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Jakubowski KP, Koffer RE, Matthews KA, Burnett-Bowie SAM, Derby CA, Yu EW, Green R, Thurston RC. Psychosocial impacts of the COVID-19 pandemic on women with trauma histories: Study of Women's Health Across the Nation (SWAN). J Trauma Stress 2023; 36:167-179. [PMID: 36463566 PMCID: PMC9877990 DOI: 10.1002/jts.22896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 09/23/2022] [Accepted: 09/30/2022] [Indexed: 12/07/2022]
Abstract
Older adults, particularly those with trauma histories, may be vulnerable to adverse psychosocial outcomes during the COVID-19 pandemic. We tested associations between prepandemic childhood abuse or intimate partner violence (IPV) and elevated depressive, anxiety, conflict, and sleep symptoms during the pandemic among aging women. Women (N = 582, age: 65-77 years) from three U.S. sites (Pittsburgh, Boston, Newark) of the longitudinal Study of Women's Health Across the Nation (SWAN) reported pandemic-related psychosocial impacts from June 2020-March 2021. Prepandemic childhood abuse; physical/emotional IPV; social functioning; physical comorbidities; and depressive, anxiety, and sleep symptoms were drawn from SWAN assessments between 2009 and 2017. There were no measures of prepandemic conflict. In total, 47.7% and 35.3% of women, respectively, reported childhood abuse or IPV. Using logistic regression models adjusted for age; race/ethnicity; education; site; prepandemic social functioning and physical comorbidities; and, in respective models, prepandemic depressive, anxiety, or sleep symptoms, childhood abuse predicted elevated anxiety symptoms, OR = 1.67, 95% CI [1.10, 2.54]; household conflict, OR = 2.19, 95% CI [1.32, 3.61]; and nonhousehold family conflict, OR = 2.14, 95% CI [1.29, 3.55]. IPV predicted elevated sleep problems, OR = 1.63, 95% CI [1.07, 2.46], and household conflict, OR = 1.96, 95% CI [1.20, 3.21]. No associations emerged for depressive symptoms after adjusting for prepandemic depression. Aging women with interpersonal trauma histories reported worse anxiety, sleep, and conflict during the COVID-19 pandemic than those without. Women's trauma histories and prepandemic symptoms are critical to understanding the psychosocial impacts of the pandemic.
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Affiliation(s)
- Karen P Jakubowski
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rachel E Koffer
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Karen A Matthews
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Carol A Derby
- Department of Neurology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Elaine W Yu
- Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robin Green
- Department of Neurology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Hollis BF, Kim N, Youk A, Dichter ME. Opportunities to More Comprehensively Assess Sexual Violence Experience in Veterans Health Administration Medical Records Data. J Gen Intern Med 2022; 37:734-741. [PMID: 36042084 PMCID: PMC9481829 DOI: 10.1007/s11606-022-07581-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Experience of sexual violence (SV) is prevalent among the Veteran population and associated with many negative mental and physical health outcomes including suicidal behavior, obesity, post-traumatic stress disorder, anxiety, depression, and poor sexual and reproductive functioning. Although Veterans of any gender may experience SV, women Veterans are particularly at risk. Research on SV among Veterans has focused primarily on the experience of SV during military service (military sexual trauma, MST), although Veterans may also experience SV prior to and following military service. The aim of the current study was to construct a more comprehensive method of identifying SV among Veterans Health Administration (VHA) patients as documented in medical records in a national cohort of 325,907 Veterans who used VHA care between 2000 and 2018 in order to inform future research in this area. METHOD We used three indicators to identify SV in VHA medical records: (a) the MST screen, (b) the sexual violence item of the intimate partner violence (IPV) screen, and (c) International Classification of Disorders (ICD) codes (versions 9 and 10) representing adult sexual abuse and assault. Univariate descriptive analyses were conducted to determine the exclusivity and overlap of the SV measures. RESULTS The universal MST screen was the most commonly identified indicator of SV in the data. However, including the IPV and ICD indicators identified an additional 5% of Veterans who had experienced SV, accounting for thousands of patients. DISCUSSION The results of the current study indicate that using the three-pronged approach of SV collection is a more comprehensive method of identifying patient SV experience through VHA medical records and contributes uniquely to the methodology of studying social factors' impact on health care. Clinical screening and documentation of SV allow for the assessment of health impacts and trends through examination of medical records data.
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Affiliation(s)
| | - Nadejda Kim
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Ada Youk
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Melissa E Dichter
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Temple University School of Social Work, Philadelphia, PA, USA
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3
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MacGregor JCD, Naeemzadah N, Oliver CL, Javan T, MacQuarrie BJ, Wathen CN. Women's Experiences of the Intersections of Work and Intimate Partner Violence: A Review of Qualitative Research. TRAUMA, VIOLENCE & ABUSE 2022; 23:224-240. [PMID: 32662354 DOI: 10.1177/1524838020933861] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The impacts of intimate partner violence (IPV) on work, workplaces, and employment are receiving increasing attention from researchers, employers, and policy makers, but research synthesis is needed to develop evidence-based strategies to address the problem. The purpose of this review of qualitative research is to explore abused women's experiences of the intersections of work and IPV, including the range of benefits and drawbacks of work. Multiple search strategies, including systematic database searches by a professional librarian, resulted in 2,306 unique articles that were independently screened for eligibility by two team members. Qualitative research articles were eligible for inclusion and were also required to (1) sample women with past and/or current IPV experience and (2) report results regarding women's experiences or views of the benefits and/or drawbacks of work. Ultimately, 32 qualitative research articles involving 757 women were included and analyzed using thematic synthesis. Results revealed the potential of work to offer survivors a great range of benefits and drawbacks, many of which have received little research attention. The importance of work for women survivors has been emphasized in the literature, often with respect to financial independence facilitating the leaving process. However, our research underscores how the impact of work for many women survivors is not straightforward and, for some, involves a "trade-off" of benefits and drawbacks. Those developing work-related interventions, services (e.g., career counseling), or policies for women who experience IPV should consider the range of benefits and drawbacks in their planning, as "one-size-fits-all" solutions are unlikely to be effective.
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Affiliation(s)
- Jennifer C D MacGregor
- Faculty of Information and Media Studies, Western University, London, Ontario, Canada
- Centre for Research and Education on Violence Against Women and Children, Western University, London, Ontario, Canada
| | - Najibullah Naeemzadah
- Faculty of Information and Media Studies, Western University, London, Ontario, Canada
| | - Casey L Oliver
- Centre for Research and Education on Violence Against Women and Children, Western University, London, Ontario, Canada
| | - Tanaz Javan
- Faculty of Information and Media Studies, Western University, London, Ontario, Canada
| | - Barbara J MacQuarrie
- Centre for Research and Education on Violence Against Women and Children, Western University, London, Ontario, Canada
| | - C Nadine Wathen
- Faculty of Information and Media Studies, Western University, London, Ontario, Canada
- Centre for Research and Education on Violence Against Women and Children, Western University, London, Ontario, Canada
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
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Montgomery AE, Dichter ME, Blosnich JR. Gender Differences in the Predictors of Suicide-related Morbidity Among Veterans Reporting Current Housing Instability. Med Care 2021; 59:S36-S41. [PMID: 33438881 DOI: 10.1097/mlr.0000000000001422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Veterans experiencing housing instability are at increased risk of suicide. Research is needed to identify gender differences in the predictors of both suicidal ideation and suicide attempt, particularly among Veterans who are unstably housed. OBJECTIVES The objective of the present study was to explore whether correlates of suicide-related morbidity among unstably housed Veterans vary by gender and identify implications for improved care for these Veterans. METHODS The study cohort included 86,325 Veterans who reported current housing instability between October 1, 2013, and September 30, 2016. This cross-sectional study assessed differences in demographic and outcome variables by gender using χ2 analyses and a series of multiple logistic regressions predicting suicidal ideation and suicide attempt, stratified by gender. RESULTS Among unstably housed female Veterans, being younger than 40 years was associated with more than double the odds of having an indicator of suicidal ideation and >12 times the odds of having an indicator of a suicide attempt. The effect sizes associated with age were much less pronounced among unstably housed male Veterans. The presence of mental health and substance use conditions as well as a positive screen for military sexual trauma were associated with increased risk of suicide morbidity among both women and men. CONCLUSIONS Intervention and prevention among unstably housed Veterans may be complicated by unpredictable living situations; further research should explore tailored interventions to address the complex needs of unstably housed Veterans and how suicide prevention can be woven throughout.
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Affiliation(s)
- Ann E Montgomery
- US Department of Veterans Affairs (VA), National Center on Homelessness among Veterans, Philadelphia, PA.,Birmingham VA Medical Center.,University of Alabama at Birmingham, School of Public Health, Birmingham, AL
| | - Melissa E Dichter
- Temple University School of Social Work.,VA Center for Health Equity Research and Promotion, Philadelphia, PA
| | - John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
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Iverson KM, Sayer NA, Meterko M, Stolzmann K, Suri P, Gormley K, Nealon Seibert M, Yan K, Pogoda TK. Intimate Partner Violence Among Female OEF/OIF/OND Veterans Who Were Evaluated for Traumatic Brain Injury in the Veterans Health Administration: A Preliminary Investigation. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:2422-2445. [PMID: 29294714 DOI: 10.1177/0886260517702491] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Many female veterans have deployed to Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND), and some experience traumatic brain injury (TBI). Although TBI is increasingly recognized as an important health issue for female OEF/OIF/OND veterans, there is little attention to stressful experiences that may exacerbate health problems or hinder recovery among veterans who may have experienced TBI. Lifetime intimate partner violence (IPV) is common among general samples of female veterans. Given the negative implications of IPV on women's health, it is important to understand whether there is a relationship between lifetime IPV and health functioning among female veterans who have experienced possible TBI. This study provides an exploration of lifetime IPV and its associations with physical and mental health, as well as community reintegration, among female OEF/OIF/OND veterans who have been evaluated for TBI. The sample comprised 127 female veterans who participated in a larger study that examined reintegration among OEF/OIF/OND veterans who received a TBI evaluation in the Veterans Heath Administration (VHA) and completed an assessment of lifetime IPV. Primary and secondary data sources included survey responses (e.g., health symptoms and reintegration) and VHA administrative data (e.g., health diagnoses). Results indicated that nearly two thirds (63.0%) of women who completed a TBI evaluation reported lifetime IPV, though clinician-confirmed TBI was not associated with IPV. Women who experienced IPV, compared with those who did not, reported higher levels of neurobehavioral symptoms and were significantly more likely to have diagnoses of back pain (48.6% vs. 30.0%, respectively) and substance abuse (12.2% vs. 0%, respectively). Notwithstanding, women with and without lifetime IPV reported similar levels of reintegration. Findings provide evidence that lifetime IPV may be common among female OEF/OIF/OND veterans who are evaluated for TBI, and that IPV is associated with several treatable health problems among this population.
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Affiliation(s)
- Katherine M Iverson
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, MA, USA
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, MA, USA
- Boston University School of Medicine, MA, USA
| | - Nina A Sayer
- Minneapolis VA Medical Center, Minnesota, USA
- University of Minnesota, Minneapolis, USA
| | - Mark Meterko
- VHA Office of Reporting, Analytics, Performance, Improvement and Deployment (RAPID), Bedford, MA, USA
- Boston University School of Public Health, MA, USA
| | - Kelly Stolzmann
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, MA, USA
| | - Pradeep Suri
- VA Puget Sound Health Care System, Seattle, Washington, USA
- University of Washington, Seattle, USA
| | - Katelyn Gormley
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, MA, USA
| | - Marjorie Nealon Seibert
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, MA, USA
| | - Kun Yan
- Northern California VA Healthcare System, Sacramento, USA
| | - Terri K Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, MA, USA
- Boston University School of Public Health, MA, USA
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Shahrabani S, Garyn-Tal S. The impact of prior combat military service on Israeli women's self-efficacy and risk attitudes. WOMENS STUDIES INTERNATIONAL FORUM 2019. [DOI: 10.1016/j.wsif.2019.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dodds CD, Kiernan MD. Hidden Veterans: A Review of the Literature on Women Veterans in Contemporary Society. ACTA ACUST UNITED AC 2019. [DOI: 10.1177/1054137319834775] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Christina D. Dodds
- Department of Social Work, Northumbria University, Newcastle upon Tyne, UK
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Evans EA, Glover DL, Washington DL, Hamilton AB. Psychosocial Factors that Shape Substance Abuse and Related Mental Health of Women Military Veterans who Use Community-Based Services. Subst Use Misuse 2018; 53:1878-1892. [PMID: 29485302 DOI: 10.1080/10826084.2018.1441309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Women Veterans who use the Veterans Health Administration (VA) have high rates of substance abuse and poorer health than non-Veteran women. Less is known about the psychosocial needs of women Veterans who seek care in non-VA settings. OBJECTIVES We provide a grounded description of factors that impact substance abuse, mental health, and related quality of life of women Veterans who use non-VA community-based health and social services. METHODS Utilizing a mixed methods design, we conducted semi-structured in-person interviews with 22 women Veterans in Los Angeles in 2013-2015. RESULTS The current health of these women Veterans was shaped by substance abuse and several other factors, including: histories of trauma (in childhood, during military service) and discrimination, and associated mental health conditions; post-military socio-economic stressors; shifting social roles and adverse social support; and lost personal identity after military service. Psychosocial factors collectively underscore areas in which delivery of health and social services to women Veterans being treated in non-VA settings could be improved: (1) diffuse, implement, and sustain evidence-based gender-sensitive substance abuse treatment; (2) address traumas contributing to poor health; (3) recognize stress proliferation processes erode women's capacity to access healthcare or cope with stressors in healthy ways; (4) champion women Veterans who embody resilience and thereby can help others to form empowered personal identities of health and wellness. CONCLUSION Findings can inform interventions and services that ameliorate vulnerability to substance abuse and other health risks among women Veterans.
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Affiliation(s)
- Elizabeth A Evans
- a Department of Health Promotion and Policy , School of Public Health and Health Sciences, University of Massachusetts , Amherst , Massachusetts , USA.,b Department of Veterans Affairs (VA) Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation , Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles , California , USA
| | - Dawn L Glover
- b Department of Veterans Affairs (VA) Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation , Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles , California , USA
| | - Donna L Washington
- b Department of Veterans Affairs (VA) Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation , Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,c Department of Medicine , Geffen School of Medicine, University of California , Los Angeles , California , USA
| | - Alison B Hamilton
- b Department of Veterans Affairs (VA) Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation , Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,d Department of Psychiatry and Biobehavioral Sciences , David Geffen School of Medicine, University of California , Los Angeles , California , USA
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