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2.
Adv Mind Body Med ; 33(2): 12-17, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31476134

RESUMEN

Objective: The purpose of this study was to examine whether the Life-Change Stop Smoking Program (tobacco dependence treatment program with Stress Management/Mindfulness Training) was more effective in achieving 6 mo of smoking abstinence among a high-risk group, such as US veterans at the Loma Linda Veterans Affairs (VA) Medical Center, compared with the VA's conventional stop smoking program. The effects of participants' initial stress level and depression risk on achieving abstinence were also assessed. Methods: Through examination of medical records and confirmation of exhaled air carbon monoxide level, abstinence status from smoking was determined at the 6-mo follow-up of the Life-Change Stop Smoking program (study group) participants and the Break the Chains program (comparison group, age and gender matched) participants. The 6-mo abstinence rates of the study group and comparison group were analzyed. Results: The statistically significant level of difference (χ2 [P < .001], regression [P = .0000]) in 6-mo abstinence rates between groups was observed. Conclusion: The stop smoking program with Stress Management/Mindfulness Training was effective (64.6% in study group, 40.1% in comparison group, P < .001) in achieving 6 mo of smoking abstinence for the high-risk group.


Asunto(s)
Atención Plena , Cese del Hábito de Fumar , Tabaquismo , Veteranos , Humanos , Fumar , Cese del Hábito de Fumar/métodos , Tabaquismo/terapia , Veteranos/psicología
3.
Sleep Health ; 5(5): 495-500, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31416799

RESUMEN

OBJECTIVES: Sleep complaints, such as insomnia and sleep disturbances caused by posttraumatic stress disorder (PTSD), are more common among women veterans than nonveteran women. Alcohol use among some women may be partially motivated by the desire to improve sleep. This study evaluated rates of alcohol use as a sleep aid among women veterans and explored the relationship between alcohol use to aid sleep and drinking frequency and sleeping pill use. DESIGN AND SETTING: National cross-sectional population-based residential mail survey on sleep and other symptoms. PARTICIPANTS: Random sample of women veteran VA users who completed a postal survey (N = 1533). INTERVENTIONS: None. MEASUREMENTS: The survey included demographics, Insomnia Severity Index, Primary Care PTSD screen, and items on alcohol use frequency (days/week), use of prescription or over-the-counter sleep medications, and use of alcohol as a sleep aid (yes/no for each item) over the past month. RESULTS: A total of 14.3% of respondents endorsed using alcohol to aid sleep. Logistic regression models showed more severe insomnia (odds ratio [OR] = 1.03; 95% confidence interval [CI]: 1.01-1.06) and PTSD (OR = 2.11; 95% CI: 1.49-2.97) were associated with increased odds of using alcohol to aid sleep. Alcohol use to aid sleep was associated with increased odds of daily drinking (OR = 8.46; 95% CI: 4.00-17.87) and prescription (OR = 1.79; 95% CI: 1.34-2.38) and over-the-counter sleep aid use (OR = 1.54; 95% CI: 1.12-2.11). CONCLUSIONS: Insomnia and PTSD may increase risk for using alcohol as a sleep aid, which may increase risk for unhealthy drinking and for mixing alcohol with sleep medications. Findings highlight the need for alcohol use screening in the context of insomnia and for delivery of cognitive-behavioral therapy for insomnia to women veterans with insomnia.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/psicología , Fármacos Inductores del Sueño/uso terapéutico , Veteranos/psicología , Adulto , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Asunción de Riesgos , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Trastornos por Estrés Postraumático/psicología , Encuestas y Cuestionarios , Veteranos/estadística & datos numéricos
4.
Behav Ther ; 50(5): 886-897, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31422845

RESUMEN

Suicide is a growing public health crisis among military veterans. Despite recent attention to this area, there are few empirically supported preventative interventions for suicidality among veterans. In the context of an empirically supported theoretical framework, the Interpersonal Theory of Suicide, the current study targeted suicide risk factors (i.e., perceived burdensomeness and thwarted belongingness) among a sample of 46 veterans selected from a larger clinical trial. Participants were randomized to receive either a newly developed computerized intervention aimed at decreasing perceived burdensomeness and thwarted belongingness, or participate in a repeated contact control condition. Results indicated a direct effect of the intervention on both perceived burdensomeness and thwarted belongingness. Temporal mediation analyses also revealed an indirect effect of condition on suicidality at Month 1 follow-up via reductions in perceived burdensomeness. The current results are the first to indicate that factors from the interpersonal theory of suicide can be reduced among veterans, and to demonstrate that these reductions in perceived burdensomeness lead to reductions in suicidality. Because of the brevity and computer delivery system, this intervention could be widely and rapidly disseminated among military veterans to reduce the public health burden of suicide in this population.


Asunto(s)
Relaciones Interpersonales , Trauma Psicológico/prevención & control , Suicidio/psicología , Terapia Asistida por Computador/métodos , Veteranos/psicología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Teoría Psicológica , Trauma Psicológico/psicología , Factores de Riesgo , Ideación Suicida , Suicidio/prevención & control
5.
Behav Ther ; 50(5): 910-923, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31422847

RESUMEN

While evidence-based interventions can help the substantial number of veterans diagnosed with comorbid PTSD and depression, an emerging literature has identified sleep disturbances as predictors of treatment nonresponse. More specifically, predicting effects of residual insomnia and nightmares on postintervention PTSD and depressive symptoms among veterans with comorbid PTSD and depression has remained unclear. The present study used data from a clinical trial of Behavioral Activation and Therapeutic Exposure (BA-TE), a combined approach to address comorbid PTSD and depression, administered to veterans (N = 232) to evaluate whether residual insomnia and nightmare symptoms remained after treatment completion and, if so, whether these residual insomnia and nightmare symptoms were associated with higher levels of comorbid PTSD and depression at the end of treatment. Participants (ages 21 to 77 years old; 47.0% Black; 61.6% married) completed demographic questions, symptom assessments, and engagement-related surveys. Hierarchical multiple linear regression models demonstrated that residual insomnia was a significant predictor of PTSD and depression symptom reduction above and beyond the influence of demographic and engagement factors (e.g., therapy satisfaction). Consistent with previous research, greater residual insomnia symptoms were predictive of smaller treatment gains. Findings illustrate the potential significance of insomnia during the course of transdiagnostic treatment (e.g., PTSD and depression), leading to several important clinical assessment and treatment implications.


Asunto(s)
Depresión/complicaciones , Trastornos del Inicio y del Mantenimiento del Sueño/complicaciones , Trastornos del Sueño-Vigilia/complicaciones , Trastornos por Estrés Postraumático/complicaciones , Veteranos/psicología , Adulto , Anciano , Depresión/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Trastornos del Sueño-Vigilia/psicología , Trastornos por Estrés Postraumático/terapia , Veteranos/estadística & datos numéricos , Adulto Joven
6.
Behav Ther ; 50(5): 952-966, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31422850

RESUMEN

The addition of the dissociative subtype of posttraumatic stress disorder (PTSD) to the DSM-5 has spurred investigation of its genetic, neurobiological, and treatment response correlates. In order to reliably assess the subtype, we developed the Dissociative Subtype of PTSD Scale (DSPS; Wolf et al., 2017), a 15-item index of dissociative features. Our initial investigation of the dichotomous DSPS lifetime items in a veteran epidemiological sample demonstrated its ability to identify the subtype, supported a three-factor measurement structure, distinguished the three subscales from the normal-range trait of absorption, and demonstrated the greater contribution of derealization and depersonalization symptoms relative to other dissociative symptomatology. In this study, we replicated and extended these findings by administering self-report and interview versions of the DSPS, and assessing personality and PTSD in a sample of 209 trauma-exposed veterans (83.73% male, 57.9% with probable current PTSD). Results replicated the three-factor structure using confirmatory factor analysis of current symptom severity interview items, and the identification of the dissociative subtype (via latent profile analysis). Associations with personality supported the discriminant validity of the DSPS and suggested the subtype was marked by tendencies towards odd and unusual cognitive experiences and low positive affect. Receiver operating characteristic curves identified diagnostic cut-points on the DSPS to inform subtype classification, which differed across the interview and self-report versions. Overall, the DSPS performed well in psychometric analyses, and results support the utility of the measure in identifying this important component of posttraumatic psychopathology.


Asunto(s)
Trastornos Disociativos/diagnóstico , Trastornos por Estrés Postraumático/diagnóstico , Encuestas y Cuestionarios/normas , Veteranos/psicología , Adulto , Despersonalización , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Trastornos Disociativos/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Personalidad , Psicometría , Autoinforme , Trastornos por Estrés Postraumático/psicología
8.
Neuropsychology ; 33(7): 913-921, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31192654

RESUMEN

OBJECTIVE: Cognitive complaints, such as attentional or memory concerns, are commonly reported by veterans diagnosed with posttraumatic stress disorder (PTSD) or a history of mild traumatic brain injury (mTBI). The degree to which those complaints actually map onto measurable cognitive deficits is unclear and is likely complicated by the severity of trauma-related sequelae. In the present study we sought to characterize the degree to which PTSD symptoms and mTBI accounted for the relationship of subjective cognitive complaints to objective cognitive performance, with the goal of facilitating the accurate assessment of trauma-exposed veterans complaining of cognitive decline. METHOD: A sample of 203 U.S. military veterans previously deployed to Iraq and/or Afghanistan were assessed for PTSD severity, history of blast and impact mTBI, objective cognitive function, and subjective cognitive complaints. Separate mediation analyses were conducted to explore the degree that PTSD severity, blast mTBI severity, and impact mTBI severity influenced the association between subjective cognitive complaints and objective cognitive performance. Models reflecting significant mediation were followed by post hoc moderated mediation analyses. RESULTS: Subjective cognitive complaints and objective cognitive performance were significantly associated (ß = -6.49, SE = 2.85, p = .03), but this relationship was mediated by PTSD severity (ß= -2.95, SE = 2.86, p = .30). PTSD mediation was not moderated by either blast or impact mTBI. CONCLUSION: The present results delineate the prominent impact of PTSD symptoms, relative to blast and impact mTBI, on cognition following combat. These findings highlight the importance of assessing for trauma-related psychopathology in those seeking neuropsychological assessment or rehabilitative care for cognitive complaints. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Conmoción Encefálica/psicología , Trastornos del Conocimiento/psicología , Trastornos de Combate/psicología , Trastornos por Estrés Postraumático/psicología , Veteranos/psicología , Adulto , Campaña Afgana 2001- , Traumatismos por Explosión/psicología , Conmoción Encefálica/complicaciones , Femenino , Humanos , Guerra de Irak 2003-2011 , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Reproducibilidad de los Resultados , Trastornos por Estrés Postraumático/complicaciones , Estados Unidos , Adulto Joven
9.
Med Care ; 57(7): 536-543, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31194701

RESUMEN

OBJECTIVE: To examine factors associated with HIV screening among women veterans receiving health care in the Department of Veterans Affairs. MATERIALS AND METHODS: Cross-sectional study of women veterans receiving Veterans Affairs care between 2001 and 2014 derived from the Women Veteran's Cohort Study. Descriptive and bivariate statistics were calculated comparing patients with and without an HIV screen. Generalized estimating equations were conducted to estimate the odds of HIV screening among women screened for military sexual trauma (MST) and the subset with a positive MST screen. Multivariable analyses were adjusted for demographic characteristics, mental health diagnoses, pregnancy, HIV risk factors, and facility level clustering. RESULTS: Among the 113,796 women veterans in the sample, 84.3% were screened for MST and 13.2% were screened for HIV. Women screened for MST were over twice as likely to be tested for HIV (odds ratio, 2.8; 95% confidence interval, 2.2-3.5). A history of MST was inversely associated with HIV screening (odds ratio, 0.9; 95% confidence interval, 0.8-0.9). CONCLUSIONS: Women veterans screened for sexual trauma received more comprehensive preventive health care in the form of increased HIV screening.


Asunto(s)
Infecciones por VIH/diagnóstico , Tamizaje Masivo , Personal Militar/psicología , Delitos Sexuales , Veteranos/psicología , Adulto , Estudios Transversales , Femenino , Humanos , Estudios Longitudinales , Estados Unidos , United States Department of Veterans Affairs
10.
Womens Health Issues ; 29 Suppl 1: S103-S111, 2019 06 25.
Artículo en Inglés | MEDLINE | ID: mdl-31253233

RESUMEN

BACKGROUND: Although most suicide-related deaths occur among male veterans, women veterans are dying by suicide in increasing numbers. Identifying and increasing access to effective treatments is imperative for Department of Veterans Affairs suicide prevention efforts. We examined the impact of evidence-based psychotherapies for depression on suicidal ideation and the role of gender and treatment type in patients' responses to treatment. METHODS: Clinicians receiving case consultation in interpersonal psychotherapy, cognitive-behavioral therapy for depression, and acceptance and commitment therapy for depression submitted data on depressive symptoms and suicidal ideation while treating veterans with depression. RESULTS: Suicidal ideation was reduced across time in all three treatments. A main effect for wave was associated with statistically significant decreases in severity of suicidal ideation, χ2 (2) = 224.01, p = .0001, and a subsequent test of the Gender × Wave interaction was associated with differentially larger decreases in ideation among women veterans, χ2 (2) = 9.26, p = .001. Within gender-stratified subsamples, a statistically significant Treatment × Time interaction was found for male veterans, χ2 (4) = 16.82, p = .002, with levels of ideation significantly decreased at waves 2 and 3 in interpersonal psychotherapy and cognitive-behavioral therapy for depression relative to acceptance and commitment therapy for depression; the Treatment × Wave interaction within the female subsample was not statistically significant, χ2 (4) = 3.41, p = .492. CONCLUSIONS: This analysis demonstrates the efficacy of each of the three tested evidence-based psychotherapies for depression as a means of decreasing suicidal ideation, especially in women veterans. For male veterans, decreases in suicidal ideation were significantly greater in interpersonal psychotherapy and cognitive-behavioral therapy for depression relative to acceptance and commitment therapy for depression.


Asunto(s)
Terapia Cognitivo-Conductual/métodos , Depresión/terapia , Práctica Clínica Basada en la Evidencia , Ideación Suicida , Suicidio/prevención & control , Veteranos/psicología , Adulto , Depresión/psicología , Trastorno Depresivo/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicoterapia , Resultado del Tratamiento
11.
Womens Health Issues ; 29 Suppl 1: S15-S23, 2019 06 25.
Artículo en Inglés | MEDLINE | ID: mdl-31253237

RESUMEN

INTRODUCTION: Female veterans smoke cigarettes at high rates compared with both male veterans and nonveteran women. Proactive outreach to smokers may reduce gender disparities in cessation care. The objectives of this study were to compare baseline experiences with VA smoking cessation care for men and women and to assess for gender differences in response to a proactive outreach intervention. METHODS: We conducted a post hoc subgroup analysis of a pragmatic, multisite randomized, controlled trial comparing proactive outreach with usual care (UC). Baseline experiences included physician advice to quit, satisfaction with care, and past-year treatment use. At the 1-year follow-up, treatment use, quit attempts, and 6-month prolonged abstinence for women and men randomized to proactive outreach versus UC were compared using logistic regression. RESULTS: Baseline and follow-up surveys were returned by 138 women and 2,516 men. At baseline, women were less likely than men to report being very or somewhat satisfied with the process of obtaining smoking cessation medications in the VA (47% of women vs. 62% of men), but no less likely to report having used cessation medications from the VA in the past year (39% of women vs. 34% of men). After the intervention, phone counseling and combined therapy increased among both women and men in proactive outreach as compared with UC. At the 1-year follow-up, men in proactive outreach were significantly more likely to report prolonged abstinence than those in UC (odds ratio, 1.65; 95% CI, 1.28-2.14); results for women were in the same direction but not statistically significant (odds ratio, 1.39; 95% CI, 0.48-3.99). CONCLUSIONS: Satisfaction with cessation care in VA remains low. Proactive outreach to smokers was associated with an increased use of cessation therapies, and increased odds of achieving prolonged abstinence. A subgroup analysis by gender did not reveal significant differences in the treatment effect.


Asunto(s)
Consejo/métodos , Cese del Hábito de Fumar/métodos , Cese del Hábito de Fumar/psicología , Fumar/psicología , Fumar/terapia , Veteranos/estadística & datos numéricos , Adulto , Femenino , Hospitales de Veteranos , Humanos , Masculino , Estudios Multicéntricos como Asunto/métodos , Médicos , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Cese del Hábito de Fumar/estadística & datos numéricos , Resultado del Tratamiento , Estados Unidos , United States Department of Veterans Affairs , Veteranos/psicología
12.
Womens Health Issues ; 29 Suppl 1: S24-S31, 2019 06 25.
Artículo en Inglés | MEDLINE | ID: mdl-31253239

RESUMEN

BACKGROUND: Chronic pain conditions are common among both male and female Iraq/Afghanistan-era veterans and can have substantial negative impacts on quality of life and function. Although in general women tend to report higher levels of pain intensity than men, findings remain mixed on whether gender differences in pain exist in Iraq/Afghanistan-era veterans. Additionally, the relationships between functional impairment, pain intensity, and gender remain unknown. METHODS: This project examined gender differences in pain intensity and pain interference in 875 male and female Iraq/Afghanistan-era veterans. Nonparametric Wilcoxon rank-tests examined gender differences in pain scores. Multivariable generalized linear regression modeling was used to evaluate the magnitude of pain intensity and interference across levels of chronicity and gender, and to evaluate the role of chronicity in gender effects in measures of pain and function. RESULTS: Pain intensity and interference scores were significantly greater among both male and female veterans reporting chronic pain relative to acute pain. Women veterans endorsed higher levels of pain intensity and pain interference compared with men. Results derived from multivariable analyses implicated pain intensity as a factor underlying gender differences in functional impairment among chronic pain sufferers, indicating that gender differences in functional measures were eliminated after controlling statistically for pain intensity. CONCLUSIONS: Results demonstrate that the effects of functional impairment are impacted by pain intensity, and not by gender.


Asunto(s)
Dolor/epidemiología , Dolor/psicología , Calidad de Vida/psicología , Veteranos/psicología , Adulto , Campaña Afgana 2001- , Afganistán , Femenino , Humanos , Irak , Guerra de Irak 2003-2011 , Masculino , Distribución por Sexo , Factores Sexuales , Estados Unidos , Veteranos/estadística & datos numéricos
13.
Womens Health Issues ; 29 Suppl 1: S32-S38, 2019 06 25.
Artículo en Inglés | MEDLINE | ID: mdl-31253240

RESUMEN

BACKGROUND: Obesity is highly stigmatized, especially for women, and therefore may negatively affect health care experiences. Past findings on the relationship between obesity and health care experiences are mixed, perhaps because few studies examine relationships by gender and obesity class. Our objective was to evaluate whether women and men with more severe obesity report worse health care experiences related to Veterans Health Administration (VA) care. METHODS: Health care experiences (self-management support, mental health assessments, office staff courtesy, communication with providers) and overall provider ratings were assessed with the 2014 VA Survey of Health Care Experiences of Patients. Using multiple regression analyses (n = 13,462 women, n = 268,180 men), we assessed associations among obesity classes, health care experiences, and overall provider ratings, adjusting for sociodemographic, health, and primary care use characteristics. RESULTS: The greatest differences in health care experiences between patients with and without obesity were in self-management support experiences, which were more favorable among women and men of all obesity classes. There were gender differences in associations between obesity and mental health assessments: for men, but not women, those in any obesity class gave higher ratings than those without obesity. For most other health care experiences and provider ratings, men with obesity reported slightly less favorable experiences than those without. There was no consistent pattern for women. CONCLUSIONS: It is promising that VA patients with obesity report more self-management support, given the behavior change required for weight management. Lower health care experience and provider ratings among men with obesity suggest a need to further investigate possible obesity-related stigma in VA primary care.


Asunto(s)
Prestación de Atención de Salud , Obesidad/psicología , Satisfacción del Paciente , Calidad de la Atención de Salud , Estereotipo , Veteranos/psicología , Adulto , Anciano , Comunicación , Femenino , Hospitales de Veteranos/organización & administración , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Obesidad/terapia , Atención Primaria de Salud , Automanejo , Estados Unidos , United States Department of Veterans Affairs , Veteranos/estadística & datos numéricos , Salud de los Veteranos
14.
Womens Health Issues ; 29 Suppl 1: S39-S46, 2019 06 25.
Artículo en Inglés | MEDLINE | ID: mdl-31253241

RESUMEN

BACKGROUND: The health of women Gulf War (deployed) and Gulf Era (nondeployed) veterans is understudied; although most studies examining the health effects of deployment to the Gulf War adjust for gender in multivariate analyses, gender-specific prevalence and effect measures are not routinely reported. The National Academy of Medicine recommended that the Department of Veterans Affairs assess gender-specific health conditions in large cohort studies of Gulf War veterans. METHODS: Data from this study come from the follow-up study of a national cohort of Gulf War and Gulf Era veterans. This study was conducted between 2012 and 2014, and was the second follow-up of a population-based cohort of Gulf War and Gulf Era veterans that began in 1995. Measures included self-reported medical conditions and frequency of doctor visits as well as validated screening instruments for mental health conditions. RESULTS: Overall, female veterans (both Gulf War and Era) reported poorer health than their male counterparts as measured by the prevalence of self-reported disease. The top five prevalent conditions in both Gulf War and Gulf Era veterans were migraine, hypertension, major depressive disorder, arthritis, and dermatitis. Female Gulf War veterans were found to have a higher prevalence of disease than male Gulf Era veterans. CONCLUSIONS: Women veterans, particularly deployed veterans, from this era have significant medical needs that may justify increased outreach from the Department of Veterans Affairs. Our findings highlight the importance of asking about military service, particularly for women veterans, in the clinical setting, both in the Department of Veterans Affairs and in the private sector.


Asunto(s)
Disparidades en el Estado de Salud , Estado de Salud , Vigilancia de la Población/métodos , Veteranos/estadística & datos numéricos , Adolescente , Adulto , Artritis/epidemiología , Estudios de Cohortes , Trastorno Depresivo Mayor/epidemiología , Dermatitis/epidemiología , Femenino , Estudios de Seguimiento , Guerra del Golfo , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/epidemiología , Prevalencia , Autoinforme , Distribución por Sexo , Estados Unidos/epidemiología , Veteranos/psicología , Adulto Joven
15.
Womens Health Issues ; 29 Suppl 1: S47-S55, 2019 06 25.
Artículo en Inglés | MEDLINE | ID: mdl-31253242

RESUMEN

OBJECTIVE: The 1990-1991 Gulf War employed more women servicemembers than any prior conflict. Gender-based differences among veterans of this era have yet to be explored. This study is among the first and most recent to stratify Gulf War veteran demographics, lifestyle factors, and self-reported diagnoses by gender. METHODS: Data from the cross-sectional Gulf War Era Cohort and Biorepository pilot study (n = 1,318; collected between 2014 and 2016), including users and nonusers of the Veterans Health Administration, were used to calculate demographics and adjusted odds ratios. RESULTS: Women veterans were oversampled and comprised approximately 23% of the sample. Women reported similar rates of Veterans Health Administration use (44%) and deployment (67%) as men (46% and 72%, respectively). Women were less likely than men to report frequent alcohol use (adjusted odds ratio [aOR], 0.59; 95% confidence interval [CI], 0.43-0.81; p = .0009) or have a history of smoking (aOR, 0.65; 95% CI, 0.49-0.84; p = .0014). Among common health conditions, women were more likely than men to report a diagnosis of osteoporosis (aOR, 4.24; 95% CI, 2.39-7.51; p < .0001), bipolar disorder (aOR, 2.15; 95% CI, 1.15-4.04; p = .0167), depression (aOR, 2.39; 95% CI, 1.81-3.16; p < .0001), irritable bowel syndrome (aOR, 2.10; 95% CI, 1.43-3.09; p = .0002), migraines (aOR, 2.96; 95% CI, 2.18-4.01; p < .0001), asthma (aOR, 1.86; 95% CI, 1.29-2.67; p = .0008), and thyroid problems (aOR, 4.60; 95% CI, 3.14-6.73; p < .0001). Women were less likely than men to report hypertension (aOR, 0.55; 95% CI, 0.41-0.72; p < .0001), tinnitus (aOR, 0.46; 95% CI, 0.33-0.63; p < .0001), and diabetes (aOR, 0.44; 95% CI, 0.28-0.69; p = .0003). CONCLUSIONS: Health differences exist between female and male veterans from the 1990-1991 Gulf War. Gender-specific analyses are needed to better understand the unique health care needs of Gulf War Era veterans and direct future research.


Asunto(s)
Depresión/epidemiología , Conductas Relacionadas con la Salud , Disparidades en el Estado de Salud , Estilo de Vida , Veteranos/psicología , Adulto , Anciano , Estudios de Cohortes , Estudios Transversales , Depresión/psicología , Femenino , Guerra del Golfo , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Prevalencia , Autoinforme , Distribución por Sexo , Estrés Psicológico/complicaciones , Encuestas y Cuestionarios , Estados Unidos/epidemiología , United States Department of Veterans Affairs , Veteranos/estadística & datos numéricos
16.
Womens Health Issues ; 29 Suppl 1: S67-S73, 2019 06 25.
Artículo en Inglés | MEDLINE | ID: mdl-31253245

RESUMEN

OBJECTIVES: Military sexual trauma (MST) is a pervasive problem among veterans, and is associated with a host of deleterious outcomes. It is, therefore, imperative to identify individuals who have experienced MST so that they can be offered appropriate treatment. To determine how to best identify MST survivors, the current study examined how different assessment modalities might affect MST endorsement, and whether endorsement varied as a product of demographic group membership. METHODS: Data from 697 male and female veterans participating in the Veterans' After-Discharge Longitudinal Registry (Project VALOR) were used to examine how three different MST assessment modalities-the Veterans Health Administration screen, a study interview, and a study questionnaire measure-might affect MST endorsement across five different demographic variables (gender, ethnicity, sexual orientation, race, and age). Each participant was evaluated for MST exposure using each of the three assessment modalities. RESULTS: Both assessment modality and demographic membership influenced MST endorsement. MST endorsement on the study measures was consistently twice as large as on the Veterans Health Administration screen, across demographic groups. For men, MST endorsement varied by a factor of 11 across measures, with endorsement being lowest on the Veterans Health Administration screen and highest on the study questionnaire. Although differences were also detected for sexual minority and Black participants, these findings may have been better explained by gender differences. CONCLUSIONS: Both assessment modality and demographic membership substantially influenced MST endorsement. Providing a clear rationale for screening and increasing privacy around screening results, particularly for male veterans, may help to facilitate MST disclosure.


Asunto(s)
Tamizaje Masivo/métodos , Personal Militar , Delitos Sexuales/estadística & datos numéricos , Veteranos/estadística & datos numéricos , Adulto , Revelación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores Sexuales , Delitos Sexuales/psicología , Encuestas y Cuestionarios , Estados Unidos/epidemiología , United States Department of Veterans Affairs , Veteranos/psicología , Salud de los Veteranos
17.
Womens Health Issues ; 29 Suppl 1: S56-S66, 2019 06 25.
Artículo en Inglés | MEDLINE | ID: mdl-31253243

RESUMEN

BACKGROUND: The Department of Veterans Affairs Million Veteran Program (MVP) is the largest ongoing cohort program of its kind, with 654,903 enrollees as of June 2018. The objectives of this study were to examine gender differences in the MVP cohort with respect to response and enrollment rates; demographic, health, and health care characteristics; and prevalence of self-reported health conditions. METHODS: The MVP Baseline Survey was completed by 415,694 veterans (8% women), providing self-report measures of demographic characteristics, health status, and medical history. RESULTS: Relative to men, women demonstrated a higher positive responder rate (23.0% vs. 16.0%), slightly higher enrollment rate (13.5% vs. 12.9%), and, among enrollees, a lower survey completion rate (59.7% vs. 63.8%). Women were younger, more racially diverse, had higher educational attainment, and were less likely to be married or cohabitating with a partner than men. Women were more likely to report good to excellent health status but poorer physical fitness, and less likely to report lifetime smoking and drinking than men. Compared with men, women veterans showed an increased prevalence of musculoskeletal conditions, thyroid problems, gastrointestinal conditions, migraine headaches, and mental health disorders, as well as a decreased prevalence of gout, cardiovascular diseases, high cholesterol, diabetes, and hearing problems. CONCLUSIONS: These results revealed some substantial gender differences in the research participation rates, demographic profile, health characteristics, and prevalence of health conditions for veterans in the MVP cohort. Findings highlight the need for tailoring recruitment efforts to ensure representation of the increasing women veteran population receiving care through the Veterans Health Administration.


Asunto(s)
Estado de Salud , Trastornos Mentales/epidemiología , Aptitud Física , Salud de los Veteranos , Veteranos/estadística & datos numéricos , Adulto , Anciano , Enfermedades Cardiovasculares/epidemiología , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/epidemiología , Enfermedades Musculoesqueléticas/epidemiología , Prevalencia , Distribución por Sexo , Factores Sexuales , Fumar/epidemiología , Encuestas y Cuestionarios , Estados Unidos/epidemiología , United States Department of Veterans Affairs , Veteranos/psicología , Salud de los Veteranos/estadística & datos numéricos , Adulto Joven
18.
Womens Health Issues ; 29 Suppl 1: S74-S82, 2019 06 25.
Artículo en Inglés | MEDLINE | ID: mdl-31253246

RESUMEN

PURPOSE: Trauma has been associated with risky sexual behavior in diverse populations. However, little is known about this association among men and women veterans. This study hypothesized that 1) a history of trauma would be associated with risky sexual behavior among men and women veterans, 2) interpersonal trauma would predict risky sexual behavior among women, whereas noninterpersonal trauma would predict risky sexual behavior among men, and 3) military-related trauma would constitute additional risk. Using data from 567 women and 524 men veterans enrolled at the Veterans Health Administration, this study investigated the association between trauma-related experiences and risky sexual behavior in the last 12 months. Risk and protective factors that have been frequently associated with sexual behavior in previous research were also included in the model. METHODS: This study was drawn from the Women Veterans Cohort Study, a national survey of veterans. Bivariate and multivariate analyses were performed after multiple imputation for missing data. RESULTS: Predictive factors associated with risky sexual behavior differed between men and women veterans. Among women, childhood sexual victimization and intimate partner violence were associated with risky sexual behavior. Among men, binge drinking was the single significant risk factor. Military exposures were not significantly associated with risky sexual behavior in either men or women. CONCLUSIONS: This study lays the groundwork for theory-generating research into the psychological underpinnings of noted associations and underscores the importance of integrated health services to address the range of issues affecting sexual behavior and related health outcomes.


Asunto(s)
Adultos Sobrevivientes del Maltrato a los Niños/psicología , Víctimas de Crimen/psicología , Violencia de Pareja/psicología , Asunción de Riesgos , Conducta Sexual , Veteranos/psicología , Adulto , Anciano , Acoso Escolar , Niño , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Personal Militar/estadística & datos numéricos , Factores de Riesgo , Encuestas y Cuestionarios , Estados Unidos , United States Department of Veterans Affairs , Salud de los Veteranos
19.
Womens Health Issues ; 29 Suppl 1: S83-S93, 2019 06 25.
Artículo en Inglés | MEDLINE | ID: mdl-31253247

RESUMEN

PURPOSE: Stranger harassment at Veterans Health Administration (VA) facilities is prevalent, affecting one in four women veteran VA primary care users. Harassment interferes with health care quality and may result in veterans forgoing or delaying needed care. To better understand this phenomenon, gender-stratified discussion groups were held with men and women veterans. This article examines gender differences in veterans' perceptions and experiences of harassment on VA grounds. METHODS: We conducted a total of 15 discussion groups at four VA medical centers, eight with men (n = 57) and seven with women (n = 38). Transcripts were coded using the constant comparative method and analyzed for overarching themes. RESULTS: Awareness of harassment was not uniformly high among participants. Although women voiced clear understandings and experiences of specific behaviors constituting harassment (e.g., cat-calls, sexual comments), many men expressed confusion about how to differentiate between harassment, "harmless flirting," and general friendliness; they were unsure which behaviors "cross a line." Furthermore, men placed the onus on women for setting boundaries, whereas women indicated it was not their responsibility to "train" men about acceptable behavior. Men and women agreed that VA staff hold primary responsibility for preventing and managing harassment. CONCLUSIONS: Substantive gender differences in understandings of harassment exist among veteran VA users. To minimize harassment, veterans recommend education of men veteran VA users, and staff-oriented trainings. Privacy, safety, dignity, and security are the cornerstones of women veterans' health care, per VA policy. Harassment undermines these standards, impeding women's access to VA care and compromising both their health outcomes and health care experiences. Understanding harassment through a gendered lens is a critical step in designing comprehensive initiatives that respond to diverse viewpoints and experiences.


Asunto(s)
Acoso no Sexual/psicología , Acoso Sexual/psicología , Salud de los Veteranos , Veteranos/psicología , Adulto , Prestación de Atención de Salud/normas , Femenino , Hospitales de Veteranos/organización & administración , Humanos , Percepción , Atención Primaria de Salud , Calidad de la Atención de Salud , Estados Unidos , United States Department of Veterans Affairs , Salud de la Mujer
20.
Womens Health Issues ; 29 Suppl 1: S94-S102, 2019 06 25.
Artículo en Inglés | MEDLINE | ID: mdl-31253249

RESUMEN

BACKGROUND: Veterans have a high prevalence of both post-traumatic stress disorder (PTSD) and substance use disorders (SUDs), which are related to suicide risk. Exploring gender-related differences in suicidal behavior risk among this subgroup of veterans is important to improve prevention and treatment strategies. To date, few studies have explored these differences. METHODS: The sample included 352,476 men and women veterans from the Women Veterans Cohort Study with a diagnosis of PTSD. First, we conducted analyses to assess gender-related differences in sociodemographic and clinical variables at baseline, as well as by suicidal behavior. Then, we conducted a series of Cox proportional hazards regression models to estimate the hazard ratios of engaging in self-directed violence (SDV) and dying by suicide by SUD status and gender, controlling for potential confounders. RESULTS: Adjusted analyses showed that, among veterans with PTSD, the presence of a SUD significantly increased the risk of SDV and death by suicide. Women with PTSD had a decreased risk of dying by suicide compared with men. No gender-related difference was observed for SDV. SUD increased the risk of SDV behavior in both women and men but increased the risk of dying by suicide only among men. CONCLUSIONS: Our findings revealed gender-related differences in SDV and suicide among veterans with a PTSD diagnosis with or without a SUD. Our study, along with the increasing numbers of women serving in the military, stresses the need to conduct gender-based analyses to help improve prevention and treatment strategies.


Asunto(s)
Conducta Autodestructiva/epidemiología , Trastornos por Estrés Postraumático/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Suicidio/estadística & datos numéricos , Veteranos/psicología , Veteranos/estadística & datos numéricos , Adulto , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Conducta Autodestructiva/psicología , Distribución por Sexo , Factores Sexuales , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/psicología , Trastornos Relacionados con Sustancias/psicología , Ideación Suicida , Suicidio/psicología , Estados Unidos/epidemiología , Violencia/psicología , Violencia/estadística & datos numéricos , Adulto Joven
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