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The U.S. Department of Veterans Affairs is actively transitioning away from a disease-centric model of healthcare to one that prioritizes disease prevention and the promotion of overall health and well-being. Described as Whole Health, this initiative aims to provide personalized, values-centered care that optimizes physical, behavioral, spiritual, and socioeconomic well-being. To inform this initiative, we analyzed cross-sectional data from a nationally representative sample of primarily older U.S. military veterans to estimate levels of well-being across these domains, and identify sociodemographic, military, and potentially modifiable health and psychosocial correlates of them. Results revealed that, overall, veterans reported high domain-specific well-being (average scores ranging from 6.7 to 8.3 out of 10), with the highest levels in the socioeconomic domain and lowest in the physical domain. Several modifiable factors, including purpose in life, resilience, and social support, were strongly associated with the examined well-being domains. Interventions targeting these constructs may help promote well-being among U.S. veterans.
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OBJECTIVE: Cigarette smoking and musculoskeletal pain are prevalent among Department of Veterans Affairs (VA) health care system users. These conditions frequently co-occur; however, there is limited empirical information specific to Afghanistan/Iraq era veterans. The present study sought to examine gender differences in the association between cigarette smoking and moderate to severe musculoskeletal pain in US veterans with Afghanistan/Iraq era service. METHODS: A random sample of 5,000 veterans with service after November 11, 2001, participated in a survey assessing health care needs and barriers to care. One thousand ninety veterans completed the survey assessing post-traumatic stress disorder (PTSD) symptoms, depressive symptoms, and current pain severity. Multivariate logistic regression was used to examine the association between gender, cigarette smoking status, and current moderate to severe musculoskeletal pain. RESULTS: Findings indicated a significant gender by smoking interaction on moderate/severe musculoskeletal pain, adjusting for age, self-reported race/ethnicity and weight status, combat exposure, probable PTSD, depressive symptoms, service-connected injury during deployment, and VA health care service utilization. Deconstruction of the interaction indicated that female veteran smokers, relative to female nonsmokers, had increased odds of endorsing moderate to severe musculoskeletal pain (odds ratio [OR] = 2.73, 95% confidence interval [CI] = 1.16-6.41), whereas this difference was nonsignificant for male veterans (OR = 1.03, 95% CI = 0.69-1.56). CONCLUSIONS: Survey data from Operation Enduring Freedom/Operation Iraqi Freedom veterans suggest an association between current smoking, gender, and moderate to severe musculoskeletal pain. The stronger relationship between smoking and pain in women supports the need for interventional and longitudinal research that can inform gender-based risk factors for pain in veteran cigarette smokers.
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Fumar Cigarros/epidemiologia , Dor Musculoesquelética/epidemiologia , Veteranos/estatística & dados numéricos , Adulto , Campanha Afegã de 2001- , Feminino , Humanos , Guerra do Iraque 2003-2011 , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por SexoRESUMO
Anger is a commonly reported problem among returning veterans, yet little attention has been devoted to studying treatment engagement among veterans who report anger problems but do not have posttraumatic stress disorder (PTSD). This study compares Iraq-Afghanistan veterans with anger/no PTSD (n = 159) to others reporting significant PTSD symptoms (n = 285) and those reporting neither anger nor PTSD (n = 716) on rates of treatment utilization, perceived barriers to treatment, and preferences for care. Relative to the PTSD group, the anger/no-PTSD group was significantly less likely to have received mental health treatment in the last year, despite endorsing barriers to treatment at a lower rate. Furthermore, the anger/no-PTSD group endorsed fewer preferences than the PTSD group. Results suggest that the anger/no-PTSD group is a unique subgroup that may be less likely to identify a need for treatment. Implications are discussed.
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Acessibilidade aos Serviços de Saúde , Serviços de Saúde Mental/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos/psicologia , Adulto , Ira , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Preferência do Paciente , Transtornos de Estresse Pós-Traumáticos/psicologiaRESUMO
BACKGROUND: Binge drinking is a significant public health concern linked to a number of health and psychosocial problems. Military service in Afghanistan (OEF) and Iraq (OIF) has been associated with posttraumatic stress disorder (PTSD) and increased hazardous drinking. Brief alcohol interventions may reduce hazardous drinking but are infrequently provided to at-risk drinkers. OBJECTIVES: This study examined the association of combat exposure, PTSD symptoms, binge drinking, use of VA and non-VA healthcare services, and the incidence of provider drinking advice. METHODS: OEF/OIF veterans (n = 1087) completed measures of demographics, military history, combat exposure, PTSD symptoms, and binge drinking as part of a confidential mail survey study conducted in 2009 and 2010 (response rate = 29%). Patient report of receiving advice in the past year from a provider about their drinking was queried for frequent binge drinkers. The association of demographic variables, combat exposure, PTSD, and use of healthcare services with binge drinking and receipt of provider drinking advice was estimated using logistic regression. RESULTS: Overall, 51% of the sample reported at least one episode of binge drinking in the past year and 19% were identified as frequent binge drinkers. PTSD was related to frequent binge drinking. At-risk veterans using VA healthcare services were significantly more likely to receive provider drinking advice (50%) than veterans not using VA (13.4%). CONCLUSIONS: There is a need for increased vigilance and action to identify and counsel at-risk veterans about alcohol misuse in this population.
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Consumo Excessivo de Bebidas Alcoólicas/epidemiologia , Concussão Encefálica/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Veteranos/estatística & dados numéricos , Adulto , Campanha Afegã de 2001- , Comorbidade , Aconselhamento/estatística & dados numéricos , Feminino , Humanos , Guerra do Iraque 2003-2011 , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Prevalência , Estados Unidos/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Although a large body of literature has linked posttraumatic stress disorder (PTSD) with poor physical health among older veterans, less is known regarding the association between PTSD and health among relatively younger cohorts of veterans. OBJECTIVE: The current study examined the association between PTSD and self-reported health among a sample of veterans who served in the recent conflicts in Iraq and Afghanistan. METHOD: Veterans (N = 1030) who served in the wars in Iraq and Afghanistan completed measures of PTSD symptom severity and self-rated health between September 2009 and February 2010. Analyses examined the association between PTSD symptoms and health outcomes. RESULTS: In analyses adjusted for age, sex, race, and combat exposure, PTSD symptom severity was positively related to the number of health conditions and health symptoms reported (ps<0.001). Additionally, in analyses adjusted for age, sex, race, combat exposure, number of health conditions, and number of health symptoms, PTSD symptom severity was associated with an increased likelihood of rating one's health as poor or fair and an increased likelihood of reporting that one's physical health limits participation in activities (ps<0.001). CONCLUSION: These findings suggest that, consistent with previous research, PTSD symptom severity has a broad negative effect on physical health among veterans of the Iraq and Afghanistan era. Health promotion among veterans with PTSD may help attenuate risk of physical health consequences.
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Campanha Afegã de 2001- , Nível de Saúde , Inquéritos Epidemiológicos/estatística & dados numéricos , Guerra do Iraque 2003-2011 , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Veteranos/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Autorrelato , Índice de Gravidade de Doença , Estados Unidos/epidemiologiaRESUMO
This study examined health care barriers and preferences among a self-selected sample of returning U.S. veterans drawn from a representative, randomly selected frame surveyed about posttraumatic stress disorder (PTSD) symptomatology and mental health utilization in the prior year. Comparisons between treated (n = 160) and untreated (n = 119) veterans reporting PTSD symptoms were conducted for measures of barriers and preferences, along with logistic models regressing mental health utilization on clusters derived from these measures. Reported barriers corroborated prior research findings as negative beliefs about treatment and stigma were strongly endorsed, but only privacy concerns were associated with lower service utilization (B = -0.408, SE = 0.142; p = .004). The most endorsed preference (91.0%) was for assistance with benefits, trailed by help for physical problems, and particular PTSD symptoms. Help-seeking veterans reported stronger preferences for multiple interventions, and desire for services for families (B = 0.468, SE = 0.219; p = .033) and specific PTSD symptoms (B = 0.659, SE = 0.302; p = .029) were associated with increased utilization. Outcomes of the study suggested PTSD severity drove help-seeking in this cohort. Results also support the integration of medical and mental health services, as well as coordination of health and benefits services. Finally, the study suggested that outreach about privacy protections and treatment options could well improve engagement in treatment.
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Serviços de Saúde Mental/estatística & dados numéricos , Preferência do Paciente , Assistência Centrada no Paciente , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos/psicologia , Adulto , Campanha Afegã de 2001- , Terapia Familiar , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Guerra do Iraque 2003-2011 , Masculino , Pessoa de Meia-Idade , Privacidade , Índice de Gravidade de Doença , Estigma Social , Transtornos de Estresse Pós-Traumáticos/psicologia , Estados UnidosRESUMO
This commentary describes the prevalence of mental health problems affecting military service members and veterans in North Carolina and the rest of the nation, with a special emphasis on those who served in the recent wars in Iraq and Afghanistan. Approximately 1.9 million of these veterans have become eligible for Veterans Affairs health care since 2002, and an estimated 1.16 million veterans have registered for this care.
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Transtornos Mentais/epidemiologia , Saúde Mental , Militares/psicologia , Veteranos/psicologia , Campanha Afegã de 2001- , Humanos , Incidência , Guerra do Iraque 2003-2011 , Militares/estatística & dados numéricos , North Carolina/epidemiologia , Prevalência , Estados Unidos , United States Department of Veterans Affairs , Veteranos/estatística & dados numéricosRESUMO
A new National Academies of Sciences, Engineering, and Medicine report, "Achieving Whole Health: A New Approach for Veterans and the Nation," redefines what it means to be healthy and creates a roadmap for health systems, including the Veterans Health Administration and the nation, to scale and spread a whole health approach to care. The report identifies 5 foundational elements for whole health care and sets 6 national, state, and local policy goals for change. This article summarizes the report, emphasizes the importance of preventive medicine, and identifies concrete actions clinicians and practices can take now to deliver whole health care.
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Atenção à Saúde , Nível de Saúde , HumanosRESUMO
In response to veterans' needs in the context of recent deployments, the Veterans Affairs (VA) health system has increased the number of its facilities and caregivers and has pioneered changes in policy and programs. We review significant recent initiatives to improve access to behavioral health services in the VA health system.
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Serviços de Saúde Mental/provisão & distribuição , United States Department of Veterans Affairs , Veteranos/psicologia , Família , Pessoas Mal Alojadas , Humanos , Saúde da População Rural , Transtornos de Estresse Pós-Traumáticos , Estados Unidos , Saúde da Mulher , Prevenção do SuicídioRESUMO
The Department of Defense and the Department of Veterans Affairs place a high priority on behavioral health assessment, treatment, and research. We present the national and regional prevalence of the most-common behavioral health problems experienced by Operation Enduring Freedom and Operation Iraqi Freedom veterans and offer resources for best practices for treatment.
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Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Militares/psicologia , Veteranos/psicologia , Campanha Afegã de 2001- , Lesões Encefálicas/epidemiologia , Feminino , Humanos , Guerra do Iraque 2003-2011 , Masculino , Guias de Prática Clínica como Assunto , Prevalência , Delitos Sexuais/psicologia , Estados Unidos/epidemiologia , Prevenção do SuicídioRESUMO
In recent years, several practice guidelines have appeared to inform clinical work in the assessment and treatment of posttraumatic stress disorder. Although there is a high level of consensus across these documents, there are also areas of apparent difference that may lead to confusion among those to whom the guidelines are targeted-providers, consumers, and purchasers of mental health services for people affected by trauma. The authors have been responsible for developing guidelines across three continents (North America, Europe, and Australia). The aim of this article is to examine the various guidelines and to compare and contrast their methodologies and recommendations to aid clinicians in making decisions about their use.
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Guias de Prática Clínica como Assunto , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/terapia , Consenso , HumanosAssuntos
Relações Médico-Paciente , Transtornos de Estresse Pós-Traumáticos/terapia , Sobreviventes/psicologia , Guerra , Ferimentos e Lesões/psicologia , Adaptação Psicológica , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Avaliação das Necessidades , Equipe de Assistência ao Paciente/organização & administração , Padrões de Prática Médica , Grupos de Autoajuda , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Estresse Psicológico , Sobreviventes/estatística & dados numéricos , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapiaRESUMO
This article traces the evolution of clinical practice guidelines (CPGs) for the treatment of Posttraumatic Stress Disorder (PTSD) to illustrate how their construction and use have become intertwined and often conflated with other pressing clinical and scientific controversies. This review locates critical analysis of key documents regarding PTSD CPG construction within the context of longstanding tensions and frank competition about the relative value of science and clinical experience in the effort to establish best practices. As is true of so many dichotomies, the competition between science and clinical practice is more apparent than real. The growing tendency of developers to exclude common clinical practices in the construction of (and within the discussion sections of) CPGs for PTSD imposes a false sense of precision and predictability on clinical practice, which is anything but precise or predictable. As such, it raises the question as to whether these CPGs are still clinical at all. It also distracts from critically important opportunities to harness the tension between competing perspectives and domains to significantly advance the care of patients. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Guias de Prática Clínica como Assunto , Transtornos de Estresse Pós-Traumáticos/terapia , Humanos , Sociedades Científicas , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Resultado do Tratamento , Estados UnidosRESUMO
The study investigated barriers to the utilization of Veterans Affairs (VA) health care services among female veterans who served in served in Iraq and Afghanistan, including reasons for not choosing VA health care, reasons for not seeking mental health treatment, and types of desired VA services. Female respondents to a survey assessing Operation Enduring Freedom/Operation Iraqi Freedom veterans' needs and health (N = 186) completed measures of military history, posttraumatic stress disorder, depression, barriers to VA health care, and preferences for services. Barriers to use of VA health care endorsed by female veterans included receiving care elsewhere and logistical issues. Barriers to utilization of mental health services among female veterans who screened positive for depression or posttraumatic stress disorder included negative treatment biases and concerns about stigma, privacy, and cost. Female veterans endorsed preferences for services related to eligibility education, nonprimary care physical health services, vocational assistance, and a few behavioral/mental health services. Findings highlight the need for ongoing outreach and education regarding eligibility and types of resources for physical and mental health problems experienced by female veterans who served in Iraq and Afghanistan, as well as inform types of VA programming and services desired by female veterans. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Transtorno Depressivo/terapia , Acessibilidade aos Serviços de Saúde , Serviços de Saúde Mental , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos , Adulto , Campanha Afegã de 2001- , Transtorno Depressivo/psicologia , Feminino , Humanos , Guerra do Iraque 2003-2011 , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Transtornos de Estresse Pós-Traumáticos/psicologia , Estados Unidos , United States Department of Veterans AffairsRESUMO
This cross-sectional study examines the association of protective psychological characteristics with mental, psychosocial, cognitive, and physical functioning in military veterans.
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Veteranos , Humanos , Veteranos/psicologia , Veteranos/estatística & dados numéricos , Estados Unidos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , Nível de Saúde , Estudos TransversaisRESUMO
This survey study analyzed data from a nationally representative sample of US veterans to examine ratings and correlates of well-being.
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Militares , Resiliência Psicológica , Veteranos , HumanosRESUMO
Military sexual trauma (MST) has been linked with increased rates of mental health disorders among veterans. Few studies have addressed how MST is related to use of VA and non-VA health care. The purpose of the current study was to (a) examine the association between MST, combat experiences, and mental health outcomes (i.e., posttraumatic stress disorder [PTSD] and depression) and (b) examine the association of MST and use of VA and non-VA health care services among female veterans who served in Iraq and Afghanistan. Female respondents to a survey assessing Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) veterans' needs and health ( N = 185) completed measures of demographic variables, military history, combat exposure, MST, PTSD, and depression symptoms, and use of VA and non-VA health care. Overall, 70% of the sample experienced one or more combat-related experiences and 15.7% endorsed MST during deployment to Iraq or Afghanistan. MST and combat exposure were both positively associated with PTSD and depression symptoms even after controlling for the effects of demographic and military history variables. MST was associated with increased use of VA mental health services in bivariate results but was not independently related to VA service utilization after accounting for PTSD and depression symptoms. Approximately half of the women who reported MST had not used VA health care. Continued outreach and education initiatives may be needed to ensure veterans understand the resources available to address MST-related mental and physical health problems through the VA.
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Campanha Afegã de 2001- , Transtorno Depressivo/epidemiologia , Guerra do Iraque 2003-2011 , Serviços de Saúde Mental/estatística & dados numéricos , Delitos Sexuais/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Veteranos/estatística & dados numéricos , Adulto , Transtorno Depressivo/psicologia , Transtorno Depressivo/terapia , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Militares/psicologia , Militares/estatística & dados numéricos , Delitos Sexuais/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Estados Unidos/epidemiologia , United States Department of Veterans Affairs , Veteranos/psicologiaRESUMO
Alcohol misuse is associated with negative mental and physical health outcomes, which presents a public health concern in veterans. However, less is known regarding outcomes among veterans with low to moderate alcohol consumption. This study included veterans with military service in Iraq and/or Afghanistan (N = 1083) who resided in the VA Mid-Atlantic region catchment area (North Carolina, Virginia, and parts of West Virginia). Participants completed a mailed survey that inquired about demographics, past-year alcohol consumption, self-rated physical health, and psychiatric symptoms. Logistic regression was used to evaluate associations between alcohol consumption and posttraumatic stress disorder (PTSD), depression, and self-rated physical health. In both bivariate results and adjusted models, non-drinkers and hazardous drinkers were more likely to endorse clinically significant PTSD and depression symptoms than moderate drinkers. Moderate drinkers were also less likely to report fair/poor health, after adjusting for demographics and psychiatric symptoms. Results overall showed a U-shaped curve, such that moderate alcohol use was associated with lower rates of mental health problems and fair/poor health. While the VA routinely screens for alcohol misuse, current results suggest that non-drinkers are also at risk for poor mental and physical health.
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Consumo de Bebidas Alcoólicas/psicologia , Autoavaliação Diagnóstica , Doenças Profissionais/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia , Adulto , Campanha Afegã de 2001- , Depressão/psicologia , Feminino , Humanos , Guerra do Iraque 2003-2011 , Modelos Logísticos , Masculino , North Carolina , Inquéritos e Questionários , Estados Unidos , Virginia , West Virginia , Adulto JovemRESUMO
Although Posttraumatic Stress Disorder (PTSD) has come to be understood in primarily biological terms, the problems of returning combat veterans from Iraq and Afghanistan (and indeed, of their families) are best understood in psychodynamic terms. Their needs would be better met through a public health model that incorporates progressive outreach and engagement of all new veterans rather than a traditional medical model which focuses only on those with a biological disorder. Work with new veterans and their families requires facilitation of their own adaptive processes (psychological, social, and biological). This approach carries with it the potential to reorient and revitalize the theory and practice of psychiatry.
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Relações Comunidade-Instituição , Família , Necessidades e Demandas de Serviços de Saúde , Psiquiatria Militar/métodos , Psicoterapia/métodos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos/estatística & dados numéricos , Guerra , Humanos , Veteranos/psicologiaRESUMO
The United States (US) Department of Veterans Affairs (VA) Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC) Post-Deployment Mental Health (PDMH) multi-site study examines post-deployment mental health in US military Afghanistan/Iraq-era veterans. The study includes the comprehensive behavioral health characterization of over 3600 study participants and the genetic, metabolomic, neurocognitive, and neuroimaging data for many of the participants. The study design also incorporates an infrastructure for a data repository to re-contact participants for follow-up studies. The overwhelming majority (94%) of participants consented to be re-contacted for future studies, and our recently completed feasibility study indicates that 73-83% of these participants could be reached successfully for enrollment into longitudinal follow-up investigations. Longitudinal concurrent cohort follow-up studies will be conducted (5-10+ years post-baseline) to examine predictors of illness chronicity, resilience, recovery, functional outcome, and other variables, and will include neuroimaging, genetic/epigenetic, serum biomarker, and neurocognitive studies, among others. To date, the PDMH study has generated more than 35 publications from the baseline data and the repository has been leveraged in over 20 publications from follow-up studies drawing from this cohort. Limitations that may affect data collection for a longitudinal follow-up study are also presented.