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Lesnewich LM, Lu SE, Weinreb KS, Sparks SO, Litke DR, Helmer DA, Pigeon WR, McAndrew LM. Associations between risky alcohol use, disability, and problem-solving impairment among Veterans with Gulf War Illness: Secondary data analysis of a randomized clinical trial. J Psychosom Res 2023; 170:111336. [PMID: 37087893 DOI: 10.1016/j.jpsychores.2023.111336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/30/2023] [Accepted: 04/09/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE Gulf War Illness (GWI) and alcohol use are both major sources of disability among Gulf War Veterans. The goal of this secondary data analysis was to examine associations between risky alcohol use, problem-solving impairment, and disability among Veterans in a randomized clinical trial of problem-solving treatment (PST) for GWI. We examined cross-sectional associations and conducted longitudinal analyses to test if alcohol use moderated treatment outcome of PST. METHODS Participants were 268 United States military Veterans with GWI randomized to PST or a control intervention. Participants were assessed at four timepoints. Measures included the World Health Organization Disability Assessment Schedule 2.0 (WHO-DAS 2.0), Problem Solving Inventory (PSI), and Alcohol Use Disorders Identification Test-Concise (AUDIT-C). We conducted multivariate regression (cross-sectional) and mixed model analyses (longitudinal) with separate models for WHO-DAS 2.0 and PSI. All models included AUDIT-C and household income. This analysis was pre-registered on the Open Science Framework. RESULTS Cross-sectional analyses revealed a significant negative association with small effect size between AUDIT-C and WHO-DAS 2.0 (p = 0.006; f2 = 0.05); worse disability was associated with less risky alcohol use. There was no evidence that risky alcohol use moderated effects of PST on disability or PSI. CONCLUSION If replicated, the cross-sectional findings suggest high levels of disability may deter heavy drinking among Veterans with GWI. We did not find evidence that risky alcohol use moderated treatment outcome of PST for GWI. More research is needed to identify moderators of GWI interventions and to understand risky drinking among Veterans with complex health problems.
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Affiliation(s)
- Laura M Lesnewich
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, 385 Tremont Ave., East Orange, NJ 07018, USA.
| | - Shou-En Lu
- Rutgers School of Public Health, 683 Hoes Ln. W, Piscataway, NJ 08854, USA; Rutgers Cancer Institute of New Jersey, 195 Little Albany St., New Brunswick, NJ 08901, USA
| | - Karly S Weinreb
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, 385 Tremont Ave., East Orange, NJ 07018, USA; Montclair State University, 1 Normal Ave., Montclair, NJ 07043, USA
| | - Sharron O Sparks
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, 385 Tremont Ave., East Orange, NJ 07018, USA; Felician University, 1 Felician Way, Rutherford, NJ 07070, USA
| | - David R Litke
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, 385 Tremont Ave., East Orange, NJ 07018, USA; Department of Rehabilitation Medicine, New York University Grossman School of Medicine, 240 E. 38th St., New York, NY 10016, USA
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness & Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd. (152), Houston, TX 77030, USA; Department of Medicine, Baylor College of Medicine, 1 Taub Loop, Houston, TX 77030, USA
| | - Wilfred R Pigeon
- VISN 2 Center of Excellence for Suicide Prevention, 400 Fort Hill Ave., Canandaigua, New York 14424, USA; University of Rochester Medical Center, 300 Crittenden Blvd. - Box PSYCH, Rochester, NY 14642, USA
| | - Lisa M McAndrew
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, 385 Tremont Ave., East Orange, NJ 07018, USA
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Jain N, Prasad S, Czárth ZC, Chodnekar SY, Mohan S, Savchenko E, Panag DS, Tanasov A, Betka MM, Platos E, Świątek D, Krygowska AM, Rozani S, Srivastava M, Evangelou K, Gristina KL, Bordeniuc A, Akbari AR, Jain S, Kostiks A, Reinis A. War Psychiatry: Identifying and Managing the Neuropsychiatric Consequences of Armed Conflicts. J Prim Care Community Health 2022; 13:21501319221106625. [PMID: 35726205 PMCID: PMC9218442 DOI: 10.1177/21501319221106625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
War refugees and veterans have been known to frequently develop neuropsychiatric conditions including depression, post-traumatic stress disorder (PTSD), and anxiety disorders that tend to leave a long-lasting scar and impact their emotional response system. The shear stress, trauma, and mental breakdown from overnight displacement, family separation, and killing of friends and families cannot be described enough. Victims often require years of mental health support as they struggle with sleep difficulties, recurring memories, anxiety, grief, and anger. Everyone develops their coping mechanism which can involve dependence and long-term addiction to alcohol, drugs, violence, or gambling. The high prevalence of mental health disorders during and after the war indicates an undeniable necessity for screening those in need of treatment. For medical health professionals, it is crucial to identify such vulnerable groups who are prone to developing neuropsychiatric morbidities and associated risk factors. It is pivotal to develop and deploy effective and affordable multi-sectoral collaborative care models and therapy, which primarily depends upon family and primary care physicians in the conflict zones. Herein, we provide a brief overview regarding the identification and management of vulnerable populations, alongside discussing the challenges and possible solutions to the same.
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Affiliation(s)
| | - Sakshi Prasad
- National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | | | | | | | | | | | - Andrei Tanasov
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | | | | | - Sofia Rozani
- National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | - Alina Bordeniuc
- "Victor Babes" University of Medicine and Pharmacy Timisoara, Timișoara, Romania
| | - Amir Reza Akbari
- Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire, UK
| | - Shivani Jain
- Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India
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