Headache Disorders in VHA Primary Care: Prevalence, Psychiatric Comorbidity, and Health Care Utilization.

Military veterans are at increased risk for headache disorders compared to the general population, yet the prevalence and burden associated with headache disorders among veterans is not yet well understood. In this electronic medical record study, we examined the prevalence of headache disorders among veterans seen in a northeastern network of Veterans Health Administration (VHA) primary care during 2017-2018. We also examined rates of psychiatric comorbidity and health care utilization of veterans with headache disorders for the year following the date of the first headache code in the medical record. Of the total population of veterans in the network, 1.3% had a headache disorder and another 3.5% had a possible headache disorder. Migraine and chronic migraine represented the majority of cases. Posttraumatic stress disorder was the most frequent psychiatric comorbidity. Having a headache disorder was associated with higher rates of primary care, neurology, pain clinic, and mental health service use but not higher rates of emergency department or Whole Health (e.g., patient-centered, holistic health services) use. Prevalence findings are comparable to those previously found among veterans, but a substantial proportion of veterans may have been misdiagnosed. Veterans with headache disorders have high rates of psychiatric comorbidity and use several types of health services at higher rates. Findings highlight the need for interdisciplinary care and further education and support for primary care providers. Primary care settings that integrate evidence-based behavioral and Whole Health services may be an optimal way of providing more holistic care for headache disorders.

Rates and Correlates of Alcohol and Substance Use Among Women Veterans During the COVID-19 Pandemic: The Moderating Role of COVID-Specific Anxiety.

INTRODUCTION: Mental health symptoms and substance use increased during the COVID-19 pandemic, and women may be disproportionately affected. Women report substantial mental health consequences, and women veterans may experience additional risks associated with military service. However, rates and correlates of substance use and consequences among women veterans are largely unknown. This study aimed to 1) report rates of substance use and consequences among women veterans; 2) identify correlates of substance use and consequences; and 3) test COVID-specific anxiety as a moderator. METHOD: Women veterans (n = 209) enrolled in Veterans Health Administration primary care completed measures of demographics, psychiatric and substance use disorder (SUD) diagnoses, current mental health symptoms, alcohol consumption, drug-related problems, and COVID-specific anxiety. Bivariate correlations evaluated demographics (age, race, employment, relationship status), psychiatric (depression/anxiety/posttraumatic stress disorder) and SUD diagnoses, and current mental health (depression/anxiety) symptoms as correlates of substance use outcomes. For any relationships between correlates and outcomes that were statistically significant, COVID-specific anxiety was tested as a moderator using the PROCESS macro in SPSS version 27. Any statistically significant moderation effects were further investigated using the PROCESS macro to estimate conditional effects. COVID-specific anxiety was mean-centered before analyses. Alpha was set to 0.05 for all statistical tests. RESULTS: Thirty-six percent screened positive for hazardous (Alcohol Use Disorder Identification Test-Consumption [AUDIT-C] ≥ 3) alcohol consumption and 26% reported drug-related problems (18% low-level, 7% moderate-level, and 2% substantial per Drug Abuse Screening Test [DAST-10] scores). Drug-related problems were positively associated with COVID-specific anxiety, psychiatric diagnosis, SUD diagnosis, and depression symptoms. Alcohol consumption was significantly associated with SUD diagnosis. COVID-specific anxiety significantly moderated relationships between SUD diagnosis and both outcomes. DISCUSSION: Results help identify women veterans with SUD diagnoses and high COVID-specific anxiety as at risk for increased substance use during COVID-19 and suggest a potential intervention target (COVID-specific anxiety).

Randomized Clinical Trial of Brief Primary Care-Based Mindfulness Training Versus a Psychoeducational Group for Veterans With Posttraumatic Stress Disorder.

Objective: Individuals with posttraumatic stress disorder (PTSD) symptoms are often reluctant to engage in traditional mental health care but do seek primary care services. Alternative strategies are needed to develop emotional regulation skills among individuals with PTSD symptoms. This study examined the feasibility and effectiveness of Primary Care Brief Mindfulness Training (PCBMT) compared to a psychoeducational group for reducing PTSD symptoms.Methods: Primary care patients (n = 55) with DSM-5 PTSD symptoms but not engaged in PTSD psychotherapies were randomized to 4-week PCBMT or a PTSD psychoeducation group (EDU). Both groups were cofacilitated by mental health providers and veteran peer specialists. Between January 2019 and March 2020, assessments were completed at baseline, post-treatment, and 16- and 24-week follow-up.Results: PCBMT participants had significantly larger decreases in PTSD symptoms from pre- to post-treatment (d = 0.57) and depression from pre-treatment to 16- and 24-week follow-ups (d = 0.67, 0.60) compared to EDU. PCBMT participants also reported significantly greater improvements in health responsibility (d = 0.79), stress management (d = 0.99), and not feeling dominated by symptoms (d = 0.71). Both interventions resulted in the majority of participants "stepping up" to a higher level of PTSD care.Conclusions: Brief mindfulness training is effective for reducing psychiatric symptoms and improving broader recovery outcomes and health promoting behaviors. For individuals who are not yet willing to engage in trauma-focused PTSD treatment, PCBMT may be preferable and more effective than psychoeducational classes as preliminary treatments. Further research is needed to confirm the effectiveness of PCBMT in a larger sample and investigate factors that will support wider implementation in primary care settings.Clinical Trials Registration: ClinicalTrials.gov identifier: NCT03352011.

Understanding Who Uses Whole Health Services: A Program Evaluation.

Background: The Veterans Health Administration is rolling out a Whole Health system of care as part of an enhanced focus on proactive, person-centered healthcare. Objective: Our program evaluation seeks to characterize what Veterans use Whole Health services, for what diagnoses they are seeking Whole Health services, and to examine "high utilizers" of Whole Health services. Methods: Data were collected on 174 Veterans using Whole Health services from December 2018 through March 2020 and consisted of chart review and self-report data. Results: Women were more likely than men Veterans to use individual only Whole Health services. High utilizers (the top 30% of the sample in Whole Health services used) were more likely to attend groups than the remainder of the sample. Conclusion: Future work should examine the community-building aspects of Whole Health and ways to create group programming tailored to women Veterans.

Relationship of rumination and self-compassion to posttraumatic stress symptoms among Veterans.

Past research demonstrates interrelationships amongst rumination, self-compassion, and posttraumatic stress disorder (PTSD) symptoms. However, little research has considered rumination and self-compassion together in relation to PTSD in clinical populations. In this cross-sectional study, we examined the unique effect of self-compassion on PTSD beyond the effect of rumination. Secondarily, we examined if rumination mediates the effect of self-compassion on PTSD. Participants included 52 US military Veterans (73.1% male) enrolled in a community support program for PTSD who completed self-report measures of study variables at one time point. Hierarchical regression results showed rumination was related to higher PTSD scores (f2 = .12; small ES) in step one, and the addition of self-compassion in step two was related to lower PTSD scores (f2 = .10; small ES) and explained a unique 9% of the variance. In contrast to previous research, results showed self-compassion mediated the relationship between rumination and PTSD, with a significant indirect effect (ab) of .20 (95% confidence interval [CI] = .028 to .457). Findings suggest the explanatory value of self-compassion for PTSD after accounting for rumination and may also reflect a process where rumination about behaviors one regrets gives rise to uncompassionate responding, which then contributes to greater PTSD.