 164.1-165.3) in 2017. Conclusions and Relevance In this cohort study comparing women veterans and civilian women, cardiac disease mortality rates for women veterans did not exhibit the improvements seen for civilian women during the nearly 2-decade study period. Further research and actionable clinical interventions are warranted to improve cardiovascular care for women veterans, who represent the fastest growing group of patients within the VHA health care system.
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Affiliation(s)
- Ramin Ebrahimi
- Department of Medicine, University of California, Los Angeles
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Elizabeth M. Yano
- Veterans Affairs Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Department of Health Policy and Management, University of California Los Angeles
| | - Carlos A. Alvarez
- Department of Pharmacy Practice, Texas Tech University Health Science Center, Dallas
- Department of Research, Veterans Affairs North Texas Health Care System, Dallas
| | - Paul A. Dennis
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - A. Laurie Shroyer
- Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
- Northport Veterans Affairs Medical Center, Northport, New York
| | - Jean C. Beckham
- Durham Veterans Affairs Medical Center, Durham, North Carolina
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
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3
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Orshak JJ, Lauver DR. Developing and Evaluating Survey Items About Women Veterans’ Care-seeking for Cardiovascular Disease Prevention. JOURNAL OF VETERANS STUDIES 2023. [DOI: 10.21061/jvs.v9i1.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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4
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Reuman L, Davison EH. Delivered as Described: A Successful Case of Cognitive Processing Therapy With an Older Woman Veteran With PTSD. COGNITIVE AND BEHAVIORAL PRACTICE 2022; 29:914-923. [PMID: 36506842 PMCID: PMC9733655 DOI: 10.1016/j.cbpra.2021.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cognitive processing therapy (CPT) is a first-line, evidence-based treatment for posttraumatic stress disorder (PTSD). Little is known, however, about the use of CPT for older adults. As the United States population continues to grow and age, an understanding of the utility of CPT for older adults is vital. We present a case study describing the assessment and cognitive treatment of a 74-year-old woman veteran with PTSD secondary to military sexual trauma. CPT was associated with decreased PTSD symptoms as measured before and after treatment. Factors contributing to the veteran's response, as well as contextual and environmental factors, are discussed. The case demonstrates that CPT may be effective for older adults without major modification.
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Affiliation(s)
- Lillian Reuman
- Boston University School of Medicine and National Center for PTSD at VA Boston Healthcare System
| | - Eve H Davison
- Boston University School of Medicine and National Center for PTSD at VA Boston Healthcare System
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5
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Differences in Burnout and Intent to Leave Between Women's Health and General Primary Care Providers in the Veterans Health Administration. J Gen Intern Med 2022; 37:2382-2389. [PMID: 34618305 PMCID: PMC9360298 DOI: 10.1007/s11606-021-07133-5] [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: 03/23/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although they are a minority of patients served by the Veterans Health Administration (VHA), women Veterans comprise a fast-growing segment of these patients and have unique clinical needs. Women's health primary care providers (WH-PCPs) are specially trained and designated to provide care for women Veterans. Prior work has demonstrated that WH-PCPs deliver better preventative care and have more satisfied patients than PCPs without the WH designation. However, due to unique clinical demands or other factors, WH-PCPs may experience more burnout and intent to leave practice than general PCPs in the VHA. OBJECTIVE To examine differences in burnout and intent to leave practice among WH and general PCPs in the VHA. DESIGN Multi-level logistic regression analysis of three cross-sectional waves of PCPs within the VHA using the national All Employee Survey and practice data (2017-2019). We modeled outcomes of burnout and intent to leave practice as a function of WH provider designation, gender, and other demographics and practice characteristics, such as support staff ratio, panel size, and setting. PARTICIPANTS A total of 7903 primary care providers (5152 general PCPs and 2751 WH-PCPs; response rates: 63.9%, 65.7%, and 67.5% in 2017, 2018, and 2019, respectively). MAIN MEASURES Burnout and intent to leave practice. KEY RESULTS WH-PCPs were more burned out than general PCPs (unadjusted: 55.0% vs. 46.9%, p<0.001; adjusted: OR=1.29, 95% confidence interval [CI] 1.10-1.55) but did not have a higher intention to leave (unadjusted: 33.4% vs. 32.1%, p=0.27; adjusted: OR=1.07, CI 0.81-1.41). WH-PCPs with intentions to leave were more likely to select the response option of "job-related (e.g., type of work, workload, burnout, boredom)" as their primary reason to leave. CONCLUSIONS Burnout is higher among WH-PCPs compared to general PCPs, even after accounting for provider and practice characteristics. More research on causes of and solutions for these differences in burnout is needed.
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6
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Mahmoudirad G, Sadeghi Akbari A. Caring for COVID-19’s patients, an opportunity for spiritual transcendence in volunteer nurses: a content analysis study. JOURNAL OF SPIRITUALITY IN MENTAL HEALTH 2022. [DOI: 10.1080/19349637.2022.2098084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - Ali Sadeghi Akbari
- Student Research Committee, Department of Nursing, Faculty of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran
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7
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Moreau C, Duron S, Bedretdinova D, Bohet A, Panjo H, Bajos N, Meynard JB. Mental health consequences of military sexual trauma: results from a national survey in the French military. BMC Public Health 2022; 22:214. [PMID: 35109815 PMCID: PMC8812201 DOI: 10.1186/s12889-022-12545-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Military sexual trauma (MST) is a major public health concern, given its prevalence and mental health sequelae. This phenomenon is particularly prevalent among women in the US military, although more cases involve men given their overrepresentation. Little is known about MST and its consequences in other military settings, including in Europe. METHODS This study draws from a national survey in the French military, including 1268 servicemen and 232 servicewomen. We conducted bivariate and multivariate analysis, using simple and multinomial logistic regressions to evaluate the associations between different forms of MST (repeated sexual comments alone/one form of sexual oppression (coercion, repeated verbal unwanted attention or assault)/ several sexual stressors) and symptoms of depression and of positive post-traumatic stress disorder (PTSD) screening scores. RESULTS Women were both more likely to experience MST and to experience more severe forms of MST than men. Women were also more likely than men to report mental health symptoms (31% versus 18% for symptoms of depression and 4.0% versus 1.8% for positive PTSD screening scores). Different forms of MST were associated with different levels of psychological distress. Women reporting repeated sexual comments alone had higher odds of depressive symptoms (OR=3.1 [1.7, 5.5]) relative to women with no MST. Likewise, the odds of depressive symptoms were 6.5 times higher among women and 8.0 times higher among men who experienced several sexual stressors relative to those who reported no MST. We also found higher relative risk of subthreshold PTSD screening scores among women reporting any form of sexual stressor, including sexual comments alone (RRR = 4.5 [2.8, 7.4]) and an elevenfold increase in the relative risk of positive PTSD screen scores (RRR = 11.3 [2.3, 55.6]) among women who experienced several sexual stressors relative to women with no MST. CONCLUSION MST is associated with mental health distress among service members in the French military, especially for women. The heightened risk of MST coupled with psychological sequelae call for preventive programs to reduce MST and for screening programs to provide adequate psychological support.
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Affiliation(s)
- Caroline Moreau
- Soins et Santé Primaire, CESP Centre for research in Epidemiology and Population Health, U1018, Inserm, F-94807, Villejuif, France. .,Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Sandrine Duron
- French Military Center for Epidemiology and Public Health, Marseille, France.,INSERM, UMR S912, « Economic & Social Sciences for Health and Processing of Medical Information » (SESSTIM), F-13385, Marseille, France
| | - Dina Bedretdinova
- Soins et Santé Primaire, CESP Centre for research in Epidemiology and Population Health, U1018, Inserm, F-94807, Villejuif, France
| | - Aline Bohet
- Soins et Santé Primaire, CESP Centre for research in Epidemiology and Population Health, U1018, Inserm, F-94807, Villejuif, France
| | - Henri Panjo
- Soins et Santé Primaire, CESP Centre for research in Epidemiology and Population Health, U1018, Inserm, F-94807, Villejuif, France
| | - Nathalie Bajos
- IRIS Interdisciplinary Research Institute on Social Issues Social Sciences Politics Health, U997 Inserm - EHESS, F-93322, Aubervilliers, France
| | - Jean Baptiste Meynard
- French Military Center for Epidemiology and Public Health, Marseille, France.,INSERM, UMR S912, « Economic & Social Sciences for Health and Processing of Medical Information » (SESSTIM), F-13385, Marseille, France.,French Military Medical Academy, Ecole du Val-de-Grâce, Paris, France
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8
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Thomas KH, Shields M. Writing of Moral Injury and Mental Wellness: A Book Review of Fidelis, by Teresa Fazio. JOURNAL OF VETERANS STUDIES 2020. [DOI: 10.21061/jvs.v6i2.208] [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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9
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Christy AY, Mottla GL. Reproductive Health Needs of the Military and Veterans: Part 3. Semin Reprod Med 2020; 37:209-210. [PMID: 32693430 DOI: 10.1055/s-0040-1714120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Alicia Y Christy
- Howard University School of Medicine, Washington, District of Columbia
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10
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Rivera-Rivera N, Villarreal ÁA. Caribbean Homeless Women Veterans: Military and Psychosocial Characteristics and the Association of Service-connected Disabilities. REVISTA PUERTORRIQUENA DE PSICOLOGIA 2020; 31:36-44. [PMID: 35846170 PMCID: PMC9280656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Women Veterans are one of the fastest growing groups among homeless people. Previous studies on race, ethnicity and homelessness have emphasized the important differences on predictors, health risks, behaviors, and service outcomes between different groups. These differences are crucial to inform policy makers and program developers in order to solve this social issue. This research assesses sociodemographic, psychosocial and military characteristics and their role in service-connected disabilities to provide a profile of the Caribbean Homeless Women Veteran of the U.S. military. We evaluated 46 healthcare records of women Veterans who requested services at the Homeless Program of the VA Caribbean Healthcare System (VACHS) from 2005 to 2014. Statistical analyses consisted of Chi square, Fisher's exact test, Wilcoxon-Rank Sum tests, and Logistic Regression. Extreme poverty, unemployment, unaffordable housing, psychological disorders and low social support were the most prevalent characteristics. Women with psychological disorders had eight times higher the odds of having a service-connected disability than women without psychological conditions. Implications of study results are discussed for VACHS and future research with this population.
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Affiliation(s)
- Naiomi Rivera-Rivera
- Veterans Affairs, Caribbean Healthcare System San Juan, Puerto Rico
- Adler University, Chicago, Illinois, USA
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11
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Harrington KM, Nguyen XMT, Song RJ, Hannagan K, Quaden R, Gagnon DR, Cho K, Deen JE, Muralidhar S, O'Leary TJ, Gaziano JM, Whitbourne SB. Gender Differences in Demographic and Health Characteristics of the Million Veteran Program Cohort. Womens Health Issues 2019; 29 Suppl 1:S56-S66. [PMID: 31253243 PMCID: PMC7061933 DOI: 10.1016/j.whi.2019.04.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 04/13/2019] [Accepted: 04/19/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND The Department of Veterans Affairs Million Veteran Program (MVP) is the largest ongoing cohort program of its kind, with 654,903 enrollees as of June 2018. The objectives of this study were to examine gender differences in the MVP cohort with respect to response and enrollment rates; demographic, health, and health care characteristics; and prevalence of self-reported health conditions. METHODS The MVP Baseline Survey was completed by 415,694 veterans (8% women), providing self-report measures of demographic characteristics, health status, and medical history. RESULTS Relative to men, women demonstrated a higher positive responder rate (23.0% vs. 16.0%), slightly higher enrollment rate (13.5% vs. 12.9%), and, among enrollees, a lower survey completion rate (59.7% vs. 63.8%). Women were younger, more racially diverse, had higher educational attainment, and were less likely to be married or cohabitating with a partner than men. Women were more likely to report good to excellent health status but poorer physical fitness, and less likely to report lifetime smoking and drinking than men. Compared with men, women veterans showed an increased prevalence of musculoskeletal conditions, thyroid problems, gastrointestinal conditions, migraine headaches, and mental health disorders, as well as a decreased prevalence of gout, cardiovascular diseases, high cholesterol, diabetes, and hearing problems. CONCLUSIONS These results revealed some substantial gender differences in the research participation rates, demographic profile, health characteristics, and prevalence of health conditions for veterans in the MVP cohort. Findings highlight the need for tailoring recruitment efforts to ensure representation of the increasing women veteran population receiving care through the Veterans Health Administration.
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Affiliation(s)
- Kelly M Harrington
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts.
| | - Xuan-Mai T Nguyen
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Rebecca J Song
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Keri Hannagan
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts
| | - Rachel Quaden
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts
| | - David R Gagnon
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jennifer E Deen
- Office of Research and Development, Veterans Health Administration, Washington, District of Columbia
| | - Sumitra Muralidhar
- Office of Research and Development, Veterans Health Administration, Washington, District of Columbia
| | - Timothy J O'Leary
- Office of Research and Development, Veterans Health Administration, Washington, District of Columbia; Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - John Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Stacey B Whitbourne
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
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12
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Katon JG, Zephyrin L, Meoli A, Hulugalle A, Bosch J, Callegari L, Galvan IV, Gray KE, Haeger KO, Hoffmire C, Levis S, Ma EW, Mccabe JE, Nillni YI, Pineles SL, Reddy SM, Savitz DA, Shaw JG, Patton EW. Reproductive Health of Women Veterans: A Systematic Review of the Literature from 2008 to 2017. Semin Reprod Med 2019; 36:315-322. [PMID: 31003246 DOI: 10.1055/s-0039-1678750] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The literature on the reproductive health and healthcare of women Veterans has increased dramatically, though there are important gaps. This article aims to synthesize recent literature on reproductive health and healthcare of women Veterans. We updated a literature search to identify manuscripts published between 2008 and July 1, 2017. We excluded studies that were not original research, only included active-duty women, or had few women Veterans in their sample. Manuscripts were reviewed using a standardized abstraction form. We identified 52 manuscripts. Nearly half (48%) of the new manuscripts addressed contraception and preconception care (n = 15) or pregnancy (n = 10). The pregnancy and family planning literature showed that (1) contraceptive use and unintended pregnancy among women Veterans using VA healthcare is similar to that of the general population; (2) demand for VA maternity care is increasing; and (3) women Veterans using VA maternity care are a high-risk population for adverse pregnancy outcomes. A recurrent finding across topics was that history of lifetime sexual assault and mental health conditions were highly prevalent among women Veterans and associated with a wide variety of adverse reproductive health outcomes across the life course. The literature on women Veterans' reproductive health is rapidly expanding, but remains largely observational. Knowledge gaps persist in the areas of sexually transmitted infections, infertility, and menopause.
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Affiliation(s)
- Jodie G Katon
- US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.,Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Laurie Zephyrin
- VA Office of Patient Care Services, Women's Health Services, Washington, District of Columbia.,Department of Obstetrics and Gynecology, VA Harbor Medical Center, New York City, New York.,Department of Obstetrics and Gynecology, New York School of Medicine, New York, NY
| | - Anne Meoli
- VHA, SimLEARN National Simulation Center, Orlando, Florida
| | - Avanthi Hulugalle
- New York University College of Global Public Health, New York City, New York
| | - Jeane Bosch
- VA San Diego Healthcare System, San Diego, California
| | - Lisa Callegari
- US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.,Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington
| | - Ileana V Galvan
- VA Office of Patient Care Services, Women's Health Services, Washington, District of Columbia
| | - Kristen E Gray
- US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.,Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Kristin O Haeger
- VA Office of Patient Care Services, Women's Health Services, Washington, District of Columbia
| | - Claire Hoffmire
- Rocky Mountain MIRECC for Suicide Prevention, VA Eastern Colorado Health Care System, Denver, Colorado.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado
| | - Silvina Levis
- Geriatric Research, Education and Clinical Center, Miami Veterans Affairs Medical Center, Miami, Florida
| | - Erica W Ma
- US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington
| | | | - Yael I Nillni
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Suzanne L Pineles
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Shivani M Reddy
- VA Boston Healthcare System, Boston, Massachusetts.,Center for Advanced Methods Development, RTI International, Waltham, Massachusetts
| | - David A Savitz
- Department of Epidemiology, Brown University, Providence, Rhode Island
| | - Jonathan G Shaw
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, California.,Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California
| | - Elizabeth W Patton
- Division of Gynecology, Department of Surgery, VA Boston Healthcare System, Boston, Massachusetts.,Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts
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13
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McCabe JE, Katon JG, Ma E, Fortney JC, Grote NK, Zephyrin LC, Callegari LS. Preconception Health Risk Factors in Women with and without a History of Military Service. Womens Health Issues 2018; 28:539-545. [PMID: 30314907 DOI: 10.1016/j.whi.2018.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 08/07/2018] [Accepted: 08/07/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Given the increasing number of women service members and veterans of childbearing age, it is important to understand the preconception risks in this potentially vulnerable population. This study compared the prevalence of modifiable preconception risk factors among women with and without a history of service. METHODS Analyses included data from the 2013 and 2014 Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System. Preconception risk factors included health behaviors, chronic conditions, and mental health among women of childbearing age. Multivariate logistic regressions were used to compare the adjusted prevalence of each outcome among women with and without a history of service. Interaction terms assessed variation by age and history of service. RESULTS Compared with women without a history of service, women with a history of service reported higher prevalence of insufficient sleep (49.6% vs. 36.3%; p < .001) and diagnosed depression (26.5% vs. 21.6%; p < .01). Women with a history of service were overall less likely to have obesity (19.8% vs. 26.5%; p < .001). Age-stratified results suggested that, compared with women without a history of service, women with a history of service were more likely to smoke in the 25 to 34 age group and reported comparable levels of obesity in the 35 to 44 age group. CONCLUSIONS Women with a history of service demonstrated a preconception health profile that differs from women without a history of service. It is critical that providers are aware of their patients' military status and potential associated risks.
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Affiliation(s)
- Jennifer E McCabe
- Department of Psychology, University of Wisconsin Oshkosh, Oshkosh, Wisconsin.
| | - Jodie G Katon
- VA Center of Innovation for Veteran-Centered and Value Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington; Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
| | - Erica Ma
- VA Center of Innovation for Veteran-Centered and Value Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington
| | - John C Fortney
- VA Center of Innovation for Veteran-Centered and Value Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington; Department of Health Services, School of Public Health, University of Washington, Seattle, Washington; Department of Psychiatry and Behavioral Medicine, School of Medicine, University of Washington, Seattle, Washington
| | - Nancy K Grote
- Graduate School of Social Work, University of Washington, Seattle, Washington
| | - Laurie C Zephyrin
- Women's Health Services, VA Office of Patient Care Services, Veterans Health Administration, Department of Veterans Affairs, Washington, DC
| | - Lisa S Callegari
- VA Center of Innovation for Veteran-Centered and Value Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington; Department of Health Services, School of Public Health, University of Washington, Seattle, Washington; Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington
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Bøg M, Filges T, Jørgensen AMK. Deployment of personnel to military operations: impact on mental health and social functioning. CAMPBELL SYSTEMATIC REVIEWS 2018; 14:1-127. [PMID: 37131363 PMCID: PMC8427986 DOI: 10.4073/csr.2018.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This Campbell systematic review examines the effects of deployment on mental health. The review summarizes evidence from 185 studies. All studies used observational data to quantify the effect of deployment. This review includes studies that evaluate the effects of deployment on mental health. A total of 185 studies were identified. However, only 40 of these were assessed to be of sufficient methodological quality to be included in the final analysis. The studies spanned the period from 1993 to 2017 and were mostly carried out in the USA, UK and Australia. The studies all had some important methodological weaknesses. None of the included studies used experimental designs (random assignment). Deployment to military operations negatively affects the mental health functioning of deployed military personnel. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all mental health domains (PTSD, depression, substance abuse/dependence, and common mental disorders), particularly on PTSD. For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive. Plain language summary Deployment to military operations negatively affects the mental health functioning of deployed military personnel: While additional research is needed, the current evidence strongly supports the notion that deployment negatively affects mental health functioning of deployed military personnel.What is this review about?: When military personnel are deployed to military operations abroad they face an increased risk of physical harm, and an increased risk of adverse shocks to their mental health.The primary condition under consideration is deployment to an international military operation. Deployment to a military operation is not a uniform condition; rather, it covers a range of scenarios. Military deployment is defined as performing military service in an operation at a location outside the home country for a limited time period, pursuant to orders.The review included studies that reported outcomes for individuals who had been deployed. This review looked at the effect of deployment on mental health outcomes. The mental health outcomes are: post-traumatic stress disorder (PTSD), major depressive disorder (MDD), common mental disorders (depression, anxiety and somatisation disorders) and substance-related disorders.By identifying the major effects of deployment on mental health and quantifying these effects, the review can inform policy development on deployment and military activity as well as post-deployment support for veterans. In this way the review enables decision-makers to prioritise key areas.What are the main findings of this review?: What studies are included?: This review includes studies that evaluate the effects of deployment on mental health. A total of 185 studies were identified. However, only 40 of these were assessed to be of sufficient methodological quality to be included in the final analysis. The studies spanned the period from 1993 to 2017 and were mostly carried out in the USA, UK and Australia. The studies all had some important methodological weaknesses. None of the included studies used experimental designs (random assignment).Does deployment have an effect on mental health?: Deployment to military operations negatively affects the mental health functioning of deployed military personnel. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all mental health domains (PTSD, depression, substance abuse/dependence, and common mental disorders), particularly on PTSD. For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive.What do the findings of this review mean?: The odds of screening positive for PTSD and depression were consistently high in the longer term. This suggests that efforts should be increased to detect and treat mental disorders, as effects may be long-lasting.Overall the risk of bias in the majority of included studies was high. While it is difficult to imagine a randomised study design to understand how deployment affects mental health, other matters such as changes to personnel policy, or unanticipated shocks to the demand for military personnel, could potentially be a rich source of quasi-experimental variation.How up-to-date is this review?: The review authors searched for studies up to 2017. This Campbell systematic review was published in March 2018. Executive summary BACKGROUND: When military personnel are deployed to military operations abroad they face an increased risk of physical harm, and an increased risk of adverse shocks to their mental health. Research suggests that the increased risk to mental health is mainly due to the hazards of war, combat exposure: firing weapons, road side bombs, seeing fellow soldiers, friends, civilians, and enemies being injured, maimed or killed. These experiences may lead to severe mental stress. The adverse impact on mental health is the psychological cost of war, and it is of interest to policymakers to learn the magnitude of these effects. This review sets out to synthesise available evidence about the consequences of deployment for deployed military personnel in the mental health and social functioning domains.OBJECTIVES: The objective of this review isto synthesise the consequences of deployment to military operation on the mental health and social functioning of deployed military personnel.SEARCH METHODS: We searched electronic databases, grey literature, and references from primary studies and related reviews. No language or date restrictions were applied to the searches. We searched the following electronic databases: Academic Search Elite, Cochrane Library, EMBASE, ERIC, MEDLINE, PsycINFO, Science Citation Index, Social Science Citation Index, SocINDEX, as well as the Nordic platforms: bibliotek.dk, BIBSYS, and LIBRIS. The conclusions of this review are based on the most recent searches performed. The last search was performed in April 2017.SELECTION CRITERIA: Primary studies had to meet the following inclusion criteria: Participants: The participants should be military personnel.Intervention: The condition should be deployment to a military operation.Comparison: The relevant comparisons were either comparing a) deployed military personnel to non-deployed military personnel, b) deployed military personnel to military personnel deployed elsewhere, for example personnel deployed to non-combat operations, c) military personnel deployed to the same operation but stratified by combat exposure.Outcomes: The study should report on one or more mental health outcomes, and/or social functioning for the deployed participants. In particular studies should report on one or more of the following mental health outcomes: PTSD, major depression, substance abuse or dependence (including alcohol), and common mental disorders (depression and anxiety disorders). The following social functioning outcomes were relevant: employment, and homelessness.Study Designs: Both experimental and quasi-experimental designs with a comparison group were eligible for inclusion in the review. Studies were excluded if they: Reported on deployments taking place before 1989.Used a within group pre-post study design.Did not report on at least one of the mental health or social functioning outcomes. DATA COLLECTION AND ANALYSIS: The total number of potentially relevant studies constituted31,049records. A total of 185 studies met the inclusion criteria and were critically appraised by the review authors. The final selection of 185 studies was from 13 different countries.Forty eight of the 185 studies did not report effect estimates or provide data that would allow the calculation of an effect size and standard error. Fifty four studies were excluded because of overlapping samples. The majority of those studies were from USA but the main reason for not using studies from USA in the synthesis was lack of information to calculate an effect size. Nearly half the studies from the UK could not be used in the synthesis due to overlap of data samples. Forty three studies were judged to have a very high risk of bias (5 on the scale) and, in accordance with the protocol, we excluded these from the data synthesis on the basis that they would be more likely to mislead than inform., Thus a total of 40 studies, from five different countries, were included in the data synthesis.Random effects models were used to pool data across the studies. We used the odds ratio. Pooled estimates were weighted with inverse variance methods, and 95% confidence intervals were calculated. The meta-analyses were carried out by time since exposure (short, medium, long, and other time since exposure) and by type of comparison (deployed versus non-deployed, all deployed but stratified by either combat operations versus non-combat operations, or stratified by combat exposure). We performed single factor subgroup analysis. The assessment of any difference between subgroups was based on 95% confidence intervals. Funnel plots were used to assess the possibility of publication bias. Sensitivity analysis was used to evaluate whether the pooled effect sizes were robust across components of methodological quality.MAIN RESULTS: The findings were mixed, depending on the outcome, the time since exposure and the approach (deployed versus non-deployed termed absolute or stratified by extent of combat termed relative) used to investigate the effect. It was not possible to analyse the outcomes homelessness and employment. All studies that could be used in the data synthesis reported on the impact of deployment on mental health; PTSD, depression, substance use or common mental disorder.For assessments taken less than 24 months since exposure the evidence was inconclusive either because too few studies reported results in the short and medium term and/or the degree of heterogeneity between studies was large.For assessments taken at other time points (a variable number of months since exposure) the evidence was inconclusive for the relative comparisons due to either too few studies or a substantial degree of heterogeneity between studies. For the absolute comparison the analysis of common mental disorder was inconclusive, whereas the average effects of PTSD and depression were positive and statistically significant (PTSD odds ratio (OR) was 1.91 (95% confidence interval (CI): 1.28 to 2.85) and OR=1.98 (95% CI: 1.05 to 3.70) for depression). The analysis concerning substance use indicated that deployed participants did not have higher odds of screening positive for substance use compared to non-deployed participants (OR=1.15 (95% CI: 0.98 to 1.36)).For assessments taken more than 24 months post exposure, meta-analyses indicated that the odds of screening positive for PTSD, depression, substance use and common mental disorder were higher for participants in the deployed group compared to participants in the group that were not deployed (PTSD OR=3.31 (95% CI: 2.69 to 4.07), OR=2.19 (95% CI: 1.58 to 3.03) for depression, OR=1.27 (95% CI: 1.15 to 1.39) for substance use, and OR=1.64 (95% CI: 1.38 to 1.96) for common mental disorder). Likewise, participants reporting high combat exposure had higher odds of screening positive for PTSD and depression than participants reporting lower exposure for long term assessments (PTSD OR=3.05 (95% CI: 1.94 to 4.80) and OR=1.81 (95% CI: 1.28 to 2.56) for depression). The analyses of substance use and common mental disorder were inconclusive due to too few studies.On the basis of the prevalence of mental health problems in pre-deployed or non-deployed population based comparison sampleswe would therefore expect the long term prevalence of PTSD in post-deployed samples to be in the range 6.1 - 14.9%, the long term prevalence of depression to be in the range from 7.6% to 18%, the long term prevalence of substance use to be in the range from 2.4% to 17.5% and the prevalence of common mental disorder to be in the range from 10% to 23%.Sensitivity analyses resulted in no appreciable change in effect size, suggesting that the results are robust.It was only possible to assess the impact of two types of personnel characteristics (branch of service and duty/enlistment status) on the mental health outcomes. We found no evidence to suggest that the effect of deployment on any outcomes differ between these two types of personnel characteristics.AUTHORS' CONCLUSIONS: Deployment to military operations negatively affects the mental health functioning of deployed military personnel. We focused on the effect of deployment on PTSD (post-traumatic stress disorder), depression, substance abuse/dependence, and common mental disorders (depression and anxiety disorders). For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all domains, particularly on PTSD. There is increased political awareness of the need to address post deployment mental health problems. The odds of screening positive for PTSD and depression were consistently high in the longer term. This suggests that efforts should be increased to detect and treat mental disorders, as effects may be long lasting. Mental illness is of particular concern in the military for operational reasons, but they may be hard to detect in the military setting because a military career is intimately linked with mental and physical strength.It was not possible to examine a number of factors which we had reason to expect would impact on the magnitude of the effect. This would have been particularly relevant from a policy perspective because these are direct parameters that one could use to optimally "organize" deployment in order to minimize impacts on mental health functioning.While additional research is needed, the current evidence strongly supports the notion that deployment negatively affects mental health functioning of deployed military personnel. The next step is to begin to examine preventive measures and policies for organizing deployment, in order to minimize the effects on mental health.
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Sadler AG, Booth BM, Torner JC, Mengeling MA. Sexual assault in the US military: A comparison of risk in deployed and non-deployed locations among Operation Enduring Freedom/Operation Iraqi Freedom active component and Reserve/National Guard servicewomen. Am J Ind Med 2017; 60:947-955. [PMID: 28857214 DOI: 10.1002/ajim.22767] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND To determine whether sexual assault in the military (SAIM) among active component and Reserve/National Guard servicewomen is more likely to occur in deployed or non-deployed locations; and which location poses greater risk for SAIM when time spent in-location is considered. METHODS A total of 1337 Operation Enduring Freedom/Operation Iraqi Freedom era servicewomen completed telephone interviews eliciting socio-demographics, military and sexual assault histories, including attempted and completed sexual assault. RESULTS Half of the sample had been deployed (58%). Overall 16% (N = 245) experienced SAIM; a higher proportion while not deployed (15%; n = 208) than while deployed (4%; n = 52). However, the incidence of SAIM per 100 person-years was higher in deployed than in non-deployed locations: 3.5 vs 2.4. Active component and Reserve/National Guard had similar deployment lengths, but Reserve/National Guard had higher SAIM incidence rates/100 person-years (2.8 vs 4.0). CONCLUSIONS A higher proportion of servicewomen experienced SAIM while not deployed; however, adjusting for time in each location, servicewomen were at greater risk during deployment.
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Affiliation(s)
- Anne G. Sadler
- The Center for Comprehensive Access & Delivery Research and Evaluation (CADRE)Iowa City VA Health Care SystemIowa CityIowa
- Department of PsychiatryUniversity of Iowa Carver College of MedicineIowa CityIowa
| | - Brenda M. Booth
- Department of PsychiatryUniversity of Arkansas for Medical SciencesLittle RockArkansas
| | - James C. Torner
- Department of Epidemiology, University of Iowa College of Public Health, Departments of Neurosurgery and SurgeryUniversity of Iowa Carver College of MedicineIowa CityIowa
| | - Michelle A. Mengeling
- The Center for Comprehensive Access & Delivery Research and Evaluation (CADRE)Iowa City VA Health Care SystemIowa CityIowa
- VA Office of Rural Health (ORH)Veterans Rural Health Resource Center‐Iowa City (VRHRC‐IC)Iowa City VA Health Care SystemIowa CityIowa
- Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIowa
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Oliveira ABD, Bernardes MMR, Kneodler TDS, Lourenço MBC. MEMÓRIAS REVELADAS: DISCURSOS DE ENFERMEIRAS VETERANAS SOBRE A SUA LUTA POR REINCLUSÃO NO CAMPO MILITAR. TEXTO & CONTEXTO ENFERMAGEM 2017. [DOI: 10.1590/0104-07072017002720016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: analisar os efeitos simbólicos da luta empreendida pelas integrantes do primeiro grupamento feminino de enfermagem das Forças Armadas brasileiras para serem reincluídas no Serviço Militar Ativo do Exército, após o término de suas atividades durante a Segunda Guerra Mundial. Método: pesquisa histórico-social cujas fontes constituíram-se de documentos escritos, orais e fotográficos. Os achados foram classificados, contextualizados e analisados em conformidade com o método histórico e à luz da Teoria do Mundo Social de Pierre Bourdieu e dos estudos de Michelle Perrot sobre a História das Mulheres. Resultados: a pesquisa demonstrou que os discursos destas enfermeiras, que atuaram no Teatro de Operações Italiano durante a guerra (1943-1945) e que foram reincorporadas ao Exército Brasileiro em 1957, apesar de reiterarem vocações e estereótipos sobre a prática de Enfermagem, trouxeram a lume os resquícios de uma luta propriamente simbólica pela conquista inédita de espaço, poder e prestígio para a profissão nesse campo culturalmente masculinizado. Conclusão: a reinclusão dessas enfermeiras no Serviço Militar Ativo do Exército serviu de fundamentação para a criação de novos corpos militarizados femininos no âmbito das Forças Armadas, a partir da década de 1980.
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Muirhead L, Hall P, Jones-Taylor C, Clifford GD, Felton-Williams T, Williams K. Critical questions: Advancing the health of female Veterans. J Am Assoc Nurse Pract 2017; 29:571-580. [PMID: 28731291 DOI: 10.1002/2327-6924.12490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 06/04/2017] [Indexed: 11/09/2022]
Abstract
PURPOSE Women are the fastest growing Veteran population in the United States and many receive all or part of their health care outside of the Department of Veterans Affairs (VA). The purpose of this article is to review the healthcare issues of women Veterans and discuss implications for care. DATA SOURCES Review of selected literature, VA resources and guidelines, and expert opinion. CONCLUSIONS Few providers are aware of the impact military service has on the health of women and fail to ask the all-important question, "Have you served in the military?" Recognizing women's military service can reveal important information that can answer perplexing clinical questions, aid in designing comprehensive plans of care, and enable women to receive the assistance needed to address complex physical and psychosocial issues to improve the quality of their lives. IMPLICATIONS FOR PRACTICE There are gender disparities related to physical health conditions, mental health issues, environmental exposures, and socioeconomic factors that contribute to female Veterans' vulnerabilities. Many of the health conditions, if recognized in a timely manner, can be ameliorated and shift the health trajectory of this population. Clinicians play a critical role in identifying health risk and helping female Veterans start the sometimes arduous journey toward wellness. Discovering and acknowledging women's military history is critical in ensuring quality care and appropriate decision making.
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Affiliation(s)
- Lisa Muirhead
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Priscilla Hall
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Cedrella Jones-Taylor
- Primary Care, Atlanta VA Medical Center, Emory University School of Medicine, Decatur, Georgia
| | - Gari D Clifford
- Department of Biomedical Informatics, Georgia Institute of Technology, Emory University, Atlanta, Georgia.,Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, Georgia
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Wooten NR, Adams RS, Mohr BA, Jeffery DD, Funk W, Williams TV, Larson MJ. Pre-deployment Year Mental Health Diagnoses and Treatment in Deployed Army Women. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 44:582-594. [PMID: 27368233 PMCID: PMC5203968 DOI: 10.1007/s10488-016-0744-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We estimated the prevalence of select mental health diagnoses (MHDX) and mental health treatment (MHT), and identified characteristics associated with MHT during the pre-deployment year (365 days before deployment) in active duty Army women (N = 14,633) who returned from Iraq or Afghanistan deployments in FY2010. Pre-deployment year prevalence estimates were: 26.2 % for any select MHDX and 18.1 % for any MHT. Army women who had physical injuries since FY2002 or any behavioral health treatment between FY2002 and the pre-deployment year had increased odds of pre-deployment year MHT. During the pre-deployment year, a substantial percentage of Army women had MHDX and at least one MHT encounter or stay. Future research should determine if pre-deployment MHDX among Army women reflect vulnerability to future MHDX, or if pre-deployment MHT results in protection from chronic symptoms.
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Affiliation(s)
- Nikki R Wooten
- College of Social Work, University of South Carolina, Columbia, SC, 29208, USA.
| | - Rachel Sayko Adams
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS035, Waltham, MA, 02454-9110, USA
| | - Beth A Mohr
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS035, Waltham, MA, 02454-9110, USA
| | - Diana D Jeffery
- Clinical Support Division, Healthcare Operations Directorate, Defense Health Agency (DHA), Office of the Assistant Secretary of Defense (Health Affairs), Department of Defense, Falls Church, VA, 22042, USA
| | - Wendy Funk
- Kennell and Associates, Incorporated, Falls Church, VA, 22041, USA
| | - Thomas V Williams
- Defense Health Agency, Department of Defense, Falls Church, VA, 20042, USA
| | - Mary Jo Larson
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS035, Waltham, MA, 02454-9110, USA
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Lee H, Aldwin CM, Choun S, Spiro A. Does combat exposure affect well-being in later life? The VA Normative Aging Study. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2017; 9:672-678. [PMID: 28447816 DOI: 10.1037/tra0000282] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Combat exposure can have long-term negative effects in later life; although aspects of service may be appraised positively, the long-term positive effects of combat on well-being in later life is largely unknown. METHOD The sample included 1,006 male veterans from the VA Normative Aging Study, surveyed by mail in 1986, 1990, and 1991 (Mage = 65.5 years, SD = 7.3). They reported on their combat exposure, desirable appraisals of military service, unit cohesion, dispositional optimism, self-rated health, and psychological well-being (PWB), as well as age, military rank, and education. Perceived positive aspects (PPA) of military service was postulated to mediate the effects of combat exposure on PWB. Structural equation modeling was used to examine both mediating and moderating effects. RESULTS Age, combat exposure, and optimism had independent effects on PPA, but optimism did not moderate the effect of combat exposure on PPA. Combat exposure had only indirect effects on PWB through PPA, controlling for the direct effects of optimism. Education had no direct effects on the positive outcomes but did have indirect effects through optimism. CONCLUSION Combat exposure contributes to positive well-being in later life, indirectly through positive appraisals, and this effect was independent of optimism. Thus, these results support the idea that combat veterans should be encouraged to focus on positive aspects of military service, which may serve as resilience resources to facilitate optimal aging. (PsycINFO Database Record
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Affiliation(s)
- Hyunyup Lee
- Human Development and Family Studies, Oregon State University
| | - Carolyn M Aldwin
- Center for Healthy Aging Research, Human Development and Family Studies, Oregon State University
| | - Soyoung Choun
- Human Development and Family Studies, Oregon State University
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Chuang E, Brunner J, Mak S, Hamilton AB, Canelo I, Darling J, Rubenstein LV, Yano EM. Challenges with Implementing a Patient-Centered Medical Home Model for Women Veterans. Womens Health Issues 2017; 27:214-220. [PMID: 28063848 PMCID: PMC6824838 DOI: 10.1016/j.whi.2016.11.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/23/2016] [Accepted: 11/29/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Veterans Health Administration (VA) Patient Aligned Care Team (PACT) initiative aims to ensure that all patients receive care consistent with medical home principles. Women veterans' unique care needs and minority status within the VA pose challenges to delivery of equitable, comprehensive primary care for this population. Currently, little is known about whether and/or how PACT should be tailored to better meet women veterans' needs. METHODS In 2014, we conducted semistructured interviews with 73 primary care providers and staff to examine facilitators and barriers encountered in providing PACT-principled care to women veterans. Respondents were located in eight VA medical centers in eight different states across the United States. RESULTS Respondents perceived PACT as improving continuity of care for patients and as increasing ability of nursing staff to practice at the top of their license. However, the implementation of core medical home features and team huddles was inconsistent and varied both within and across medical centers. Short staffing, inclusion of part-time providers on teams, balancing performance requirements for continuity and same-day access, and space constraints were identified as ongoing barriers to PACT implementation. Challenges unique to care of women veterans included a higher prevalence of psychosocial needs, the need for specialized training of primary care personnel, and short staffing owing to additional sharing of primary care support staff with specialist providers. CONCLUSION Providers and staff face unique challenges in delivering comprehensive primary care to women veterans that may require special policy, practice, and management action if benefits of PACT are to be fully realized for this population.
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Affiliation(s)
- Emmeline Chuang
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California.
| | - Julian Brunner
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Selene Mak
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Alison B Hamilton
- HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, Los Angeles, California
| | - Ismelda Canelo
- HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, Los Angeles, California
| | - Jill Darling
- HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, Los Angeles, California
| | - Lisa V Rubenstein
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California; HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, Los Angeles, California
| | - Elizabeth M Yano
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California; HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, Los Angeles, California
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Weitlauf JC, Washington DL, Stefanick ML. Who Are the Women Veterans in the Women's Health Initiative? THE GERONTOLOGIST 2017; 56 Suppl 1:S6-9. [PMID: 26768392 DOI: 10.1093/geront/gnv674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Julie C Weitlauf
- Veterans Affairs Pal`o Alto Health Care System, Sierra Pacific MIRECC and Center for Implementation to Innovation (Ci2i), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto.
| | - Donna L Washington
- Veterans Affairs Greater Los Angeles Health Care System, David Geffen School of Medicine, University of California, Los Angeles
| | - Marcia L Stefanick
- Stanford University School of Medicine, Departments of Medicine and Obstetrics and Gynecology, Stanford Prevention Research Center Stanford
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Attitudes, Practices, and Experiences with Implementing a Patient-Centered Medical Home for Women Veterans. Womens Health Issues 2017; 27:221-227. [PMID: 28087130 DOI: 10.1016/j.whi.2016.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 10/31/2016] [Accepted: 11/30/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite the growing demand for health care among women veterans in the Veterans Health Administration (VHA), little is known about the perspectives of primary care providers (PCPs) and other primary care staff about the care they provide to women veterans. We sought to understand whether barriers to, attitudes about, and practices in caring for women veterans were associated with two measures of implementation of the VHA patient-centered medical home for women veterans (self-efficacy and satisfaction). METHODS We administered a cross-sectional survey by Internet from September 8, 2014, through April 27, 2015 (and by mail from December 16, 2014, through June 18, 2015) to all PCPs and affiliated primary care staff in 12 VHA medical centers. We used descriptive and bivariate analyses to characterize their barriers, attitudes, and practices regarding care for women veterans; and ordinary least squares regression to identify associations with satisfaction and self-efficacy regarding medical home implementation for women veterans among members of a VHA patient-centered medical home teamlet for women patients. RESULTS Of 775 surveys sent, 288 were completed (94 PCPs and 194 staff) for a response rate of 37% (33% for PCPs; 39% for staff). On average, providers had one female patient for every five patients in their panels. Lower perceived barriers, higher gender-sensitive attitudes, and being a PCP were significantly associated with satisfaction and self-efficacy of patient-centered medical home for women patients. CONCLUSIONS Training efforts focused on eliminating perceived barriers and strengthening positive attitudes toward women may be more successful than changing women's health practice characteristics alone.
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Mankowski M, Everett JE. Women service members, veterans, and their families: What we know now. NURSE EDUCATION TODAY 2016; 47:23-28. [PMID: 26833173 DOI: 10.1016/j.nedt.2015.12.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 12/08/2015] [Accepted: 12/22/2015] [Indexed: 06/05/2023]
Abstract
The purpose of this paper is to highlight what we know now about female service members, veterans, and their families. The experiences of U.S. female service members and veterans are more complex than previous eras and significant demographic changes have taken place. U.S. female veterans are more likely to be younger, come from ethnic and racial minority groups, have children, and combat exposure. U.S. female service members report high rates of sexual violence and they are more vulnerable to homelessness and unemployment when compared to previous female military cohorts. U.S. female service members and veterans are also at higher risk for significant mental and health issues. Children and adolescents of women service members and veterans may also carry a heavy burden as a result of lengthy deployments. A majority of female service members and veterans will utilize community based healthcare and social services, therefore, it is essential that all healthcare providers understand the unique needs of this cohort of women. Practice implications at the micro, mezzo, and macro levels are discussed. Qualitative and quantitative studies that expand our understanding of women's experience in the military and as veterans are encouraged.
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Affiliation(s)
- Mariann Mankowski
- West Virginia University, School of Social Work, B15 Knapp Hall, Morgantown, WV 26505, United States.
| | - Joyce E Everett
- Smith College, School of Social Work, Lilly Hall, Northampton, MA 01084, United States.
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Abstract
: The last two decades have seen increasing numbers of women entering all branches of the U.S. armed forces. Now that women in the military are no longer prohibited from holding direct combat positions, they are often exposed to traumatic events that place them at higher risk for mental health conditions. Nurses working within the Veterans Affairs (VA) system and those working in non-VA settings are likely to encounter female veterans. It's essential for all nurses to be knowledgeable about the mental health issues commonly seen in this population, and to understand the importance of screening, not only for mental health issues but also for physical conditions that may be related to service.Numerous studies have focused on the mental health effects of deployment among military men, but very few have been conducted among military women. To learn more, the literature was searched for relevant articles published between January 2005 and December 2015. The research supports the contention that both active-duty and veteran women are at increased risk for postdeployment mental health problems, including posttraumatic stress disorder, military sexual trauma, and suicide. This article discusses the relevant research; identifies gaps in the literature; and addresses the nursing practice implications, including screening.
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Yano EM, Darling JE, Hamilton AB, Canelo I, Chuang E, Meredith LS, Rubenstein LV. Cluster randomized trial of a multilevel evidence-based quality improvement approach to tailoring VA Patient Aligned Care Teams to the needs of women Veterans. Implement Sci 2016; 11:101. [PMID: 27435723 PMCID: PMC4950741 DOI: 10.1186/s13012-016-0461-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/24/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The Veterans Health Administration (VA) has undertaken a major initiative to transform care through implementation of Patient Aligned Care Teams (PACTs). Based on the patient-centered medical home (PCMH) concept, PACT aims to improve access, continuity, coordination, and comprehensiveness using team-based care that is patient-driven and patient-centered. However, how VA should adapt PACT to meet the needs of special populations, such as women Veterans (WVs), was not considered in initial implementation guidance. WVs' numerical minority in VA healthcare settings (approximately 7-8 % of users) creates logistical challenges to delivering gender-sensitive comprehensive care. The main goal of this study is to test an evidence-based quality improvement approach (EBQI) to tailoring PACT to meet the needs of WVs, incorporating comprehensive primary care services and gender-specific care in gender-sensitive environments, thereby accelerating achievement of PACT tenets for women (Women's Health (WH)-PACT). METHODS/DESIGN EBQI is a systematic approach to developing a multilevel research-clinical partnership that engages senior organizational leaders and local quality improvement (QI) teams in adapting and implementing new care models in the context of prior evidence and local practice conditions, with researchers providing technical support, formative feedback, and practice facilitation. In a 12-site cluster randomized trial, we will evaluate WH-PACT model achievement using patient, provider, staff, and practice surveys, in addition to analyses of secondary administrative and chart-based data. We will explore impacts of receipt of WH-PACT care on quality of chronic disease care and prevention, health status, patient satisfaction and experience of care, provider experience, utilization, and costs. Using mixed methods, we will assess pre-post practice contexts; document EBQI activities undertaken in participating facilities and their relationship to provider/staff and team actions/attitudes; document WH-PACT implementation; and examine barriers/facilitators to EBQI-supported WH-PACT implementation through a combination of semi-structured interviews and monthly formative progress narratives and administrative data. DISCUSSION Lack of gender-sensitive comprehensive care has demonstrated consequences for the technical quality and ratings of care among WVs and may contribute to decisions to continue use or seek care elsewhere under the US Affordable Care Act. We hypothesize that tailoring PACT implementation through EBQI may improve the experience and quality of care at many levels. TRIAL REGISTRATION ClinicalTrials.gov, NCT02039856.
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Affiliation(s)
- Elizabeth M. Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Street, Building 25 (Mailcode 152), Sepulveda, CA 91343 USA
- Department of Health Policy & Management, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South, Center for Health Sciences, Los Angeles, CA 90095-1772 USA
| | - Jill E. Darling
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Street, Building 25 (Mailcode 152), Sepulveda, CA 91343 USA
- Dornsife Center for Economic and Social Research, University of Southern California, 635 Downey Way, Los Angeles, CA 90089 USA
| | - Alison B. Hamilton
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Street, Building 25 (Mailcode 152), Sepulveda, CA 91343 USA
- Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, 760 Westwood Plaza, Los Angeles, CA 90095 USA
| | - Ismelda Canelo
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Street, Building 25 (Mailcode 152), Sepulveda, CA 91343 USA
| | - Emmeline Chuang
- Department of Health Policy & Management, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South, Center for Health Sciences, Los Angeles, CA 90095-1772 USA
| | | | - Lisa V. Rubenstein
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Street, Building 25 (Mailcode 152), Sepulveda, CA 91343 USA
- RAND Health, 1776 Main Street, Santa Monica, CA 90401-3208 USA
- Department of Medicine, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073 USA
- Department of Medicine, UCLA Geffen School of Medicine, 611 Charles E. Young Drive East, Los Angeles, CA 90095 USA
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Cohen GH, Sampson LA, Fink DS, Wang J, Russell D, Gifford R, Fullerton C, Ursano R, Galea S. Gender, Position of Authority, and the Risk of Depression and Posttraumatic Stress Disorder among a National Sample of U.S. Reserve Component Personnel. Womens Health Issues 2016; 26:268-77. [PMID: 26899583 PMCID: PMC5008021 DOI: 10.1016/j.whi.2016.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 12/24/2015] [Accepted: 01/05/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Recent U.S. military operations in Iraq and Afghanistan have seen dramatic increases in the proportion of women serving and the breadth of their occupational roles. General population studies suggest that women, compared with men, and persons with lower, as compared with higher, social position may be at greater risk of posttraumatic stress disorder (PTSD) and depression. However, these relations remain unclear in military populations. Accordingly, we aimed to estimate the effects of 1) gender, 2) military authority (i.e., rank), and 3) the interaction of gender and military authority on a) risk of most recent deployment-related PTSD and b) risk of depression since most recent deployment. METHODS Using a nationally representative sample of 1,024 previously deployed Reserve Component personnel surveyed in 2010, we constructed multivariable logistic regression models to estimate effects of interest. RESULTS Weighted multivariable logistic regression models demonstrated no statistically significant associations between gender or authority, and either PTSD or depression. Interaction models demonstrated multiplicative statistical interaction between gender and authority for PTSD (beta = -2.37; p = .01), and depression (beta = -1.21; p = .057). Predicted probabilities of PTSD and depression, respectively, were lowest in male officers (0.06, 0.09), followed by male enlisted (0.07, 0.14), female enlisted (0.07, 0.15), and female officers (0.30, 0.25). CONCLUSIONS Female officers in the Reserve Component may be at greatest risk for PTSD and depression after deployment, relative to their male and enlisted counterparts, and this relation is not explained by deployment trauma exposure. Future studies may fruitfully examine whether social support, family responsibilities peri-deployment, or contradictory class status may explain these findings.
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Affiliation(s)
- Gregory H Cohen
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
| | - Laura A Sampson
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - David S Fink
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York
| | - Jing Wang
- Center for the Study of Traumatic Stress, Hebert School of Medicine, Uniformed Services University of the Health Sciences, Department of Psychiatry Bethesda, MD
| | - Dale Russell
- Center for the Study of Traumatic Stress, Hebert School of Medicine, Uniformed Services University of the Health Sciences, Department of Psychiatry Bethesda, MD
| | - Robert Gifford
- Center for the Study of Traumatic Stress, Hebert School of Medicine, Uniformed Services University of the Health Sciences, Department of Psychiatry Bethesda, MD
| | - Carol Fullerton
- Center for the Study of Traumatic Stress, Hebert School of Medicine, Uniformed Services University of the Health Sciences, Department of Psychiatry Bethesda, MD
| | - Robert Ursano
- Center for the Study of Traumatic Stress, Hebert School of Medicine, Uniformed Services University of the Health Sciences, Department of Psychiatry Bethesda, MD
| | - Sandro Galea
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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Washington DL, Bird CE, LaMonte MJ, Goldstein KM, Rillamas-Sun E, Stefanick ML, Woods NF, Bastian LA, Gass M, Weitlauf JC. Military Generation and Its Relationship to Mortality in Women Veterans in the Women's Health Initiative. THE GERONTOLOGIST 2016; 56 Suppl 1:S126-37. [PMID: 26768386 PMCID: PMC5881617 DOI: 10.1093/geront/gnv669] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/05/2015] [Indexed: 11/14/2022] Open
Abstract
PURPOSE OF THE STUDY Women's military roles, exposures, and associated health outcomes have changed over time. However, mortality risk-within military generations or compared with non-Veteran women-has not been assessed. Using data from the Women's Health Initiative (WHI), we examined all-cause and cause-specific mortality by Veteran status and military generation among older women. DESIGN AND METHODS WHI participants (3,719 Veterans; 141,802 non-Veterans), followed for a mean of 15.2 years, were categorized into pre-Vietnam or Vietnam/after generations based on their birth cohort. We used cox proportional hazards models to examine the association between Veteran status and mortality by generation. RESULTS After adjusting for sociodemographic characteristics and WHI study arm, all-cause mortality hazard rate ratios (HRs) for Veterans relative to non-Veterans were 1.16 (95% CI: 1.09-1.23) for pre-Vietnam and 1.16 (95% CI: 0.99-1.36) for Vietnam/after generations. With additional adjustment for health behaviors and risk factors, this excess mortality rate persisted for pre-Vietnam but attenuated for Vietnam/after generations. After further adjustment for medical morbidities, across both generations, Veterans and non-Veterans had similar all-cause mortality rates. Relative to non-Veterans, adjusting for sociodemographics and WHI study arm, pre-Vietnam generation Veterans had higher cancer, cardiovascular, and trauma-related morality rates; Vietnam/after generation Veterans had the highest trauma-related mortality rates (HR = 2.93, 1.64-5.23). IMPLICATIONS Veterans' higher all-cause mortality rates were limited to the pre-Vietnam generation, consistent with diminution of the healthy soldier effect over the life course. Mechanisms underlying Vietnam/after generation Veteran trauma-related mortality should be elucidated. Efforts to modify salient health risk behaviors specific to each military generation are needed.
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Affiliation(s)
- Donna L Washington
- VA Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, California. University of California Los Angeles, Geffen School of Medicine.
| | - Chloe E Bird
- RAND Corporation, Pardee Rand Graduate School, Santa Monica, California
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York at Buffalo
| | | | | | - Marcia L Stefanick
- Stanford University School of Medicine, Stanford Center for Health Research on Women & Sex Differences in Medicine, California
| | - Nancy F Woods
- Division of Biobehavioral Nursing & Health Systems, University of Washington School of Nursing, Seattle
| | - Lori A Bastian
- VA Connecticut, and University of Connecticut Health Center, West Haven
| | - Margery Gass
- The North American Menopause Society, Mayfield Heights, Ohio
| | - Julie C Weitlauf
- VA Palo Alto Health Care System, Sierra Pacific MIRECC and Center for Innovation to Implementation, California. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California
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Abstract
As more women have joined the US military, there has been a shift in the overall veteran population. Those who served in the US military, especially women, have undergone experiences that will impact their overall health and wellbeing. It is therefore critical for providers to better understand US military culture and be prepared on how to ask patients about their military experience. Health care providers need to be aware of the unique medical, psychiatric, and psychosocial needs of women veterans in order to best serve this patient population.
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Affiliation(s)
- Ximena A Levander
- Department of Medicine, VA Puget Sound Health Care System, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195-6421, USA.
| | - Maryann K Overland
- Department of Medicine, VA Puget Sound Health Care System, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195-6421, USA
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deKleijn M, Lagro-Janssen AL, Canelo I, Yano EM. Creating a roadmap for delivering gender-sensitive comprehensive care for women Veterans: results of a national expert panel. Med Care 2015; 53:S156-64. [PMID: 25767971 PMCID: PMC4379113 DOI: 10.1097/mlr.0000000000000307] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Women Veterans are a significant minority of users of the VA healthcare system, limiting provider and staff experience meeting their needs in environments historically designed for men. The VA is nonetheless committed to ensuring that women Veterans have access to comprehensive care in environments sensitive to their needs. OBJECTIVES We sought to determine what aspects of care need to be tailored to the needs of women Veterans in order for the VA to deliver gender-sensitive comprehensive care. RESEARCH DESIGN Modified Delphi expert panel process. SUBJECTS Eleven clinicians and social scientists with expertise in women's health, primary care, and mental health. MEASURES Importance of tailoring over 100 discrete aspects of care derived from the Institute of Medicine's definition of comprehensive care and literature-based domains of sex-sensitive care on a 5-point scale. RESULTS Panelists rated over half of the aspects of care as very-to-extremely important (median score 4+) to tailor to the needs of women Veterans. The panel arrived at 14 priority recommendations that broadly encompassed the importance of (1) the design/delivery of services sensitive to trauma histories, (2) adapting to women's preferences and information needs, and (3) sex awareness and cultural transformation in every facet of VA operations. CONCLUSIONS We used expert panel methods to arrive at consensus on top priority recommendations for improving delivery of sex-sensitive comprehensive care in VA settings. Accomplishment of their breadth will require national, regional, and local strategic action and multilevel stakeholder engagement, and will support VA's national efforts at improving customer service for all Veterans.
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Affiliation(s)
- Miriam deKleijn
- Department of Primary and Community Care, Gender and Women's Health Unit, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Antoine L.M. Lagro-Janssen
- Department of Primary and Community Care, Gender and Women's Health Unit, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ismelda Canelo
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles, Sepulveda
| | - Elizabeth M. Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles, Sepulveda
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
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Wang JM, Lee LO, Spiro A. Gender differences in the impact of warfare exposure on self-rated health. Womens Health Issues 2014; 25:35-41. [PMID: 25442366 DOI: 10.1016/j.whi.2014.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 09/07/2014] [Accepted: 09/10/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study examined gender differences in the impact of warfare exposure on self-reported physical health. METHODS Data are from the 2010 National Survey of Veterans, a nationally representative survey of veterans from multiple eras of service. Regression analyses assessed gender differences in the association between warfare exposure (deployment to a war zone, exposure to casualties) and health status and functional impairment, adjusting for sociodemographics. FINDINGS Women reported better health status but greater functional impairment than men. Among men, those who experienced casualties only or both casualties and deployment to a war zone had worse health compared with those who experienced neither stressor or deployment to a war zone only. Among women, those who experienced casualties only or both stressors reported worse health than those who experienced war zone only, who did not differ from the unexposed. No association was found between warfare exposure and functional impairment in women; in men, however, those who experienced exposure to casualties or both stressors had greater odds of functional impairment compared with those who experienced war zone only or neither stressor. CONCLUSIONS Exposure to casualties may be more predictive of health than deployment to a war zone, especially for men. We did not find a stronger association between warfare exposure and health for women than men. Given that the expansion of women's military roles has allowed them to serve in direct combat, their degree and scope of warfare exposure is likely to increase in the future.
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Affiliation(s)
- Joyce M Wang
- VA Boston Healthcare System, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts.
| | - Lewina O Lee
- VA Boston Healthcare System, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Boston University School of Medicine, Boston, Massachusetts
| | - Avron Spiro
- VA Boston Healthcare System, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Boston University School of Medicine, Boston, Massachusetts; Boston University School of Dental Medicine, Boston, Massachusetts
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Delivery of gender-sensitive comprehensive primary care to women veterans: implications for VA Patient Aligned Care Teams. J Gen Intern Med 2014; 29 Suppl 2:S703-7. [PMID: 24715395 PMCID: PMC4070234 DOI: 10.1007/s11606-013-2699-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The Veterans Health Administration (VA) has undertaken a major initiative to transform primary care delivery through implementation of Patient Aligned Care Teams (PACTs). Based on the patient-centered medical home concept, PACTs aim to improve access, continuity, coordination, and comprehensiveness using team-based care that is patient driven and patient centered. However, how PACT principles should be applied to meet the needs of special populations, including women veterans, is not entirely clear. While historical differences in military participation meant women veterans were rarely seen in VA healthcare settings, they now represent the fastest growing segment of new VA users. They also have complex healthcare needs, adding gender-specific services and other needs to the spectrum of services that the VA must deliver. These trends are changing the VA landscape, introducing challenges to how VA care is organized, how VA providers need to be trained, and how VA considers implementation of new initiatives, such as PACT. We briefly describe the evolution of VA primary care delivery for women veterans, review VA policy for delivering gender-sensitive comprehensive primary care for women, and discuss the challenges that women veterans' needs pose in the context of PACT implementation. We conclude with recommendations for addressing some of these challenges moving forward.
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Gerber MR, Iverson KM, Dichter ME, Klap R, Latta RE. Women Veterans and Intimate Partner Violence: Current State of Knowledge and Future Directions. J Womens Health (Larchmt) 2014; 23:302-9. [DOI: 10.1089/jwh.2013.4513] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Megan R. Gerber
- Women Veterans Health Program, VA Boston Healthcare System, Boston, Massachusetts
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Katherine M. Iverson
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Melissa E. Dichter
- VA Center for Health Equity Research and Promotion (CHERP), Philadelphia VA Medical Center, Philadelphia, Pennsylvania
| | - Ruth Klap
- VA Greater Los Angeles Healthcare System, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, California
| | - Rachel E. Latta
- New England Mental Illness Research, Education and Clinical Center (MIRECC), Edith Nourse Rogers Memorial Veterans Administration Hospital, Bedford, Massachusetts
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Chapman SLC, Wu LT. Suicide and substance use among female veterans: a need for research. Drug Alcohol Depend 2014; 136:1-10. [PMID: 24315571 PMCID: PMC3945024 DOI: 10.1016/j.drugalcdep.2013.11.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 11/06/2013] [Accepted: 11/07/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The number of female veterans is increasing. Veterans Administration (VA) enrollment increased over 40% from past eras. However, little research has focused on their mental health. We reviewed literature to examine associations of substance use with suicide in female veterans, identify research gaps, and inform future studies. METHODS Google Scholar, Pub Med, and PsychINFO were searched using: substance use, female veteran, and suicide. Exclusion criteria (e.g., not discussing U.S. veterans) left 17 articles. RESULTS Nine studies examined completed suicide among veterans. In most recent years, rates of deaths were greater for veterans than nonveterans, including females. Completed suicide was associated with past trauma, young age, and a mental disorder. Studies have often not addressed substance use. Three studies examined completed suicide among VA treated veterans without examining substance use as an associated factor. Rates of completed suicides were also higher among veterans than nonveterans, including females. A large proportion of females also had a mental diagnosis. Five studies examined substance use and attempted or completed suicide among VA treated veterans. Veterans in poor mental health had increased odds of suicide mortality; women with a substance use disorder (SUD) had a higher hazard ratio for completed suicide than men with a SUD. Engagement in substance abuse treatment decreased odds of suicide attempt among veterans. CONCLUSION Available data suggest that suicide rates are higher among female veterans than women in the general population. Substance use may increase the likelihood of suicidal behaviors among female veterans, particularly those with a mental diagnosis.
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Affiliation(s)
- Shawna L. Carroll Chapman
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA,Address for correspondence: Shawna L. Carroll Chapman, Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC 27710, USA; tel.: 785-840-6632; fax: 919-681-8400;
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA
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Gaunaurd IA, Gailey RS, Pasquina PF. More than the final score: development, application, and future research of comprehensive high-level activity mobility predictor. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2013; 50:vii-xiii. [PMID: 24301440 DOI: 10.1682/jrrd.2013.05.0111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ignacio A Gaunaurd
- Functional Outcomes Research and Evaluation Center, Miami Department of Veterans Affairs Healthcare System, Miami, FL
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Faith as a resource in patients with multiple sclerosis is associated with a positive interpretation of illness and experience of gratitude/awe. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:128575. [PMID: 24319471 PMCID: PMC3844211 DOI: 10.1155/2013/128575] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 09/25/2013] [Indexed: 11/17/2022]
Abstract
The aim of this cross-sectional anonymous survey with standardized questionnaires was to investigate which resources to cope were used by patients with multiple sclerosis (MS). We focussed on patients' conviction that their faith might be a strong hold in difficult times and on their engagement in different forms of spirituality. Consecutively 213 German patients (75% women; mean age 43 ± 11 years) were enrolled. Fifty-five percent regarded themselves as neither religious nor spiritual (R-S-), while 31% describe themselves as religious. For 29%, faith was a strong hold in difficult times. This resource was neither related to patients' EDSS scores, and life affections, fatigue, negative mood states, life satisfaction nor to Positive attitudes. Instead it was moderately associated with a Reappraisal strategy (i.e., and positive interpretation of illness) and experience of gratitude/awe. Compared to spiritual/religious patients, R-S- individuals had significantly (P < .0001) lower Reappraisal scores and lower engagement in specific forms of spiritual practices. The ability to reflect on what is essential in life, to appreciate and value life, and also the conviction that illness may have meaning and could be regarded as a chance for development was low in R-S- individuals which either may have no specific interest or are less willing to reflect these issues.
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Delcher C, Wang Y, Maldonado-Molina M. Trends in financial barriers to medical care for women veterans, 2003-2004 and 2009-2010. Prev Chronic Dis 2013; 10:E171. [PMID: 24157074 PMCID: PMC3809923 DOI: 10.5888/pcd10.130071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Women veterans are a fast-growing segment of the veteran population, yet they face many barriers to medical care. The objective of this study was to examine factors that put women veterans at risk for a financial barrier to medical care. METHODS We conducted repeated cross-sectional analyses of data from the 2003, 2004, 2009, and 2010 Behavioral Risk Factor Surveillance System. We used weighted logistic regression to examine the risk of a financial barrier to medical care as the primary outcome in a multivariate model controlling for factors in health-related domains. RESULTS In 2010, there were an estimated 1,719,750 (11.6%) working-aged veterans who needed to see a doctor in the previous 12 months but could not because of cost. For women, 13.4% faced this financial barrier. Over the study period, facing a financial barrier was consistently associated with insurance coverage, physical and mental distress days, and having children in the home. Other associations emerged in particular years, such as binge drinking in 2010. The trends for women veterans relative to men and for younger women veterans relative to older women veterans show reduction in financial barriers to health care. CONCLUSION The Veteran's Health Administration (VHA) should continue efforts to reduce financial and other barriers, especially among the higher risk groups we identified. This will help meet the VHA's objectives of providing comprehensive care to all veterans including women.
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Affiliation(s)
- Chris Delcher
- University of Florida, Department of Epidemiology, 2004 Mowry Rd, Gainesville, FL 32610. E-mail:
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Frayne SM, Carney DV, Bastian L, Bean-Mayberry B, Sadler A, Klap R, Phibbs CS, Kimerling R, Vogt D, Yee EF, Lin JY, Yano EM. The VA Women's Health Practice-Based Research Network: amplifying women veterans' voices in VA research. J Gen Intern Med 2013; 28 Suppl 2:S504-9. [PMID: 23807057 PMCID: PMC3695282 DOI: 10.1007/s11606-013-2476-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Susan M. Frayne
- />VA HSR&D Center of Excellence, VA Palo Alto Health Care System, Palo Alto, CA USA
- />Division of General Medical Disciplines, Stanford University School of Medicine, Palo Alto, CA USA
- />Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Palo Alto, CA USA
| | - Diane V. Carney
- />VA HSR&D Center of Excellence, VA Palo Alto Health Care System, Palo Alto, CA USA
| | - Lori Bastian
- />VA HSR&D Center of Excellence, VA Medical Center, Durham, NC USA
- />Division of General Internal Medicine, University of Connecticut Health Center, Farmington, CT USA
| | - Bevanne Bean-Mayberry
- />VA HSR&D Center of Excellence, VA Greater Los Angeles Healthcare System, Sepulveda, CA USA
- />Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA USA
| | - Anne Sadler
- />VA HSR&D Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Mental Health Service Line, Iowa City VA Health Care System, Iowa City, IA USA
- />Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, IA USA
| | - Ruth Klap
- />VA HSR&D Center of Excellence, VA Greater Los Angeles Healthcare System, Sepulveda, CA USA
| | - Ciaran S. Phibbs
- />VA HSR&D Center of Excellence, VA Palo Alto Health Care System, Palo Alto, CA USA
- />Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Palo Alto, CA USA
- />Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, CA USA
- />Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA USA
| | - Rachel Kimerling
- />VA HSR&D Center of Excellence, VA Palo Alto Health Care System, Palo Alto, CA USA
- />National Center for PTSD, VA Palo Alto Health Care System, Palo Alto, CA USA
| | - Dawne Vogt
- />National Center for PTSD, VA Boston Healthcare System, Boston, MA USA
- />Division of Psychiatry, Boston University School of Medicine, Boston, MA USA
| | - Ellen F. Yee
- />New Mexico VA Health Care System, Albuquerque, NM USA
- />University of New Mexico, Albuquerque, NM USA
| | - Julia Y. Lin
- />VA Cooperative Studies Program Coordinating Center, VA Palo Alto Health Care System, Palo Alto, CA USA
| | - Elizabeth M. Yano
- />VA HSR&D Center of Excellence, VA Greater Los Angeles Healthcare System, Sepulveda, CA USA
- />Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA USA
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Yan GW, McAndrew L, D'Andrea EA, Lange G, Santos SL, Engel CC, Quigley KS. Self-reported stressors of National Guard women veterans before and after deployment: the relevance of interpersonal relationships. J Gen Intern Med 2013; 28 Suppl 2:S549-55. [PMID: 23807064 PMCID: PMC3695274 DOI: 10.1007/s11606-012-2247-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND With their rapidly expanding roles in the military, women service members experience significant stressors throughout their deployment experience. However, there are few studies that examine changes in women Veterans' stressors before and after deployment. OBJECTIVE This study examines the types of stressors women Veterans report before deployment, immediately after deployment, 3 months after deployment, and 1 year post-deployment. DESIGN Descriptive data on reported stressors was collected at four time points of a longitudinal study (HEROES Project). Open-ended responses from the Coping Response Inventory (CRI) were coded into six possible major stressor categories for analysis. PARTICIPANTS Seventy-nine Army National Guard and Reserve female personnel deploying to Operation Enduring Freedom (OFF)/Operation Iraqi Freedom (OIF) were surveyed prior to deployment. Of these participants, 35 women completed Phase 2, 41 completed Phase 3, and 48 completed Phase 4 of the study. KEY RESULTS We identified six major stressor categories: (1) interpersonal (i.e., issues with family and/or friends), (2) deployment-related and military-related, (3) health concerns, (4) death of a loved one, (5) daily needs (i.e., financial/housing/transportation concerns), and (6) employment or school-related concerns. At all time points, interpersonal issues were one of the most common type of stressor for this sample. Daily needs concerns increased from 3 months post-deployment to 1 year post-deployment. CONCLUSIONS Interpersonal concerns are commonly reported by women Veterans both before and after their combat experience, suggesting that this is a time during which interpersonal support is especially critical. We discuss implications, which include the need for a more coordinated approach to women Veterans' health care (e.g., greater community-based outreach), and the need for more and more accessible Veterans Affairs (VA) services to address the needs of female Veterans.
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Affiliation(s)
- Grace W Yan
- Department of Veterans Affairs, NJ War Related Illness & Injury Study Center, 385 Tremont Ave. Mailstop 129, East Orange, NJ 07018, USA.
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Blosnich J, Foynes MM, Shipherd JC. Health disparities among sexual minority women veterans. J Womens Health (Larchmt) 2013; 22:631-6. [PMID: 23746281 DOI: 10.1089/jwh.2012.4214] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Lesbian and bisexual (i.e., sexual minority) identity is more common among women veterans than among male veterans. Unique health issues have been identified among women veterans and among sexual minority women, but little is known about women who are both sexual minorities and veterans. This study aimed to compare demographic and health information from sexual minority women veterans with sexual minority women non-veterans and heterosexual women veterans. METHODS Behavioral Risk Factor Surveillance Survey data were pooled from ten U.S. states that elected to ask sexual identity during 2010. The analytic sample was comprised of women who identified both their sexual identity and veteran status (n=1,908). Mental health indicators were frequent mental distress, sleep problems, low social/emotional support, and low satisfaction with life. Health risk indicators included current smoking, overweight, and obesity. Physical health status was defined by three components: disability requiring assistive equipment, >14 days of poor physical health in the past 30 days, and activity limitations. RESULTS Compared with heterosexual women veterans, sexual minority women veterans had higher odds of mental distress (odds ratio [OR]=3.03, 95% confidence interval [CI]: 1.61-5.70) and smoking (OR=2.31, 95%CI: 1.19-4.48). After adjusting for demographic correlates, sexual minority women veterans had three times the odds of poor physical health (OR=3.01, 95%CI: 1.51-5.99) than their sexual minority non-veteran peers. CONCLUSIONS Results suggest sexual minority women veterans may experience unique health disparities relevant to provision of care in both Veterans Affairs (VA) and non-VA healthcare systems. Future research requires availability of data that include sexual minority status.
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Affiliation(s)
- John Blosnich
- VISN2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA.
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The meaning of leprosy and everyday experiences: an exploration in cirebon, indonesia. J Trop Med 2013; 2013:507034. [PMID: 23577037 PMCID: PMC3615632 DOI: 10.1155/2013/507034] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 01/13/2013] [Accepted: 02/03/2013] [Indexed: 11/17/2022] Open
Abstract
It is imperative to consider the meaning of leprosy and everyday experiences of people affected by leprosy and key persons in the community if one aims to make leprosy services more effective, which appears necessary in Indonesia given the large numbers of new cases detected annually. However, little is written in the international literature about the experiences of people currently being treated for leprosy, those cured, or other key informants. This paper analyses the narratives of the people by drawing upon in-depth interviews with 53 participants and 20 focus groups discussions. The participants were purposively selected. We provide insights into the experiences of people and the meaning they give to leprosy and highlight aspect of aetiology, spirituality, religion, darkening of the skin, and sorcery. We also examine experiences of seeking care and focused on the impact of the disease in particular on the elderly and children. In conclusion, the continued need for implementation of leprosy services in Indonesia is very evident. The diversities in people's experiences with leprosy indicate a demand for responsive leprosy services to serve the diverse needs, including services for those formally declared to be “cured.”
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Gailey RS, Gaunaurd IA, Raya MA, Roach KE, Linberg AA, Campbell SM, Jayne DM, Scoville C. Development and reliability testing of the Comprehensive High-Level Activity Mobility Predictor (CHAMP) in male servicemembers with traumatic lower-limb loss. ACTA ACUST UNITED AC 2013; 50:905-18. [DOI: 10.1682/jrrd.2012.05.0099] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 01/10/2013] [Indexed: 11/05/2022]
Affiliation(s)
- Robert S. Gailey
- Functional Outcomes Research and Evaluation (FORE) Center, Miami Department of Veterans Affairs Healthcare System, Miami, FL
| | - Ignacio A. Gaunaurd
- Functional Outcomes Research and Evaluation (FORE) Center, Miami Department of Veterans Affairs Healthcare System, Miami, FL
| | - Michele A. Raya
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL
| | - Kathryn E. Roach
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL
| | - Alison A. Linberg
- Military Advanced Training Center, Walter Reed Army Medical Center, Washington, DC
| | | | | | - Charles Scoville
- Military Advanced Training Center, Walter Reed Army Medical Center, Washington, DC
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Koenig HG. Religion, spirituality, and health: the research and clinical implications. ISRN PSYCHIATRY 2012; 2012:278730. [PMID: 23762764 PMCID: PMC3671693 DOI: 10.5402/2012/278730] [Citation(s) in RCA: 632] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 10/15/2012] [Indexed: 12/31/2022]
Abstract
This paper provides a concise but comprehensive review of research on religion/spirituality (R/S) and both mental health and physical health. It is based on a systematic review of original data-based quantitative research published in peer-reviewed journals between 1872 and 2010, including a few seminal articles published since 2010. First, I provide a brief historical background to set the stage. Then I review research on R/S and mental health, examining relationships with both positive and negative mental health outcomes, where positive outcomes include well-being, happiness, hope, optimism, and gratefulness, and negative outcomes involve depression, suicide, anxiety, psychosis, substance abuse, delinquency/crime, marital instability, and personality traits (positive and negative). I then explain how and why R/S might influence mental health. Next, I review research on R/S and health behaviors such as physical activity, cigarette smoking, diet, and sexual practices, followed by a review of relationships between R/S and heart disease, hypertension, cerebrovascular disease, Alzheimer's disease and dementia, immune functions, endocrine functions, cancer, overall mortality, physical disability, pain, and somatic symptoms. I then present a theoretical model explaining how R/S might influence physical health. Finally, I discuss what health professionals should do in light of these research findings and make recommendations in this regard.
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Affiliation(s)
- Harold G. Koenig
- Departments of Medicine and Psychiatry, Duke University Medical Center, P.O. Box 3400, Durham, NC 27705, USA
- Department of Medicine, King Abdulaziz University, Jeddah 21413, Saudi Arabia
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Zullig LL, Jackson GL, Dorn RA, Provenzale DT, McNeil R, Thomas CM, Kelley MJ. Cancer incidence among patients of the U.S. Veterans Affairs Health Care System. Mil Med 2012; 177:693-701. [PMID: 22730846 DOI: 10.7205/milmed-d-11-00434] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Approximately 40,000 incident cancer cases are reported in the Veterans Affairs Central Cancer Registry (VACCR) annually (approximately 3% of U.S. cancer cases). Our objective was to provide the first comprehensive description of cancer incidence as reported in VACCR. METHODS Data were obtained from VACCR for incident cancers diagnosed in VA. Analyses focused on 2007 data. Cancer incidence among VA patients was compared to the general U.S. cancer population. RESULTS In 2007, 97.5% of VA cancers were diagnosed among men. Approximately 78.5% of newly diagnosed patients were White, 19.0% Black, and 2.5% were another race. Median age at diagnosis was 66 years. The geographic distribution of cancer patients in VA aligns that of VA users. The most commonly diagnosed cancers were similar between VA and the U.S. male cancer population. The five most frequently diagnosed cancers among VA cancer patients were: prostate (31.8%), lung/bronchus (18.8%), colon/rectum (8.6%), urinary bladder (3.6%), and skin melanomas (3.4%). VA patients were diagnosed at an earlier stage of disease for the three most commonly diagnosed cancers--lung/bronchus, colon/rectum, and prostate--compared to the U.S. male cancer population. CONCLUSIONS Registry data indicate that incident cancers in VA in 2007 approximately mirrored those observed among U.S. men.
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Affiliation(s)
- Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC 27705, USA
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Lehavot K, Hoerster KD, Nelson KM, Jakupcak M, Simpson TL. Health indicators for military, veteran, and civilian women. Am J Prev Med 2012; 42:473-80. [PMID: 22516487 DOI: 10.1016/j.amepre.2012.01.006] [Citation(s) in RCA: 153] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 11/16/2011] [Accepted: 01/06/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Women who have served in the military are a rapidly growing population. No previous studies have compared directly their health status to that of civilians. PURPOSE To provide estimates of several leading U.S. health indicators by military service status among women. METHODS Data were obtained from the 2010 Behavioral Risk Factor Surveillance Survey, a U.S. population-based study. Health outcomes were compared by military status using multivariable logistic regression among the female participants (274,399 civilians, 4221 veterans, 661 active duty, and 995 National Guard or Reserves [NG/R]). Data were analyzed in August 2011. RESULTS Veterans reported poorer general health and greater incidence of health risk behaviors, mental health conditions, and chronic health conditions than civilian women. Active duty women reported better access to health care, better physical health, less engagement in health risk behaviors, and greater likelihood of having had a recent Pap than civilian women. Women from the NG/R were comparable to civilians across most health domains, although they had a greater likelihood of being overweight or obese and reporting a depressive and anxiety disorder. CONCLUSIONS Compared with civilian women, NG/R women rated their health and access to health care similarly and active duty women rated theirs better on several domains, but veterans consistently reported poorer health.
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Affiliation(s)
- Keren Lehavot
- VA Puget Sound Health Care System, Seattle Division, Washington, 98108, USA.
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Larson MJ, Wooten NR, Adams RS, Merrick EL. Military Combat Deployments and Substance Use: Review and Future Directions. JOURNAL OF SOCIAL WORK PRACTICE IN THE ADDICTIONS 2012; 12:6-27. [PMID: 22496626 PMCID: PMC3321386 DOI: 10.1080/1533256x.2012.647586] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Iraq and Afghanistan veterans experience extreme stressors and injuries during deployments, witnessing and participating in traumatic events. The military has organized prevention and treatment programs as a result of increasing suicides and posttraumatic stress disorder among troops; however, there is limited research on how to intervene with alcohol misuse and drug use that accompany these problems. This review presents statistics about post-deployment substance use problems and comorbidities, and discusses the military's dual role in 1) enforcing troop readiness with its alcohol and drug policies and resiliency-building programs, and 2) seeking to provide treatment to troops with combat-acquired problems including substance abuse.
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Affiliation(s)
- Mary Jo Larson
- Senior Scientist, Heller School, Institute for Behavioral Health, Brandeis University, Waltham, MA, USA
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Nayback-Beebe AM, Yoder LH. Social conflict versus social support: what is more influential in mental health symptom severity for female service members? Arch Psychiatr Nurs 2011; 25:469-78. [PMID: 22114800 DOI: 10.1016/j.apnu.2011.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 02/09/2011] [Accepted: 02/19/2011] [Indexed: 11/16/2022]
Abstract
Research has validated the importance of postdeployment social support in mitigating the effects of combat deployment on mental health for female service members. However, the influence of social conflict on mental health during this period has not been explored. The purposes of this descriptive correlational study were (a) to examine the strength and direction of the relationships between social support, social conflict, and stressful life events to depression, anxiety, and posstraumatic stress disorder and (b) to determine whether the absence of social support or the presence social conflict was more influential to the severity of these symptoms.
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Affiliation(s)
- Ann M Nayback-Beebe
- Brooke Army Medical Center, Nursing Research Services, 18815 Millhollow, San Antonio, TX 78258, USA.
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Rohrer LD, Gierisch JM, Fish LJ, Blakeney JK, Bastian LA. A five-step guide for moving from observational studies to interventional research for women veterans. Womens Health Issues 2011; 21:S98-102. [PMID: 21724150 DOI: 10.1016/j.whi.2011.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 04/18/2011] [Accepted: 04/20/2011] [Indexed: 10/28/2022]
Affiliation(s)
- Lesley D Rohrer
- Center for Health Services Research in Primary Care, Durham, North Carolina 27705, USA.
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Yano EM, Frayne SM. Health and health care of women veterans and women in the military: research informing evidence-based practice and policy. Womens Health Issues 2011; 21:S64-6. [PMID: 21724145 DOI: 10.1016/j.whi.2011.04.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 04/26/2011] [Indexed: 10/28/2022]
Affiliation(s)
- Elizabeth M Yano
- VA Greater Los Angeles HSR&D Center of Excellence for the Study of Healthcare Provider Behavior, Sepulveda, California 91343, USA.
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