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McDermott MC, Musilli MG, Brown JE, Melton JL, Miller MJ, Allard RJ, Lutgendorf MA. Female-Specific Health Care of Military Female-Designated Service Members and Veterans: A Systematic Overview of Reviews. Mil Med 2024; 189:e1917-e1930. [PMID: 38537156 DOI: 10.1093/milmed/usae101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/25/2024] [Accepted: 02/28/2024] [Indexed: 08/31/2024] Open
Abstract
INTRODUCTION Since the War in Afghanistan began in 2001, service members have faced significant health effects related to service during war, with female-designated service members facing unique challenges. Numerous high-quality review articles have been published on the health and care of female-designated service members and veterans. Given the increasing volume of literature, we completed an overview of reviews on the health and health care of female-designated military populations. Our objective was to conduct an overview of reviews on the obstetrics and gynecologic health and health care of female-designated military populations since 2000 to understand female-specific health consequences of military service during war and make clinical recommendations. MATERIALS AND METHODS On May 10, 2022, a medical librarian performed a comprehensive search across five databases (Ovid Medline, Embase, CINAHL, PsycINFO, Ovid All EBM Reviews, and Web of Science) for all relevant reviews published from 2000 to May 10, 2022. Results were limited to English language. After the removal of duplicates, 2,438 records were reviewed, and 69 studies were included in the final review. The search strategy and methods were registered with PROSPERO and are reported according to the Preferred Reporting Items for Overviews of Reviews (PRIOR) guidelines. Two independent reviewers conducted title and abstract screening and subsequent full text review using Covidence Systematic Review Software. Reviews addressing female-specific and obstetrics and gynecologic health of female-designated service members or veterans, utilizing a clear and systematic methodology, were eligible for inclusion. Quality assessment was conducted by teams of two reviewers. RESULTS A total of 69 studies were included in the final review. Themes included mental health and impact of sexual assault on service members or veterans, veteran health care, issues of menstruation, pregnancy, and urogenital concerns. Areas with few reviews included occupational risks of military service and impact on obstetric outcomes, eating disorders, and menopause. There were insufficient or no reviews on the impact of military service on fertility, access to abortion care, reproductive health outcomes of lesbian, bisexual and transgender service members, surgical treatment of gynecologic conditions, and screening and treatment for breast, gynecologic, and non-pelvic organ cancers. CONCLUSIONS Female-designated military populations serving during periods of war face unique health challenges that should be considered in screening practices and the delivery of trauma informed care. Further research and reviews are needed for female-specific oncology, fertility, abortion access, and sexual and non-binary and expansive gender identities to better capture female-designated service member and veteran health during wartime and beyond.
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Affiliation(s)
- Megan C McDermott
- Department of Gynecologic Surgery & Obstetrics, Womack Army Medical Center, Ft. Liberty, NC 28310, USA
| | - Megan G Musilli
- Department of Gynecologic Surgery & Obstetrics, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Jill E Brown
- Department of Gynecologic Surgery & Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - John L Melton
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Michael J Miller
- Department of Gynecologic Surgery & Obstetrics, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Rhonda J Allard
- Learning Resource Center, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Monica A Lutgendorf
- Department of Gynecologic Surgery & Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Bourassa KJ, Wagner HR, Halverson TF, Ashley-Koch AE, Beckham J, Garrett ME, Kimbrel NA, Naylor JC. Deployment-related toxic exposures are associated with worsening mental and physical health after military service: Results from a self-report screening of veterans deployed after 9/11. J Psychiatr Res 2024; 174:283-288. [PMID: 38678685 PMCID: PMC11102311 DOI: 10.1016/j.jpsychires.2024.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
Exposure to toxins-such as heavy metals and air pollution-can result in poor health and wellbeing. Recent scientific and media attention has highlighted negative health outcomes associated with toxic exposures for U.S. military personnel deployed overseas. Despite established health risks, less empirical work has examined whether deployment-related toxic exposures are associated with declines in mental and physical health after leaving military service, particularly among the most recent cohort of veterans deployed after September 11, 2001. Using data from 659 U.S. veterans in the VISN 6 MIRECC Post-Deployment Mental Health Study, we tested whether self-reported toxic exposures were associated with poorer mental and physical health. At baseline, veterans who reported more toxic exposures also reported more mental health, β = 0.14, 95% CI [0.04, 0.23], p = 0.004, and physical health symptoms, β = 0.21, 95% CI [0.11, 0.30], p < 0.001. Over the next ten years, veterans reporting more toxic exposures also had greater increases in mental health symptoms, β = 0.23, 95% CI [0.15, 0.31], p < 0.001, physical health symptoms, β = 0.22, 95% CI [0.14, 0.30], p < 0.001, and chronic disease diagnoses, β = 0.15, 95% CI [0.07, 0.23], p < 0.001. These associations accounted for demographic and military covariates, including combat exposure. Our findings suggest that toxic exposures are associated with worsening mental and physical health after military service, and this recent cohort of veterans will have increased need for mental health and medical care as they age into midlife and older age.
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Affiliation(s)
- Kyle J Bourassa
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, USA; Geriatric Research, Education, and Clinical Center, Durham Veteran Affairs (VA) Health Care System, USA; Center for the Study of Aging and Human Development, Duke University Medical Center, USA.
| | - H Ryan Wagner
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, USA
| | - Tate F Halverson
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, USA
| | | | - Jean Beckham
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, USA
| | - Melanie E Garrett
- Duke Molecular Physiology Institute, Duke University Medical Center, USA
| | - Nathan A Kimbrel
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, USA
| | - Jennifer C Naylor
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, USA
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Gnall KE, Sacco SJ, Sinnott SM, Park CL, Mazure CM, Hoff RA. Physical activity, posttraumatic stress, and gender: A longitudinal study of post-9/11 veterans. J Health Psychol 2024:13591053241233380. [PMID: 38400566 DOI: 10.1177/13591053241233380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
Given the importance of physical activity (PA) for both physical and mental health, the present study characterizes post-9/11 veterans' leisure-time PA engagement over time. Further, this study examines the relationship between PA and posttraumatic stress symptoms (PTSS), as well as whether this relation differs by gender and time since military discharge. This study was a secondary analysis of a 12-month longitudinal observational investigation of 410 (39.5% female) post-9/11 veterans. Participants completed self-report questionnaires at baseline and 12 months. Over a third of post-9/11 veterans were not engaging in any weekly leisure-time PA at study baseline and PA engagement significantly decreased in the subsequent year. The longitudinal relationship between PA and PTSS depended on both gender and time since military discharge. These results underscore the importance of considering both gender and time since discharge when tailoring interventions to support leisure-time PA as a key health habit in post-9/11 veterans.
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Affiliation(s)
| | | | | | | | | | - Rani A Hoff
- Yale School of Medicine, USA
- Northeast Program Evaluation Center (NEPEC), USA
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Ryan JB, Scott TE, McDonough RE, Kaye EK, Schindler DK. Depression and Differential Oral Health Status Among U.S. Adults With and Without Prior Active Duty Service in the U.S. Military, National Health and Nutrition Examination Survey 2011-2018. Mil Med 2024; 189:e157-e165. [PMID: 37318110 DOI: 10.1093/milmed/usad217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Veterans suffer from lower overall well-being than non-veterans because of their unique life course. This study aims to compare the impact of depression on oral health for veteran and non-veteran populations. MATERIALS AND METHODS Data from 11,693 adults (18+) participating in the National Health and Nutrition Examination Survey (2011-2018) were analyzed. The outcome variables were dichotomous (at/above mean) decayed, missing, and filled teeth due to caries (DMFT), as well as the components, namely, missing teeth, filled teeth (FT), and decayed teeth (DT). The primary predictor variable combined depression screening outcome and veteran status (veteran/depressed, veteran/not depressed, non-veteran/depressed, and non-veteran/not depressed). Covariates included socioeconomic factors, demographics, wellness factors, and oral health-related habits. Associations between outcome and predictor variables were assessed with a fully adjusted logistic regression analysis. RESULTS Veterans, regardless of depression status, had more DMFT, FT, missing teeth, and DT compared to non-veterans. After controlling for covariates, veterans suffering from depression had higher odds of DT (1.5, 95% CI, 1.0-2.4) compared to non-veterans without depression. In general, veterans who screened negative for depression had better oral health compared to all groups, with lower odds of DT (0.7, 95% CI, 0.6-0.9) and higher odds of FT (1.4, 95% CI, 1.1-1.7) compared to non-veterans with and without depression. CONCLUSIONS This study found that not only veterans have higher odds of overall caries experience, but also veterans suffering from depression have higher odds of active caries compared to non-depressed veterans. Most veterans lack Veterans Health Administration dental benefits and face challenges maintaining oral health on top of medical and mental health burdens. Our results add further urgency to increasing dental care access for this vulnerable population because of the exacerbation of unmet oral health care needs attributable to the additional mental health challenges veterans face.
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Affiliation(s)
- J Brett Ryan
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA 02118, USA
| | - Thayer E Scott
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA 02118, USA
| | - Robert E McDonough
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA 02118, USA
| | - Elizabeth K Kaye
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA 02118, USA
| | - David K Schindler
- USAF Dental Research and Consultation Service (DRCS), Institute of Surgical Research, Fort Sam Houston, TX 78234, USA
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Kochar A, Deo SV, Charest B, Peterman-Rocha F, Elgudin Y, Chu D, Yeh RW, Rao SV, Kim DH, Driver JA, Hall DE, Orkaby AR. Preoperative frailty and adverse outcomes following coronary artery bypass grafting surgery in US veterans. J Am Geriatr Soc 2023; 71:2736-2747. [PMID: 37083188 PMCID: PMC10524307 DOI: 10.1111/jgs.18390] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Contemporary guidelines emphasize the value of incorporating frailty into clinical decision-making regarding revascularization strategies for coronary artery disease. Yet, there are limited data describing the association between frailty and longer-term mortality among coronary artery bypass grafting (CABG) patients. METHODS We conducted a retrospective cohort study (2016-2020, 40 VA medical centers) of US veterans nationwide that underwent coronary artery bypass grafting (CABG). Frailty was quantified by the Veterans Administration Frailty Index (VA-FI), which applies the cumulative deficit method to render a proportion of 30 pertinent diagnosis codes. Patients were classified as non-frail (VA-FI ≤ 0.1), pre-frail (0.1 < VA-FI ≤ 0.2), or frail (VA-FI > 0.2). We used Cox proportional hazards models to ascertain the association of frailty with all-cause mortality. Our primary study outcome was 5-year all-cause mortality; the co-primary outcome was days alive and out of the hospital within the first postoperative year. RESULTS There were 13,554 CABG patients (median 69 years, 79% White, 1.5% women). The mean pre-operative VA-FI was 0.21 (SD: 0.11); 31% were pre-frail (VA-FI: 0.17) and 47% were frail (VA-FI: 0.31). Frail patients were older and had higher co-morbidity burdens than pre-frail and non-frail patients. Compared with non-frail patients (13.0% [11.4, 14.7]), there was a significant association between frail and pre-frail patients and increased cumulative 5-year all-cause mortality (frail: 24.8% [23.3, 26.1]; HR: 1.75 [95% CI 1.54, 2.00]; pre-frail 16.8% [95% CI 15.3, 18.4]; HR 1.2 [1.08,1.34]). Compared with non-frail patients (mean 362[SD 12]), pre-frail (mean 361 [SD 14]; p < 0.01) and frail patients (mean 358[SD 18]; p < 0.01) spent fewer days alive and out of the hospital in the first postoperative year. CONCLUSIONS Pre-frailty and frailty were prevalent among US veterans undergoing CABG and associated with worse mid-term outcomes. Given the high prevalence of frailty with attendant adverse outcomes, there may be an opportunity to improve outcomes by identifying and mitigating frailty before surgery.
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Affiliation(s)
- Ajar Kochar
- Department of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston USA
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston USA
| | - Salil V Deo
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland USA
- Case School of Medicine, Case Western Reserve University, Cleveland USA
| | - Brian Charest
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston USA
| | | | - Yakov Elgudin
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland USA
- Case School of Medicine, Case Western Reserve University, Cleveland USA
| | - Danny Chu
- Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh USA
| | - Robert W Yeh
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston USA
| | - Sunil V Rao
- The Durham Veterans Affairs Healthcare System, Durham, NC, USA
| | - Dae H. Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston USA
| | - Jane A. Driver
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston USA
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare system, Boston USA
| | - Daniel E Hall
- Wolff Center, University of Pittsburgh Medical Center, Pittsburgh USA
- Center for Health Equity Research and Promotion, Veteran Affairs Pittsburgh Healthcare System, Pittsburgh USA
| | - Ariela R. Orkaby
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston USA
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare system, Boston USA
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston USA
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DeGutis J, Agnoli S, Bernstein JPK, Jagger-Rickels A, Evans TC, Fortier CB, McGlinchey RE, Milberg WP, Esterman M. Poorer Inhibitory Control Uniquely Contributes to Greater Functional Disability in Post-9/11 Veterans. Arch Clin Neuropsychol 2023; 38:944-961. [PMID: 36781401 PMCID: PMC10456219 DOI: 10.1093/arclin/acad012] [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] [Accepted: 01/11/2023] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVE Post-9/11 Veterans endorse greater self-reported functional disability than 80% of the adult population. Previous studies of trauma-exposed populations have shown that increased post-traumatic stress disorder (PTSD) and depressive symptoms are consistently associated with greater disability. Additionally, poorer cognitive performance in the domain of executive functions, particularly inhibitory control, has been associated with disability, though it is unclear if this effect is independent of and/or interacts with PTSD and depression. METHOD Three overlapping samples of n = 582, 297, and 183 combat-deployed post-9/11 Veterans completed comprehensive assessments of executive functions, PTSD and depressive symptoms, and self-reported World Health Organization Disability Assessment Schedule-II (WHODAS II). RESULTS Poorer performance on measures of inhibitory control (Delis-Kaplan Executive Functioning System Color-Word Interference-CWI Test and gradual-onset Continuous Performance Test-gradCPT), but not other executive functions, were significantly associated with greater disability on the WHODAS II (ρ's = -.13 and -.13, p = .002 and .026, respectively). CWI inhibitory control measures accounted for unique variance in disability after controlling for PTSD and depressive symptoms (R2 change = 0.02, p < .001). Further, CWI significantly moderated the effect of depressive symptoms on disability, such that better inhibitory control weakened the relationship between depression and disability. CONCLUSIONS Inhibitory control deficits are uniquely associated with increased disability in combat-deployed post-9/11 Veterans, and better inhibitory control abilities may serve as a protective factor for depressive symptoms leading to increased disability. KEY POINTS
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Affiliation(s)
- Joseph DeGutis
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, USA
- Boston Attention and Learning (BAL) Lab, VA Boston Health Care System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Sam Agnoli
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, USA
- Boston Attention and Learning (BAL) Lab, VA Boston Health Care System, Boston, MA, USA
| | - John P K Bernstein
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, USA
| | - Audreyana Jagger-Rickels
- Boston Attention and Learning (BAL) Lab, VA Boston Health Care System, Boston, MA, USA
- National Center for PTSD, VA Boston Health Care System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Travis C Evans
- Boston Attention and Learning (BAL) Lab, VA Boston Health Care System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Catherine B Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Regina E McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - William P Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Michael Esterman
- Boston Attention and Learning (BAL) Lab, VA Boston Health Care System, Boston, MA, USA
- National Center for PTSD, VA Boston Health Care System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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Schapira MM, Hubbard RA, Whittle J, Vachani A, Kaminstein D, Chhatre S, Rodriguez KL, Bastian LA, Kravetz JD, Asan O, Prigge JM, Meline J, Schrand S, Ibarra JV, Dye DA, Rieder JB, Frempong JO, Fraenkel L. Lung Cancer Screening Decision Aid Designed for a Primary Care Setting: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2330452. [PMID: 37647070 PMCID: PMC10469267 DOI: 10.1001/jamanetworkopen.2023.30452] [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: 05/25/2023] [Accepted: 07/09/2023] [Indexed: 09/01/2023] Open
Abstract
Importance Guidelines recommend shared decision-making prior to initiating lung cancer screening (LCS). However, evidence is lacking on how to best implement shared decision-making in clinical practice. Objective To evaluate the impact of an LCS Decision Tool (LCSDecTool) on the quality of decision-making and LCS uptake. Design, Setting, and Participants This randomized clinical trial enrolled participants at Veteran Affairs Medical Centers in Philadelphia, Pennsylvania; Milwaukee, Wisconsin; and West Haven, Connecticut, from March 18, 2019, to September 29, 2021, with follow-up through July 18, 2022. Individuals aged 55 to 80 years with a smoking history of at least 30 pack-years who were current smokers or had quit within the past 15 years were eligible to participate. Individuals with LCS within 15 months were excluded. Of 1047 individuals who were sent a recruitment letter or had referred themselves, 140 were enrolled. Intervention A web-based patient- and clinician-facing LCS decision support tool vs an attention control intervention. Main Outcome and Measures The primary outcome was decisional conflict at 1 month. Secondary outcomes included decisional conflict immediately after intervention and 3 months after intervention, knowledge, decisional regret, and anxiety immediately after intervention and 1 and 3 months after intervention and LCS by 6 months. Results Of 140 enrolled participants (median age, 64.0 [IQR, 61.0-69.0] years), 129 (92.1%) were men and 11 (7.9%) were women. Of 137 participants with data available, 75 (53.6%) were African American or Black and 62 (44.3%) were White; 4 participants (2.9%) also reported Hispanic or Latino ethnicity. Mean decisional conflict score at 1 month did not differ between the LCSDecTool and control groups (25.7 [95% CI, 21.4-30.1] vs 29.9 [95% CI, 25.6-34.2], respectively; P = .18). Mean LCS knowledge score was greater in the LCSDecTool group immediately after intervention (7.0 [95% CI, 6.3-7.7] vs 4.9 [95% CI, 4.3-5.5]; P < .001) and remained higher at 1 month (6.3 [95% CI, 5.7-6.8] vs 5.2 [95% CI, 4.5-5.8]; P = .03) and 3 months (6.2 [95% CI, 5.6-6.8] vs 5.1 [95% CI, 4.4-5.8]; P = .01). Uptake of LCS was greater in the LCSDecTool group at 6 months (26 of 69 [37.7%] vs 15 of 71 [21.1%]; P = .04). Conclusions and Relevance In this randomized clinical trial of an LCSDecTool compared with attention control, no effect on decisional conflict occurred at 1 month. The LCSDecTool used in the primary care setting did not yield a significant difference in decisional conflict. The intervention led to greater knowledge and LCS uptake. These findings can inform future implementation strategies and research in LCS shared decision-making. Trial Registration ClinicalTrials.gov Identifier: NCT02899754.
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Affiliation(s)
- Marilyn M Schapira
- Center for Health Equity Research and Promotion (CHERP), Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, Pennsylvania
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania School of Medicine, Philadelphia
| | - Jeff Whittle
- Division of Medicine, Clement J Zablocki VA Medical Center, Milwaukee, Wisconsin
- Center for Advancing Population Science, Medical College of Wisconsin, Wauwatosa
| | - Anil Vachani
- Department of Medicine, Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Dana Kaminstein
- Center for Health Equity Research and Promotion (CHERP), Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, Pennsylvania
- Department of Organizational Dynamics, School of Arts & Sciences, University of Pennsylvania, Philadelphia
| | - Sumedha Chhatre
- Center for Health Equity Research and Promotion (CHERP), Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, Pennsylvania
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Keri L Rodriguez
- CHERP, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Lori A Bastian
- Department of Medicine, Yale University, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven
| | - Jeffrey D Kravetz
- Department of Medicine, Yale University, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven
| | - Onur Asan
- The Stevens Institute of Technology, School of Systems and Enterprise, Hoboken, New Jersey
| | - Jason M Prigge
- Center for Health Equity Research and Promotion (CHERP), Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, Pennsylvania
| | - Jessica Meline
- Center for Health Equity Research and Promotion (CHERP), Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, Pennsylvania
| | - Susan Schrand
- Department of Medicine, Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | | | - Deborah A Dye
- Office of Research, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | - Julie B Rieder
- Office of Research, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | - Jemimah O Frempong
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Liana Fraenkel
- Department of Medicine, Yale University, New Haven, Connecticut
- Berkshire Health Systems, Pittsfield, Massachusetts
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Kamdar N, Khan S, Brostow DP, Spencer L, Roy S, Sisson A, Hundt NE. Association between modifiable social determinants and mental health among post-9/11 Veterans: A systematic review. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2023; 9:8-26. [PMID: 37886122 PMCID: PMC10601397 DOI: 10.3138/jmvfh-2022-0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Introduction As U.S. Veterans reintegrate from active duty to civilian life, many are at risk for negative modifiable social determinants of health. The prevalence of mental health conditions among Veterans is also high. Awareness of the associations between these two factors is growing. This systematic review provides a comprehensive analysis of the current state of knowledge of the associations between modifiable social determinants and mental health among U.S. Veterans. Methods The authors systematically searched four databases and identified 28 articles representing 25 unique studies that met inclusion criteria. Findings from the studies were extracted and synthesized on the basis of modifiable social determinants. Study quality and risk of bias were assessed using the Methodological Quality Questionnaire. Results The studies identified in the systematic review examined three modifiable social determinants of health: 1) housing stability, 2) employment and finances, and 3) social support. Although the lack of validity for measures of housing stability, employment, and finances compromised study quality, the overall evidence suggests that Veterans with access to supportive social determinants had better mental health status. Evidence was particularly robust for the association between strong social support and lower symptoms of posttraumatic stress disorder. Discussion Current evidence suggests the need to consider modifiable social determinants of health when designing mental health interventions. However, more research encompassing a wider range of modifiable social determinants such as food security, education, and transportation and using comprehensive methods and validated instruments is needed. Future research also needs to intentionally include Veterans from diverse racial-ethnic groups.
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Affiliation(s)
- Nipa Kamdar
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, United States
| | - Sundas Khan
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, United States
| | - Diana P. Brostow
- Veterans Health Administration Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, United States
| | - Lia Spencer
- Brandeis University, Waltham, Massachusetts, United States
| | - Sharmily Roy
- School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, United States
| | - Amy Sisson
- The Texas Medical Center Library, Houston, Texas, United States
| | - Natalie E. Hundt
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, United States
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Cypel YS, Vogt D, Maguen S, Bernhard P, Lowery E, Culpepper WJ, Armand-Gibbs I, Schneiderman AI. Physical health of Post-9/11 U.S. Military veterans in the context of Healthy People 2020 targeted topic areas: Results from the Comparative Health Assessment Interview Research Study. Prev Med Rep 2023; 32:102122. [PMID: 36922958 PMCID: PMC10009290 DOI: 10.1016/j.pmedr.2023.102122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
Large-scale epidemiological studies suggest that veterans may have poorer physical health than nonveterans, but this has been largely unexamined in post-9/11 veterans despite research indicating their high levels of disability and healthcare utilization. Additionally, little investigation has been conducted on sex-based differences and interactions by veteran status. Notably, few studies have explored veteran physical health in relation to national health guidelines. Self-reported, weighted data were analyzed on post-9/11 U.S. veterans and nonveterans (n = 19,693; 6,992 women, 12,701 men; 15,160 veterans, 4,533 nonveterans). Prevalence was estimated for 24 physical health conditions classified by Healthy People 2020 targeted topic areas. Associations between physical health outcomes and veteran status were evaluated using bivariable and multivariable analyses. Back/neck pain was most reported by veterans (49.3 %), twice that of nonveterans (22.8 %)(p < 0.001). Adjusted odds ratios (AORs) for musculoskeletal and hearing disorders, traumatic brain injury, and chronic fatigue syndrome (CFS) were 3-6 times higher in veterans versus nonveterans (p < 0.001). Women versus men had the greatest adjusted odds for bladder infections (males:females, AOR = 0.08, 95 % CI:0.04-0.18)(p < 0.001), and greater odds than men for multiple sclerosis, CFS, cancer, irritable bowel syndrome/colitis, respiratory disease, some musculoskeletal disorders, and vision loss (p < 0.05). Cardiovascular-related conditions were most prominent for men (p < 0.001). Veteran status by sex interactions were found for obesity (p < 0.03; greater for male veterans) and migraine (p < 0.01; greater for females). Healthy People 2020 targeted topic areas exclude some important physical health conditions that are associated with being a veteran. National health guidelines for Americans should provide greater consideration of veterans in their design.
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Affiliation(s)
- Yasmin S. Cypel
- Epidemiology Program, Health Outcomes Military Exposures (HOME) (12POP5), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), Washington, DC, USA
- Corresponding author at: Epidemiology Program, Health Outcomes Military Exposures (HOME) (12POP5), Office of Patient Care Services, U.S. Department of Veterans Affairs, 810 Vermont Avenue, N.W., Washington, DC 20420, USA.
| | - Dawne Vogt
- National Center for PTSD, VA Boston Health Care System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Shira Maguen
- San Francisco VA Health Care System, San Francisco, CA, USA
- University of California-San Francisco, San Francisco, CA, USA
| | - Paul Bernhard
- Epidemiology Program, Health Outcomes Military Exposures (HOME) (12POP5), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), Washington, DC, USA
| | - Elizabeth Lowery
- Epidemiology Program, Health Outcomes Military Exposures (HOME) (12POP5), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), Washington, DC, USA
| | - William J. Culpepper
- Epidemiology Program, Health Outcomes Military Exposures (HOME) (12POP5), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), Washington, DC, USA
| | - Irvine Armand-Gibbs
- Epidemiology Program, Health Outcomes Military Exposures (HOME) (12POP5), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), Washington, DC, USA
| | - Aaron I. Schneiderman
- Epidemiology Program, Health Outcomes Military Exposures (HOME) (12POP5), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), Washington, DC, USA
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Senecal G, Adorno RL, LaFleur R, McNamara KA. Autoethnographic Family Case Study: Combat Veteran PTSD and its Effects on Familial Dynamics, Parenting, and Marriage. JOURNAL OF VETERANS STUDIES 2022. [DOI: 10.21061/jvs.v8i3.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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11
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Anderson E, Dvorin K, Etingen B, Barker AM, Rai Z, Herbst AN, Mozer R, Kingston RP, Bokhour BG. 'It Makes You Sit Back and Think Where You Wanna Go': Veteran experiences in virtual whole health peer-led groups. Health Expect 2022; 25:2548-2556. [PMID: 35957491 PMCID: PMC9615064 DOI: 10.1111/hex.13581] [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: 04/29/2022] [Revised: 07/28/2022] [Accepted: 07/31/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The Veterans Health Administration (VHA) is building a Whole Health system of care that aspires to empower and equip each Veteran to pursue a personally meaningful vision of health and well-being. As part of this effort, VHA has developed Taking Charge of My Life and Health (TCMLH), a peer-led, group-based programme that seeks to support Veterans in setting and pursuing health and well-being goals. Prior research showed TCMLH groups to positively impact Veteran outcomes; yet, little is known about Veterans' own experiences and perspectives. METHODS We completed semi-structured telephone interviews with 15 Veterans across 8 sites who had participated in TCMLH groups offered by the VHA in the virtual format between Summer 2020 and Fall 2021. Inductive thematic analysis was applied to interview transcripts to generate themes. FINDINGS We identified five themes regarding Veterans' experiences with TCMLH: (1) navigating the virtual format; (2) internalizing the value of health engagement; (3) making healthy lifestyle changes; (4) forging social connections; and (5) taking on a more active role in healthcare. CONCLUSION Veterans perceived virtual TCMLH groups as meaningful and beneficial, yet also highlighted several challenges. Their perspectives speak to the need to supplement time-limited programmes like TCMLH with ongoing, community-based support. Virtual group-based well-being programmes are a promising innovation. Other healthcare systems may draw on VHA's experience while tailoring format and content to the needs of their patient populations. PATIENT OR PUBLIC CONTRIBUTION Veterans were involved as evaluation participants. A Veteran consultant, who is a coauthor on this paper, was engaged through the conceptualization of the evaluation, development of data collection materials (interview guide) and writing.
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Affiliation(s)
- Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Bedford Healthcare SystemBedfordMassachusettsUSA
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Chan Medical SchoolWorcesterMassachusettsUSA
| | - Kelly Dvorin
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Bella Etingen
- Center of Innovation for Complex Chronic Healthcare (CINCCH)Edward Hines Jr. VA HospitalHinesIllinoisUSA
| | - Anna M. Barker
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Zenith Rai
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Abigail N. Herbst
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Reagan Mozer
- Department of Mathematical SciencesBentley UniversityWalthamMassachusettsUSA
| | - Rodger P. Kingston
- Veteran Engagement in Research Group, Center for Healthcare Organization and Implementation Research (CHOIR)VA Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Barbara G. Bokhour
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Bedford Healthcare SystemBedfordMassachusettsUSA
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Chan Medical SchoolWorcesterMassachusettsUSA
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12
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Johnston-Brooks CH, Grassmeyer RP, Filley CM, Kelly JP. The Marcus Institute for Brain Health: an integrated practice unit for the care of traumatic brain injury in military veterans. Brain Inj 2021; 35:1702-1710. [PMID: 34894933 DOI: 10.1080/02699052.2021.2013535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PRIMARY OBJECTIVE Traumatic brain injury (TBI) is a signature wound of recent Unites States military conflicts. The National Intrepid Center of Excellence (NICoE) has demonstrated that interdisciplinary care is effective for active-duty military personnel with TBI and related psychological health conditions. This paper details how the Marcus Institute for Brain Health (MIBH), established in 2017 as an Integrated Practice Unit (IPU), is founded on the NICoE model and is dedicated to interdisciplinary care for Veterans with persistent symptoms due to TBI and psychological comorbidities. RESEARCH DESIGN A highly integrated group of clinicians from diverse disciplines combine their expertise to offer comprehensive evaluation, intensive outpatient treatment, and program outcomes evaluation. METHODS AND PROCEDURES The role of each discipline in the provision of care, and the regular interaction of all clinicians, are delineated. A strong connection to academic medicine is maintained so that clinical research and education complement patient care. MAIN OUTCOMES AND RESULTS Over three hundred veterans and family members have received treatment at the MIBH. Program evaluation is underway. CONCLUSIONS As the understanding of TBI and related psychological conditions continues its rapid evolution, the expert interdisciplinary care at the MIBH has great promise as a Veteran counterpart of the NICoE.
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Affiliation(s)
- Catharine H Johnston-Brooks
- Marcus Institute for Brain Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Physical Medicine & Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Riley P Grassmeyer
- Department of Physical Medicine & Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA.,Research Core, Rocky Mountain Mental Illness Research, Education, and Clinical Center, Aurora, Colorado, USA
| | - Christopher M Filley
- Marcus Institute for Brain Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - James P Kelly
- Marcus Institute for Brain Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, Colorado, USA
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13
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Analysis of Content Gaps in Prelicensure Nursing Textbooks to Meet Veteran Care Competencies. Nurse Educ 2021; 46:E108-E112. [PMID: 34435762 DOI: 10.1097/nne.0000000000001024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the Joining Forces initiative and recently published veteran care competencies, nursing students and graduates are often unprepared to care for veterans who have unique service-connected illnesses and injuries. PURPOSE The purpose was to evaluate identified content gaps in prelicensure nursing textbooks with the veteran care competencies knowledge, skills, and attitude (KSA) domains. METHODS A secondary qualitative analysis was conducted of veteran content in prelicensure nursing textbooks. RESULTS The skills and attitude domains of veteran care competencies were poorly addressed in nursing textbooks. Overall, the knowledge domain was adequately covered; however, most had limited connection with veterans and veteran care. Competency-focused recommendations for expanding and enhancing veteran content, KSAs, and teaching strategies are offered. CONCLUSIONS Prelicensure textbooks met the knowledge domain for each veteran competency. Overcoming content gaps needed to achieve requisite skills and attitudes requires interaction with veterans through clinical immersion experiences in various care settings.
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Shepherd-Banigan M, Pogoda TK, McKenna K, Sperber N, Van Houtven CH. Experiences of VA vocational and education training and assistance services: Facilitators and barriers reported by veterans with disabilities. Psychiatr Rehabil J 2021; 44:148-156. [PMID: 32597666 PMCID: PMC9677616 DOI: 10.1037/prj0000437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To understand the experiences of veterans with disabilities and caregiving needs who use Department of Veterans Affairs (VA) vocational and education services, including Supported Employment, the Post-9/11 GI Bill, and Vocational Rehabilitation and Employment. METHOD We conducted 26 joint semistructured interviews with post-9/11 veterans who had used at least one of three vocational and education services, and their family members who were enrolled in a VA Caregiver Support Program. RESULTS VA vocational and education services helped veterans with disabilities transition from the military into civilian life by providing skills and incremental exposure to engaging in everyday life tasks. Veteran motivation, caregiver support, and engaged staff at VA and academic institutions were key drivers of veteran success. Veterans who experienced challenges cited the following barriers: health problems, concerns about benefits loss if they became employed, and VA and academic programs that did not accommodate the needs of nontraditional veteran learners. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE There is a need to bolster VA vocational and educational services for veterans with disabilities in several domains, including modifying the roles of frontline staff and increasing communication between vocational counselors and health care teams to better accommodate the veteran's health-related limitations. Providing a vocational rehabilitation navigator to help veterans identify opportunities within VA and work/educational settings that are a good match for the veteran's goals and abilities could also be beneficial across vocational and educational services. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Megan Shepherd-Banigan
- Durham Veterans Affairs Health Services Research and Development (HSR&D), Center of Innovation to Accelerate Discovery and Practice Transformation(ADAPT),VA Durham Healthcare System
| | - Terri K Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System
| | - Kevin McKenna
- Department of Population Health Sciences, Duke School of Medicine
| | - Nina Sperber
- Durham Veterans Affairs Health Services Research and Development (HSR&D), Center of Innovation to Accelerate Discovery and Practice Transformation(ADAPT),VA Durham Healthcare System
| | - Courtney H Van Houtven
- Durham Veterans Affairs Health Services Research and Development (HSR&D), Center of Innovation to Accelerate Discovery and Practice Transformation(ADAPT),VA Durham Healthcare System
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15
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Stanik-Hutt J. Caring for those “Who Shall Have Borne The Battle”. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Pittman JOE, Lindamer L, Afari N, Depp C, Villodas M, Hamilton A, Kim B, Mor MK, Almklov E, Gault J, Rabin B. Implementing eScreening for suicide prevention in VA post-9/11 transition programs using a stepped-wedge, mixed-method, hybrid type-II implementation trial: a study protocol. Implement Sci Commun 2021; 2:46. [PMID: 33926577 PMCID: PMC8082763 DOI: 10.1186/s43058-021-00142-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/25/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Post-9/11 veterans who enroll in VA health care frequently present with suicidal ideation and/or recent suicidal behavior. Most of these veterans are not screened on their day of enrollment and their risk goes undetected. Screening for suicide risk, and associated mental health factors, can lead to early detection and referral to effective treatment, thereby decreasing suicide risk. eScreening is an innovative Gold Standard Practice with evidence to support its effectiveness and implementation potential in transition and care management (TCM) programs. We will evaluate the impact of eScreening to improve the rate and speed of suicide risk screening and referral to mental health care compared to current screening methods used by transition care managers. We will also evaluate the impact of an innovative, multicomponent implementation strategy (MCIS) on the reach, adoption, implementation, and sustained use of eScreening. METHODS This is an eight-site 4-year, stepped-wedge, mixed-method, hybrid type-II implementation trial comparing eScreening to screening as usual while also evaluating the potential impact of the MCIS focusing on external facilitation and Lean/SixSigma rapid process improvement workshops in TCM. The aims will address: 1) whether using eScreening compared to oral and/or paper-based methods in TCM programs is associated with improved rates and speed of PTSD, depression, alcohol, and suicide screening & evaluation, and increased referral to mental health treatment; 2) whether and to what degree our MCIS is feasible, acceptable, and has the potential to impact adoption, implementation, and maintenance of eScreening; and 3) how contextual factors influence the implementation of eScreening between high- and low-eScreening adopting sites. We will use a mixed methods approach guided by the RE-AIM outcomes of the Practical Robust Implementation and Sustainability Model (PRISM). Data to address Aim 1 will be collected via medical record query while data for Aims 2 and 3 will be collected from TCM staff questionnaires and qualitative interviews. DISCUSSION The results of this study will help identify best practices for screening in suicide prevention for Post-9/11 veterans enrolling in VA health care and will provide information on how best to implement technology-based screening into real-world clinical care programs. TRIAL REGISTRATION ClinicalTrials.gov : NCT04506164; date registered: August 20, 2020; retrospectively registered.
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Affiliation(s)
- James O E Pittman
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA.
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA.
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA.
| | - Laurie Lindamer
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA
| | - Niloofar Afari
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA
| | - Colin Depp
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA
| | - Miguel Villodas
- San Diego State University, 5500 Campanile Dr, San Diego, CA, USA
| | - Alison Hamilton
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, USA
| | - Bo Kim
- HSR&D Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, USA
| | - Maria K Mor
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- VA Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erin Almklov
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA
| | - John Gault
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA
| | - Borsika Rabin
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA
- UC San Diego Dissemination and Implementation Science Center, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA
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Mathewson-Chapman M, Chapman HJ. One Health and veterans' post-deployment health. CLINICAL TEACHER 2020; 18:24-31. [PMID: 32909399 DOI: 10.1111/tct.13244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022]
Abstract
Since 2001, more than 3.3 million US service members have been deployed to operations Iraqi Freedom, Enduring Freedom, New Dawn, Inherent Resolve and Freedom's Sentinel. Visible and invisible war wounds from direct combat experiences, coupled with environmental exposures to harmful substances, can complicate veterans' health throughout their lifespan. While promoting a holistic view of health, health professionals should be attentive for potential risks associated with environmental or animal exposures (One Health concept). During deployment, infectious and non-infectious environmental exposures and harmful substances in the air, on the land and in the water may result in immediate- or long-term health effects. Veterans can also face psychosocial health risks when home that may impact their concentration, emotional responses and social interactions. To strengthen health professions education, the authors recommend that curricula incorporate a comprehensive overview of veterans' physical and psychosocial health risks as a result of their deployment. They describe four specific curriculum topics, competencies and didactic methods that can reinforce veteran-specific content for clinical education and training. By applying the One Health concept, health professionals can document harmful environmental exposures during deployment, report gaps in clinical practice, and provide support for veterans' physical and psychosocial health needs when returning to civilian life.
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Affiliation(s)
| | - Helena J Chapman
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Kopacz MS, Dillard SB, Drame EF, Quigley KS. Faith-Based Groups as a Bridge to the Community for Military Veterans: Preliminary Findings and Lessons Learned in Online Surveying. JOURNAL OF RELIGION AND HEALTH 2019; 58:236-245. [PMID: 30302728 DOI: 10.1007/s10943-018-0706-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This report examines responses to a brief online survey, comparing how faith-based (n = 27) and non-faith-based (n = 61) organizations engage with Veteran populations as well as the supportive services they provide. Data were analyzed using two-sample z-tests and Chi-squared tests. No significant differences were noted between respondents for self-reported confidence in responding to health care issues/concerns or engagement with Veteran populations. Faith-based respondents were found to provide significantly less mental health, suicide prevention, education/outreach, and other services, while providing significantly more spiritual care. There appears to be ample opportunity for expanding the supportive services provided by faith-based organizations.
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Affiliation(s)
- Marek S Kopacz
- VISN 2 Center of Excellence for Suicide Prevention, US Department of Veterans Affairs, 400 Fort Hill Avenue, Canandaigua, NY, 14424, USA.
- Mid-Atlantic Mental Illness Research, Education and Clinical Center, Mental Health and Chaplaincy, US Department of Veterans Affairs, Durham, NC, USA.
| | - Stephen B Dillard
- Center for Faith and Opportunity Initiative, US Department of Veterans Affairs, Washington, DC, USA
| | - Erica F Drame
- Center for Faith and Opportunity Initiative, US Department of Veterans Affairs, Washington, DC, USA
| | - Karen S Quigley
- Bedford Memorial VA Hospital, Bedford, MA, USA
- Northeastern University, Boston, MA, USA
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