Prevalence of Obstructive Sleep Apnea Among Veterans and Nonveterans.

PURPOSE: Understanding disease prevalence can inform treatment and resource needs across populations. This study aimed to identify the prevalence of sleep apnea (OSA) among veterans and nonveterans. DESIGN: The national Comparative Health Assessment Interview Study, cross-sectional survey using probability-based sampling frames. SETTING: Surveys completed by Internet or phone. SUBJECTS: 15,166 veterans (40% response rate) and 4,654 nonveterans (57% response rate). MEASURES: Self-report of healthcare provider-based diagnosis of OSA. ANALYSIS: Calculation of prevalence of OSA using statistical weighting to allow for direct comparison between veterans and nonveterans. Secondary analyses evaluated OSA by deployment status among veterans and compared average age of OSA diagnosis and differences in OSA prevalence among veterans and nonveterans stratified by gender, marital status, race/ethnicity, and posttraumatic stress disorder diagnosis. RESULTS: OSA diagnosis was more than twice as prevalent among veterans (21%, 95% CI 20%-22%) than nonveterans (9%, 95% CI 8%-10%; aOR: 2.56, 95% CI 2.22-2.95, P < .001). Deployment was associated with higher odds of OSA among veterans (aOR: 1.64, 95% CI 1.43-18.7, P < 001.) Veterans were diagnosed with OSA on average 5 years earlier than nonveterans. CONCLUSION: Veterans have a high prevalence rate of OSA, highlighting the importance of veterans' access to treatment. OSA is likely underdiagnosed in nonveterans, particularly among racial/ethnic minoritized groups. Future research should investigate disparities in access to diagnostic testing for racial/ethnic minority nonveterans and/or risk factors for OSA among racial/ethnic minority veterans. The increased odds of OSA among those with PTSD highlights in the importance of early referral for OSA testing by providers as well as development of trauma-informed strategies to promote OSA treatment adherence. Limitations include a bias toward underestimation of true disease prevalence due to self-report of diagnosis.

Trauma exposure, mental health, and mental health treatment among LGBTQ+ veterans and nonveterans.

OBJECTIVE: The purpose of the study was to compare lesbian, gay, bisexual, transgender, queer+ (LGBTQ+) veterans' and nonveterans' prevalence of potentially traumatic events (PTEs) and other stressor exposures, mental health concerns, and mental health treatment. METHOD: A subsample of veterans and nonveterans who identified as LGBTQ+ (N = 1,291; 851 veterans; 440 nonveterans) were identified from a national cohort of post-9/11 veterans and matched nonveterans. Majority of the sample identified as White (59.7%), men (40.4%), and gay or lesbian (48.6%). Measures included PTEs and other stressors, depression, anxiety, posttraumatic stress disorder (PTSD), and receipt of mental health treatment. Logistic regressions compared the likelihood of experiencing PTEs and other stressors, self-reported mental health diagnoses, and mental health treatment between LGBTQ+ veterans and nonveterans. RESULTS: Compared with LGBTQ+ nonveterans, LGBTQ+ veterans were more likely to report financial strain, divorce, discrimination, witnessing the sudden death of a friend or family member, and experiencing a serious accident or disaster. LGBTQ+ veterans reported greater depression, anxiety, and PTSD symptom severity than LGBTQ+ nonveterans. However, LGBTQ+ veterans were only more likely to receive psychotherapy for PTSD and did not differ from nonveterans in the likelihood of receiving any other types of mental health treatment. CONCLUSIONS: The study was the first to demonstrate that LGBTQ+ veterans have a greater prevalence of PTEs and other stressors and report worse mental health symptoms. These findings suggest that LGBTQ+ veterans may have unmet mental health treatment needs and need interventions to increase engagement in needed mental health services, especially for depression and anxiety. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Gender as a moderator of associations between military sexual trauma and posttraumatic stress disorder treatment utilization.

The present study sought to investigate whether gender moderates the relationship between military sexual trauma (MST) and posttraumatic stress disorder (PTSD) treatment utilization, among veterans with clinically significant PTSD symptoms. Participants were 2,664 veterans with probable PTSD from a nationwide, population-based survey. Participants reported sociodemographic information, history of MST (including military sexual harassment and military sexual assault), and lifetime receipt of PTSD psychotherapy and medication treatment. We found that gender significantly moderated relationships between (a) military sexual harassment and PTSD psychotherapy, (b) military sexual assault and PTSD psychotherapy, and (c) military sexual harassment and PTSD medication. For women, MST was associated with a greater likelihood of receiving treatment, but for men, MST was not associated with PTSD treatment. Future research is needed to better understand gender differences in how experiences of MST may affect engagement in PTSD treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Prevalence and Correlates of Food and/or Housing Instability among Men and Women Post-9/11 US Veterans.

Food and/or housing instability (FHI) has been minimally examined in post-9/11 US veterans. A randomly selected nationally representative sample of men and women veterans (n = 38,633) from the post-9/11 US veteran population were mailed invitation letters to complete a survey on health and well-being. Principal component analysis and multivariable logistic regression were used to identify FHI's key constructs and correlates for 15,166 men and women respondents (9524 men, 5642 women). One-third of veterans reported FHI; it was significantly more likely among women than men (crude odds ratio = 1.31, 95% CI:1.21-1.41) and most prevalent post-service (64.2%). "Mental Health/Stress/Trauma", "Physical Health", and "Substance Use" were FHI's major constructs. In both sexes, significant adjusted associations (p < 0.01) were found between FHI and homelessness, depression, adverse childhood experiences, low social support, being enlisted, being non-deployed, living with seriously ill/disabled person(s), and living in dangerous neighborhoods. In men only, posttraumatic stress disorder (adjusted odds ratio (AOR) = 1.37, 95% CI:1.14-1.64), cholesterol level (elevated versus normal, AOR = 0.79, 95% CI:0.67-0.92), hypertension (AOR = 1.25, 95% CI:1.07-1.47), and illegal/street drug use (AOR = 1.28, 95% CI:1.10-1.49) were significant (p < 0.01). In women only, morbid obesity (AOR = 1.90, 95%CI:1.05-3.42) and diabetes (AOR = 1.53, 95% CI:1.06-2.20) were significant (p < 0.05). Interventions are needed that jointly target adverse food and housing, especially for post-9/11 veteran women and enlisted personnel.

Perceived social support moderates the relations between mental health symptoms and current suicidal ideation.

Despite efforts to identify risk factors associated with suicidal ideation (SI), less work has been conducted to highlight protective factors to promote prevention. Perceived social support has been shown to positively impact a wide range of psychological outcomes; however, prior efforts exploring whether perceived social support moderates the relationship between mental health (MH) symptoms and current SI among men and women have been hampered by limitations. To address knowledge gaps, data from the Comparative Health Assessment Interview Research Study was used to evaluate whether (a) perceived social support moderates the relationship between mental health symptoms (posttraumatic stress, anxiety, alcohol use, depressive) and current SI among veterans and nonveterans; (b) the strength of this moderating effect varies by gender and veteran status; and (c) the strength of this moderating effect varies by social support source (significant other, friend, family). Results suggest that perceived social support is more protective against SI for those with lower levels of mental health symptoms (≤ 25th percentile) than for those with higher symptom levels (≥ 75th percentile). Findings were largely consistent across study groups, support sources, and mental health symptoms examined; however, a significant moderating effect on the alcohol use-SI relationship was only observed for veteran men. Those with a lower mental health symptom severity may receive more benefit from strategies aimed at increasing perceived social support compared to those with higher symptom severity. Research is needed to match protective factors to individual phenotypes, with the goal of engaging those living with SI in more effective interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Which veterans with PTSD are most likely to report being told of their diagnosis?

Veterans who do not know about their posttraumatic stress disorder (PTSD) diagnosis experience a fundamental barrier to accessing effective treatment. Little is known about the characteristics that influence veterans' PTSD diagnosis knowledge (i.e., report of being told they have a PTSD diagnosis by a healthcare provider). Veterans who met probable and provisional criteria for PTSD on the self-report PTSD checklist for DSM-5 were identified from the Comparative Health Assessment Interview Research Study (n = 2335). Weighted logistic regression was performed to identify demographic variables, clinical characteristics, and social determinants of health (e.g., economic instability, homelessness, healthcare coverage) associated with PTSD diagnosis knowledge among post-9/11 veterans. Approximately 62% of veterans with probable and provisional PTSD had PTSD diagnosis knowledge. Predictors with the strongest associations included another mental health diagnosis (OR = 6.10, CI95:4.58,8.12) and having Veterans Affairs (VA) healthcare coverage (OR = 2.63, CI95:1.97,3.51). Veterans with combat or sexual trauma were more likely to have PTSD diagnosis knowledge than those with different trauma types. Results suggest veterans with VA healthcare coverage and military-related trauma are more likely to be informed by a healthcare professional about a PTSD diagnosis. Further research is needed to improve PTSD diagnosis knowledge for those with non-military-related trauma and those without VA healthcare coverage.

Suicide Risk Among US Veterans With Military Service During the Vietnam War.

Importance: There are persistent questions about suicide deaths among US veterans who served in the Vietnam War. It has been believed that Vietnam War veterans may be at an increased risk for suicide. Objective: To determine whether military service in the Vietnam War was associated with an increased risk of suicide, and to enumerate the number of suicides and analyze patterns in suicides among Vietnam War theater veterans compared with the US population. Design, Setting, and Participants: This cohort study compiled a roster of all Vietnam War-era veterans and Vietnam War theater veterans who served between February 28, 1961, and May 7, 1975. The 2 cohorts included theater veterans, defined as those who were deployed to the Vietnam War, and nontheater veterans, defined as those who served during the Vietnam War era but were not deployed to the Vietnam War. Mortality in these 2 cohorts was monitored from 1979 (beginning of follow-up) through 2019 (end of follow-up). Data analysis was performed between January 2022 and July 2023. Main Outcomes and Measures: The outcome of interest was death by suicide occurring between January 1, 1979, and December 31, 2019. Suicide mortality was ascertained from the National Death Index. Hazard ratios (HRs) that reflected adjusted associations between suicide risk and theater status were estimated with Cox proportional hazards regression models. Standardized mortality rates (SMRs) were calculated to compare the number of suicides among theater and nontheater veterans with the expected number of suicides among the US population. Results: This study identified 2 465 343 theater veterans (2 450 025 males [99.4%]; mean [SD] age at year of entry, 33.8 [6.7] years) and 7 122 976 nontheater veterans (6 874 606 males [96.5%]; mean [SD] age at year of entry, 33.3 [8.2] years). There were 22 736 suicides (24.1%) among theater veterans and 71 761 (75.9%) among nontheater veterans. After adjustments for covariates, Vietnam War deployment was not associated with an increased risk of suicide (HR, 0.94; 95% CI, 0.93-0.96). There was no increased risk of suicide among either theater (SMR, 0.97; 95% CI, 0.96-0.99) or nontheater (SMR, 0.97; 95% CI, 0.97-0.98) veterans compared with the US population. Conclusions and Relevance: This cohort study found no association between Vietnam War-era military service and increased risk of suicide between 1979 and 2019. Nonetheless, the 94 497 suicides among all Vietnam War-era veterans during this period are noteworthy and merit the ongoing attention of health policymakers and mental health professionals.

Factors associated with receipt of minimally adequate psychotherapy for PTSD at the Veterans Health Administration.

BACKGROUND: Despite Veterans Health Administration (VHA) efforts, many Veterans do not receive minimally adequate psychotherapy (MAP) for posttraumatic stress disorder (PTSD). It is important to understand factors associated with receipt of PTSD MAP (at least eight sessions) so that we may tailor efforts to increase treatment utilization for those who experience the greatest barriers to care. METHODS: Participants were 2008 post-9/11 Veterans who participated in a nationwide survey and had a PTSD diagnosis documented in the VHA electronic health record (EHR) before 2018. Participants self-reported sociodemographic information and trauma history. Service utilization data (e.g., PTSD MAP) were obtained from EHR. Logistic regression was used to model factors associated with PTSD MAP. RESULTS: Only 24% of Veterans (n = 479) received PTSD MAP. Veterans who reported that they were not employed and had reported history of military sexual trauma were more likely to have received PTSD MAP. CONCLUSIONS: Understanding and addressing barriers to PTSD care for Veterans who are employed could help improve PTSD treatment utilization for this group.

Comparison of Health Outcomes Over Time Among Women 1990-1991 Gulf War Veterans, Women 1990-1991 Gulf Era Veterans, and Women in the U.S. General Population.

INTRODUCTION: The aim of this study is to examine health over almost 20 years of follow-up among women Gulf War veterans and women Gulf Era veterans and compare their health to that of women in the U.S. general population. METHODS: We used data from a health survey of 1,274 women Gulf War veteran and Gulf Era veteran participants of the Gulf War Longitudinal Study who responded to all three waves. Data on the U.S. population of women came from the 1999-2000, 2005-2006, and 2011-2014 National Health and Nutrition Examination Survey (NHANES). Generalized estimating equations (GEEs) were used to compare the report of disease over time in women Gulf War and Gulf Era veterans. Differences in prevalence at the three survey timepoints were calculated between women Gulf War veterans and the NHANES women population, and women Gulf War Era veterans and the NHANES women population. RESULTS: Women veterans who deployed to the 1990-1991 Gulf War report poorer health than women veterans who served during the same time but did not deploy. Women veterans reported a lower prevalence of hypertension, stroke, and diabetes than women in the NHANES sample. Women veterans also reported a higher prevalence of arthritis, chronic obstructive pulmonary disease, and skin cancer than women in the NHANES sample. CONCLUSIONS: This study is the first to characterize the health of a population-based cohort of women Gulf War and women Gulf Era veterans over time and compare it with women's health in a civilian NHANES population. This demonstrates the value of epidemiological research on women veterans and the importance of developing longitudinal cohorts across genders.

International perspective on military exposure data sources, applications, and opportunities for collaboration.

Military personnel may be exposed to a range of hazards. The assessment, documentation and reporting of military exposure information are important steps to guide health protection, services, and research to support actively serving members and veterans. In 2021, a Working Group of researchers from veteran and defense administrations across the Five Eyes countries (Australia, Canada, New Zealand, the United Kingdom, and the United States) was established to examine large military exposure data sources available in each country, their applications, and opportunities to leverage information across administrations and internationally. We provide a brief summary of this work here to highlight some successful examples of data applications and to elicit interest in this evolving area of exposure science.

Relationship of social determinants of health with symptom severity among Veterans and non-Veterans with probable posttraumatic stress disorder or depression.

PURPOSE: Social determinants of health (SDoH) refer to the conditions in the environments in which people live that affect health outcomes and risks. SDoH may provide proximal, actionable targets for interventions. This study examined how SDoH are associated with posttraumatic stress disorder (PTSD) and depression symptoms among Veterans and non-Veterans with probable PTSD or depression. METHODS: Four multiple regressions were conducted. Two multiple regressions with Veterans examined the impact of SDoH on PTSD symptoms and on depression symptoms. Two multiple regressions with non-Veterans examined the impact of SDoH on PTSD symptoms and on depression symptoms. Independent variables included demographic characteristics, adverse experiences (in childhood and adulthood), and SDoH (discrimination, education, employment, economic instability, homelessness, justice involvement, and social support). Correlates that were statistically significant (p < 0.05) and clinically meaningful (rpart >|0.10|) were interpreted. RESULTS: For Veterans, lower social support (rpart = - 0.14) and unemployment (rpart = 0.12) were associated with greater PTSD symptoms. Among non-Veterans, greater economic instability (rpart = 0.19) was associated with greater PTSD symptoms. In the depression models, lower social support (rpart = - 0.23) and greater economic instability (rpart = 0.12) were associated with greater depression for Veterans, while only lower social support was associated with greater depression for non-Veterans (rpart = - 0.14). CONCLUSION: Among Veterans and non-Veterans with probable PTSD or depression, SDoH were associated with PTSD and depression symptoms, particularly social support, economic instability, and employment. Beyond direct treatment of mental health symptoms, addressing social support and economic factors such as instability and employment in the context of PTSD and depression are potential intervention targets that would benefit from future research.

Alcohol use and treatment utilization in a national sample of veterans and nonveterans.

BACKGROUND: Research comparing prevalence of alcohol use problems and alcohol treatment utilization between veterans and nonveterans is lacking. Whether predictors of alcohol use problems and alcohol treatment utilization differ in veterans vs. nonveterans is also unclear. METHODS: Using survey data from national samples of post-9/11 veterans and nonveterans (N = 17,298; 13,451 veterans, 3847 nonveterans), we investigated associations between veteran status and 1) alcohol consumption, 2) need for intensive alcohol treatment, and 3) past-year and lifetime alcohol treatment utilization. We also investigated associations between predictors and these three outcomes in separate models for veterans and nonveterans. Predictors included age, gender, racial/ethnic identity, sexual orientation, marital status, education, health coverage, financial difficulty, social support, adverse childhood experiences (ACEs), and adult sexual trauma. RESULTS: Population weighted regression models demonstrated that veterans reported modestly higher alcohol consumption than nonveterans, but were not significantly more likely to need intensive alcohol treatment. Veterans and nonveterans did not differ in past-year alcohol treatment utilization, but veterans were 2.8 times more likely to utilize lifetime treatment than nonveterans. We found several differences between veterans and nonveterans in associations between predictors and outcomes. For veterans, being male, having higher financial difficulty, and lower social support were associated with need for intensive treatment, but for nonveterans, only ACEs were associated with need for intensive treatment. CONCLUSIONS: Veterans may benefit from interventions with social and financial support to reduce alcohol problems. These findings can help to identify veterans and nonveterans who are more likely to need treatment.

Physical health of Post-9/11 U.S. Military veterans in the context of Healthy People 2020 targeted topic areas: Results from the Comparative Health Assessment Interview Research Study.

Large-scale epidemiological studies suggest that veterans may have poorer physical health than nonveterans, but this has been largely unexamined in post-9/11 veterans despite research indicating their high levels of disability and healthcare utilization. Additionally, little investigation has been conducted on sex-based differences and interactions by veteran status. Notably, few studies have explored veteran physical health in relation to national health guidelines. Self-reported, weighted data were analyzed on post-9/11 U.S. veterans and nonveterans (n = 19,693; 6,992 women, 12,701 men; 15,160 veterans, 4,533 nonveterans). Prevalence was estimated for 24 physical health conditions classified by Healthy People 2020 targeted topic areas. Associations between physical health outcomes and veteran status were evaluated using bivariable and multivariable analyses. Back/neck pain was most reported by veterans (49.3 %), twice that of nonveterans (22.8 %)(p < 0.001). Adjusted odds ratios (AORs) for musculoskeletal and hearing disorders, traumatic brain injury, and chronic fatigue syndrome (CFS) were 3-6 times higher in veterans versus nonveterans (p < 0.001). Women versus men had the greatest adjusted odds for bladder infections (males:females, AOR = 0.08, 95 % CI:0.04-0.18)(p < 0.001), and greater odds than men for multiple sclerosis, CFS, cancer, irritable bowel syndrome/colitis, respiratory disease, some musculoskeletal disorders, and vision loss (p < 0.05). Cardiovascular-related conditions were most prominent for men (p < 0.001). Veteran status by sex interactions were found for obesity (p < 0.03; greater for male veterans) and migraine (p < 0.01; greater for females). Healthy People 2020 targeted topic areas exclude some important physical health conditions that are associated with being a veteran. National health guidelines for Americans should provide greater consideration of veterans in their design.

Treatment Utilization for Posttraumatic Stress Disorder in a National Sample of Veterans and Nonveterans.

OBJECTIVE: The current study sought to compare rates of posttraumatic stress disorder (PTSD) treatment utilization (medication and psychotherapy) among veterans and nonveterans-and to investigate which factors are associated with treatment utilization among veterans versus nonveterans. METHODS: Participants were 2775 individuals (veteran, n=2508; nonveteran, n=267) meeting criteria for probable PTSD (determined by the PTSD Checklist) drawn from a nationwide, population-based survey. Participants reported demographic information, trauma history, mental health symptoms, insurance coverage, and treatment history. RESULTS: Analyses revealed that the majority of veterans and nonveterans with probable PTSD had not received any PTSD treatment (56% of veterans and 86% of nonveterans). Population-weighted logistic regression models demonstrated that veterans with probable PTSD were substantially more likely to receive medication and psychotherapy for PTSD than nonveterans with probable PTSD. Logistic regression models demonstrated that, among veterans, having Veterans Affairs health care coverage was most strongly associated with receiving PTSD medication and psychotherapy. Black (vs. White) veterans were less likely to have received PTSD medication and psychotherapy. In contrast, among nonveterans, being married or divorced (vs. never married) was most strongly associated with receiving PTSD medication, and reporting a history of sexual trauma was most strongly associated with receiving PTSD psychotherapy. CONCLUSION: Given that most individuals do not receive PTSD treatment, additional understanding of treatment barriers and facilitators for both veterans and nonveterans is needed to improve intervention reach.

"Development and validation of a brief warfare exposure measure among U.S. Iraq and Afghanistan war veterans: The Deployment Risk and Resilience Inventory-2 Warfare Exposure-Short Form (DRRI-2 WE-SF)": Correction.

Reports an error in "Development and validation of a brief warfare exposure measure among U.S. Iraq and Afghanistan war veterans: The Deployment Risk and Resilience Inventory-2 Warfare Exposure-Short Form (DRRI-2 WE-SF)" by Michelle J. Bovin, Aaron Schneiderman, Paul A. Bernhard, Shira Maguen, Claire A. Hoffmire, John R. Blosnich, Brian N. Smith, Richard Kulka and Dawne Vogt (Psychological Trauma: Theory, Research, Practice, and Policy, Advanced Online Publication, Jun 02, 2022, np). In the original article, the following acknowledgment of funding was missing from the title page author note: "This material was based upon work supported by the United States Department of Veterans Affairs (VA), Veterans Health Administration, Patient Care Services, Health Outcomes Military Exposures Epidemiology Program as well as two VA Health Services Research and Development Service Grants "Validation of Modified DRRI Scales in a National Sample of OEF/OIF Veterans" (Project DHI 09-086, Dawne Vogt, Principal Investigator) and "Work and Family Functioning in Women Veterans: Implications for VA Service Use" (Project IIR 12-345, Dawne Vogt and Brian N. Smith, Principal Investigators)." All versions of this article have been corrected. (The following abstract of the original article appeared in record 2022-66811-001). OBJECTIVE: It is important to assess warfare experiences beyond direct combat exposure, as these exposures can negatively impact military veterans' health. Although two validated scales from the Deployment Risk and Resilience Inventory-2 [DRRI-2] together capture a broad range of stressful warfare experiences, the length of this combined measure (30 items) is prohibitively long for some settings. Therefore, the goal of this project was to develop and validate a short form Warfare Exposure measure (DRRI-2-WE-SF). METHOD: U.S. veterans deployed for the wars in Iraq and Afghanistan completed questionnaires across 2 studies (study 1, N = 1046; study 2, N = 7141) to develop and validate the DRRI-2 WE-SF. RESULTS: Study 1 involved developing the DRRI-2 WE-SF, a 9-item self-report instrument with strong internal consistency (α = .86) and large correlations with the full Warfare Exposure measure (r = .97). In study 2, the DRRI-2 WE-SF again demonstrated high levels of reliability and validity and evidenced high levels of classification accuracy (89.7% correct classification) and significant time savings (all ts > 39; all ps < .05) in comparison to the full measure. CONCLUSIONS: The DRRI-2 WE-SF is a psychometrically sound measure of direct exposures to warfare and its consequences. This measure of proximal warfare exposure retains the strong properties of the full measure while significantly reducing completion time. These properties make the DRRI-2 WE-SF a useful tool for efficiently evaluating proximal warfare exposure among individuals who have served in both combat and noncombat roles. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Moral injury and peri- and post-military suicide attempts among post-9/11 veterans.

BACKGROUND: Our goal was to examine the association between moral injury, mental health, and suicide attempts during military service and after separation by gender in post-9/11 veterans. METHODS: A nationally representative sample of 14057 veterans completed a cross-sectional survey. To examine associations of exposure to potentially morally injurious events (PMIEs; witnessing, perpetrating, and betrayal) and suicidal self-directed violence, we estimated two series of multivariable logistic regressions stratified by gender, with peri- and post-military suicide attempt as the dependent variables. RESULTS: PMIE exposure accounted for additional risk of suicide attempt during and after military service after controlling for demographic and military characteristics, current mental health status, and pre-military history of suicidal ideation and attempt. Men who endorsed PMIE exposure by perpetration were 50% more likely to attempt suicide during service and twice as likely to attempt suicide after separating from service. Men who endorsed betrayal were nearly twice as likely to attempt suicide during service; however, this association attenuated to non-significance after separation in the fully adjusted models. In contrast, women who endorsed betrayal were over 50% more likely to attempt suicide during service and after separation; PMIE exposure by perpetration did not significantly predict suicide attempts before or after service among women in the fully adjusted models. CONCLUSIONS: Our findings indicate that suicide assessment and prevention programs should consider the impact of moral injury and attend to gender differences in this risk factor in order to provide the most comprehensive care.

Development and validation of a brief warfare exposure measure among U.S. Iraq and Afghanistan war veterans: The Deployment Risk and Resilience Inventory-2 Warfare Exposure-Short Form (DRRI-2 WE-SF).

[Correction Notice: An Erratum for this article was reported online in Psychological Trauma: Theory, Research, Practice, and Policy on Jun 30 2022 (see record 2022-76274-001). In the original article, the following acknowledgment of funding was missing from the title page author note: "This material was based upon work supported by the United States Department of Veterans Affairs (VA), Veterans Health Administration, Patient Care Services, Health Outcomes Military Exposures Epidemiology Program as well as two VA Health Services Research and Development Service Grants "Validation of Modified DRRI Scales in a National Sample of OEF/OIF Veterans" (Project DHI 09-086, Dawne Vogt, Principal Investigator) and "Work and Family Functioning in Women Veterans: Implications for VA Service Use" (Project IIR 12-345, Dawne Vogt and Brian N. Smith, Principal Investigators)." All versions of this article have been corrected.] Objective: It is important to assess warfare experiences beyond direct combat exposure, as these exposures can negatively impact military veterans' health. Although two validated scales from the Deployment Risk and Resilience Inventory-2 [DRRI-2] together capture a broad range of stressful warfare experiences, the length of this combined measure (30 items) is prohibitively long for some settings. Therefore, the goal of this project was to develop and validate a short form Warfare Exposure measure (DRRI-2-WE-SF). METHOD: U.S. veterans deployed for the wars in Iraq and Afghanistan completed questionnaires across 2 studies (study 1, N = 1046; study 2, N = 7141) to develop and validate the DRRI-2 WE-SF. RESULTS: Study 1 involved developing the DRRI-2 WE-SF, a 9-item self-report instrument with strong internal consistency (α = .86) and large correlations with the full Warfare Exposure measure (r = .97). In study 2, the DRRI-2 WE-SF again demonstrated high levels of reliability and validity and evidenced high levels of classification accuracy (89.7% correct classification) and significant time savings (all ts > 39; all ps < .05) in comparison to the full measure. CONCLUSIONS: The DRRI-2 WE-SF is a psychometrically sound measure of direct exposures to warfare and its consequences. This measure of proximal warfare exposure retains the strong properties of the full measure while significantly reducing completion time. These properties make the DRRI-2 WE-SF a useful tool for efficiently evaluating proximal warfare exposure among individuals who have served in both combat and noncombat roles. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychosocial Outcomes Among Veteran and Non-Veteran Survivors of Sexual Assault.

Although it is well-established that sexual assault results in variable and long-lasting negative impacts on emotional well-being, perceptions of physical health, and relationship functioning, these "psychosocial" outcomes may vary based on the type(s) of sexual trauma experienced. To identify the differential impact of sexual trauma type(s) on psychosocial outcomes among veterans and non-veterans, we conducted a secondary analysis of data from the Comparative Health Assessment Interview Research Study, a large, national survey study sponsored by the Department of Veterans Affairs. Participants included veterans (n = 3588) and non-veterans (n = 935) who endorsed experiencing childhood sexual assault (CSA), adult sexual assault (ASA, outside of military service for veteran participants), and/or military sexual assault (MSA). Eight measures were used to assess psychosocial outcomes: Well-Being Inventory (WBI) health satisfaction and physical health functioning items, Posttraumatic Stress Disorder Checklist, Patient Health Questionnaire (depression symptoms), Generalized Anxiety Disorder Questionnaire, WBI social satisfaction items, WBI social functioning items, and the Multidimensional Scale of Perceived Social Support (social). A profile analysis was used to determine how sexual trauma type(s) influenced the pattern of responding to the eight psychosocial outcome measures. Veteran sexual assault survivors reported poorer psychological outcomes compared to non-veteran sexual assault survivors. Non-veteran sexual assault survivors reported poorer outcomes on the majority of social variables compared to veteran sexual assault survivors. Survivors of MSA-only reported poorer psychosocial outcomes compared to veteran and non-veteran survivors of CSA-only and ASA-only on most of the variables assessed. Survivors of ASA-only reported similar or modestly worse psychosocial outcomes when compared to survivors of CSA-only on the majority of variables assessed. Survivors of different types of sexual trauma reported distinct psychosocial outcomes, suggesting that assessment and treatment needs may differ by trauma type.

Strengths and vulnerabilities: Comparing post-9/11 U.S. veterans' and non-veterans' perceptions of health and broader well-being.

Background: Prior research has examined how the post-military health and well-being of both the larger veteran population and earlier veteran cohorts differs from non-veterans. However, no study has yet to provide a holistic examination of how the health, vocational, financial, and social well-being of the newest generation of post-9/11 U.S. military veterans compares with their non-veteran peers. This is a significant oversight, as accurate knowledge of the strengths and vulnerabilities of post-9/11 veterans is required to ensure that the needs of this population are adequately addressed, as well as to counter inaccurate veteran stereotypes. Methods: Post-9/11 U.S. veterans' (N = 15,160) and non-veterans' (N = 4,533) reported on their health and broader well-being as part of a confidential web-based survey in 2018. Participants were drawn from probability-based sampling frames, and sex-stratified weighted logistic regressions were conducted to examine differences in veterans' and non-veterans' reports of health, vocational, financial, and social outcomes. Results: Although both men and women post-9/11 veterans endorsed poorer health status than non-veterans, they reported greater engagement in a number of positive health behaviors (healthy eating and exercise) and were more likely to indicate having access to health care. Veterans also endorsed greater social well-being than non-veterans on several outcomes, whereas few differences were observed in vocational and financial well-being. Conclusion: Despite their greater vulnerability to experiencing health conditions, the newest generation of post-9/11 U.S. veterans report experiencing similar or better outcomes than non-veterans in many aspects of their lives. Findings underscore the value of examining a wider range of health and well-being outcomes in veteran research and highlight a number of important directions for intervention, public health education, policy, and research related to the reintegration of military veterans within broader civilian society.

Moral injury and chronic pain in veterans.

Posttraumatic stress disorder (PTSD) and chronic pain are highly prevalent and co-morbid among veterans. Moral injury (MI), which results from traumatic experiences that conflict with deeply held moral beliefs, is also associated with pain. However, relationships between different types of exposures to potentially morally injurious events (PMIEs) and pain have not yet been investigated. In the current study, we investigated these relationships between exposure to PMIEs (betrayal, witnessing, and perpetration) and different types of pain (joint pain, muscle pain, and overall pain intensity), while controlling for other relevant variables (including PTSD symptoms, combat exposure, adverse childhood experiences, age, gender, and race/ethnicity). We also examined gender differences in these associations. Participants were 11,871 veterans drawn from a nationwide, population-based survey who self-reported exposure to PMIEs, PTSD symptoms, frequency of adverse childhood experiences, combat exposure, sociodemographic information, past six-month joint pain, past six-month muscle pain, and past week overall pain intensity. Population weighted regression models demonstrated that PMIEs were not significantly associated with joint or muscle pain, but that betrayal was associated with past week overall pain intensity, even when controlling for all other variables. Models investigating men and women separately found that for women, betrayal was associated with joint pain and pain intensity, but for men, betrayal was not associated with any pain outcome. These findings suggest that it may be especially important to assess betrayal when treating patients with a history of trauma and chronic pain.