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Lin SC, Chang KSG, Marjavi A, Chon KY, Dichter ME, DuBois Palardy J. Intimate Partner Violence and Human Trafficking Screening and Services in Primary Care Across Underserved Communities in the United States-Initial Examination of Trends, 2020-2021. Public Health Rep 2024:333549241239886. [PMID: 38562004 DOI: 10.1177/00333549241239886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVES The Health Resources and Services Administration (HRSA) began collecting data on intimate partner violence (IPV) and human trafficking (HT) in the 2020 Uniform Data System (UDS). We examined patients affected by IPV and HT served by HRSA-funded health centers in medically underserved US communities during the COVID-19 pandemic. METHODS We established a baseline and measured trends in patient care by analyzing data from the 2020 (N = 28 590 897) and 2021 (N = 30 193 278) UDS. We conducted longitudinal ordinal logistic regression analyses to assess the association of care trends and organization-level and patient characteristics using proportional odds ratios (PORs) and 95% CIs. RESULTS The number of clinical visits for patients affected by IPV and HT decreased by 29.4% and 88.3%, respectively, from 2020 to 2021. Health centers serving a higher (vs lower) percentage of pediatric patients were more likely to continuously serve patients affected by IPV (POR = 2.58; 95% CI, 1.01-6.61) and HT (POR = 6.14; 95% CI, 2.06-18.29). Health centers serving (vs not serving) patients affected by IPV were associated with a higher percentage of patients who had limited English proficiency (POR = 1.77; 95% CI, 1.02-3.05) and Medicaid beneficiaries (POR = 2.88; 95% CI, 1.48-5.62), whereas health centers serving (vs not serving) patients affected by HT were associated with a higher percentage of female patients of reproductive age (POR = 15.89; 95% CI, 1.61-157.38) and urban settings (POR = 1.74; 95% CI, 1.26-2.37). CONCLUSIONS The number of clinical visits for patients affected by IPV and HT during the COVID-19 pandemic declined. Delayed care will pose challenges for future health care needs of these populations.
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Affiliation(s)
- Sue C Lin
- Bureau of Primary Health Care Office of Quality Improvement, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, MD, USA
| | | | - Anna Marjavi
- Futures Without Violence, San Francisco, CA, USA
| | - Katherine Y Chon
- Office of Trafficking in Persons, Administration for Children and Families, US Department of Health and Human Services, Washington, DC, USA
| | - Melissa E Dichter
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Temple University School of Social Work, Philadelphia, PA, USA
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Dichter ME, Agha AZ, Monteith LL, Krishnamurti LS, Iverson KM, Montgomery AE. "Something Has to Be Done to Make Women Feel Safe": Women Veterans' Recommendations for Strengthening the Veterans Crisis Line for Women Veterans. Womens Health Issues 2024:S1049-3867(23)00213-X. [PMID: 38199835 DOI: 10.1016/j.whi.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Women represent 15% of veteran callers to the Veterans Crisis Line (VCL); there has been little research identifying the experiences and needs of women veterans who use the VCL. The objective of this study was to identify women veterans' experiences with and recommendations for strengthening VCL services for women. METHOD We conducted qualitative interviews with 26 women veterans across the United States who had contacted the VCL in the preceding year. Interviews were conducted by telephone in 2022 and were audio recorded and transcribed. A team-based content analysis approach was used to identify participants' concerns around contacting the VCL and recommendations for strengthening the service. RESULTS Interviews revealed women veterans' concerns with regard to contacting the VCL related to responder gender, appropriateness of VCL services for veterans not at imminent risk for suicide, and potential consequences of contacting the VCL. Key recommendations included letting veterans select the gender of the responder who takes their call, providing more information to potential callers about what to expect from the VCL calls, and raising awareness about and maintaining options for caller anonymity. CONCLUSIONS This study uniquely focused on women veterans' experiences and perspectives, in their own voices. Findings point to trauma-informed approaches supporting women veteran callers to the VCL and may also hold implications for other similar crisis hotline services.
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Affiliation(s)
- Melissa E Dichter
- Center for Health Equity Research and Promotion, Crescenz VA Medical Center, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania; College of Public Health, Temple University School of Social Work, Philadelphia, Pennsylvania.
| | - Aneeza Z Agha
- Center for Health Equity Research and Promotion, Crescenz VA Medical Center, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania
| | - Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, U.S. Department of Veterans Affairs, Denver, Colorado; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Denver, Colorado
| | - Lauren S Krishnamurti
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, U.S. Department of Veterans Affairs, Denver, Colorado
| | - Katherine M Iverson
- National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, U.S. Department of Veterans Affairs, Boston, Massachusetts; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Ann Elizabeth Montgomery
- Birmingham VA Health Care System, U.S. Department of Veterans Affairs, Birmingham, Alabama; School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
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Makaroun LK, Halaszynski JJ, Smith KA, Drake R, Amelio-Hering V, Atchison K, Dichter ME, Rosland AM, Thorpe CT, Rosen T. Screening for Elder Abuse in the Veterans Health Administration: Varied Approaches Across a National Health System. J Gen Intern Med 2024:10.1007/s11606-023-08560-2. [PMID: 38191973 DOI: 10.1007/s11606-023-08560-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/01/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Elder abuse (EA) is common and has devastating health consequences yet is rarely detected by healthcare professionals. While EA screening tools exist, little is known about if and how these tools are implemented in real-world clinical settings. The Veterans Health Administration (VHA) has experience screening for, and resources to respond to, other forms of interpersonal violence and may provide valuable insights into approaches for EA screening. OBJECTIVE Describe EA screening practices across a national integrated healthcare system serving a large population of older adults at risk for EA. DESIGN Survey of all 139 VHA medical centers from January to August 2021. PARTICIPANTS Surveys were completed by the Social Work Chief, or delegate, at each site. MAIN MEASURES The survey assessed the presence and characteristics of EA-specific screening practices as well as general abuse/neglect screening conducted with patients of all ages, including older adults. Follow-up emails were sent to sites that reported screening requesting additional details not included in the initial survey. KEY RESULTS Overall, 130 sites (94%) responded. Among respondents, 5 (4%) reported screening older adults for EA using a previously published tool, while 6 (5%) reported screening for EA with an unstudied or locally developed tool. Forty-eight percent reported screening patients of all ages for general abuse/neglect using unstudied questions/tools, and 44% reported no EA screening at their site. Characteristics of screening programs (e.g., frequency, clinical setting, provider type) varied widely between sites, as did respondents' understanding of the definition of screening. CONCLUSIONS High variability in screening practices for abuse/neglect and lack of EA-specific screening in a system that has successfully deployed other standardized screening approaches present an important opportunity to standardize and improve EA detection practices. Lessons learned in VHA could help advance the evidence base for EA screening more broadly to increase overall detection rates for EA nationally.
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Affiliation(s)
- Lena K Makaroun
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- VA Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
| | | | | | - Ruth Drake
- G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS, USA
| | | | - Karley Atchison
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Melissa E Dichter
- VA Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- School of Social Work, Temple University Philadelphia, Philadelphia, PA, USA
| | - Ann-Marie Rosland
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carolyn T Thorpe
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College/New-York Presbyterian Hospital, New York, NY, USA
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Adjognon OL, Brady JE, Iverson KM, Stolzmann K, Dichter ME, Lew RA, Gerber MR, Portnoy GA, Iqbal S, Haskell SG, Bruce LAE, Miller CJ. Using the Matrixed Multiple Case Study approach to identify factors affecting the uptake of IPV screening programs following the use of implementation facilitation. Implement Sci Commun 2023; 4:145. [PMID: 37990345 PMCID: PMC10664531 DOI: 10.1186/s43058-023-00528-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is a prevalent social determinant of health. The US Preventive Services Task Force recommends routine IPV screening of women, but uptake remains variable. The Veterans Health Administration (VHA) initiated implementation facilitation (IF) to support integration of IPV screening programs into primary care clinics. An evaluation of IF efforts showed variability in IPV screening rates across sites. The follow-up study presented here used a Matrixed Multiple Case Study (MMCS) approach to examine the multilevel factors impacting IPV screening program implementation across sites with varying levels of implementation success. METHODS This mixed methods study is part of a larger cluster randomized stepped wedge Hybrid-II program evaluation. In the larger trial, participating sites received 6 months of IF consisting of an external facilitator from VHA's Office of Women's Health working closely with an internal facilitator and key site personnel. Recognizing the heterogeneity in implementation outcomes across sites, the MMCS approach was used to enable interpretation of qualitative and quantitative data within and across sites to help contextualize the primary findings from the larger study. Qualitative data collection was guided by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and included interviews with key informants involved in IPV screening implementation at eight sites. Quantitative data on IPV screening uptake was derived from medical records and surveys completed by key personnel at the same eight sites to understand implementation facilitation activities. RESULTS Fifteen factors influencing IPV screening implementation spanning all four i-PARIHS domains were identified and categorized into three distinct categories: (1) factors with enabling influence across all sites, (2) factors deemed important to implementation success, and (3) factors differentiating sites with high/medium versus low implementation success. CONCLUSIONS Understanding the influencing factors across multi-level domains contributing to variable success of IPV screening implementation can inform the tailoring of IF efforts to promote spread and quality of screening. Implementation of IPV screening programs in primary care with IF should consider consistent engagement of internal facilitators with clinic staff involved in implementation, the resourcefulness of external facilitators, and appending resources to IPV screening tools to help key personnel address positive screens. TRIAL REGISTRATION ClinicalTrials.gov NCT04106193. Registered on September 26, 2019.
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Affiliation(s)
- Omonyêlé L Adjognon
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.
| | - Julianne E Brady
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
| | - Katherine M Iverson
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Kelly Stolzmann
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
| | - Melissa E Dichter
- Center for Health Equity Research and Promotion (CHERP), Crescenz VA Medical Center, Philadelphia, PA, USA
- School of Social Work, Temple University, Philadelphia, PA, USA
| | - Robert A Lew
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA
| | - Megan R Gerber
- Division of General Internal Medicine, Albany Medical College, Albany, NY, USA
- Albany Stratton VA Medical Center, Albany, NY, USA
| | - Galina A Portnoy
- Pain Research Informatics Multi-morbidity Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Samina Iqbal
- VA Palo Alto Healthcare System, Palo Alto, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Sally G Haskell
- Pain Research Informatics Multi-morbidity Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, USA
- Office of Women's Health, Department of Veterans Affairs, Washington, DC, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Le Ann E Bruce
- Intimate Partner Violence Assistance Program, Care Management and Social Work Services, Department of Veterans Affairs, Washington, DC, USA
- Department of Social Work, Western Kentucky University, Bowling Green, KY, USA
| | - Christopher J Miller
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, USA
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Chhatre S, Hoffmire CA, Bellamy SL, Agha AZ, Dichter ME. Relationship between Veterans Crisis Line risk rating and subsequent suicidal self-directed violence among veteran callers: A gender comparison. Suicide Life Threat Behav 2023; 53:739-747. [PMID: 37526407 PMCID: PMC10840528 DOI: 10.1111/sltb.12979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/07/2023] [Accepted: 07/05/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Disparities in suicide rates by veteran status are particularly striking for women. Veterans Crisis Line (VCL) is a preventive strategy. OBJECTIVES Examine the relationships and gender differences between VCL risk rating, and subsequent suicidal self-directed violence (SSDV) in the 12-months following VCL index call. METHODS Cohort study of VCL callers in 2018. OUTCOMES Dichotomized composite SSDV (non-fatal suicide event and/or suicide) in the 12 months following VCL call. RESULTS Veterans with high/moderate VCL risk had significantly higher odds of SSDV (OR = 4.02, 95% CI: 3.75, 4.30). There were no gender/VCL risk interaction (p = 0.3605). We also examined the association of gender, combination of VCL risk and suicide attempt (SA) history, on SSDV. Differential odds of SSDV for gender and combined VCL risk and SA history combinations were observed (p = 0.0005). Compared to those with lower VCL risk without SA history, those with high/moderate VCL risk with SA history showed higher odds of SSDV. Magnitude was higher for men, than for women veterans. CONCLUSIONS AND RELEVANCE Veterans Crisis Line risk assessment performs relatively stable across the gender binary and highlights potential gender differences when factoring in SA history. Combining risk assessment and attempt history may lead to effective suicide prevention strategies.
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Affiliation(s)
- Sumedha Chhatre
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Claire A. Hoffmire
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Scarlett L. Bellamy
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Aneeza Z. Agha
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Melissa E. Dichter
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Temple University School of Social Work, Philadelphia, Pennsylvania, USA
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Krishnamurti LS, Denneson LM, Agha A, Beyer N, Mitchell S, Dichter ME. Improving suicide prevention for women veterans: Recommendations from VHA suicide prevention coordinators. Gen Hosp Psychiatry 2023; 84:67-72. [PMID: 37393650 DOI: 10.1016/j.genhosppsych.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Women are a minority veteran subpopulation experiencing particular risk for suicide and facing distinct challenges in accessing Veterans Health Administration (VHA) care. As part of efforts to enhance suicide prevention, the VHA established Suicide Prevention Coordinators (SPC) as clinicians who work exclusively to connect high-risk veterans to the scope of VHA's services. To understand the experiences of women veterans with suicide risk who access care, this study presents findings from qualitative interviews with SPCs regarding the care needs, preferences, and concerns of women veterans who utilize VHA for enhanced suicide-related care. METHODS We conducted qualitative interviews with 20 SPCs from 13 VAMCs around the United States. We specifically asked SPCs to share perspectives on women veterans' barriers to accessing care and their recommendations to improve suicide prevention for this subpopulation. We conducted a thematic content analysis to extract key themes. RESULTS SPCs revealed that women veterans opt to avoid VHA due to prior negative experiences, often related to provider sensitivity to women's issues. Safety was another key concern, specifically related to feeling unwelcome or intimidated in the male dominated veteran community. Key provider recommendations include increasing the availability of gender-sensitive providers and making changes to the physical spaces of the VHA to better facilitate women veterans' access to care. CONCLUSIONS SPCs underscored the importance of comfort and relatability between women patients and providers, especially in relation to enhanced care for suicide risk. This study presents important evidence in support of enhancing suicide prevention by better engaging women veterans in care that is more inclusive and more sensitive to their experiences and identity, in and outside VHA.
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Affiliation(s)
- Lauren S Krishnamurti
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America.
| | - Lauren M Denneson
- U.S. Department of Veterans Affairs, VA Portland Health Care System, Portland, OR, United States of America; Oregon Health and Science University School of Medicine, Portland, OR, United States of America
| | - Aneeza Agha
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, PA, United States of America
| | - Nicole Beyer
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America
| | - Shannon Mitchell
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America
| | - Melissa E Dichter
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, PA, United States of America; Temple University School of Social Work, Philadelphia, PA, United States of America
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Montgomery AE, Blosnich JR, deRussy A, Richman JS, Dichter ME, True G. Association between Services to Address Adverse Social Determinants of Health and Suicide Mortality among Veterans with Indicators of Housing Instability, Unemployment, and Justice Involvement. Arch Suicide Res 2023:1-17. [PMID: 37565799 DOI: 10.1080/13811118.2023.2244534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Suicide among Veterans continues to be a priority issue addressed by the U.S. Department of Veterans Affairs (VA). In addition to a variety of services specifically intended to prevent suicide, VA also offers a number of services to address Veterans' social determinants of health (SDH), several of which may be associated with elevated risk for suicide. For the present study, we assessed whether participation in services to address adverse SDH is associated with a reduction in risk of suicide mortality among Veterans using secondary data from VA datasets (1/1/2014-12/31/2019) for Veterans with an indicator of housing instability, unemployment, or justice involvement. Logistic regressions modeled suicide mortality; use of services to address SDH was the primary predictor. There was not a statistically significant association between services use and suicide mortality; significant correlates included race other than African American, low or no compensation related to disability incurred during military service, and suicidal ideation/attempt during observation period. Suicide is a complex outcome, difficult to predict, and likely the result of many factors; while there is not a consistent association between services use related to adverse SDH and suicide mortality, providers should intervene with Veterans who do not engage in SDH-focused services but have risk factors for suicide mortality.
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Iverson KM, Stolzmann KL, Brady JE, Adjognon OL, Dichter ME, Lew RA, Gerber MR, Portnoy GA, Iqbal S, Haskell SG, Bruce LE, Miller CJ. Integrating Intimate Partner Violence Screening Programs in Primary Care: Results from a Hybrid-II Implementation-Effectiveness RCT. Am J Prev Med 2023; 65:251-260. [PMID: 37031032 PMCID: PMC10568536 DOI: 10.1016/j.amepre.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 04/10/2023]
Abstract
INTRODUCTION The Veterans Health Administration initiated implementation facilitation to integrate intimate partner screening programs in primary care. This study investigates implementation facilitation's impact on implementation and clinical effectiveness outcomes. STUDY DESIGN A cluster randomized, stepped-wedge, hybrid-II implementation-effectiveness trial (January 2021-April 2022) was conducted amidst the COVID-19 pandemic. SETTING/PARTICIPANTS Implementation facilitation was applied at 9 Veterans Health Administration facilities, staged across 2 waves. Participants were all women receiving care at participating primary care clinics 3 months before (pre-implementation facilitation n=2,272) and 9 months after initiation of implementation facilitation (implementation facilitation n=5,149). INTERVENTION Implementation facilitation included an operations-funded external facilitator working for 6 months with a facility-funded internal facilitator from participating clinics. The pre-implementation facilitation period comprised implementation as usual in the Veterans Health Administration. MAIN OUTCOME MEASURES Primary outcomes were changes in (1) reach of intimate partner violence (IPV) screening programs among eligible women (i.e., those seen within participating clinics during the assessment period; implementation outcome) and (2) disclosure rates among screened women (effectiveness outcome). Secondary outcomes included disclosure rates among all eligible women and post-screening psychosocial service use. Administrative data were analyzed. RESULTS For primary outcomes, women seen during the implementation facilitation period were nearly 3 times more likely to be screened for IPV than women seen during the pre-implementation facilitation period (OR=2.70, 95% CI=2.46, 2.97). Women screened during the implementation facilitation period were not more likely to disclose IPV than those screened during the pre-implementation facilitation period (OR=1.14, 95% CI=0.86, 1.51). For secondary outcomes, owing to increased reach of screening during implementation facilitation, women seen during the implementation facilitation period were more likely to disclose IPV than those seen during the pre-implementation facilitation period (OR=2.09, 95% CI=1.52, 2.86). Women screened during implementation facilitation were more likely to use post-screening psychosocial services than those screened during pre-implementation facilitation (OR=1.29, 95% CI=1.06, 1.57). CONCLUSIONS Findings indicate that implementation facilitation may be a promising strategy for increasing the reach of IPV screening programs in primary care, thereby increasing IPV detection and strengthening connections to support services among the patient population. TRIAL REGISTRATION This study is registered at www. CLINICALTRIALS gov NCT04106193.
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Affiliation(s)
- Katherine M Iverson
- Women's Health Sciences Division, PTSD: National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts; Center for Healthcare Organization & Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts.
| | - Kelly L Stolzmann
- Center for Healthcare Organization & Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts
| | - Julianne E Brady
- Center for Healthcare Organization & Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts
| | - Omonyêlé L Adjognon
- Center for Healthcare Organization & Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts
| | - Melissa E Dichter
- Center for Health Equity Research and Promotion (CHERP), Crescenz VA Medical Center, Philadelphia, Pennsylvania; School of Social Work, Temple University, Philadelphia, Pennsylvania
| | - Robert A Lew
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC) & CSP Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts
| | - Megan R Gerber
- Division of General Internal Medicine, Department of Medicine, Albany Medical College, Albany, New York; Albany Stratton VA Medical Center, Albany, New York
| | - Galina A Portnoy
- Pain Research Informatics Multi-Morbidity Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Samina Iqbal
- VA Palo Alto Healthcare System, Palo Alto, California; Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Sally G Haskell
- Pain Research Informatics Multi-Morbidity Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut; Office of Women's Health, U.S. Department of Veterans Affairs, Washington, District of Columbia; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - LeAnn E Bruce
- Intimate Partner Violence Assistance Program, Care Management and Social Work, U.S. Department of Veterans Affairs, Washington, District of Columbia; Department of Social Work, Western Kentucky University, Bowling Green, Kentucky
| | - Christopher J Miller
- Center for Healthcare Organization & Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Dichter ME. Addressing intimate partner violence in healthcare: Implications for the inpatient setting. J Hosp Med 2023. [PMID: 37497668 DOI: 10.1002/jhm.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Melissa E Dichter
- Center for Health Equity Research and Promotion, U.S. Department of Veterans Affairs, Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- School of Social Work, Temple University, Phialdelphia, Pennsylvania, USA
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Makaroun LK, Rosland AM, Mor MK, Zhang H, Lovelace E, Rosen T, Dichter ME, Thorpe CT. Frailty predicts referral for elder abuse evaluation in a nationwide healthcare system-Results from a case-control study. J Am Geriatr Soc 2023; 71:1724-1734. [PMID: 36695515 PMCID: PMC10258119 DOI: 10.1111/jgs.18245] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/14/2022] [Accepted: 12/23/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Elder abuse (EA) is common and has devastating health impacts. Frailty may increase susceptibility to and consequences of EA for older adults, making healthcare system detection more likely, but this relationship has been difficult to study. We examined the association between a recently validated frailty index and referral to social work (SW) for EA evaluation in the Veterans Administration (VA) healthcare system. METHODS We conducted a case-control study of veterans aged ≥60 years evaluated by SW for suspected EA between 2010 and 2018 (n = 14,723) and controls receiving VA primary care services in the same 60-day window (n = 58,369). We used VA and Medicare claims data to measure frailty (VA Frailty Index) and comorbidity burden (the Elixhauser Comorbidity Index) in the 2 years prior to the index. We used adjusted logistic regression models to examine the association of frailty or comorbidity burden with referral to SW for EA evaluation. We used Akaike Information Criterion (AIC) values to evaluate model fit and likelihood ratio (LR) tests to assess the statistical significance of including frailty and comorbidity in the same model. RESULTS The sample (n = 73,092) had a mean age 72 years; 14% were Black, and 6% were Hispanic. More cases (67%) than controls (36%) were frail. LR tests comparing the nested models were highly significant (p < 0.001), and AIC values indicated superior model fit when including both frailty and comorbidity in the same model. In a model adjusting for comorbidity and all covariates, pre-frailty (aOR vs. robust 1.7; 95% CI 1.5-1.8) and frailty (aOR vs. robust 3.6; 95% CI 3.3-3.9) were independently associated with referral for EA evaluation. CONCLUSIONS A claims-based measure of frailty predicted referral to SW for EA evaluation in a national healthcare system, independent of comorbidity burden. Electronic health record measures of frailty may facilitate EA risk assessment and detection for this important but under-recognized phenomenon.
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Affiliation(s)
- Lena K. Makaroun
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- VA Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ann-Marie Rosland
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maria K. Mor
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hongwei Zhang
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Elijah Lovelace
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College/New-York Presbyterian Hospital, New York, New York, USA
| | - Melissa E. Dichter
- VA Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- School of Social Work, Temple University Philadelphia, PA
| | - Carolyn T. Thorpe
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
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11
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Abstract
OBJECTIVE The mental health impacts of the COVID-19 pandemic have been widely felt among already vulnerable populations, such as U.S. military veterans, including a heightened risk for depression and suicidal ideation. Support hotlines such as the Veterans Crisis Line (VCL) took a central role in addressing various concerns from callers in distress; research has yet to examine the concerns of veterans who used the VCL during the early months of the pandemic. METHODS A mixed-methods analysis of characteristics of veteran outreach to the VCL during the first year of the COVID-19 pandemic in the United States was conducted on 342,248 calls during April-December 2020; 3.8% (N=12,869) of calls were coded as related to COVID-19. Quantitative examination was conducted regarding COVID-19-related reasons for contact, suicide risk screens, and caller concerns; 360 unique calls with synopsis notes that included a COVID-19 flag were qualitatively analyzed. RESULTS Quantitative analysis of the calls with a COVID-19 flag revealed mental health concerns, loneliness, and suicidal thoughts as top reasons veterans contacted the VCL during the pandemic. Qualitative analysis identified specific economic and mental health concerns, including negative impacts on income and housing, increased feelings of depression or anxiety, and pandemic-specific concerns such as testing and vaccine availability. Disrupted access to resources for coping, including support groups or gyms, had negative perceived impacts and sometimes exacerbated preexisting problems such as substance abuse or depression. CONCLUSIONS These findings emphasize the role of VCL as providing general support to veterans experiencing loneliness and supplying assistance in coping with pandemic-related distress.
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Affiliation(s)
- Lauren Sealy Krishnamurti
- Center for Health Equity Research and Promotion, U.S. Department of Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh (Krishnamurti); Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia (Agha, Dichter); Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, School of Medicine, Boston University, Boston (Iverson); Department of Psychiatry, University of Colorado Anschutz Medical Campus, and Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, VA, Denver (Monteith); School of Social Work, Temple University, Philadelphia (Dichter)
| | - Aneeza Agha
- Center for Health Equity Research and Promotion, U.S. Department of Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh (Krishnamurti); Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia (Agha, Dichter); Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, School of Medicine, Boston University, Boston (Iverson); Department of Psychiatry, University of Colorado Anschutz Medical Campus, and Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, VA, Denver (Monteith); School of Social Work, Temple University, Philadelphia (Dichter)
| | - Katherine M Iverson
- Center for Health Equity Research and Promotion, U.S. Department of Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh (Krishnamurti); Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia (Agha, Dichter); Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, School of Medicine, Boston University, Boston (Iverson); Department of Psychiatry, University of Colorado Anschutz Medical Campus, and Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, VA, Denver (Monteith); School of Social Work, Temple University, Philadelphia (Dichter)
| | - Lindsey L Monteith
- Center for Health Equity Research and Promotion, U.S. Department of Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh (Krishnamurti); Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia (Agha, Dichter); Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, School of Medicine, Boston University, Boston (Iverson); Department of Psychiatry, University of Colorado Anschutz Medical Campus, and Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, VA, Denver (Monteith); School of Social Work, Temple University, Philadelphia (Dichter)
| | - Melissa E Dichter
- Center for Health Equity Research and Promotion, U.S. Department of Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh (Krishnamurti); Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia (Agha, Dichter); Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, School of Medicine, Boston University, Boston (Iverson); Department of Psychiatry, University of Colorado Anschutz Medical Campus, and Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, VA, Denver (Monteith); School of Social Work, Temple University, Philadelphia (Dichter)
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12
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Krishnamurti LS, Agha A, Denneson LM, Montgomery AE, Chhatre S, Dichter ME. Gender Differences in Connecting Veterans to Care Through the Veterans Crisis Line: A Mixed Methods Evaluation of Referrals to Suicide Prevention Coordinators. Med Care 2023; 61:50-53. [PMID: 36477620 DOI: 10.1097/mlr.0000000000001789] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Suicide is a major public health crisis within the US military veteran community, with distinct gender differences in suicide risk and behavior. The Veterans Crisis Line (VCL) is a component of the Veterans Health Administration (VHA) suicide prevention program; through VCL, veterans may be referred to a VHA Suicide Prevention Coordinator (SPC) to arrange follow-up care. Research shows that engagement with an SPC is a strong protective factor in reducing veteran suicide risk. METHODS We evaluated SPC referral acceptance and assessed correlates of SPC referral decline using VCL administrative data for contacts: (1) made between January 1, 2018, through December 31, 2019; (2) by veterans contacting VCL on their own behalf; (3) with gender identified; and (4) current thoughts of suicide. Then, among a subsample of 200 veterans, evenly distributed by gender, we examined data from call synopsis notes to identify reasons given for veterans declining an SPC referral. RESULTS We found it was generally callers rated as lower risk by responders, and callers with loneliness as a reason for contacting VCL, who more frequently declined the SPC referral. An analysis of reasons given for declining SPC referral found that concerns with/about Veterans Affairs care were a key concern, particularly among women veterans articulating specific negative care experiences. Other reasons for referral decline included managing the veteran's needs directly on the call or via alternative resources. CONCLUSION The VCL as an intervention provides an important opportunity to re-engage vulnerable veterans into care, one that may be more challenging for women veterans.
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Affiliation(s)
- Lauren S Krishnamurti
- US Department of Veterans Affairs, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh
| | - Aneeza Agha
- US Department of Veterans Affairs, Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, PA
| | - Lauren M Denneson
- US Department of Veterans Affairs, VA Portland Health Care System
- Oregon Health and Science University School of Medicine, Portland, OR
| | - Ann E Montgomery
- Birmingham VA Health Care System & National Center on Homelessness among Veterans
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | | | - Melissa E Dichter
- US Department of Veterans Affairs, Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, PA
- Temple University School of Social Work, Philadelphia, PA
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13
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Gurewich D, Kressin N, Bokhour BG, Linsky AM, Dichter ME, Hunt KJ, Fix GM, Niles BL. Randomised controlled trial evaluating the effects of screening and referral for social determinants of health on Veterans' outcomes: protocol. BMJ Open 2022; 12:e058972. [PMID: 36153033 PMCID: PMC9511545 DOI: 10.1136/bmjopen-2021-058972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 08/12/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Health policy leaders recommend screening and referral (S&R) for unmet social needs (eg, food) in clinical settings, and the American Heart Association recently concluded that the most significant opportunities for reducing cardiovascular disease (CVD) death and disability lie with addressing the social determinants of CVD outcomes. A limited but promising evidence base supports these recommendations, but more rigorous research is needed to guide health care-based S&R efforts. Funded by the Veteran Health Administration (VA), the study described in this paper will assess the efficacy of S&R on Veterans' connections to new resources to address social needs, reduction of unmet needs and health-related outcomes (adherence, utilisation and clinical outcomes). METHODS AND ANALYSIS We will conduct a 1-year mixed-methods randomised controlled trial at three VA sites, enrolling Veterans with CVD and CVD-risk. 880 Veterans experiencing one or more social needs will be randomised within each site (n=293 per site) to one of three study arms representing referral mechanisms of varying intensity (screening only, screening and provision of resource sheet(s), screening and provision of resource sheet(s) plus social work assistance). For each Veteran, we will examine associations of unmet social needs with health-related outcomes at baseline, and longitudinally compare the impact of each approach on connection to new resources (primary outcome) and follow-up outcomes over a 12-month period. We will additionally conduct qualitative interviews with key stakeholders, including Veterans to identify potential explanatory factors related to the relative success of the interventions. ETHICS AND DISSEMINATION Ethics approval was obtained from the VA Central Internal Review Board on 13 July 2021 (reference #: 20-07-Amendment No. 02). Findings will be disseminated through reports, lay summaries, policy briefs, academic publications, and conference presentations. TRIAL REGISTRATION NUMBER NCT04977583.
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Affiliation(s)
- Deborah Gurewich
- Center for Healthcare Organization and Implementation Research, VA Boston Health Care System, Boston, Massachusetts, USA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Nancy Kressin
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan School of Medicine, Worcester, MA, USA
| | - Amy M Linsky
- Center for Healthcare Organization and Implementation Research, VA Boston Health Care System, Boston, Massachusetts, USA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- General Internal Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Melissa E Dichter
- Center for Health Equity Research and Promotion (CHERP), Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- School of Social Work, Temple University, Philadelphia, Pennsylvania, USA
| | - Kelly J Hunt
- Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H Johnson VAMC, Charleston, South Carolina, USA
| | - Gemmae M Fix
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Barbara L Niles
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
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14
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Hollis BF, Kim N, Youk A, Dichter ME. Opportunities to More Comprehensively Assess Sexual Violence Experience in Veterans Health Administration Medical Records Data. J Gen Intern Med 2022; 37:734-741. [PMID: 36042084 PMCID: PMC9481829 DOI: 10.1007/s11606-022-07581-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Experience of sexual violence (SV) is prevalent among the Veteran population and associated with many negative mental and physical health outcomes including suicidal behavior, obesity, post-traumatic stress disorder, anxiety, depression, and poor sexual and reproductive functioning. Although Veterans of any gender may experience SV, women Veterans are particularly at risk. Research on SV among Veterans has focused primarily on the experience of SV during military service (military sexual trauma, MST), although Veterans may also experience SV prior to and following military service. The aim of the current study was to construct a more comprehensive method of identifying SV among Veterans Health Administration (VHA) patients as documented in medical records in a national cohort of 325,907 Veterans who used VHA care between 2000 and 2018 in order to inform future research in this area. METHOD We used three indicators to identify SV in VHA medical records: (a) the MST screen, (b) the sexual violence item of the intimate partner violence (IPV) screen, and (c) International Classification of Disorders (ICD) codes (versions 9 and 10) representing adult sexual abuse and assault. Univariate descriptive analyses were conducted to determine the exclusivity and overlap of the SV measures. RESULTS The universal MST screen was the most commonly identified indicator of SV in the data. However, including the IPV and ICD indicators identified an additional 5% of Veterans who had experienced SV, accounting for thousands of patients. DISCUSSION The results of the current study indicate that using the three-pronged approach of SV collection is a more comprehensive method of identifying patient SV experience through VHA medical records and contributes uniquely to the methodology of studying social factors' impact on health care. Clinical screening and documentation of SV allow for the assessment of health impacts and trends through examination of medical records data.
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Affiliation(s)
| | - Nadejda Kim
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Ada Youk
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Melissa E Dichter
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Temple University School of Social Work, Philadelphia, PA, USA
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15
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Monteith LL, Holliday R, Dichter ME, Hoffmire CA. Preventing Suicide Among Women Veterans: Gender-Sensitive, Trauma-Informed Conceptualization. Curr Treat Options Psych 2022; 9:186-201. [PMID: 35730002 PMCID: PMC9198614 DOI: 10.1007/s40501-022-00266-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/26/2022]
Abstract
Purpose of Review There is growing concern regarding suicide among women veterans, who have experienced an increase in suicide rates that has exceeded that reported for other US adult populations. Recent research has bolstered understanding of correlates of suicide risk specific to women veterans. Yet most existing suicide prevention initiatives take a gender-neutral, rather than gender-sensitive, approach. We offer clinical considerations and suggestions for suicide prevention tailored to the needs, preferences, and experiences of women veterans. Discussion is framed around the White House strategy for preventing suicide among military service members and veterans. Recent Findings Considering high rates of trauma exposure among women veterans, we propose that a trauma-informed lens is essential for taking a gender-sensitive approach to suicide prevention with this population. Nonetheless, research to inform evidence-based assessment and intervention remains largely focused on veteran men or gender-neutral. Integral next steps for research are posited. Summary Extant research provides an initial foundation for beginning to understand and address suicide among women veterans in a gender-sensitive, trauma-informed manner. Additional research that is specific to women veterans or that examines gender differences is critical to ensure women veterans receive optimal, evidence-based care to prevent suicide.
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16
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Iverson KM, Dardis CM, Cowlishaw S, Webermann AR, Shayani DR, Dichter ME, Mitchell KS, Mattocks KM, Gerber MR, Portnoy GR. Effects of Intimate Partner Violence During COVID-19 and Pandemic-Related Stress on the Mental and Physical Health of Women Veterans. J Gen Intern Med 2022; 37:724-733. [PMID: 36042090 PMCID: PMC9427167 DOI: 10.1007/s11606-022-07589-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about women veterans' intimate partner violence (IPV) experiences during the COVID-19 pandemic or the impacts of pandemic-related stress on their mental and physical health. OBJECTIVES To identify IPV experiences among women veterans prior to and during the pandemic, pandemic-related stressors, and examine their respective contributions to mental and physical health. DESIGN National sample of women veterans drawn from a larger web-based longitudinal study. Relationships between recent IPV and pandemic-related stressors were tested with linear regressions, controlling for pre-pandemic IPV and mental and physical health symptoms, demographic, and military-related covariates. PARTICIPANTS One hundred forty-two women veterans (Mage=58.8 years). MAIN MEASURES We assessed IPV (CTS-2), PTSD (PCL-5), depression (CESD), anxiety (DASS-A), physical health (PHQ-15), and physical health-related quality of life (SF-12) prior to the pandemic (June 2016-December 2016/January 2017) and during the pandemic study period (March 2020-December 2020/January 2021). We assessed pandemic-related stressors (EPII) during the pandemic study period. KEY RESULTS Over a third (38.7%) of participants experienced IPV during the pandemic study period (psychological: 35.9%, physical: 9.9%, sexual: 4.2%). Overall rates, frequency, and severity of IPV experience did not significantly differ between the pre-pandemic and pandemic study periods. Few participants tested positive for COVID-19 (4.2%); however, most participants reported experiencing pandemic-related stressors across life domains (e.g., social activities: 88%, physical health: 80.3%, emotional health: 68.3%). IPV during the pandemic and pandemic-related stressors were both associated with greater PTSD and depressive symptoms. Pandemic-related stressors were associated with worse anxiety and physical health symptoms. Neither IPV during the pandemic nor pandemic-related stressors were associated with physical health-related quality of life. CONCLUSIONS IPV experiences during the pandemic were common among women veterans, as were pandemic-related stressors. Although IPV did not increase in the context of COVID-19, IPV experiences during the pandemic and pandemic-related stressors were linked with poorer mental and physical health.
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Affiliation(s)
- Katherine M Iverson
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
| | | | - Sean Cowlishaw
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | | | - Danielle R Shayani
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - Melissa E Dichter
- VA Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- School of Social Work, Temple University, Philadelphia, PA, USA
| | - Karen S Mitchell
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Megan R Gerber
- Division of General Medicine, Albany Medical College, Albany, NY, USA
- Albany Stratton VA Medical Center, Albany, NY, USA
| | - Galina R Portnoy
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
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17
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Dichter ME, Chhatre S, Hoffmire C, Bellamy S, Montgomery AE, McCoy I. Variation in call volume to the Veterans Crisis Line by women and men veterans prior to and following onset of the COVID-19 pandemic. J Psychiatr Res 2022; 151:561-563. [PMID: 35636032 PMCID: PMC9126311 DOI: 10.1016/j.jpsychires.2022.05.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/28/2022] [Accepted: 05/20/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To identify trends in volume of calls to the Veterans Crisis Line (VCL) around the onset of the COVID-19 pandemic. METHODS Analysis of call frequency from VCL administrative records for all veteran contacts calling on their own behalf with gender identified from January 1, 2018 through December 31, 2020. Interrupted time series analysis used to identify potential impact of COVID-19 pandemic on call volume by women and men veteran contacts. RESULTS Call volume to VCL from veterans increased over time, for both women and men veterans, with no significant change in call volume by women contacts following the onset of the COVID-19 pandemic and a decrease in calls by men contacts associated with COVID-19 onset. Call volume varied by month with patterns similar in years prior to and following COVID-19 onset. CONCLUSIONS The onset of the COVID-19 pandemic in 2020 was not associated with a spike in calls by veterans to VCL. The pandemic may have led to an increase in calls by some as well as a decrease in calls by others, leveling out the overall volume trends.
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Affiliation(s)
- Melissa E Dichter
- Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, PA, USA; School of Social Work, Temple University, Philadelphia, PA, USA.
| | - Sumedha Chhatre
- Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, PA, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Claire Hoffmire
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA; Department of Physical Medicine and Rehabilitation, University of Anschutz Medical Campus, Aurora, CO, USA
| | - Scarlett Bellamy
- Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Drexel University, Dornsife School of Public Health, Philadelphia, PA, USA
| | - Ann Elizabeth Montgomery
- Birmingham VA Health Care System & National Center on Homelessness among Veterans, Birmingham, AL, USA; University of Alabama at Birmingham, School of Public Health, Birmingham, AL, USA
| | - Ian McCoy
- Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, PA, USA
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18
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Iverson KM, Danitz SB, Driscoll M, Vogt D, Hamilton AB, Gerber MR, Wiltsey Stirman S, Shayani DR, Suvak MK, Dichter ME. "Recovering from intimate partner violence through Strengths and Empowerment (RISE): Development, pilot testing, and refinement of a patient-centered brief counseling intervention for women": Correction. Psychol Serv 2022; 19:112. [PMID: 35587426 DOI: 10.1037/ser0000674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Reports an error in "Recovering from intimate partner violence through Strengths and Empowerment (RISE): Development, pilot testing, and refinement of a patient-centered brief counseling intervention for women" by Katherine M. Iverson, Sara B. Danitz, Mary Driscoll, Dawne Vogt, Alison B. Hamilton, Megan R. Gerber, Shannon Wiltsey Stirman, Danielle R. Shayani, Michael K. Suvak and Melissa E. Dichter (Psychological Services, Advanced Online Publication, Jun 10, 2021, np). In the original article, the columns in Table 3 were misaligned such that the data presented in the columns did not correspond with the correct variable. Additionally, for clarity, the table should have presented a separate column "n" for sample size and displayed total scores for the Personal Progress Scale (PPS) as opposed to mean scores. None of these errors impacted the results or conclusions. All versions of this article have been corrected. (The following abstract of the original article appeared in record 2021-53476-001). This article describes the rationale, development, and preliminary examination of a brief, variable-length (up to six sessions), modular-based counseling intervention for women who experience intimate partner violence (IPV). Recovering from IPV through Strengths and Empowerment (RISE) is an empowerment and skills-focused treatment that incorporates Motivational Interviewing. RISE was developed to fill the gap in interventions for women who disclose IPV within integrated healthcare settings such as the Veterans Health Administration (VHA). Fifteen women Veterans with past-year IPV participated in an open trial at two VHA hospitals to evaluate the potential helpfulness, feasibility, and acceptability of RISE using a mixed-methods approach to assessment. Qualitative feedback from women Veterans and five RISE clinicians (psychologists and social workers) was collected posttreatment. Descriptive analyses of quantitative psychosocial outcomes before and after the intervention provide evidence of support for RISE as potentially helpful in improving psychosocial well-being. High retention and high satisfaction ratings, along with positive qualitative feedback from both IPV survivor participants and clinicians, supported intervention feasibility and acceptability. Overall, this pilot study offers feasibility and acceptability data for RISE as a potentially helpful intervention for women experiencing past-year IPV. Refinements to RISE based on the open trial and subsequent testing of the clinical effectiveness of the intervention are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | | | - Mary Driscoll
- VA Patient Research, Informatics, Multi-morbidities, and Education
| | | | - Alison B Hamilton
- VA Center for the Study of Healthcare Innovation, Implementation and Policy
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Ogden SN, Dichter ME, Bazzi AR. Intimate partner violence as a predictor of substance use outcomes among women: A systematic review. Addict Behav 2022; 127:107214. [PMID: 34933089 PMCID: PMC10007694 DOI: 10.1016/j.addbeh.2021.107214] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/30/2021] [Accepted: 12/14/2021] [Indexed: 11/17/2022]
Abstract
Although the correlation between experience of intimate partner violence (IPV) and substance use among women has been well-established, there is no consensus on whether or how IPV impacts subsequent substance use behaviors or treatment success. To identify research gaps and implications for substance use treatment, we conducted a systematic review to identify and examine evidence on IPV as a predictor of subsequent substance use behaviors, substance use disorders (SUD), and treatment outcomes among women. We included studies published between 2010 and 2020 that assessed IPV experiences as a predictor of subsequent substance use behaviors (i.e., use initiation, increased use), SUD diagnosis, or treatment outcomes (i.e., incomplete treatment, relapse) among women. From 576 unique records, we included 10 studies (4 longitudinal, 4 cross-sectional, 2 qualitative). Alcohol use and alcohol use disorder were the most commonly studied outcomes (n = 6); findings were mixed regarding the significance of IPV being associated with subsequent alcohol outcomes. Three studies examined illicit drug use, finding that physical and sexual IPV predicted crack/cocaine use and were associated with SUD diagnoses. Four studies examining SUD treatment outcomes found IPV to impede treatment engagement and completion, increasing the likelihood of relapse. To our knowledge, this is the first systematic review of the literature on IPV as a predictor of substance use behaviors and treatment outcomes among women. Findings highlight the need for diverse SUD treatment modalities to incorporate IPV screening and referral to appropriate services into their programming to improve SUD management and the overall health and wellbeing of women.
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Affiliation(s)
- Shannon N Ogden
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, United States.
| | - Melissa E Dichter
- Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, PA, United States; Temple University School of Social Work, Philadelphia, PA, United States.
| | - Angela R Bazzi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, United States; Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States.
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20
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Krishnamurti LS, Monteith LL, McCoy I, Dichter ME. Gender differences in use of suicide crisis hotlines: a scoping review of current literature. JPMH 2022. [DOI: 10.1108/jpmh-10-2021-0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Little is known about the gender profile of callers to crisis hotlines, despite distinct gender differences in suicide risk and behavior. The authors assessed current knowledge of the role of caller gender in the use of crisis hotlines for suicide, specifically whether there are differences in frequency, reason for call and caller outcomes by gender.
Design/methodology/approach
The authors conducted a scoping literature review of peer-reviewed studies published since 2000 in Medline, PubMed and PsychInfo, examining a total of 18 articles based on 16 studies.
Findings
Overall, women represent a higher percentage of calls to crisis hotlines worldwide, despite men having higher rates of suicide. Primary reasons for calling hotlines were the same for men and women, regardless of geography or culture. When gender differences in reason for call were reported, they were consistent with literature documenting gender differences in the prevalence of risk factors for suicide, including higher rates of substance use among men and higher instances of domestic violence/abuse among women.
Research limitations/implications
There was variability in the studies the authors examined. This review was limited to research on crisis telephone hotlines and did not include text or chat services. Due to data reporting, the findings are constrained to reporting on a male/female gender binary.
Originality/value
Findings on gender differences in crisis line use suggest a need for continued research in this area to determine how to best meet the needs of callers of all genders.
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21
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Miller CJ, Stolzmann K, Dichter ME, Adjognon OL, Brady JE, Portnoy GA, Gerber MR, Iqbal S, Iverson KM. Intimate Partner Violence Screening for Women in the Veterans Health Administration: Temporal Trends from the Early Years of Implementation 2014-2020. J Aggress Maltreat Trauma 2022; a:1-19. [PMID: 36713478 PMCID: PMC9881187 DOI: 10.1080/10926771.2021.2019160] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/28/2021] [Accepted: 11/23/2021] [Indexed: 06/10/2023]
Abstract
Thousands of women Veterans experience intimate partner violence (IPV) each year. The Veterans Health Administration (VHA) has encouraged IPV screening in Veterans Affairs medical centers (VAMCs) since 2014. Through retrospective analysis of VHA administrative data from fiscal year (FY) 2014 into FY2020, we examined IPV screening implementation outcomes of reach and adoption, as well as screen-positive rates using descriptive and multivariate linear regression analyses. We examined reach and screen-positive rates overall and as a function of childbearing age (18-44 vs. 45+ years). In FY2014 only one VAMC was screening women for IPV; by FY2020, over half of VAMCs had adopted IPV screening. This rollout of IPV screening was associated with a large increase in the number of women primary care patients screened (from fewer than 500 in FY2014, to nearly 35,000 in early FY2020). Overall, among women screened, 6.7% screened positive for IPV; this rate was higher among women of childbearing age (8.1% vs. 5.6%). Despite the spread of IPV screening practices during the early years of implementation in VHA, additional work is needed. This study is the first comprehensive analysis of implementation outcomes associated with VHA's IPV screening efforts, and lays the groundwork for ongoing evaluation and quality improvement.
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Affiliation(s)
- Christopher J. Miller
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Kelly Stolzmann
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Melissa E. Dichter
- VA Center for Health Equity Research and Promotion (CHERP), Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Omonyele L. Adjognon
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Julianne E. Brady
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Galina A. Portnoy
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut USA
| | | | - Samina Iqbal
- VA Palo Alto Healthcare System, Palo Alto, California, USA
| | - Katherine M. Iverson
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
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22
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Dichter ME, Krishnamurti LS, Chhatre S, Hoffmire CA, Monteith LL, Bellamy SL, Iverson KM, Montgomery AE, Agha A, McCoy I. Gender differences in veterans' use of the Veterans Crisis Line (VCL): Findings from VCL call data. Gen Hosp Psychiatry 2022; 74:65-70. [PMID: 34923376 DOI: 10.1016/j.genhosppsych.2021.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/22/2021] [Accepted: 12/13/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare characteristics of calls to the Veterans Crisis Line (VCL) by caller gender and identify potentially unique needs of women callers. METHOD Retrospective review of clinical data collected during VCL calls, comparing call characteristics between women and men veteran callers. RESULTS The data included 116,029 calls by women veterans and 651,239 calls by men veterans between January 1, 2018-December 31, 2019. Timing (hour/day/season) of VCL calls was similar between women and men callers. We observed gender differences in reason for call, with the most salient differences in reasons related to interpersonal violence, including sexual trauma (e.g., military sexual trauma as reason for call - prevalence ratio (PR) for women vs. men = 9.13, 95% CI = 8.83, 9.46). Women callers were also more likely than men callers to screen positive for suicide risk (PR = 1.28, 95% CI = 1.26, 1.29), receive a higher suicide risk assessment rating (PR = 1.05, 95% CI = 1.02, 1.07), and be referred to a VA Suicide Prevention Coordinator for follow-up (PR = 1.09, 95% CI = 1.09, 1.11). CONCLUSIONS Analysis of VCL call data indicated both similarities and differences across genders in call characteristics, including interpersonal relationships and experiences of abuse and assault as particularly salient factors prompting women veterans' calls to VCL. This study also suggests the presence of increased suicide risk among women versus men veteran VCL callers.
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Affiliation(s)
- Melissa E Dichter
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Crescenz VA Medical Center, USA; Temple University School of Social Work, USA.
| | - Lauren Sealy Krishnamurti
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, USA
| | - Sumedha Chhatre
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Crescenz VA Medical Center, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, USA
| | - Claire A Hoffmire
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, USA; Department of Physical Medicine and Rehabilitation, University of Anschutz Medical Campus, USA
| | - Lindsey L Monteith
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, USA; Department of Psychiatry, University of Anschutz Medical Campus, USA
| | - Scarlett L Bellamy
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Crescenz VA Medical Center, USA; Department of Epidemiology and Biostatistics, Drexel University, Dornsife School of Public Health, USA
| | - Katherine M Iverson
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, USA; Department of Psychiatry, Boston University School of Medicine, USA
| | - Ann Elizabeth Montgomery
- Birmingham VA Health Care System & National Center on Homelessness among Veterans, USA; University of Alabama at Birmingham, School of Public Health, USA
| | - Aneeza Agha
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Crescenz VA Medical Center, USA
| | - Ian McCoy
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Crescenz VA Medical Center, USA
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23
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Keddem S, Dichter ME, Hamilton AB, Chhatre S, Sonalkar S. Awareness of HIV Preexposure Prophylaxis Among People at Risk for HIV: Results From the 2017-2019 National Survey of Family Growth. Sex Transm Dis 2021; 48:967-972. [PMID: 34108411 DOI: 10.1097/olq.0000000000001494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although daily preexposure prophylaxis (PrEP) is now widely accepted as a safe and effective method for reducing the risk of HIV in high-risk groups, uptake has been slow. The goal of this analysis was to identify factors associated with PrEP awareness among individuals at risk for HIV. METHODS This investigation analyzed data from the Centers for Disease Control and Prevention nationally representative survey, National Survey of Family Growth, for the years 2017 to 2019. Logistic regression was used to explore the relationship between PrEP awareness and demographics, HIV risk factors, and provider HIV risk screening. RESULTS Only 37% of survey respondents with an increased risk of HIV were aware of PrEP. Several segments of the at-risk population had lower odds of being aware of PrEP, including heterosexual women, heterosexual men, individuals younger than 20 years, and individuals with lower levels of education. Those who participate in sex in exchange for money or drugs had significantly lower odds of being aware of PrEP. In comparison, PrEP awareness was significantly higher among nonheterosexual men and both men and women whose partners were HIV positive. Lastly, those who had been screened by a provider for HIV risk had significantly higher odds of being aware of PrEP. CONCLUSIONS This research supports the need for policies and programs to increase awareness of PrEP, especially among certain segments of the population at increased risk for HIV.
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Affiliation(s)
| | | | | | | | - Sarita Sonalkar
- From the Perelman School of Medicine, University of Pennsylvania
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24
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Makaroun LK, Thorpe CT, Mor MK, Zhang H, Lovelace E, Rosen T, Dichter ME, Rosland AM. Medical and Social Factors Associated with Referral for Elder Abuse Services in a National Healthcare System. J Gerontol A Biol Sci Med Sci 2021; 77:1706-1714. [PMID: 34849854 PMCID: PMC9373957 DOI: 10.1093/gerona/glab354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Elder abuse (EA) is common and has devastating health consequences yet is not systematically assessed or documented in most health systems, limiting efforts to target healthcare-based interventions. Our objective was to examine sociodemographic and medical characteristics associated with documented referrals for EA assessment or services in a national US healthcare system. METHODS We conducted a national case-control study in US Veterans Health Administration facilities of primary care (PC)-engaged Veterans age ≥60 years who were evaluated by social work (SW) for EA-related concerns between 2010-18. Cases were matched 1:5 to controls with a PC visit within 60 days of the matched case SW encounter. We examined the association of patient sociodemographic and health factors with receipt of EA services in unadjusted and adjusted models. RESULTS Of 5,567,664 Veterans meeting eligibility criteria during the study period, 15,752 (0.3%) received services for EA (cases). Cases were mean age 74, and 54% unmarried. In adjusted logistic regression models (aOR; 95%CI), age ≥85 (3.56 v. age 60-64; 3.24-3.91), female sex (1.96; 1.76-2.21), child as next-of-kin (1.70 v. spouse; 1.57-1.85), lower neighborhood socioeconomic status (1.18 per higher quartile; 1.15-1.21), dementia diagnosis (3.01; 2.77-3.28) and receiving a VA pension (1.34; 1.23-1.46) were associated with receiving EA services. CONCLUSION In the largest cohort of patients receiving EA-related healthcare services studied to date, this study identified novel factors associated with clinical suspicion of EA that can be used to inform improvements in healthcare-based EA surveillance and detection.
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Affiliation(s)
- Lena K Makaroun
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.,VA Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh PA.,Department of Medicine, School of Medicine, University of Pittsburgh
| | - Carolyn T Thorpe
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.,University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC
| | - Maria K Mor
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.,Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh
| | - Hongwei Zhang
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Elijah Lovelace
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Tony Rosen
- New-York Presbyterian Hospital Weill Cornell Medical College, New York, NY
| | - Melissa E Dichter
- VA Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA.,School of Social Work, Temple University Philadelphia, PA
| | - Ann-Marie Rosland
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.,Department of Medicine, School of Medicine, University of Pittsburgh
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25
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Iverson KM, Danitz SB, Shayani DR, Vogt D, Stirman SW, Hamilton AB, Mahoney CT, Gerber MR, Dichter ME. Recovering From Intimate Partner Violence Through Strengths and Empowerment: Findings From a Randomized Clinical Trial. J Clin Psychiatry 2021; 83. [PMID: 34813687 DOI: 10.4088/jcp.21m14041] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective: Recovering from Intimate Partner Violence through Strengths and Empowerment (RISE) is a brief, variable-length (1-6 sessions), modular, individualized psychosocial counseling intervention for women experiencing intimate partner violence (IPV). Pilot findings demonstrated the potential helpfulness, acceptability, and feasibility of RISE; however, a randomized clinical trial (RCT) is needed to support program effectiveness. Methods: This RCT enrolled 60 women who experienced IPV within the prior year. Participants were recruited from an urban Veterans Health Administration hospital (October 2018 to September 2020). Participants completed a pretreatment assessment that included measures of relevant outcomes (primary: empowerment, self-efficacy, patient activation, and valued living; secondary: depression symptoms, IPV, and satisfaction with the intervention) and were randomly assigned to RISE or an enhanced care as usual (ECAU) condition. RISE participants received 1 to 6 sessions. ECAU participants received a single session consisting of psychoeducation, safety planning, resources, and referrals. Participants were reassessed 10 and 14 weeks after enrollment. Results: Intent-to-treat analyses using unconditional growth models revealed significant time-by-condition effects: RISE participants demonstrated higher increases in empowerment (d = 3.46) and self-efficacy (d = 1.09). RISE participants also experienced significant improvements in valued living (d = 0.53), depression symptoms (d = 0.49), and IPV reduction (d = 1.07) over time; however, the lack of a significant difference by condition suggested similar effectiveness of the interventions on these outcomes. Satisfaction was significantly higher for RISE than ECAU (d = 1.23). Conclusions: Results indicate the effectiveness of RISE in enhancing psychosocial well-being, especially empowerment and self-efficacy, among women experiencing IPV, for whom accessible health care-based interventions are needed. Trial Registration: ClinicalTrials.gov identifier: NCT03261700.
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Affiliation(s)
- Katherine M Iverson
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts.,Corresponding author: Katherine M. Iverson, PhD, Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, 150 South Huntington St, Boston, MA 02130
| | - Sara B Danitz
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts
| | - Danielle R Shayani
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts
| | - Dawne Vogt
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Shannon Wiltsey Stirman
- Dissemination and Training Division of the National Center for PTSD, VA Palo Alto Healthcare System, Palo Alto, California.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Alison B Hamilton
- VA Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles Geffen School of Medicine, Los Angeles, California
| | - Colin T Mahoney
- Western New England University, Department of Psychology, Springfield, Massachusetts.,Dr Mahoney is now affiliated with the University of Colorado at Colorado Springs and the Lyda Hill Institute for Human Resilience, Colorado Springs, Colorado
| | - Megan R Gerber
- Women's Health Center, VA Boston Healthcare System, Boston, Massachusetts.,Department of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts.,Dr Gerber is now affiliated with the Department of Medicine, Albany Medical College, Albany, New York
| | - Melissa E Dichter
- VA Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.,School of Social Work, Temple University, Philadelphia, Pennsylvania
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26
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Creech SK, Pulverman CS, Kroll-Desrosiers A, Kinney R, Dichter ME, Mattocks K. Intimate Partner Violence Among Pregnant Veterans: Prevalence, Associated Mental Health Conditions, and Health Care Utilization. J Gen Intern Med 2021; 36:2982-2988. [PMID: 33464464 PMCID: PMC8481457 DOI: 10.1007/s11606-020-06498-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) is a prevalent and serious health concern for women veterans, associated with mental and physical health symptoms. The adverse impacts of IPV are exacerbated during pregnancy, with added risks for pregnancy and postpartum outcomes. OBJECTIVE Identify the scope of IPV among pregnant veterans and associations with health outcomes. DESIGN Data were obtained from a national retrospective cohort study. PARTICIPANTS Study participants were 442 pregnant veterans using VHA maternity care benefits. MAIN MEASURES Mental health history was assessed via self-report measure and chart review; history of IPV and perinatal depression were assessed via brief validated self-report measures. KEY RESULTS Fourteen percent of the sample reported past-year IPV. Report of past-year IPV was associated with higher self-reported rates of lifetime mental health disorders including depression (p = 0.01), posttraumatic stress disorder (p = 0.02), anxiety disorders (p = 0.05), mood disorders (p = 0.01), bipolar disorder (p = 0.001), and eating disorders (p = 0.003); past-year IPV was also associated with the diagnosis of posttraumatic stress disorder during pregnancy (p = 0.002). Additionally, past-year IPV was associated with higher rates of military sexual trauma (MST; p = 0.03), pregnancy health risk behaviors (i.e., smoking, alcohol, and drug use; p = 0.004), greater number of VHA mental health visits during pregnancy (p = 0.04), and a lower likelihood of seeking social support from a spouse or partner (p < 0.0001). CONCLUSIONS Results indicate substantial rates of IPV among pregnant veterans, and high rates of mental health conditions which may be exacerbated by MST experience and lower likelihood of seeking social support. Clinicians treating pregnant veterans should screen for and address IPV and mental health treatment needs, and risks should be assessed among pregnant veterans experiencing IPV.
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Affiliation(s)
- Suzannah K Creech
- VHA VISN 17 Center of Excellence for Research on Returning War Veterans and the Central Texas Veterans Health Care System, Waco, USA.
- Department of Psychiatry, Dell Medical School of the University of Texas at Austin, Austin, USA.
| | - Carey S Pulverman
- VHA VISN 17 Center of Excellence for Research on Returning War Veterans and the Central Texas Veterans Health Care System, Waco, USA
- Department of Psychiatry, Dell Medical School of the University of Texas at Austin, Austin, USA
| | - Aimee Kroll-Desrosiers
- VHA Central Western Massachusetts Healthcare System, Leeds, USA
- VHA Center for Health Equity Research and Promotion, Crescenz VHA Medical Center, Philadelphia, USA
| | - Rebecca Kinney
- VHA Central Western Massachusetts Healthcare System, Leeds, USA
| | - Melissa E Dichter
- VHA Center for Health Equity Research and Promotion, Crescenz VHA Medical Center, Philadelphia, USA
- Temple University School of Social Work, Philadelphia, USA
| | - Kristin Mattocks
- VHA Central Western Massachusetts Healthcare System, Leeds, USA
- University of Massachusetts Medical School, Worcester, USA
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27
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Miller CJ, Adjognon OL, Brady JE, Dichter ME, Iverson KM. Screening for intimate partner violence in healthcare settings: An implementation-oriented systematic review. Implement Res Pract 2021; 2:10.1177/26334895211039894. [PMID: 36712586 PMCID: PMC9881185 DOI: 10.1177/26334895211039894] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background Intimate partner violence (IPV) is a population health problem affecting millions of women worldwide. Screening for IPV within healthcare settings can identify women who experience IPV and inform counseling, referrals, and interventions to improve their health outcomes. Unfortunately, many screening programs used to detect IPV have only been tested in research contexts featuring externally funded study staff and resources. This systematic review therefore investigated the utility of IPV screening administered by frontline clinical personnel. Methods We conducted a systematic literature review focusing on studies of IPV screening programs for women delivered by frontline healthcare staff. We based our data synthesis on two widely used implementation models (Reach, Effectiveness, Adoption, Implementation and Maintenance [RE-AIM] and Proctor's dimensions of implementation effectiveness). Results We extracted data from 59 qualifying studies. Based on data extraction guided by the RE-AIM framework, the median reach of the IPV screening programs was high (80%), but Emergency Department (ED) settings were found to have a much lower reach (47%). The median screen positive rate was 11%, which is comparable to the screen-positive rate found in studies using externally funded research staff. Among those screening positive, a median of 32% received a referral to follow-up services. Based on data extraction guided by Proctor's dimension of appropriateness, a lack of available referral services frustrated some efforts to implement IPV screening. Among studies reporting data on maintenance or sustainability of IPV screening programs, only half concluded that IPV screening rates held steady during the maintenance phase. Other domains of the RE-AIM and Proctor frameworks (e.g., implementation fidelity and costs) were reported less frequently. Conclusions IPV is a population health issue, and successfully implementing IPV screening programs may be part of the solution. Our review emphasizes the importance of ongoing provider trainings, readily available referral sources, and consistent institutional support in maintaining appropriate IPV screening programs. Plain language abstract Intimate partner violence (IPV) is a population health problem affecting millions of women worldwide. IPV screening and response can identify women who experience IPV and can inform interventions to improve their health outcomes. Unfortunately, many of the screening programs used to detect IPV have only been tested in research contexts featuring administration by externally funded study staff. This systematic review of IPV screening programs for women is particularly novel, as previous reviews have not focused on clinical implementation. It provides a better understanding of successful ways of implementing IPV screening and response practices with frontline clinical personnel in the context of routine care. Successfully implementing IPV screening programs may help mitigate the harms resulting from IPV against women. Findings from this review can inform future efforts to improve implementation of IPV screening programs in clinical settings to ensure that the victims of IPV have access to appropriate counseling, resources, and referrals.
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Affiliation(s)
- Christopher J Miller
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Omonyêlé L Adjognon
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA,Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - Julianne E Brady
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA,Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - Melissa E Dichter
- VA Center for Health Equity Research and Promotion (CHERP), Crescenz VA Medical Center, Philadelphia, PA, USA,School of Social Work, Temple University, Philadelphia, PA, USA
| | - Katherine M Iverson
- Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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28
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Dichter ME, Chatterjee A, Protasiuk E, Newman BS. "I'd Go from a Mountain Top and Tell My Story": Perspectives of Survivors of Intimate Partner Violence on Storytelling for Social Change. Violence Against Women 2021; 28:1708-1720. [PMID: 34435520 DOI: 10.1177/10778012211024267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Storytelling has well-documented therapeutic benefits for survivors of trauma. However, little is known about intimate partner violence (IPV) survivors' perspectives on sharing their stories. This article presents findings based on the analysis of 26 qualitative interviews with individuals who had experienced IPV regarding first-person story sharing. Participants described telling their stories as an act of healing and empowerment. They also named ways that storytelling can challenge societal views and structures that perpetuate IPV. Based on our findings, we offer suggestions for supporting survivor expertise and storytelling as part of a survivor-centered approach to IPV advocacy and social change.
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Affiliation(s)
- Melissa E Dichter
- Center on Health Equity Research and Promotion, Crescenz VA Medical Center, School of Social Work, 6558Temple University, Philadelphia, PA, USA
| | - Alicia Chatterjee
- School of Social Policy & Practice, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Ewa Protasiuk
- Department of Sociology, 6558Temple University, Philadelphia, PA, USA
| | - Bernie S Newman
- School of Social Work, 6558Temple University, Philadelphia, PA, USA
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Grillo AR, Danitz SB, Dichter ME, Driscoll MA, Gerber MR, Hamilton AB, Wiltsey-Stirman S, Iverson KM. Strides Toward Recovery From Intimate Partner Violence: Elucidating Patient-Centered Outcomes to Optimize a Brief Counseling Intervention for Women. J Interpers Violence 2021; 36:NP8431-NP8453. [PMID: 30994401 DOI: 10.1177/0886260519840408] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Women in the United States continue to experience intimate partner violence (IPV) at unprecedented rates, necessitating the development and implementation of personalized, effective healthcare-based interventions. Methods of developing patient-centered interventions for IPV should elicit the voice of the target population (i.e., women who experience IPV) while assuring that outcomes identified as important are incorporated into the refined intervention. This pilot study is part of a multiphase, larger study aiming to refine an IPV intervention and clinical outcome measurements prior to formal evaluation of the effectiveness of the intervention. Specifically, this study elucidates patient-centered outcomes identified by women who have experienced IPV. Women patients of the Veterans Health Administration (VHA) in New England participated in focus groups to provide feedback and desired outcomes of a new IPV intervention. Patient-centered outcomes were defined by the participants. Focus groups were transcribed and analyzed using conventional content analysis and matrix analysis. A total of 25 women participated in focus groups (n = 5) at two large VHA facilities. Participant feedback revealed five common themes related to desired outcomes. Women opined increased feelings of empowerment as a key outcome of engaging in an IPV intervention. Women desired increased social connectedness and support to be gained during treatment, citing providers and other survivors of IPV as exemplary sources. Self-esteem was viewed as critical to enhancing recovery, as was increased knowledge across domains of IPV (e.g., warning signs, the link between mental and physical health for self and children). Finally, women identified valued action and goal setting, such as achieving more independence, as an optimal outcome. Addressing IPV against women requires patient-centered interventions that specifically target the types of outcomes deemed important by the end users: women who experience IPV. Findings have implications for tailoring treatments for IPV and selecting measures that tap into women's desired outcomes.
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Affiliation(s)
- Alessandra R Grillo
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - Sara B Danitz
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - Melissa E Dichter
- VA Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, PA, USA
- University of Pennsylvania, Philadelphia, PA, USA
| | - Mary A Driscoll
- VA Connecticut Healthcare System, New Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Megan R Gerber
- Boston University School of Medicine, Boston, MA, USA
- Women's Health Services, VA Boston Healthcare System, Boston, MA, USA
| | - Alison B Hamilton
- VA Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- University of California, Los Angeles, CA, USA
| | - Shannon Wiltsey-Stirman
- National Center for PTSD, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Stanford School of Medicine, Stanford, CA, USA
| | - Katherine M Iverson
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
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Iverson KM, Danitz SB, Driscoll M, Vogt D, Hamilton AB, Gerber MR, Wiltsey Stirman S, Shayani DR, Suvak MK, Dichter ME. Recovering from intimate partner violence through Strengths and Empowerment (RISE): Development, pilot testing, and refinement of a patient-centered brief counseling intervention for women. Psychol Serv 2021; 19:102-112. [PMID: 34110870 DOI: 10.1037/ser0000544] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article describes the rationale, development, and preliminary examination of a brief, variable-length (up to six sessions), modular-based counseling intervention for women who experience intimate partner violence (IPV). Recovering from IPV through Strengths and Empowerment (RISE) is an empowerment and skills-focused treatment that incorporates Motivational Interviewing. RISE was developed to fill the gap in interventions for women who disclose IPV within integrated healthcare settings such as the Veterans Health Administration (VHA). Fifteen women Veterans with past-year IPV participated in an open trial at two VHA hospitals to evaluate the potential helpfulness, feasibility, and acceptability of RISE using a mixed-methods approach to assessment. Qualitative feedback from women Veterans and five RISE clinicians (psychologists and social workers) was collected posttreatment. Descriptive analyses of quantitative psychosocial outcomes before and after the intervention provide evidence of support for RISE as potentially helpful in improving psychosocial well-being. High retention and high satisfaction ratings, along with positive qualitative feedback from both IPV survivor participants and clinicians, supported intervention feasibility and acceptability. Overall, this pilot study offers feasibility and acceptability data for RISE as a potentially helpful intervention for women experiencing past-year IPV. Refinements to RISE based on the open trial and subsequent testing of the clinical effectiveness of the intervention are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | - Mary Driscoll
- VA Patient Research, Informatics, Multi-morbidities, and Education
| | | | - Alison B Hamilton
- VA Center for the Study of Healthcare Innovation, Implementation and Policy
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Nadler LE, Ogden SN, Scheffey KL, Cronholm PF, Dichter ME. Provider Practices and Perspectives regarding Collection and Documentation of Gender Identity. J Homosex 2021; 68:901-913. [PMID: 31526306 PMCID: PMC7676221 DOI: 10.1080/00918369.2019.1667162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Recent recommendations to include patient sexual orientation (SO) and gender identity (GI) in the electronic health record (EHR) aim to improve clinical care and address health disparities among sexual and gender minority patients. Collection and documentation of GI may be complex due to multiple clinically relevant components. This study explored provider practices in collecting and documenting GI across multiple specialties. Qualitative interviews with 25 healthcare providers were transcribed verbatim, and thematic analysis and principles of grounded theory were used to analyze the data. Without a protocol and absent dedicated locations in the EHR for collecting and documenting patient GI, provider practices were inconsistent and highlighted challenges for communication across clinical staff. Providers noted that patients' disclosure of GI was typically unprompted, or was presumed through disclosure of gender affirming treatments. Findings indicate the need for provider training and appropriate EHR fields to support GI collection and documentation.
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Affiliation(s)
- Lauren E. Nadler
- Department of Family Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Shannon N. Ogden
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kathryn L. Scheffey
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter F. Cronholm
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melissa E. Dichter
- School of Social Work, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
- Center for Health Equity Research and Promotion, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania, USA
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Montgomery AE, Dichter ME, Blosnich JR. Gender Differences in the Predictors of Suicide-related Morbidity Among Veterans Reporting Current Housing Instability. Med Care 2021; 59:S36-S41. [PMID: 33438881 DOI: 10.1097/mlr.0000000000001422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Veterans experiencing housing instability are at increased risk of suicide. Research is needed to identify gender differences in the predictors of both suicidal ideation and suicide attempt, particularly among Veterans who are unstably housed. OBJECTIVES The objective of the present study was to explore whether correlates of suicide-related morbidity among unstably housed Veterans vary by gender and identify implications for improved care for these Veterans. METHODS The study cohort included 86,325 Veterans who reported current housing instability between October 1, 2013, and September 30, 2016. This cross-sectional study assessed differences in demographic and outcome variables by gender using χ2 analyses and a series of multiple logistic regressions predicting suicidal ideation and suicide attempt, stratified by gender. RESULTS Among unstably housed female Veterans, being younger than 40 years was associated with more than double the odds of having an indicator of suicidal ideation and >12 times the odds of having an indicator of a suicide attempt. The effect sizes associated with age were much less pronounced among unstably housed male Veterans. The presence of mental health and substance use conditions as well as a positive screen for military sexual trauma were associated with increased risk of suicide morbidity among both women and men. CONCLUSIONS Intervention and prevention among unstably housed Veterans may be complicated by unpredictable living situations; further research should explore tailored interventions to address the complex needs of unstably housed Veterans and how suicide prevention can be woven throughout.
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Affiliation(s)
- Ann E Montgomery
- US Department of Veterans Affairs (VA), National Center on Homelessness among Veterans, Philadelphia, PA.,Birmingham VA Medical Center.,University of Alabama at Birmingham, School of Public Health, Birmingham, AL
| | - Melissa E Dichter
- Temple University School of Social Work.,VA Center for Health Equity Research and Promotion, Philadelphia, PA
| | - John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
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Hoffmire CA, Denneson LM, Monteith LL, Dichter ME, Gradus JL, Cappelletti MM, Brenner LA, Yano EM. Accelerating Research on Suicide Risk and Prevention in Women Veterans Through Research-Operations Partnerships. Med Care 2021; 59:S11-S16. [PMID: 33438877 DOI: 10.1097/mlr.0000000000001432] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Suicide rates for women veterans are increasing faster than for nonveterans. The 2017 suicide rate for women veterans was more than double that for women nonveterans. However, research to inform improved suicide prevention for women veterans is scant. OBJECTIVES To accelerate research on women veterans' unique risks and resiliencies for suicide, the Department of Veterans Affairs (VA) Women's Health Research Network launched a Women Veterans Suicide Prevention Research Work Group to target technical support for researchers, promote collaboration with national VA program offices, and ultimately increase dissemination and translation of research into clinical practice, public health strategies, and policies. The objective of this paper is to report on the process and outcomes of the Work Group's strategic planning efforts to identify and fill gaps in suicide prevention research among women veterans. METHODS An in-person meeting of 20 researchers and operational leaders was convened to summarize existing research evidence and identify research priorities and challenges. RESULTS Research priorities included civilian reintegration, community connections, psychosocial stressors (eg, social determinants of health) and trauma, risk assessment, clinical interventions, upstream prevention, and health care access. The importance of increasing evidence on gender differences and for women veterans not using VA health care was emphasized. CONCLUSIONS Research to inform suicide prevention tailored to meet women veterans' needs is essential; however, many priorities and challenges remain unaddressed. Although Work Group efforts have achieved funding gains, further work to formalize, promote and meet the demands of a suicide prevention research agenda for women veterans requires is ongoing focus.
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Affiliation(s)
- Claire A Hoffmire
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, VA Eastern Colorado Health Care System
- Department of Physical Medicine & Rehabilitation, Anschutz School of Medicine, University of Colorado, Aurora, CO
| | - Lauren M Denneson
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System
- Department of Psychiatry, Oregon Health & Science University, Portland, OR
| | - Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, VA Eastern Colorado Health Care System
- Department of Psychiatry, University of Colorado, Anschutz School of Medicine, Aurora, CO
| | - Melissa E Dichter
- VA Center for Health Equity Research and Promotion, Crescenz VA Medical Center
- College of Public Health, Temple University School of Social Work, Philadelphia, PA
| | - Jaimie L Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
- National Center for PTSD, VA Boston Healthcare System, Boston, MA
| | - Maurand M Cappelletti
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, VA Eastern Colorado Health Care System
| | - Lisa A Brenner
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, VA Eastern Colorado Health Care System
- Department of Physical Medicine & Rehabilitation, Anschutz School of Medicine, University of Colorado, Aurora, CO
- Department of Psychiatry, University of Colorado, Anschutz School of Medicine, Aurora, CO
- Department of Neurology, University of Colorado, Anschutz School of Medicine, Aurora, CO
| | - Elizabeth M Yano
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA
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Denneson LM, Hoffmire CA, Blosnich JR, Dichter ME, Fitelson E, Holliday R, Monteith LL, Smolenski DJ, Yano EM. Advancing Knowledge of Suicide Risk and Prevention Among Women: Introduction to the Supplement. Med Care 2021; 59:S1-S3. [PMID: 33438873 DOI: 10.1097/mlr.0000000000001483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Lauren M Denneson
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System
- Department of Psychiatry, Oregon Health & Science University, Portland, OR
| | - Claire A Hoffmire
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, VA Eastern Colorado Health Care System
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - John R Blosnich
- Suzanne Dworak-Peck School of Social Work at the University of Southern California, Los Angeles, CA
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh
| | - Melissa E Dichter
- VA Center for Health Equity Research and Promotion, Philadelphia VA Medical Center
- Temple University School of Social Work, Philadelphia, PA
| | | | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, VA Eastern Colorado Health Care System
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, VA Eastern Colorado Health Care System
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Derek J Smolenski
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, MD
| | - Elizabeth M Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System
- Department of Health Policy and Management, UCLA Fielding School of Public Health
- Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA
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Blosnich JR, Garfin DR, Maguen S, Vogt D, Dichter ME, Hoffmire CA, Bernhard PA, Schneiderman A. Differences in childhood adversity, suicidal ideation, and suicide attempt among veterans and nonveterans. ACTA ACUST UNITED AC 2021; 76:284-299. [PMID: 33734795 DOI: 10.1037/amp0000755] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adverse childhood experiences (ACEs) are robustly associated with physical and mental health problems over the life span. Relatively limited research has examined the breadth of ACEs among military veteran populations, for whom ACEs may be premilitary traumas associated with suicidal ideation and attempt. Using data from the Comparative Health Assessment Interview Research Study, a large national survey sponsored by the U.S. Department of Veterans Affairs, this investigation examined the prevalence of 22 self-reported potentially traumatic experiences before the age of 18 (i.e., ACEs) among veterans and nonveterans and estimated the association of ACEs with suicidal ideation and attempt at age 18 or older. All analyses were weighted to account for complex sampling design and stratified by gender. The study sample included 9,571 veteran men, 3,143 nonveteran men, 5,543 veteran women, and 1,364 nonveteran women. Veteran men reported greater average frequency of ACEs than nonveteran men (2.7 ACEs vs. 2.3 ACEs, respectively, p < .001); 11.1% of veteran men indicated >6 ACEs compared with 7.3% of nonveteran men (p < .001). Veteran women reported greater average frequency of ACEs than nonveteran women (3.1 ACEs vs. 2.4 ACEs, respectively, p < .001). Among women, more veterans than nonveterans reported >6 ACEs (14.9% vs. 8.6%, respectively, p < .001). The strongest correlate of suicide attempt at age 18 or older for veteran men was having >6 ACEs (adjusted odds ratio, aOR = 4.20, 95%CI = 2.72-6.49); for veteran women, the strongest correlate was suicidal ideation or attempt before age 18 (aOR = 5.37, 95%CI = 4.11-7.03). Suicide prevention research, policy, and practice should address ACEs among veterans as salient premilitary risk factors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Dana Rose Garfin
- Sue & Bill Gross School of Nursing, University of California, Irvine
| | - Shira Maguen
- Department of Psychiatry, School of Medicine, University of California, San Francisco
| | - Dawne Vogt
- Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System
| | | | - Claire A Hoffmire
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs
| | - Paul A Bernhard
- Epidemiology Program, Post Deployment Health Services, U.S. Department of Veterans Affairs
| | - Aaron Schneiderman
- Epidemiology Program, Post Deployment Health Services, U.S. Department of Veterans Affairs
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Dichter ME, Ogden SN, Tuepker A, Iverson KM, True G. Survivors' Input on Health Care-Connected Services for Intimate Partner Violence. J Womens Health (Larchmt) 2021; 30:1744-1750. [PMID: 33416430 DOI: 10.1089/jwh.2020.8585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Intimate partner violence (IPV) is increasingly recognized as a social factor impacting health, and health care providers are encouraged to routinely screen and refer patients for needs related to IPV. Health care settings are often challenged, however, in their ability to connect patients with community-based IPV services. Some organizations have invested in on-site programs to facilitate identification and connection. Methods: The goal of this study was to understand IPV survivors' experiences with and perspectives on health care-connected IPV services. Semistructured in-depth interviews were conducted in-person by a trained and experienced interviewer and were audio-recorded and transcribed verbatim. Interview transcripts were analyzed using team-based qualitative thematic content analysis. Participants included 68 individuals who had experienced IPV, recruited through one of two settings: (1) a health care organization with embedded IPV services or (2) a community-based IPV service organization that partners with health care settings. Results: Interviews revealed benefits of having health care-connected IPV services, including that the health care setting can be critical for providing information about IPV programs and that survivors may need assistance with navigation of community services. Survivors further highlighted recommendations for trauma-sensitive care that includes providing clarification about the role and scope of IPV services, following-up with but not forcing intervention, and ensuring privacy, confidentiality, and trust in interactions. Conclusions: Findings support health care settings having in-house or close partnership with IPV advocates to adequately support patients' needs in connecting with and navigating community based IPV-related services.
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Affiliation(s)
- Melissa E Dichter
- Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Temple University School of Social Work, Philadelphia, Pennsylvania, USA
| | - Shannon N Ogden
- Boston University School of Public Health, Boston, Massachusetts, USA
| | - Anaïs Tuepker
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon, USA.,Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Katherine M Iverson
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Gala True
- South Central MIRECC, Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana, USA.,Section on Community and Population Medicine, LSU School of Medicine, New Orleans, Louisiana, USA
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Blosnich JR, Montgomery AE, Taylor LD, Dichter ME. Adverse social factors and all-cause mortality among male and female patients receiving care in the Veterans Health Administration. Prev Med 2020; 141:106272. [PMID: 33022319 DOI: 10.1016/j.ypmed.2020.106272] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/23/2020] [Accepted: 09/27/2020] [Indexed: 10/23/2022]
Abstract
Social factors account more for health outcomes than medical care, yet health services research in this area is limited due to the lack of social factors data contained within electronic health records (EHR) systems. Few investigations have examined how cumulative burdens of co-occurring adverse social factors impact health outcomes. From 293,872 patients in one region of the Veterans Health Administration (VHA), we examined how increasing numbers of adverse social factors extracted from the EHR were associated with mortality across a one-year period for male and female patients. Adverse social factors were identified using four sources in the EHR: responses to universal VHA screens, International Classification of Disease (ICD) diagnostic codes that indicate social factors, receipt of VHA services related to social factors, and templated social work referrals. Seven types of adverse social factors were coded: violence, housing instability, employment or financial problems, legal issues, social or familial problems, lack of access to care or transportation, and nonspecific psychosocial needs. Overall, each increase in an adverse social factor was associated with 27% increased odds of mortality, after accounting for demographics, medical comorbidity, and military service-related disability. Non-specific psychosocial factors were most strongly associated with mortality, followed by social or familial problems. Although women were more likely than men to have multiple adverse social factors, social factors were not associated with mortality among women as they were among men. By incorporating social factors data, health care systems can better understand patient all-cause mortality and identify potential prevention efforts built around social determinants.
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Affiliation(s)
- John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States of America; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America.
| | - Ann Elizabeth Montgomery
- U.S. Department of Veterans Affairs (VA), National Center on Homelessness Among Veterans, Tampa, FL, United States of America; Birmingham VA Medical Center, Birmingham, AL, United States of America; Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Laura D Taylor
- U.S. Department of Veterans Affairs (VA), National Social Work Program Office, Washington, DC, United States of America
| | - Melissa E Dichter
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States of America; School of Social Work, College of Public Health, Temple University, Philadelphia, PA, United States of America
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Blosnich JR, Dichter ME, Gurewich D, Montgomery AE, Kressin NR, Lee R, Hester CM, Hausmann LRM. Health Services Research and Social Determinants of Health in the Nation's Largest Integrated Health Care System: Steps and Leaps in the Veterans Health Administration. Mil Med 2020; 185:e1353-e1356. [PMID: 32592393 DOI: 10.1093/milmed/usaa067] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/16/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- John R Blosnich
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion (CHERP), 151 University Drive C, Building 30, Pittsburgh, PA 15240.,Suzanne Dworak-Peck School of Social Work, University of Southern California, Montgomery Ross Fisher Building, 669 W 34th St, Los Angeles, CA 90089-0411
| | - Melissa E Dichter
- Corporal Michael J. Crescenz VA Medical Center, CHERP, 21 S University Ave, Philadelphia, PA 19104.,School of Social Work, Temple University, 1301 Cecil B. Moore Ave., Philadelphia, PA 19122
| | - Deborah Gurewich
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), 150 South Huntington Avenue (152M), Jamaica Plain Campus, Building 9, Boston, MA 02130
| | - Ann Elizabeth Montgomery
- Birmingham VA Medical Center, 700 19th St S, Birmingham, AL 35233.,School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL 35233
| | - Nancy R Kressin
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), 150 South Huntington Avenue (152M), Jamaica Plain Campus, Building 9, Boston, MA 02130.,Department of Medicine, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118
| | - Richard Lee
- Veterans Rural Health Resource Center, 163 Veterans Dr, White River Junction, VT 05009
| | - Christina M Hester
- American Academy of Family Physicians, 11400 Tomahawk Creek Pkwy, Leawood, KS 66211
| | - Leslie R M Hausmann
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion (CHERP), 151 University Drive C, Building 30, Pittsburgh, PA 15240.,Suzanne Dworak-Peck School of Social Work, University of Southern California, Montgomery Ross Fisher Building, 669 W 34th St, Los Angeles, CA 90089-0411.,Division of General Internal Medicine, University of Pittsburgh School of Medicine, 1218 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 1526
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Ogden SN, Scheffey KL, Blosnich JR, Dichter ME. "Do I feel safe revealing this information to you?": Patient perspectives on disclosing sexual orientation and gender identity in healthcare. J Am Coll Health 2020; 68:617-623. [PMID: 32897171 DOI: 10.1080/07448481.2019.1583663] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/21/2018] [Accepted: 02/08/2019] [Indexed: 06/11/2023]
Abstract
Objective: To examine university student perspectives on, and experiences with, disclosing sexual orientation and gender identity (SO/GI) in healthcare. Participants: Thirty-four graduate and undergraduate students from a large mid-Atlantic city in the United States participated in 1 of 6 focus groups held from October 2017 to February 2018. Methods: Focus groups were audio-recorded and transcribed verbatim. Transcripts were analyzed using thematic analysis and principles of grounded theory to identify emerging themes. Results: Patient considerations around disclosing SO/GI fell within three thematic categories: the relevancy of SO/GI information to the clinical encounter, the patient-provider relationship, and concerns about negative provider reactions to disclosure. Conclusions: Findings highlight the need for provider understanding of SO/GI diversity and establishing safe and comfortable environments to facilitate disclosure for young adult patients. Lack of sensitivity to patients' experiences may exacerbate health disparities among sexual and gender minorities by failing to collect accurate epidemiological data and discouraging seeking care.
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Affiliation(s)
- Shannon N Ogden
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kathryn L Scheffey
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John R Blosnich
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, U.S. Department of Veteran Affairs, Pittsburgh, Pennsylvania, USA
| | - Melissa E Dichter
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, U.S. Department of Veteran Affairs, Philadelphia, Pennsylvania, USA
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Blosnich JR, Montgomery AE, Dichter ME, Gordon AJ, Kavalieratos D, Taylor L, Ketterer B, Bossarte RM. Social Determinants and Military Veterans' Suicide Ideation and Attempt: a Cross-sectional Analysis of Electronic Health Record Data. J Gen Intern Med 2020; 35:1759-1767. [PMID: 31745856 PMCID: PMC7280399 DOI: 10.1007/s11606-019-05447-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Health care systems struggle to identify risk factors for suicide. Adverse social determinants of health (SDH) are strong predictors of suicide risk, but most electronic health records (EHR) do not include SDH data. OBJECTIVE To determine the prevalence of SDH documentation in the EHR and how SDH are associated with suicide ideation and attempt. DESIGN This cross-sectional analysis included EHR data spanning October 1, 2015-September 30, 2016, from the Veterans Integrated Service Network Region 4. PARTICIPANTS The study included all patients with at least one inpatient or outpatient visit (n = 293,872). MAIN MEASUREMENTS Adverse SDH, operationalized using Veterans Health Administration (VHA) coding for services and International Statistical Classification of Diseases and Related Health Problems (ICD)-10 codes, encompassed seven types (violence, housing instability, financial/employment problems, legal problems, familial/social problems, lack of access to care/transportation, and nonspecific psychosocial needs). We defined suicide morbidity by ICD-10 codes and data from the VHA's Suicide Prevention Applications Network. Logistic regression assessed associations of SDH with suicide morbidity, adjusting for socio-demographics and mental health diagnoses (e.g., major depression). Statistical significance was assessed with p < .01. KEY RESULTS Overall, 16.4% of patients had at least one adverse SDH indicator. Adverse SDH exhibited dose-response-like associations with suicidal ideation and suicide attempt: each additional adverse SDH increased odds of suicidal ideation by 67% (AOR = 1.67, 99%CI = 1.60-1.75; p < .01) and suicide attempt by 49% (AOR = 1.49, 99%CI = 1.33-1.68; p < .01). Independently, each adverse SDH had strong effect sizes, ranging from 1.86 (99%CI = 1.58-2.19; p < .01) for legal issues to 3.10 (99%CI = 2.74-3.50; p < .01) for non-specific psychosocial needs in models assessing suicidal ideation and from 1.58 (99%CI = 1.10-2.27; p < .01) for employment/financial problems to 2.90 (99%CI = 2.30-4.16; p < .01) for violence in models assessing suicide attempt. CONCLUSIONS SDH were strongly associated with suicidal ideation and suicide attempt even after adjusting for mental health diagnoses. Integration of SDH data in EHR could improve suicide prevention.
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Affiliation(s)
- John R Blosnich
- Department of Veterans Affairs, VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive C (151C-U), Building 30, Pittsburgh, PA, 15240-1001, USA.
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Ann Elizabeth Montgomery
- U.S. Department of Veterans Affairs (VA), National Center on Homelessness Among Veterans, Tampa, FL, USA
- Birmingham VA Medical Center, Birmingham, AL, USA
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Melissa E Dichter
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- School of Social Work, Temple University, Philadelphia, PA, USA
| | - Adam J Gordon
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Dio Kavalieratos
- Department of Veterans Affairs, VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive C (151C-U), Building 30, Pittsburgh, PA, 15240-1001, USA
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Laura Taylor
- Department of Veterans Affairs, Veterans Health Administration, Care Management and Social Work, Washington, DC, USA
| | - Bryan Ketterer
- Center of Excellence for Suicide Prevention, Canandaigua, NY, USA
| | - Robert M Bossarte
- Center of Excellence for Suicide Prevention, Canandaigua, NY, USA
- Injury Control Research Center, West Virginia University, Morgantown, WV, USA
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA
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Iverson KM, Dichter ME, Stolzmann K, Adjognon OL, Lew RA, Bruce LE, Gerber MR, Portnoy GA, Miller CJ. Assessing the Veterans Health Administration's response to intimate partner violence among women: protocol for a randomized hybrid type 2 implementation-effectiveness trial. Implement Sci 2020; 15:29. [PMID: 32381013 PMCID: PMC7206678 DOI: 10.1186/s13012-020-0969-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/27/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) against women in the United States (US) remains a complex public health crisis. Women who experience IPV are among the most vulnerable patients seen in primary care. Screening increases the detection of IPV and, when paired with appropriate response interventions, can mitigate the health effects of IPV. The Department of Veterans Affairs (VA) has encouraged evidence-based IPV screening programs since 2014, yet adoption is modest and questions remain regarding the optimal ways to implement these practices, which are not yet available within the majority of VA primary care clinics. METHODS/DESIGN This paper describes the planned evaluation of VA's nationwide implementation of IPV screening programs in primary care clinics through a randomized implementation-effectiveness hybrid type 2 trial. With the support of our VA operational partners, we propose a stepped wedge design to compare the impact of two implementation strategies of differing intensities (toolkit + implementation as usual vs. toolkit + implementation facilitation) and investigate the clinical effectiveness of IPV screening programs. Using balanced randomization, 16-20 VA Medical Centers will be assigned to receive implementation facilitation in one of three waves, with implementation support lasting 6 months. Implementation facilitation in this effort consists of the coordinated efforts of the two types of facilitators, external and internal. Implementation facilitation is compared to dissemination of a toolkit plus implementation as usual. We propose a mixed methods approach to collect quantitative (clinical records data) and qualitative (key informant interviews) implementation outcomes, as well as quantitative (clinical records data) clinical effectiveness outcomes. We will supplement these data collection methods with provider surveys to assess discrete implementation strategies used before, during, and following implementation facilitation. The integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will guide the qualitative data collection and analysis. Summative data will be analyzed using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. DISCUSSION This research will advance national VHA efforts by identifying the practices and strategies useful for enhancing the implementation of IPV screening programs, thereby ultimately improving services for and health of women seen in primary care. TRIAL REGISTRATION NCT04106193. Registered on 23 September 2019.
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Affiliation(s)
- Katherine M. Iverson
- Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Ave (116B-3), Boston, MA 02130 USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA USA
| | - Melissa E. Dichter
- VA Center for Health Equity Research and Promotion (CHERP), Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, 19104 PA USA
- Department of Social Work, Temple University, Philadelphia, PA USA
| | - Kelly Stolzmann
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, 150 S. Huntington Ave (152 M), Boston, MA 02130 USA
| | - Omonyêlé L. Adjognon
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, 150 S. Huntington Ave (152 M), Boston, MA 02130 USA
| | - Robert A. Lew
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, 150 S. Huntington Ave (152 M), Boston, MA 02130 USA
| | - LeAnn E. Bruce
- Intimate Partner Violence Assistance Program, Care Management and Social Work, Department of Veterans Affairs, 810 Vermont Avenue, Washington, DC 20420 USA
- Department of Social Work, Western Kentucky University School of Social Work, Bowling Green, KY USA
| | - Megan R. Gerber
- Women’s Health Center, VA Boston Healthcare System, 150 S. Huntington Ave, Boston, MA 02130 USA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA USA
| | - Galina A. Portnoy
- Pain, Research, Informatics, Medical comorbidities, and Education (PRIME) Center, VA Conneticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516 USA
- Yale School of Medicine, New Haven, CT USA
| | - Christopher J. Miller
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, 150 S. Huntington Ave (152 M), Boston, MA 02130 USA
- Department of Psychiatry, Harvard Medical School, Boston, MA USA
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Sorrentino AE, Iverson KM, Tuepker A, True G, Cusack M, Newell S, Dichter ME. Mental health care in the context of intimate partner violence: Survivor perspectives. Psychol Serv 2020; 18:512-522. [PMID: 32237873 DOI: 10.1037/ser0000427] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Experience of violence or abuse from an intimate partner (intimate partner violence, IPV) can result in a variety of psychological and mental health impacts for which survivors may seek psychotherapy or other mental health services. Individuals experiencing IPV may have specific needs and preferences related to mental health care, yet the question of how to best provide client-centered mental health care in the context of IPV has received little attention in the literature. In this article, we report on findings from qualitative interviews with 50 women reporting past-year IPV who received care through the Veterans Health Administration regarding experiences with and recommendations for mental health services. Participants described client-centered mental health care in the context of recent or ongoing IPV as being characterized by flexibility and responsiveness around discussion of IPV; respect for the complexity of clients' lives and support for self-determination; and promoting safety and access to internal and external resources for healthy coping. We discuss findings in terms of their implications for the mental health field, highlighting the need for flexibility in application of evidence-based treatments, improved coordination between therapeutic and advocacy services, and training to enhance competencies around understanding and responding to IPV. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Katherine M Iverson
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System
| | - Anaïs Tuepker
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System
| | - Gala True
- South Central Mental Illness, Research, Education, and Clinical Center, Southeast Louisiana Veterans Health Care System
| | - Meagan Cusack
- VA Center for Health Equity Research and Promotion, Crescenz VA Medical Center
| | - Summer Newell
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System
| | - Melissa E Dichter
- VA Center for Health Equity Research and Promotion, Crescenz VA Medical Center
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Makaroun LK, Brignone E, Rosland AM, Dichter ME. Association of Health Conditions and Health Service Utilization With Intimate Partner Violence Identified via Routine Screening Among Middle-Aged and Older Women. JAMA Netw Open 2020; 3:e203138. [PMID: 32315066 PMCID: PMC7175082 DOI: 10.1001/jamanetworkopen.2020.3138] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The US Preventive Services Task Force recently determined that there is insufficient evidence to recommend routine screening for intimate partner violence (IPV) in women who are middle-aged and older. Certain Veterans Health Administration (VHA) clinics have been routinely screening women of all ages for IPV since 2014. OBJECTIVES To examine the proportion of women older than childbearing age (ie, ≥45 years) who have positive results when routinely screened for past-year IPV at VHA clinics and to evaluate the associations of a positive screening result with health conditions and health service utilization. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 4481 women aged 45 years and older who were screened for past-year IPV in 13 VHA outpatient clinics in 11 states between April 2014 and April 2016. Data analysis was conducted from March 2019 to August 2019. EXPOSURE Positive screening result for past-year IPV. MAIN OUTCOMES AND MEASURES Mental and physical health conditions (identified using International Classification of Diseases, Ninth Edition [ICD-9] and ICD-10 codes from VHA medical record data) and VHA health services utilization (identified using inpatient and outpatient VHA encounter data) in the 20 months after screening. RESULTS In this study, 2937 of 4481 women (65.5%) were middle-aged (ie, aged 45 to 59 years), and 1544 (34.5%) were older (ie, aged ≥60 years), with 1955 (43.6%) black participants. A total of 255 middle-aged women (8.7%; mean [SD] age, 51 [4] years) and 79 older women (5.1%; mean [SD] age, 64 [5] years) screened positive for past-year IPV. In adjusted logistic regression models among middle-aged women, screening positive for IPV was associated with subsequent diagnoses of anxiety (adjusted odds ratio [aOR], 2.00; 95% CI, 1.50-2.70; P < .001), depression (aOR, 2.30; 95% CI, 1.80-3.00; P < .001), posttraumatic stress disorder (aOR, 2.30; 95% CI, 1.80-3.00; P < .001), suicidal ideation and/or behavior (aOR, 3.80; 95% CI, 2.10-6.90; P < .001), and substance use disorder (aOR, 2.50; 95% CI, 1.80-3.50; P < .001). Similar but attenuated associations were seen for older women (eg, substance use disorder: aOR, 2.20; 95% CI, 1.10-4.40; P = .04). In adjusted negative binomial regression models among middle-aged women, screening positive for IPV was associated with a higher rate of subsequent psychosocial (eg, mental health) visits (adjusted rate ratio [aRR], 2.40; 95% CI, 2.00-2.90; P < .001), primary care visits (aRR, 1.20; 95% CI, 1.10-1.30; P < .001), and emergency department visits (aRR, 1.50; 95% CI 1.20-1.80; P < .001). Older women screening positive for IPV had a higher rate of psychosocial visits (aRR, 1.90; 95% CI, 1.30-2.70; P < .001) but not of other visit types. CONCLUSIONS AND RELEVANCE To our knowledge, this study was the largest to evaluate routine screening for IPV among women aged 45 years and older, and it found that IPV remained prevalent and was associated with morbidity for these women. Screening for IPV in women older than 44 years may improve detection and provision of evidence-based services to this growing population.
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Affiliation(s)
- Lena K. Makaroun
- VA Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Emily Brignone
- VA Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Ann-Marie Rosland
- VA Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Melissa E. Dichter
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Temple University School of Social Work, Philadelphia, Pennsylvania
- VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania
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Dichter ME, Sorrentino AE, Haywood TN, Tuepker A, Newell S, Cusack M, True G. Women's Participation in Research on Intimate Partner Violence: Findings on Recruitment, Retention, and Participants' Experiences. Womens Health Issues 2019; 29:440-446. [PMID: 31072755 PMCID: PMC10077872 DOI: 10.1016/j.whi.2019.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 03/13/2019] [Accepted: 03/27/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Research on intimate partner violence (IPV) faces unique challenges to recruitment and retention. Little is known about successful strategies for recruiting and retaining in research women who have experienced IPV, and their experiences of research participation. PURPOSE This article presents findings on recruitment, retention, and research participation experiences from a longitudinal observational study of IPV among women receiving care through the Veterans Health Administration. METHODS Administrative tracking data were analyzed to identify strengths, challenges, and outcomes of multiple recruitment strategies for an observational study of women patients who had experienced past-year IPV. Qualitative interviews with a purposively selected subset of the larger sample were used to identify motivations for and experiences of study participation. RESULTS Of the total sample (N = 169), 92.3% were recruited via direct outreach by the research team (63.3% via letter, 29.0% in person), compared with provider or patient self-referral (3.6% and 4.1%, respectively); 88% returned for a follow-up assessment. In qualitative interviews (n = 50), participants expressed a desire to help others as a primary motivation for study participation. Although some participants experienced emotional strain during or after study visits, they also expressed perceiving value in sharing their experiences, and several participants found the experience personally beneficial. Participants expressed that disclosure was facilitated by interviewers' empathic and neutral stance, as well as the relative anonymity and time-limited nature of the research relationship. CONCLUSIONS Direct outreach to women Veterans Health Administration patients to participate in research interviews about IPV experience was feasible and effective, and proved more fruitful for recruitment than reliance on provider or patient self-referral. Women who have experienced IPV may welcome opportunities to contribute to improvements in care through participation in interviews.
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Scheffey KL, Ogden SN, Dichter ME. "The Idea of Categorizing Makes Me Feel Uncomfortable": University Student Perspectives on Sexual Orientation and Gender Identity Labeling in the Healthcare Setting. Arch Sex Behav 2019; 48:1555-1562. [PMID: 30850917 DOI: 10.1007/s10508-019-1401-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 06/09/2023]
Abstract
As healthcare settings are increasingly adding sexual orientation and gender identity (SO/GI) to routinely collected patient demographic information, it is important to understand how patients conceptualize and label these identities. This study explored university students' perspectives on and experiences with choosing SO/GI labels in the healthcare setting. We employed a mixed-method approach, collecting survey data on self-identified SO/GI labels across various contexts and conducting focus groups centered around experiences of SO/GI data collection and labeling in healthcare. Thirty-four graduate and undergraduate university students completed the survey and participated in six one-time focus groups. While many participants indicated that their self-identified SO/GI labels were consistent across contexts/relationships, 47% indicated that they used different labels to describe their SO or GI depending on the context. The focus group discussions revealed ways in which participants struggled to label their SO/GI on forms: They reported that (1) their authentic SO/GI labels were not among the commonly listed labels or (2) they felt that labeling their SO/GI identities was problematic. Participants reported that choosing a label that did not fit their lived experience was not only inaccurate, but could also feel painful and alienating. These findings hold implications for the collection and interpretation of patient SO/GI information, both for epidemiological purposes and for patient-centered care.
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Affiliation(s)
- Kathryn L Scheffey
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, PPMC Andrew Mutch Building, Floor 7, 51 N. 39th Street, Philadelphia, PA, 19104, USA
| | - Shannon N Ogden
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, PPMC Andrew Mutch Building, Floor 7, 51 N. 39th Street, Philadelphia, PA, 19104, USA
| | - Melissa E Dichter
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, PPMC Andrew Mutch Building, Floor 7, 51 N. 39th Street, Philadelphia, PA, 19104, USA.
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Philadelphia, PA, USA.
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46
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Chhabra M, Sorrentino AE, Cusack M, Dichter ME, Montgomery AE, True G. Screening for Housing Instability: Providers' Reflections on Addressing a Social Determinant of Health. J Gen Intern Med 2019; 34:1213-1219. [PMID: 30993632 PMCID: PMC6614210 DOI: 10.1007/s11606-019-04895-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/19/2018] [Accepted: 01/03/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND The Veterans Health Administration (VHA) has a long history of addressing social determinants of health, including housing. In 2012, the VA integrated a two-question Homelessness Screening Clinical Reminder (HSCR) into the electronic medical record in outpatient clinics to identify Veterans experiencing housing instability and ensure referral to appropriate services. OBJECTIVE This study explores perspectives of VA clinical providers regarding administration of the HSCR, their role in addressing housing status, and how a patient's housing status impacts clinical decision-making. DESIGN We conducted a qualitative study using in-depth semi-structured interviewing. PARTICIPANTS Twenty-two providers were interviewed (20 physicians and two nurse practitioners) between March and September 2016. APPROACH Interviews were conducted with Veterans Health Administration (VHA) physician and non-physician practitioners who had administered the HSCR and documented at least five positive screens between 2013 and 2015. Our interview guide investigated provider experiences with administering the HSCR and addressing affirmative responses. The guide also elicited details about how patients' housing instability was identified (if at all) prior to implementation of the screening reminder, and how practices changed following implementation of the HSCR. Transcripts were analyzed using a modified grounded theory approach. KEY RESULTS Providers reported that the HSCR prompted them to incorporate patient housing status into routine assessment, which they typically did not do prior to its implementation. Providers discussed adverse impacts of housing instability on patients' overall health and described how they factored patients' housing instability into clinical decision-making. Although providers viewed the health system as having an important role in addressing housing concerns, there were mixed opinions on whether it was the role of providers to directly administer the screening. CONCLUSIONS Integration of a screener for housing instability into the electronic medical record increased provider attention to housing instability into the social history, and positive responses commonly impacted plans of care.
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Affiliation(s)
- Manik Chhabra
- U.S. Department of Veterans Affairs, Department of Medicine at the Cpl. Michael Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Anneliese E Sorrentino
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Philadelphia, PA, USA
| | - Meagan Cusack
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Philadelphia, PA, USA
| | - Melissa E Dichter
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Philadelphia, PA, USA.,University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Ann Elizabeth Montgomery
- U.S. Department of Veterans Affairs, National Center on Homelessness Among Veterans, Philadelphia, PA, USA. .,School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA. .,Health Services Research & Development, Mail Stop 151(A) - Pickwick Center, Birmingham VA Medical Center, 700 S 19th Street, Birmingham, AL, 35233, USA.
| | - Gala True
- U.S. Department of Veterans Affairs, South Central Mental Illness, Research, Education and Clinical Center, New Orleans, LA, USA.,School of Medicine, Louisiana State University, New Orleans, LA, USA
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Yu B, Montgomery AE, True G, Cusack M, Sorrentino A, Chhabra M, Dichter ME. The intersection of interpersonal violence and housing instability: Perspectives from women veterans. Am J Orthopsychiatry 2018; 90:63-69. [PMID: 30596443 PMCID: PMC6731153 DOI: 10.1037/ort0000379] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Women veterans in the United States face a disproportionate risk of housing instability (HI) and interpersonal violence (IV), largely perpetrated by intimate partners or involving nonpartner sexual violence, compared to both male veterans and nonveteran women. To explore the ways in which IV and HI intersect in the experiences of women veterans, we analyzed transcripts of in-depth qualitative interviews with 20 women veterans who had screened positive for HI at a Veterans Affairs Medical Center. Three broad themes emerged related to the intersection of IV (specifically intimate partner violence or nonpartner sexual violence) and HI among women veterans: (1) HI can be precipitated by and increase vulnerability to IV, (2) experiences of IV impact women's definitions of housing safety and security, and (3) IV can pose a barrier to accessing housing services and other support systems. Findings indicate areas for improvement to screening processes and service provision to more effectively address the co-occurring and interacting safety and housing needs of women veterans. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Benjamin Yu
- Department of Family Medicine and Community Health
| | | | - Gala True
- South Central Mental Illness Research, Education, and Clinical Center
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Brignone E, Sorrentino AE, Roberts CB, Dichter ME. Suicidal ideation and behaviors among women veterans with recent exposure to intimate partner violence. Gen Hosp Psychiatry 2018; 55:60-64. [PMID: 30412860 DOI: 10.1016/j.genhosppsych.2018.10.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/22/2018] [Accepted: 10/22/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Women veterans have disproportionately high risk for both suicide and intimate partner violence compared to women non-veterans. The objective of this study was to assess the relationship between intimate partner violence (IPV) and suicidal ideation and suicidal or self-harm behaviors among women veterans. METHOD Veterans Health Administration (VHA) electronic medical records were extracted for 8427 women veterans who completed screening for past-year IPV between April 2014 and 2016. Risk for suicidal ideation and self-harm behaviors were estimated as function of screening results using logistic regression. RESULTS Overall, 8.4% screened positive for IPV. Suicidal ideation or self-harm behaviors were recorded for 3.2%. Positive IPV screen was associated with double the odds for suicidal ideation (AOR = 2.04; 95% CI = 1.47-2.86) and self-harm behaviors (AOR = 2.05, 95% CI = 1.10-3.83). Risks did not significantly differ by IPV type. Suicide-related ICD codes were most often recorded prior to IPV screening. CONCLUSIONS There is a strong association between positive IPV screen and suicidal ideation and self-harm behaviors among VHA-engaged women veterans. Documentation of either event is an important marker for the other. Integration of suicide prevention with IPV services may enhance identification of women at risk and speed service uptake. Suicidal ideation and behaviors should be assessed among women with positive IPV screens, and identification of suicide risk should trigger IPV assessment.
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Affiliation(s)
- Emily Brignone
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States.
| | - Anneliese E Sorrentino
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Christopher B Roberts
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Melissa E Dichter
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States; Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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Affiliation(s)
- Karin V Rhodes
- Office of Population Health Management, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Melissa E Dichter
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- US Department of Veterans Affairs Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania
| | - Kristofer L Smith
- Office of Population Health Management, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
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Dichter ME, Teitelman A, Klusaritz H, Maurer DM, Cronholm PF, Doubeni CA. Trauma-Informed Care Training in Family Medicine Residency Programs Results From a CERA Survey. Fam Med 2018; 50:617-622. [PMID: 30215822 DOI: 10.22454/fammed.2018.505481] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Experiences of psychological trauma are common among primary care patient populations, and adversely affect patients' health and health care utilization. Trauma-informed care (TIC) is a framework for identifying and responding to patients' experiences of psychological trauma to avoid retraumatization. The purpose of this study was to evaluate the current state of TIC training in family medicine residency programs in the United States in order to identify opportunities for and barriers to TIC training. METHODS Items addressing the four core domains of TIC were incorporated into the 2017 Council of Academy Family Medicine Educational Research Alliance (CERA) survey of program directors. The items assessed the presence, content, and sufficiency of TIC curriculum, as well as barriers to further integration of TIC training. RESULTS Approximately 50% of programs responded to the survey. Of 263 respondents, 71 (27%) reported TIC training in their curriculum, but the majority devoted less than 5 hours annually to core content. The content most commonly addressed recognizing signs of trauma, most frequently using didactic formats. Overall, just over one-half of the programs reported that their curriculum met patients' TIC needs "somewhat" (48.5%) or "a great deal" (4.6%). Lack of a champion followed by lack of time were the most commonly cited barriers to integrating TIC training. CONCLUSIONS Despite the acknowledged importance of effects of trauma in health care, this study identified insufficient exposure to training in the core TIC domains in family medicine residency programs, underscoring a need for greater integration of TIC training during residency.
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Affiliation(s)
- Melissa E Dichter
- University of Pennsylvania Perelman School of Medicine, Department of Family and Community Medicine
| | | | - Heather Klusaritz
- University of Pennsylvania Perelman School of Medicine, Department of Family and Community Medicine
| | | | - Peter F Cronholm
- Department of Family and Community Health, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Chyke A Doubeni
- University of Pennsylvania Perelman School of Medicine, Department of Family and Community Medicine
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