RESUMO
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.
RESUMO
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.
RESUMO
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.