1
|
Garcia-Davis S, Tyagi P, Bouldin ED, Hansen J, Brintz BJ, Noel P, Rupper R, Trivedi R, Kinosian B, Intrator O, Pugh MJ, Leykum LK, Dang S. Sex differences in unmet needs between male and female older veterans. J Women Aging 2024:1-16. [PMID: 38976516 DOI: 10.1080/08952841.2024.2375480] [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: 12/21/2023] [Accepted: 06/27/2024] [Indexed: 07/10/2024]
Abstract
Aging Veterans face complex needs across multiple domains. However, the needs of older female Veterans and the degree to which unmet needs differ by sex are unknown. We analyzed responses to the HERO CARE survey from 7,955 Veterans aged 55 years and older (weighted N = 490,148), 93.9% males and 6.1% females. We evaluated needs and unmet needs across the following domains: activities of daily living (ADLs), instrumental ADLs (IADLs), health management, and social. We calculated weighted estimates and compared sex differences using age-adjusted prevalence ratios. On average, female Veterans were younger, more were Non-Hispanic Black and unmarried. Females and males reported a similar prevalence of problems across all domains. However, compared to males, female Veterans had a lesser prevalence of missed appointments due to transportation (aPR 0.49; 95% CI: 0.26-0.92), housework unmet needs (aPR: 0.44; 95% CI: 0.20-0.97), and medication management unmet needs (aPR: 0.33; 95% CI: 0.11-0.95) but a higher prevalence of healthcare communication unmet needs (aPR: 2.40; 95% CI: 1.13-5.05) and monitoring health conditions unmet needs (aPR: 2.13, 95% CI: 1.08-4.20). Female Veterans' common experience of unmet needs in communicating with their healthcare teams could result in care that is less aligned with their preferences or needs. As the number of older female Veterans grows, these data and additional work to understand sex-specific unmet needs and ways to address them are essential to providing high-quality care for female Veterans.
Collapse
Affiliation(s)
- Sandra Garcia-Davis
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Pranjal Tyagi
- South Florida Veterans Affairs Foundation for Research and Education (SFVAFRE), Miami, Florida, USA
| | - Erin D Bouldin
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
| | - Jared Hansen
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
- Division of Epidemiology, University of Utah Health, Salt Lake City, Utah, USA
| | - Ben J Brintz
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah Health, Salt Lake City, Utah, USA
| | - Polly Noel
- South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Randall Rupper
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
- Salt Lake City Veterans Affairs Geriatric Research Education and Clinical Center (GRECC), Salt Lake City, Utah, USA
| | - Ranak Trivedi
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA
- Division of Public Mental Health and Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Bruce Kinosian
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Orna Intrator
- Canandaigua VA Medical Center Geriatrics and Extended Care Data Analysis Center (GECDAC), Canandaigua, New York, USA
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Luci K Leykum
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
- South Texas Veterans Health Care System, San Antonio, Texas, USA
- Harbor Health, Austin, Texas, USA
- Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Stuti Dang
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
- Miami Veterans Affairs Geriatric Research Education and Clinical Center (GRECC), Miami, Florida, USA
- Division of Geriatrics and Palliative Care, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
2
|
Smucker S, Ruder T, Yi S, Farris C. Veteran Single Parents: Surviving but Not Thriving. RAND HEALTH QUARTERLY 2024; 11:9. [PMID: 38855387 PMCID: PMC11147641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
The demographics of the veteran population are changing. Veterans who served after September 11, 2001 (post-9/11 veterans), are more likely to be female and identify as a person of color than their older counterparts. They are also more likely to be raising children, many of them without support from a partner. This study provides a comprehensive look at the financial, physical, and mental health of veteran single parents; explores the differences across these factors by race, ethnicity, and gender; and includes recommendations on policies and programs that can better support veteran single parents and their children.
Collapse
|
3
|
Mitchell NA, McCauley M, O’Brien D, Wilson CE. Mental health and resilience in the Irish defense forces during the COVID-19 global pandemic. MILITARY PSYCHOLOGY 2023; 35:383-393. [PMID: 37615557 PMCID: PMC10453996 DOI: 10.1080/08995605.2021.2007728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
The Irish Defense Forces (DF) responded to the COVID-19 pandemic and national public health crisis by deploying personnel to aid domestic civil authorities in medical and care settings, contact tracing, logistics, and operations. Current research on COVID-19 reveals increased psychological distress among frontline workers and the general public. Resilience has previously been associated with lower levels of psychological distress. This study sets out to test these associations, and to examine mental health differences between DF personnel deployed in Ireland on pandemic-related duties (DIPD) and non-DIPD. Participants were 231 DF members who completed the: Connor-Davidson Resilience Scale-10, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Perceived Coronavirus Threat Questionnaire, Brief Trauma Questionnaire, Post-traumatic Stress Disorder Checklist-5, and Alcohol Use Disorder Identification Test. Independent t-tests revealed no differences between DIPD and non-DIPD on measures of psychological distress or on self-rated mental health prior to COVID-19 (PC19) and during COVID-19 (DC19). Results of multiple hierarchical regression analyses revealed that depression predicted lower levels of resilience, while multiple traumatic events predicted higher levels of resilience. The total adjusted variance explained by the model was 25%. Clinical and policy implications for improving access to psychological support within the DF and military populations are discussed.
Collapse
Affiliation(s)
- Nicola A. Mitchell
- School of Psychology, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Mathew McCauley
- School of Psychology, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
- Military Clinical Psychology, Office of the DMB, Defence Forces Ireland, Dublin, Ireland
| | - Dorota O’Brien
- Military Clinical Psychology, Office of the DMB, Defence Forces Ireland, Dublin, Ireland
| | - Charlotte E. Wilson
- School of Psychology, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| |
Collapse
|
4
|
Koehlmoos TP, Lee E, Wisdahl J, Donaldson T. Fetal alcohol spectrum disorders prevention and clinical guidelines research-workshop report. BMC Proc 2023; 17:19. [PMID: 37580722 PMCID: PMC10426045 DOI: 10.1186/s12919-023-00272-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
It is estimated that up to 1 in 20 people in the United States are affected by fetal alcohol spectrum disorders (FASD), an array of cognitive, emotional, physical and social disorders caused by exposure to alcohol during prenatal development. Common diagnoses encompassed within FASD include mood and behavioral disorders, memory and central nervous system deficits, attention-deficit/hyperactivity disorder (ADHD), slow growth and low body weight. While this condition affects a broad range of individuals and families, it is of particular concern in the military community, where cultural factors including an increased prevalence of alcohol misuse pose a unique set of challenges. To shed light on these issues and provide an overview of the existing research, programs, and clinical practice guidelines surrounding FASD, the Uniformed Services University of the Health Sciences (USUHS), in conjunction with FASD United, hosted the Workshop on Fetal Alcohol Spectrum Disorders Prevention and Clinical Guidelines Research on 21 September 2022 in Washington, DC. More than 50 attendees from academia, healthcare, federal agencies, and consumer advocacy organizations gathered to share research findings, lived experiences, and strategies for improving FASD prevention, diagnosis, interventions, and support.The workshop began with a series of presentations on FASD risk factors and causes, strategies for diagnosis and interventions, and impacts and lived experiences. Individuals and families affected by FASD spoke about the ways FASD, its symptoms, and the social stigma associated with it influences their daily lives, experiences at school and work, and access to healthcare. Several speakers highlighted the work of non-profit organizations and advocacy groups in supporting families affected by FASD and other challenges faced by military families more broadly. The workshop closed with a discussion of federal agency perspectives highlighting initiatives aimed at advancing research and access to care for women and families at-risk and those currently affected by FASD.
Collapse
Affiliation(s)
- Tracey Pérez Koehlmoos
- Center for Health Services Research, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
| | - Elizabeth Lee
- Department of Pediatrics, Division of Pediatric Health Systems Research and Clinical Epidemiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Building 61 Room E225, Bethesda, MD 20814 USA
| | - Jennifer Wisdahl
- FASD United, 1200 Eton Ct NW, 3rd Floor, Washington, DC 20007 USA
| | - Tom Donaldson
- FASD United, 1200 Eton Ct NW, 3rd Floor, Washington, DC 20007 USA
| |
Collapse
|
5
|
Ben-Shalom U, Reizer A, Connelly V, Rickover I. The adaptation of soldiers to post-service life - the mediating impact of political views on the relationship between violence and adaptation. Front Psychol 2023; 14:1131316. [PMID: 37645069 PMCID: PMC10461056 DOI: 10.3389/fpsyg.2023.1131316] [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: 12/24/2022] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction The current research explores the association between political views, combat experiences, and the adaptation of soldiers to post-service life. Violent experiences in military service were explored as contributors to both positive and negative dimensions of adaptation, while political views served as possible mediators. Methods Three hundred and twenty Israeli veterans participated in the study. Results Political views were correlated with adaptation, especially left-to-right voting and anti-militarism. The results support the mediating role of political beliefs (left-right voting and militarism) in the relationship between combat experience and adaptation to post-service life. Discussion We contend that political perceptions affect adaptation through sense-making of the combat experiences and the individual processing of these experiences, and the willingness to continue in reserve service, which allows social support and recognition. In addition, they are linked to a sense of bitterness following the reduction of public participation in military and reserve service.
Collapse
Affiliation(s)
- Uzi Ben-Shalom
- Department of Sociology and Anthropology, Ariel University, Ariel, Israel
- Department of Psychology, Health and Professional Development, Oxford Brookes University, Oxford, United Kingdom
| | - Abira Reizer
- Department of Psychology, Ariel University, Ariel, Israel
| | - Vincent Connelly
- Department of Psychology, Health and Professional Development, Oxford Brookes University, Oxford, United Kingdom
| | - Itamar Rickover
- Department of Sociology and Anthropology, Ariel University, Ariel, Israel
| |
Collapse
|
6
|
DuBois D, Richmond R, Stephanie Roberts L, Mahar A, Fear N, Gill K, Samantha Leroux J, Cramm H. A scoping review of military and Veteran families within international suicidality and suicide prevention research. Prev Med Rep 2023; 33:102206. [PMID: 37223562 PMCID: PMC10201831 DOI: 10.1016/j.pmedr.2023.102206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 05/25/2023] Open
Abstract
The impacts of suicidality on families are well known, which is particularly relevant in at-risk populations, such as active duty military personnel and Veteran communities. This scoping review describes how military and Veteran families have been conceptualized within suicide prevention research. A systematic, multi-database search was conducted, and 4,835 studies were screened. All included studies underwent quality assessment. Bibliographic, participant, methodological, and family-relevant data was extracted and descriptively analyzed into Factors, Actors, and Impacts. In total, 51 studies (2007 - 2021) were included. Most studies focused on suicidality rather than suicide prevention. Factor studies described family constructs as a suicidality risk or protective factor for military personnel or Veterans. Actor studies described families' roles or responsibilities to act in relation to the suicidality of military personnel or Veterans. Impacts studies described the impacts of suicidality on military and Veteran family members. The search was limited to English language studies. There were few studies on suicide prevention interventions for or including military and Veteran family members. Family was typically considered peripheral to the military personnel or Veteran experiencing suicidality. However, there was also emerging evidence of suicidality and its consequences in military-connected family members.
Collapse
Affiliation(s)
- Denise DuBois
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
| | - Rachel Richmond
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
| | - Lauren Stephanie Roberts
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
| | - Alyson Mahar
- Max Rady College of Medicine, Community Health Sciences, University of Manitoba, Winnipeg, Ontario R3E 3P5, Canada
| | - Nicola Fear
- Department of Military Mental Health, Institute of Psychiatry, King’s College London, London WC2R 2LS, England, United Kingdom
| | - Kamaldeep Gill
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
| | - Janette Samantha Leroux
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
| | - Heidi Cramm
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
| |
Collapse
|
7
|
Whitbourne SB, Li Y, Brewer JV, Deen J, Gutierrez C, Murphy SA, Lord E, Yan J, Nguyen XMT, Tsao PS, Gaziano JM, Muralidhar S. Overview of Efforts to Increase Women Enrollment in the Veterans Affairs Million Veteran Program. Health Equity 2023; 7:324-332. [PMID: 37284530 PMCID: PMC10240313 DOI: 10.1089/heq.2023.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 06/08/2023] Open
Abstract
Background Ensuring enhanced delivery of care to women Veterans is a top Veterans Affairs (VA) priority; however, women are historically underrepresented in research that informs evidence-based health care. A primary barrier to women's participation is the inability to engage with research in person due to a number of documented challenges. The VA Million Veteran Program (MVP) is committed to increasing access for women Veterans to participate in research, thereby better understanding conditions specific to this population and how disease manifests differently in women compared to men. The goal of this work is to describe the results of the MVP Women's Campaign, an effort designed to increase outreach to and awareness of remote enrollment options for women Veterans. Materials and Methods The MVP Women's Campaign launched two phases between March 2021 and April 2022: the Multimedia Phase leveraged a variety of strategic multichannel communication tactics and the Email Phase focused on direct email communication to women Veterans. The effect of the Multimedia Phase was determined using t-tests and chi-square tests, as well as logistic regression models to compare demographic subgroups. The Email Phase was evaluated using comparisons of the enrollment rate across demographic groups through a multivariate adjusted logistic regression model. Results Overall, 4694 women Veterans enrolled during the MVP Women's Campaign (54% during the Multimedia Phase and 46% during the Email Phase). For the Multimedia Phase, the percentage of older women online enrollees increased, along with women from the southwest and western regions of the United States. Differences for women Veteran online enrollment across different ethnicity and race groups were not observed. During the Email Phase, the enrollment rate increased with age. Compared to White women Veterans, Blacks, Asians, and Native Americans were significantly less likely to enroll while Veterans with multiple races were more likely to enroll. Conclusion The MVP Women's Campaign is the first large-scale outreach effort focusing on recruitment of women Veterans into MVP. The combination of print and digital outreach tactics and direct email recruitment resulted in over a fivefold increase in women Veteran enrollees during a 7-month period. Attention to messaging and communication channels, combined with a better understanding of effective recruitment methods for certain Veteran populations, allows MVP the opportunity to advance health and health care not only for women Veterans, but beyond. Lessons learned will be applied to increase other populations in MVP such as Blacks, Hispanics, Asians, Native Americans, younger Veterans, and Veterans with certain health conditions.
Collapse
Affiliation(s)
- Stacey B. Whitbourne
- Million Veteran Program Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yanping Li
- Million Veteran Program Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jessica V.V. Brewer
- Million Veteran Program Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jennifer Deen
- Office of Research and Development, Veterans Health Administration, Washington, District of Columbia, USA
| | - Claudia Gutierrez
- Million Veteran Program Coordinating Center, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Sybil A. Murphy
- Million Veteran Program Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Emily Lord
- Million Veteran Program Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Joseph Yan
- Million Veteran Program Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Xuan-Mai T. Nguyen
- Million Veteran Program Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Carle Illinois College of Medicine, University of Illinois, Champaign, Illinois, USA
| | - Philip S. Tsao
- Million Veteran Program Coordinating Center, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
| | - J. Michael Gaziano
- Million Veteran Program Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sumitra Muralidhar
- Office of Research and Development, Veterans Health Administration, Washington, District of Columbia, USA
| |
Collapse
|
8
|
Ashley-Koch AE, Kimbrel NA, Qin XJ, Lindquist JH, Garrett ME, Dennis MF, Hair LP, Huffman JE, Jacobson DA, Madduri RK, Coon H, Docherty AR, Kang J, Mullins N, Ruderfer DM, Harvey PD, McMahon BH, Oslin DW, Hauser ER, Hauser MA, Beckham JC. Genome-wide association study identifies four pan-ancestry loci for suicidal ideation in the Million Veteran Program. PLoS Genet 2023; 19:e1010623. [PMID: 36940203 PMCID: PMC10063168 DOI: 10.1371/journal.pgen.1010623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/30/2023] [Accepted: 01/18/2023] [Indexed: 03/21/2023] Open
Abstract
Suicidal ideation (SI) often precedes and predicts suicide attempt and death, is the most common suicidal phenotype and is over-represented in veterans. The genetic architecture of SI in the absence of suicide attempt (SA) is unknown, yet believed to have distinct and overlapping risk with other suicidal behaviors. We performed the first GWAS of SI without SA in the Million Veteran Program (MVP), identifying 99,814 SI cases from electronic health records without a history of SA or suicide death (SD) and 512,567 controls without SI, SA or SD. GWAS was performed separately in the four largest ancestry groups, controlling for sex, age and genetic substructure. Ancestry-specific results were combined via meta-analysis to identify pan-ancestry loci. Four genome-wide significant (GWS) loci were identified in the pan-ancestry meta-analysis with loci on chromosomes 6 and 9 associated with suicide attempt in an independent sample. Pan-ancestry gene-based analysis identified GWS associations with DRD2, DCC, FBXL19, BCL7C, CTF1, ANNK1, and EXD3. Gene-set analysis implicated synaptic and startle response pathways (q's<0.05). European ancestry (EA) analysis identified GWS loci on chromosomes 6 and 9, as well as GWS gene associations in EXD3, DRD2, and DCC. No other ancestry-specific GWS results were identified, underscoring the need to increase representation of diverse individuals. The genetic correlation of SI and SA within MVP was high (rG = 0.87; p = 1.09e-50), as well as with post-traumatic stress disorder (PTSD; rG = 0.78; p = 1.98e-95) and major depressive disorder (MDD; rG = 0.78; p = 8.33e-83). Conditional analysis on PTSD and MDD attenuated most pan-ancestry and EA GWS signals for SI without SA to nominal significance, with the exception of EXD3 which remained GWS. Our novel findings support a polygenic and complex architecture for SI without SA which is largely shared with SA and overlaps with psychiatric conditions frequently comorbid with suicidal behaviors.
Collapse
Affiliation(s)
- Allison E. Ashley-Koch
- Duke Molecular Physiology Institute, Durham, North Carolina, United States of America
- Department of Medicine, Duke University Health System, Durham, North Carolina, United States of America
| | - Nathan A. Kimbrel
- Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina, United States of America
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina, United States of America
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, United States of America
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Xue J. Qin
- Duke Molecular Physiology Institute, Durham, North Carolina, United States of America
- Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina, United States of America
| | - Jennifer H. Lindquist
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, United States of America
| | - Melanie E. Garrett
- Duke Molecular Physiology Institute, Durham, North Carolina, United States of America
| | - Michelle F. Dennis
- Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina, United States of America
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Lauren P. Hair
- Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina, United States of America
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Jennifer E. Huffman
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Daniel A. Jacobson
- Biosciences, Oak Ridge National Laboratory, Oak Ridge, TN, United States of America
- Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee Knoxville, Knoxville, Tennessee, United States of America
- Department of Psychology, NeuroNet Research Center, University of Tennessee Knoxville, Knoxville, Tennessee, United States of America
| | - Ravi K. Madduri
- Consortium for Advanced Science and Engineering, The University of Chicago, Chicago, Illinois, United States of America
- Data Science and Learning Division, Argonne National Laboratory, Lemont, Illinois, United States of America
| | - Hilary Coon
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Anna R. Docherty
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Jooeun Kang
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Niamh Mullins
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Douglas M. Ruderfer
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | | | | | | | - Philip D. Harvey
- Research Service Bruce W. Carter VA Medical Center, Miami, Florida, United States of America
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Benjamin H. McMahon
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - David W. Oslin
- VISN 4 Mental Illness Research, Education, and Clinical Center, Center of Excellence, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, United States of America
| | - Elizabeth R. Hauser
- Duke Molecular Physiology Institute, Durham, North Carolina, United States of America
- Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina, United States of America
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Michael A. Hauser
- Duke Molecular Physiology Institute, Durham, North Carolina, United States of America
| | - Jean C. Beckham
- Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina, United States of America
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina, United States of America
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America
| |
Collapse
|
9
|
Sidiropoulos AN, Glasberg JJ, Moore TE, Nelson LM, Maikos JT. Acute influence of an adaptive sporting event on quality of life in veterans with disabilities. PLoS One 2022; 17:e0277909. [PMID: 36441761 PMCID: PMC9704555 DOI: 10.1371/journal.pone.0277909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 11/06/2022] [Indexed: 11/29/2022] Open
Abstract
Veterans with disabilities can experience poor quality of life following military service due to the associated negative physical and psychological ramifications. However, participation in physical activities has shown to induce both physical and mental benefits and improve the quality of life of this population. Adaptive sports, an innovative approach to address the unique physical and psychosocial needs of veterans with disabilities, are becoming more widely used as a rehabilitation tool to improve the quality of life for these veterans. This study aimed to determine the acute influence of participation in a single-day, veteran-based, adaptive kayaking and sailing event on the perceived overall health, quality of life, and quality of social life of veterans with varying disabilities. It was hypothesized that all three categories and the sum score of quality of life would reflect a positive acute response after participation in the community-based physical activity event. Veterans responded to three quality of life-related questions using a 5-point Likert scale before and directly after participating in the event. Findings indicated that an adaptive sporting event can have an acute positive influence on the quality of life of veteran participants, with improvements observed in all three categories of perceived quality of life. Therefore, it is advantageous for the whole-health rehabilitation of veterans with disabilities for the Department of Veterans Affairs to continue to provide opportunities for veterans to participate in non-traditional, community-based activities.
Collapse
Affiliation(s)
- Alexis N. Sidiropoulos
- Department of Veterans Affairs, New York Harbor Healthcare System, New York, New York, United States of America
- * E-mail:
| | - Jonathan J. Glasberg
- Department of Veterans Affairs, New York Harbor Healthcare System, New York, New York, United States of America
| | - Timothy E. Moore
- Statistical Consulting Services, Center for Open Research Resources and Equipment, University of Connecticut, Storrs, CT, United States of America
| | - Leif M. Nelson
- Department of Veterans Affairs, National Veterans Sports Programs and Special Events, Washington, DC, United States of America
| | - Jason T. Maikos
- Department of Veterans Affairs, New York Harbor Healthcare System, New York, New York, United States of America
| |
Collapse
|
10
|
Recent and Frequent Mental Distress Among Women with a History of Military Service, 2003–2019. J Behav Health Serv Res 2022; 50:119-127. [PMID: 36369432 DOI: 10.1007/s11414-022-09825-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/13/2022]
Abstract
Examining women veterans' self-reported mental health is critical to understanding their unique mental and physical health needs. This study describes self-reported mental distress over a 17-year period among cross-sectional nationally representative samples of women in the USA using data from the Behavioral Risk Factor Surveillance System (BRFSS) core national surveys from 2003 to 2019. Nationally representative prevalence estimates of self-reported mental distress were compared between women veterans and their (1) men veteran and (2) women civilian counterparts. In each year examined, women veterans report significantly more days of recent mental distress and significantly higher prevalence of frequent mental distress than their men veteran counterparts. In several years, women veterans also report greater levels of recent and frequent mental distress than women civilians. These findings highlight the long-standing high prevalence of self-reported poor mental health among women veterans and suggest that specific efforts to address mental health among women veterans as a unique population may be warranted.
Collapse
|
11
|
Valladares-Garrido MJ, Huamani-Colquichagua Y, Anchay-Zuloeta C, Picón-Reátegui CK, Valladares-Garrido D. Time in Service and Resilience in Active Military Personnel during the COVID-19 Pandemic: A Cross-Sectional Study in Northern Peru. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11052. [PMID: 36078763 PMCID: PMC9518471 DOI: 10.3390/ijerph191711052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
Greater occupational exposure may have a positive effect on the development of resilience. We aimed to determine the association between working time and resilience in Peruvian military personnel during the COVID-19 pandemic. A secondary data analysis was performed including 586 records of military personnel who supported the health emergency during the second epidemic wave in Lambayeque, Peru. Resilience was measured with the short form of the Connor-Davidson Resilience Scale (CD-RISC). Working time and other relevant covariates were collected by self-report. Generalized linear models were used. The mean resilience score was 22.18 and 43.2% scored high for resilience. Participants reported that they are strong individuals when facing difficulties (42.3%), are able to handle unpleasant feelings (40.3%), and achieve their goals despite obstacles (40.4%). Working more than 18 months was associated with a 35% higher prevalence of high resilience (PR: 1.35; 95% CI: 1.05-1.75). In conclusion, a notable number of military personnel experienced high levels of resilience during the pandemic. Working time may have played an important role in the development of this ability. Our findings could help guide the deployment and organization of the military in health emergency support missions.
Collapse
Affiliation(s)
- Mario J. Valladares-Garrido
- South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima 15046, Peru
- Oficina de Epidemiología, Hospital Regional Lambayeque, Chiclayo 14012, Peru
| | | | - Claudia Anchay-Zuloeta
- Facultad de Medicina, Universidad de San Martín de Porres, Chiclayo 14012, Peru
- Sociedad Científica de Estudiantes de Medicina Veritas (SCIEMVE), Chiclayo 14012, Peru
| | | | | |
Collapse
|
12
|
Getting Connected: a Retrospective Cohort Investigation of Video-to-Home Telehealth for Mental Health Care Utilization Among Women Veterans. J Gen Intern Med 2022; 37:778-785. [PMID: 36042096 PMCID: PMC9427431 DOI: 10.1007/s11606-022-07594-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/01/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Increasingly, women are serving in the military and seeking care at the Veterans Health Administration (VHA). Women veterans face unique challenges and barriers in seeking mental health (MH) care within VHA. VA Video Connect (VVC), which facilitates video-based teleconferencing between patients and providers, can reduce barriers while maintaining clinical effectiveness. OBJECTIVE Primary aims were to examine gender differences in VVC use, describe changes in VVC use over time (including pre-COVID and 6 months following the beginning of COVID), and determine whether changes over time differed by gender. DESIGN A retrospective cohort investigation of video-to-home telehealth for MH care utilization among veterans having at least 1 MH visit from October 2019 to September 2020. PARTICIPANTS Veterans (236,268 women; 1,318,024 men). INTERVENTIONS (IF APPLICABLE) VVC involves face-to-face, synchronous, video-based teleconferencing between patients and providers, enabling care at home or another private location. MAIN MEASURES Percentage of MH encounters delivered via VA Video Connect. KEY RESULTS Women veterans were more likely than men to have at least 1 VVC encounter and had a greater percentage of MH care delivered via VVC in FY20. There was an increase in the percentage of MH encounters that were VVC over FY20, and this increase was greater for women than men. Women veterans who were younger than 55 (compared to those 55 and older), lived in urban areas (compared to those in rural areas), or were Asian (compared to other races) had a greater percentage of MH encounters that were VVC since the start of the pandemic, controlling for the mean percentage of VVC MH encounters in the 6 months pre-pandemic. CONCLUSIONS VVC use for MH care is greater in women veterans compared to male veterans and may reduce gender-specific access barriers. Future research and VVC implementation efforts should emphasize maximizing patient choice and satisfaction.
Collapse
|
13
|
Boscarino JA, Adams RE, Wingate TJ, Boscarino JJ, Urosevich TG, Hoffman SN, Kirchner HL, Figley CR, Nash WP. Impact and Risk of Moral Injury Among Deployed Veterans: Implications for Veterans and Mental Health. Front Psychiatry 2022; 13:899084. [PMID: 35733800 PMCID: PMC9207252 DOI: 10.3389/fpsyt.2022.899084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
The impact of "moral injury" (MI) among deployed veterans, defined as actions in combat that violate a veteran's moral beliefs and result in psychological distress, has increasingly become a significant clinical concern separate from other trauma- and stressor-related disorders. MI involves severe distress over violations of core beliefs often followed by feelings of guilt and conflict and is common among veterans with PTSD. While the psychological impact of PTSD is well-documented among veterans, this has been done less so with respect to MI. We studied MI among 1,032 deployed veterans who were outpatients in a large non-profit multi-hospital system in central Pennsylvania. The study included active duty and Guard/Reserve members, as well as veterans who were not Department of Veterans Affairs (VA) service users. Our hypothesis was that, controlling for other risk factors, veterans with high MI would have current mental disorders. Our secondary hypothesis was that MI would be associated with other psychopathologies, including chronic pain, sleep disorders, fear of death, anomie, and use of alcohol/drugs to cope post deployment. Most veterans studied were deployed to Vietnam (64.1%), while others were deployed to post-Vietnam conflicts in Iraq and Afghanistan and elsewhere. Altogether, 95.1% of the veterans were male and their mean age was 61.6 years (SD = 11.8). Among the veterans, 24.4% had high combat exposure, 10.9% had PTSD, 19.8% had major depressive disorder, and 11.7% had a history of suicidal thoughts. Based on the Moral Injury Events Scale (MIES), 25.8% had high MI post deployment, defined as a score above the 75th percentile. Results show that high MI among veterans was associated with current global mental health severity and recent mental health service use, but not suicidal thoughts. In addition, as hypothesized, MI was also associated with pain, sleep disorders, fear of death, anomie, use of alcohol/drugs to cope post-deployment, and poor unit support/morale during deployment. Deployed veterans with MI are more likely to have current mental health disorders and other psychological problems years after deployment. Further research is advised related to the screening, assessment, treatment, and prevention of MI among veterans and others after trauma exposures.
Collapse
Affiliation(s)
- Joseph A Boscarino
- Department of Population Health Sciences, Geisinger Clinic, Danville, PA, United States
| | - Richard E Adams
- Department of Sociology, Kent State University, Kent, OH, United States
| | - Tiah J Wingate
- Department of Sociology, Kent State University, Kent, OH, United States
| | - Joseph J Boscarino
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, United States
| | - Thomas G Urosevich
- Ophthalmology Service, Geisinger Clinic, Mount Pocono, PA, United States
| | - Stuart N Hoffman
- Department of Sleep Medicine, Geisinger Clinic, Danville, PA, United States
| | - H Lester Kirchner
- Department of Population Health Sciences, Geisinger Clinic, Danville, PA, United States
| | - Charles R Figley
- School of Social Work, Tulane University, New Orleans, LA, United States
| | - William P Nash
- Department of Veterans Affairs (VA), Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| |
Collapse
|