Obsessive-compulsive symptoms, perceived burdensomeness, and thwarted belongingness: Associations and implications among US veterans.

OBJECTIVE: Obsessive-compulsive disorder (OCD) is among the most debilitating psychiatric disorders worldwide, but has gone relatively unnoticed within the US veteran population. Simultaneously, suicide rates continue to remain high within this population despite the high volume of veterans who receive psychiatric care. With recent research demonstrating OCD's unique relationship with suicidality, it is imperative to explore this association and factors that may explain this association within veterans. METHODS: The present study investigated OCD symptoms and their relationship with two known risk factors of suicide, perceived burdensomeness (PB) and thwarted belongingness (TB), in two samples of veterans. RESULTS: In the first study (N = 100), OCD symptoms were found to be uniquely related to both PB and TB even after covarying for demographics, trauma exposure, and probable depression. In the second study (N = 99), these relationships were replicated longitudinally. OCD symptoms at baseline were found to be indirectly related to suicidal ideation severity at a 1-month follow-up via PB and TB at post-treatment. CONCLUSION: This study highlights the importance of assessing and addressing OCD symptoms within veterans due to the unique relationship these symptoms have with suicidal constructs. A deeper understanding of the impact of OCD within the veteran population will inform future prevention and intervention efforts.

Efficacy of a brief web-based tonic immobility psychoeducation intervention among trauma-exposed adults: A randomized clinical trial.

Tonic immobility (TI) is a defensive response that may occur during traumatic events. Although TI is adaptive in certain circumstances, it has been shown to contribute to increased trauma-related symptoms and poorer recovery. However, current frontline treatments for posttraumatic stress disorder (PTSD) have not focused significant attention on the experience of TI. Thus, the aim of this study was to develop and test the impact of a brief TI-focused psychoeducation (TIP) intervention on posttraumatic cognitions and PTSD symptoms relative to a health education control intervention. The sample included 46 adults with elevated PTSD symptoms who endorsed prior TI episodes. After providing informed consent, participants were randomly assigned to either the active or control intervention and completed self-report questionnaires including the tonic immobility questionnaire (TIQ-R), Life Events Checklist for DSM-5 (LEC-5), Posttraumatic Stress Checklist for DSM-5 (PCL-5), Posttraumatic Cognitions Inventory (PTCI), and Positive and Negative Affect Schedule (PANAS) at baseline, 1-week, and 1-month follow-up assessments. Results from linear mixed effects models indicated that participants in the TIP condition reported significantly larger reductions in posttraumatic cognitions and PTSD symptoms at 1-week, ds = 0.48 and 0.84, respectively, and 1-month, ds = 0.67 and 0.74. The findings suggest that TIP is a promising intervention that may be used to reduce posttraumatic cognitions and PTSD symptoms associated with TI. Given the ease of access, TIP could be used as a standalone intervention or as an add-on to existing evidence-based treatments for PTSD.

Perceptions of childhood unpredictability, delay discounting, risk-taking, and adult externalizing behaviors: A life-history approach.

Guided by principles from life-history theory, theories of adaptive calibration provide an overarching theoretical framework for understanding the developmental roots of impulsivity and externalizing psychopathology. The current research provides evidence for robust associations between perceptions of childhood unpredictability, delay discounting (Studies 1a and 1b), and adult externalizing traits and behaviors (Study 2). Both associations were observed while controlling for perceptions of the harshness of childhood environments, as well as a range of demographic characteristics. The association with externalizing traits and behavior was observed over and above current mood and depressive symptoms. Study 2 also replicated a previously documented association between changes in maternal employment, residence, and cohabitation during childhood and externalizing behavior and, furthermore, suggested that this association was mediated by perceptions of unpredictability. These studies provided no evidence for links between perceived childhood unpredictability and basic forms of risk-taking (Studies 1a and 1c). This research adds to a growing body of work leveraging principles from life-history theory to demonstrate links between childhood experiences, impulsivity, and potentially debilitating forms of mental illness. This work also highlights the value of assessing people's perceptions of their childhood environments.

Depressive Symptoms Prospectively Predict Peer Victimization: A Longitudinal Study Among Adolescent Females.

Research has consistently demonstrated a relationship between peer victimization, a major issue in early adolescence, and depression. However, longitudinal studies examining the relationship between peer victimization and depressive symptoms have yielded mixed results. Thus, the current study examined how specific aspects of peer victimization and subtypes of depressive symptoms are related over a two-year period. Adolescent females (N = 265) completed a questionnaire battery at baseline and two-year follow-up. Results indicated that baseline depressive symptoms prospectively predict peer overt victimization, relational victimization, and decreased prosocial behaviors at follow-up; baseline peer victimization did not predict depressive symptoms at follow-up. Further, results demonstrate the differential predictive value of specific depressive symptoms for overt vs. relational aggression and decreased prosocial behavior. Taken together, this study provides insight into the impact of depressive symptoms on peer victimization and the importance of addressing peer relations in the context of treatment for adolescent depression.

Vulnerability to COVID-19-Related Disability: The Impact of Posttraumatic Stress Symptoms on Psychosocial Impairment During the Pandemic.

As a result of the COVID-19 pandemic, many individuals have experienced disruptions in social, occupational, and daily life activities. Individuals with mental health difficulties, particularly those with elevated posttraumatic stress symptoms (PTSS), may be especially vulnerable to increased impairment as a result of COVID-19. Additionally, demographic factors, such as age, gender, and race/ethnicity, may impact individual difficulties related to the pandemic. The current study examined the concurrent and prospective associations between posttraumatic stress disorder (PTSD) symptoms, broader anxiety and depression symptoms, and COVID-19-related disability. Participants recruited through Amazon's Mechanical Turk (N = 136) completed questionnaire batteries approximately 1 month apart during the COVID-19 pandemic (i.e., Wave 1 and Wave 2). The results indicated that PTSD, anxiety, and depressive symptoms were all associated with increased COVID-19-related disability across assessment points, rs = .44-.68. PTSD symptoms, specifically negative alterations in cognition and mood, significantly predicted COVID-19-related disability after accounting for anxiety and depressive symptoms as well as demographic factors, ßs = .31-.38. Overall, these findings suggest that individuals experiencing elevated PTSS are particularly vulnerable to increased functional impairment as a result of COVID-19 and suggest a need for additional outreach and clinical care among individuals with elevated PTSD symptoms during the pandemic.

Secondary prevention for posttraumatic stress and related symptoms among women whohave experienced a recent sexual assault: A systematic review and meta-analysis.

BACKGROUND: Women who have experienced a recent sexual assault (SA) are at high risk for posttraumatic stress disorder (PTSD) and related conditions, with approximately half of women experiencing SA meeting criteria for PTSD. There are no guidelines for the prevention of PTSD and other common mental health disorders after SA. Thus, the purpose of this systematic review and meta-analysis is to synthesize research on secondary preventions for PTSD after SA, determine efficacy whether any intervention seems promising, and ascertain when, how, and to whom interventions should be delivered. METHODS: After searching electronic databases for secondary preventions for PTSD and related conditions among women who have experienced a recent SA, 17 studies were reviewed, their quality was rated on the clinical trial assessment measure, and 10 studies were meta-analyzed (7 were excluded, as they were not randomized controlled trials or due to the absence of heterogeneity). RESULTS: Results suggested a small-to-moderate effect of prevention on reducing PTSD and related symptoms. There was no moderating effect of medication versus psychosocial interventions, timing, treatment modality, or targeted versus universal prevention. Half of the studies were of high quality. CONCLUSION: Cognitive-behavioral secondary preventions for PTSD appear to be safe and effective among women who have experienced a recent SA. Future research should identify best practices and mechanisms of treatment, and once identified, it should move toward implementation science.

Epidemiological and Clinical Gender Differences in OCD.

PURPOSE OF REVIEW: This review highlights recent research regarding gender differences in OCD, with a focus on prevalence, course of illness, symptom presentation, comorbidity, and treatment response. RECENT FINDINGS: Overall, findings remain mixed. OCD may be more common among males in childhood, but is more common among females in adolescence and adulthood. Males tend to report an earlier age of onset and present with symptoms related to blasphemous thoughts. Females often describe symptom onset as occurring during or after puberty or pregnancy and present with symptoms related to contamination and/or aggressive obsessions. Females also tend to report significantly higher depression and anxiety. There are no reported gender differences in treatment outcome. Gender may play a role in the onset, presentation, and impact of OCD symptoms. However, more work is needed to account for differences across studies, with one promising future direction being the study of reproductive hormones.

Cannabis, Cannabinoids, and Sleep: a Review of the Literature.

PURPOSE OF REVIEW: The current review aims to summarize the state of research on cannabis and sleep up to 2014 and to review in detail the literature on cannabis and specific sleep disorders from 2014 to the time of publication. RECENT FINDINGS: Preliminary research into cannabis and insomnia suggests that cannabidiol (CBD) may have therapeutic potential for the treatment of insomnia. Delta-9 tetrahydrocannabinol (THC) may decrease sleep latency but could impair sleep quality long-term. Novel studies investigating cannabinoids and obstructive sleep apnea suggest that synthetic cannabinoids such as nabilone and dronabinol may have short-term benefit for sleep apnea due to their modulatory effects on serotonin-mediated apneas. CBD may hold promise for REM sleep behavior disorder and excessive daytime sleepiness, while nabilone may reduce nightmares associated with PTSD and may improve sleep among patients with chronic pain. Research on cannabis and sleep is in its infancy and has yielded mixed results. Additional controlled and longitudinal research is critical to advance our understanding of research and clinical implications.

Peritraumatic tonic immobility and posttraumatic symptoms among LGBTQ+ versus straight cisgender female sexual assault survivors.

OBJECTIVE: The current study examined group differences in peritraumatic tonic immobility (TI) and posttraumatic symptoms among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) females and their straight, cisgender counterparts. METHOD: Adult female sexual assault (SA) survivors (N = 86; 41.9% LGBTQ+) completed a questionnaire battery assessing demographics, TI experience, posttraumatic stress disorder symptoms, dissociative symptoms, and posttraumatic cognitions. Chi-square analyses, analyses of variance, and hierarchical linear regressions were used to characterize the associations among these variables. RESULTS: Individuals identifying as LGBTQ+ endorsed higher rates and severity of TI as well as greater posttraumatic stress symptoms compared to their straight, cisgender counterparts. Both LGBTQ+ status and TI experience predicted greater posttraumatic stress symptoms. CONCLUSIONS: Findings suggest that LGBTQ+ individuals who endorse TI during SA experience greater posttraumatic symptoms than their non-LGBTQ+ and non-TI counterparts. These findings have important implications for future research and treatment of female SA survivors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Efficacy of probiotic supplements in improving the symptoms of psychosis, anxiety, insomnia, and anorexia due to amphetamine and methamphetamine use: a randomized clinical trial.

RATIONALE: Changes in the density and diversity of gut microbiota in chronic use of methamphetamine have been mentioned as contributors to psychotic and anxiety symptoms, sleep problems, and loss of appetite. OBJECTIVE: In this placebo-controlled clinical trial, we investigated the effect of the probiotic Lactobacillus Acidophilus in improving psychiatric symptoms among hospitalized patients with chronic methamphetamine use along with psychotic symptoms. METHODS: 60 inpatients with a history of more than 3 years of methamphetamine use, were randomly assigned to one of two groups receiving either a probiotic capsule or placebo along with risperidone for 8 weeks based on a simple randomization method. In weeks 0, 4, and 8, patients were evaluated using the Brief Psychiatric Rating Scale (BPRS), Beck Anxiety Inventory (BAI), Pittsburgh Sleep Quality Index (PSQI), Simple Appetite Nutritional Questionnaire (SANQ), and Body Mass Index (BMI). RESULTS: Compared to the control group, patients receiving probiotics had better sleep quality, greater appetite, and higher body mass index (there were significant interaction effects of group and time at Week 8 in these variables (t = -3.32, B = -1.83, p = .001, d = 0.89), (t = 10.50, B = 2.65, p <.001, d = 1.25) and (t = 3.40, B = 0.76, p <.001, d = 0.30), respectively. In terms of the improvement of psychotic and anxiety symptoms, there was no statistically significant difference between the two groups. CONCLUSIONS: The use of probiotics was associated with improved sleep quality, increased appetite, and increased body mass index in patients with chronic methamphetamine use. Conducting more definitive clinical trials with larger sample sizes and longer-term follow-up of cases is recommended.

A home-based telehealth randomized controlled trial of skills training in affective and interpersonal regulation versus present-centered therapy for women veterans who have experienced military sexual trauma.

OBJECTIVE: This randomized trial tested the effectiveness of Skills Training in Affective and Interpersonal Regulation (STAIR) compared to present-centered therapy (PCT) delivered virtually to women veterans who had experienced military sexual trauma (MST) and screened positive for posttraumatic stress disorder (PTSD). METHOD: One hundred sixty-one eligible women veterans were randomized into the study. The primary outcome was clinician-assessed PTSD severity (Clinician-Administered PTSD Scale-5), while secondary outcomes included social support and several other symptom measures at posttreatment through 2- and 4-month follow-up. RESULTS: PTSD severity decreased in both conditions by posttreatment but significantly more (p = .028, d = 0.39) in STAIR (d = 1.12 [0.87, 1.37]) than PCT (d = .78 [0.54, 1.02]). STAIR was also superior in improving social support and emotion regulation and reducing depression and negative cognitions. Improvement in psychosocial functioning was moderate and did not differ between conditions. All changes were maintained through 2- and 4-month follow-ups. Dropout rates were low and did not differ (19.0% and 12.2%, respectively). CONCLUSION: STAIR provided superior outcomes compared to PCT regarding PTSD, social support, and multiple types of mental health problems among women veterans with MST. The application of STAIR to other populations with social support and related concerns warrants investigation. The substantial effect sizes for PTSD symptoms in both treatments suggest that they are practical alternatives for individuals who do not wish to participate in trauma-focused therapy and may increase engagement in mental health services. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The interactive effects of AS and trauma exposure on suicide capability and suicide risk.

BACKGROUND: Trauma exposure has been linked with heightened suicide risk purportedly through habituation to threatening stimuli, thereby reducing fear of suicide. However, no research has examined variables that may influence this process. Anxiety sensitivity (AS) is one cognitive-affective factor that may strengthen the relationship between trauma exposure and reduced fear of suicide by amplifying traumatic reactivity. The present study evaluated this by examining the interaction of AS and trauma exposure type (e.g., direct vs. witnessed) predicting fear of suicide and self-reported suicide risk. METHODS: Participants (n = 124) were recruited for a long-term (∼3-4 years) follow-up after participation in a clinical trial targeting suicide risk factors and were asked to complete self-report measures of trauma history, AS, fear of suicide, and suicide risk. RESULTS: Significant interactions emerged such that a greater number of direct traumasexperienced predicted lower fear of suicide and greater suicide risk among those with greater AS. The interactive effect of witnessed traumas and AS predicting suicidality was insignificant. Results remained even after including relevant covariates. DISCUSSION: The current findings suggest that AS augments the effects of repeated trauma exposure on fear of suicide and suicide risk. It is plausible these painful and provocative events are more potent among those with high AS due to the amplification of traumatic affective responses, though future research examining the longitudinal relations is needed to confirm this process.

Evaluating the long-term (Three Year) durability of brief interventions targeting risk factors for psychopathology.

Despite their brevity, prior work indicates that computer-based interventions can substantially impact risk factors for psychopathology including anxiety sensitivity (AS), thwarted belongingness (TB), and perceived burdensomeness (PB). However, very few studies have assessed the long-term (> 1 year) effects of these interventions. The primary aim of the current study was to evaluate post-hoc, the long-term (3 year) durability of brief interventions targeting risk factors for anxiety and mood psychopathology using data from a pre-registered randomized clinical trial. Moreover, we were interested in evaluating whether mitigation in these risk factors mediated long-term symptom change. A sample determined to be at-risk for anxiety and mood pathology based on elevations on several risk factors (N = 303) was randomly assigned to one of four experimental conditions focused on: (1) reducing TB and PB; (2) reducing AS, (3) reducing TB,PB, and AS; or (4) a repeated contact control condition. Participants were assessed at post-intervention, one, three, six, 12, and 36 month follow-ups. Participants in the active treatment conditions showed sustained reductions in AS and PB through long-term follow-up. Mediation analyses suggested that reductions in AS mediated long-term reductions in anxiety and depression symptoms. These findings suggest that brief and scalable risk reduction protocols have long-term durability and efficacy both in terms of reducing risk factors for psychopathology.

Anxiety sensitivity prospectively predicts pandemic-related distress.

BACKGROUND: Anxiety sensitivity (AS) is a well-studied transdiagnostic risk construct that is believed to amplify responses to many forms of stress. The COVID-19 pandemic is a broad stressor with significant physical and social threats. In the current study, we were interested in ascertaining the degree to which AS would relate to distress and disability in the context of COVID-19. We hypothesized that AS would be associated with increased distress and disability. Moreover, we hypothesized that AS would be uniquely predictive while controlling for other relevant risk factors such as age, race, and perceived local COVID-19 infection rates. METHOD: Participants (N = 249) were U.S. adults assessed using online data resourcing and re-assessed one month later. RESULTS: At the first time point, during the beginning phases of the COVID-19 pandemic, AS was significantly related to COVID-19 distress and disability with a moderate effect size. AS was longitudinally associated with higher COVID-19 worry and depression. LIMITATIONS: Our findings are limited by the use of a relatively small online sample. Additionally, assessment of pre-pandemic and post-pandemic symptoms and functioning would be beneficial for future research. CONCLUSIONS: Taken together, the current study provided evidence consistent with AS as a causal risk factor for the development of distress and depression during the COVID-19 pandemic.

Distress intolerance mediates attentional control on posttraumatic stress symptoms: Evidence from two clinical samples.

Theoretical models emphasize the importance of both affective and cognitive risk factors in the development of posttraumatic stress symptoms (PTSS). Two such factors predicting PTSS have been studied extensively: distress intolerance (DI) - an affective factor indicative of the ability to tolerate negative affective states - and attentional control (AC), a cognitive factor reflecting the ability to flexibly shift and maintain attention to goal-relevant tasks. Previous work primarily highlights the independent contributions of DI and AC and their interaction to predict PTSS. Some models, however, suggest a mediational pathway such that AC indirectly affects PTSS via diminished DI. The current paper addressed this gap by first attempting to replicate prior findings, while also exploring this mediation model. Results were examined in two clinical samples - a trauma-exposed sample of adults (study 1; N = 73) and trauma-exposed treatment-seeking adults (study 2; N = 204). Results partially supported our hypotheses; both studies failed to replicate prior moderation findings, but our mediational hypothesis was supported in both samples. Low AC appears to decrease an individual's tolerance for distressing situations, which in turn increases the severity of PTSS. Results suggest that PTSD treatments may benefit by incorporating components of AC, DI, or a combination of the two to mitigate PTSS. Taken together, this study provides a novel examination of how cognitive and affective risk factors, namely AC and DI, work in tandem to increase PTSS.

Hyperarousal symptoms and perceived burdensomeness interact to predict suicidal ideation among trauma-exposed individuals.

The association between posttraumatic stress disorder (PTSD) and suicidal ideation is well-established and recent prospective studies have demonstrated the unique role of hyperarousal symptoms. In particular, over-arousal may elevate suicide risk in the presence of interpersonal vulnerability factors including thwarted belongingness, perceived burdensomeness, and acquired capability. Therefore, the current study sought to examine the differential associations between PTSD symptom clusters and suicidality and the impact of interpersonal risk factors. Trauma-exposed adults (N = 247) completed a questionnaire battery at baseline and three-month follow-up, as part of a larger randomized controlled trial of computerized interventions for suicide risk. Given the focus of the current study, treatment condition was controlled for in all analyses. Results indicated that hyperarousal symptoms significantly predict suicidality, while reexperiencing and avoidance symptoms do not. Specifically, greater hyperarousal symptoms predicted increased suicidal ideation among individuals with high perceived burdensomeness. Although the interaction effect was not significant, hyperarousal symptoms were also pertinent among individuals with high acquired capability. Taken together, findings suggest that assessment of hyperarousal symptoms and perceived burdensomeness may serve to identify trauma-exposed individuals at greater risk for suicide. Additionally, these factors may serve as effective intervention targets.

A longitudinal investigation of the association between rumination, hostility, and PTSD symptoms among trauma-exposed individuals.

BACKGROUND: Rumination, defined as perseverative thinking regarding the causes and consequences of psychological symptoms, is a risk and maintaining factor for PTSD. Existing work has largely focused on the extent to which rumination functions as a coping strategy used to avoid traumatic memories and associated emotions. However, rumination may also maintain negative thinking patterns, such as hostility, which has been positively associated with both rumination and PTSD symptoms. The current study therefore investigated the extent to which hostility was a significant mediator of the prospective association between rumination and PTSD symptoms. METHODS: The sample consisted of 119 trauma-exposed individuals (48.7% female), who completed self-report questionnaires at three time points during a clinical trial. RESULTS: When controlling for treatment condition and baseline depressive disorder diagnosis, hostility temporally mediated the effects of rumination on PTSD symptoms. Specificity analyses provided further support for the direction and specific variables examined in this model, such that rumination was positively and uniquely associated with later hostility. LIMITATIONS: Our findings are limited by the use of a sample in which only 30% of participants met diagnostic criteria for a trauma-related disorder, as well as the administration of the rumination measure at only one time point. CONCLUSIONS: Results suggest that rumination and hostility may be promising treatment and prevention targets for PTSD symptoms.

Unique and Interactive Relations among Posttraumatic Stress, Distress Tolerance, and Anger Responding to Traumatic Event Cues.

Experimental and clinical studies have demonstrated an association between posttraumatic stress symptoms (PTSS) and anger. Expanding upon past research, the current study examined the interactive associations among PTSS, distress tolerance (DT), and anger responding among a sample of 95 trauma-exposed adults. This study used a personalized script-driven imagery procedure to gauge emotional responses. Results from a hierarchical linear regression demonstrated a main effect of PTSS and an interaction between PTSS and DT. Simple slope analyses indicated that PTSS level was unrelated to anger responding among traumatic event-exposed people relatively low in DT, while anger responses were positively correlated with levels of PTSS among those relatively higher in DT. These findings highlight the need for future research to consider distress tolerance as well as other emotional vulnerability factors in assessing PTSD-related anger.

Navigating Blind in the Green Rush: Clinical Considerations and Harm Reduction Practices for Cannabis.

BACKGROUND: The United States has recently experienced extensive changes in state policy regarding the use of cannabis for recreational and medicinal purposes. Despite its rapidly increasing accessibility and social acceptance, there is a striking dearth of research on cannabis as a treatment for medical and psychological conditions. Research on cannabis is difficult to conduct as it is classified as a schedule I drug with high potential for abuse and currently no accepted medical use in treatment. As a result, no standard dosing procedures exist and the lack of conclusive scientific evidence has left clinical providers without evidence-based guidelines about if, when, and how to guide clients on using cannabis safely. OBJECTIVE: To (1) provide critical psychoeducational information about cannabis and cannabis problems to guide client-provider conversations about cannabis use and (2) describe common clinical concerns around cannabis use, highlight special considerations for vulnerable populations, and review harm reduction techniques and practical resources that may help clinicians and their clients navigate safer cannabis use. CONCLUSION: The removal of regulatory barriers would enable researchers to address key public health questions about the potential therapeutic and adverse effects of cannabis use. Additionally, funds for research, clinician education, and public health education initiatives are necessary to reduce risk around cannabis use in the United States.

US Veterans Who Do and Do Not Utilize Veterans Affairs Health Care Services: Demographic, Military, Medical, and Psychosocial Characteristics.

OBJECTIVE: To examine sociodemographic and military characteristics of US veterans who do and do not utilize Veterans Affairs (VA) health care services as their primary source of health care and examine the relationship between VA utilization and medical and psychosocial characteristics. METHODS: Participants were a nationally representative sample of 3,152 military veterans (89.8% male, 83.5% white, 6.0% black, mean age = 62.0 [SD = 13.1] years) who completed a survey in 2011 assessing health care utilization, sociodemographic, military service, medical, and psychosocial characteristics. Receiver operator characteristic analyses and logistic and linear regressions were conducted to provide a comprehensive and multivariate examination of factors associated with VA utilization. RESULTS: Veterans who used VA services were more likely to be black, younger, female, unmarried, and less educated and to have lower household incomes. They were also more likely to have served longer in the military and in combat. VA users were more likely to screen positive for lifetime psychopathology, endorse current suicidality, and report enduring more traumas. VA users were also more likely to report more medical conditions, endorse a disability, and score lower on measures of functioning. The primary factor differentiating VA users from those that did not use VA services was presence of lifetime psychopathology. CONCLUSIONS: Results provide a comprehensive profile of veterans who do and do not utilize VA services and suggest that veterans who use VA services have a substantially elevated health burden compared to other veterans. Results may help inform outreach and engagement initiatives targeting the unique health care needs of veterans who do and do not utilize VA services.