Caucasian Veterans Research Articles

The Efficacy of Cognitive Processing Therapy for PTSD Related to Military Sexual Trauma in Veterans: A Review

ABSTRACTWomen currently comprise 12% of the total number of service personnel who have served in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. Presently, 15% of active duty personnel, 17% of National Guard personnel, and 20% of new recruits are female. The number of female veterans utilizing the Veterans Health Administration has more than doubled, from 159,000 to 337,000 from 2000–2011 and is expected to double again within the next decade. Similar overall numbers of female and male service members report experiencing military sexual trauma (MST). Prevalence rates vary by study where 20 to 68% of female service members and 1% to 6% of male service members have experienced MST. Many of these service members subsequently develop mental health issues and are diagnosed with conditions related to MST.Purpose: The purpose of this review was to summarize outcome studies examining Cognitive Processing Therapy (CPT) for the treatment of Post-traumatic Stress Disorder (PTSD) related to Military Sexual Trauma.Methods: The informational databases that were utilized for the current review were ERIC (EBSCO), ERIC (ProQuest), Google Scholar, and PsycINFO. The dates for literature inclusion was from 2010 to March of 2019. The literature search was initiated in March and was terminated in April of 2019.Results: The results indicated that CPT is an effective intervention for the reduction of MST related PTSD symptoms, including negative cognitions, compared to Present-Centered Therapy (PCT). Additionally, at 6-month post-treatment follow-up symptom reduction was stable. Results were mixed for CPT associated with quality of life and exposure to child Sexual abuse (CSA). Veterans who self-identified as African-American and Caucasian female veterans experienced significant reductions in PTSD symptomology with no differences between groups.Discussion: All studies included in the review resulted in significant reductions in PTSD but four of five also suffered from treatment fidelity in the CPT treatment condition. Researchers chose to exclude participant data from the therapists who did not adhere to CPT protocol resulting in a reduction of statistical power in these studies. The final study included in the review administered multiple treatment modalities concurrently.

Abstract 1569: Racial differences in incidence and impact of TP53 deletion on outcome in African American and Caucasian veterans with multiple myeloma

Abstract BACKGROUND: In multiple myeloma (MM), the presence of TP53 deletion is associated with poor prognosis. It is found in roughly 10% of newly diagnosed patients. Lower incidence of TP53 deletion is reported in African American (AA) compared to Caucasian (CA), suggesting a possible contribution of disease biology to clinical disparity in AA. Our recent report of a significantly superior age-adjusted risk of death in AA compared to CA patients in the Veteran population also suggests possible racial differences in disease biology. Here we investigated the incidence of TP53 deletion among younger (<65) versus older AA and CA patients with MM at the VA. METHODS: We identified 15717 patients with MM from 1999 to 2017 using the VA’s nationwide Corporate Data Warehouse. We extracted data on patients’ age, race, and ISS stage, as well as data on their therapy at induction and stem-cell transplant (SCT). Additionally, we extracted data on TP53 deletion testing and results using a natural language processing algorithm and focused our analysis on patients with these data. RESULTS: We identified 5,744 MM patients evaluated for TP53 deletion by conventional cytogenetics and/or FISH, including 32.5% AA (1,864) and 67.5% CA (3,880) patients. Greater proportion of AA patients (53%) were younger (<65 years), compared to CA (39%; p<0.001). Overall, among those tested, TP53 deletion was reported in 9.6% of patients, but the incidence was significantly lower in AA (7.2%) compared to CA (10.7%; p<0.001). Among patients <65 years of age, difference in incidence of TP53 deletion between AA and CA was 3.2% (8.1% vs 11.3%; p=0.01), while in those ≥65 years age, it was 4.1% (6.4% vs 10.5%; p=0.0005), suggesting increased difference in the incidence of TP53 deletion with age. The rates of TP53 deletion across different ISS stages were not significantly different, nor did ISS stage differ across race. The majority of patients with TP53 deletion (95.2%) received either proteasome inhibitor or immunomodulator at induction, but only 24.7% were treated with the combination, and only 21.4% proceeded to SCT. Median survival among younger patients with TP53 deletion appeared substantially lower in AA than in CA (5.1 vs 7.0 years; p=0.74), though without reaching significance, perhaps due to sample size. In contrast, younger AA without TP53 deletion had a significantly longer median survival than CA (8.0 vs 6.2 years; p<0.01). Among older patients, AA had longer median survival regardless of TP53 deletion status. CONCLUSIONS: This large cohort study identified significantly lower incidence of TP53 deletion in AA compared to CA. Yet, when present in younger AA patients, TP53 deletion correlated with worse survival. These results identify racial disparity in both occurrence and impact of TP53 deletion and now suggests the need for a more comprehensive genetic assessment to develop risk stratification in AA myeloma patients. Citation Format: Diana Cirstea, Nathanael Fillmore, Hassan Yameen, Sarvari Yellapragada, Chizoba Ifeorah, Nhan Do, Mary Brophy, Nikhil Munshi. Racial differences in incidence and impact of TP53 deletion on outcome in African American and Caucasian veterans with multiple myeloma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1569.

The rate of tumor growth, g, as a biomarker for overall survival (OS) in prostate cancer (PC) in clinical trials as well as in real-world data from the Veterans Administration Medical Centers (VAMCs).

5074 Background: Novel assessments of efficacy are needed to improve determination of treatment outcomes in clinical trials and in real-world settings. Methods: Cancer treatments usually lead to concurrent regression and growth of the drug-sensitive and drug-resistant fractions of a tumor, respectively. We have exploited novel methods of analysis that assess these two simultaneous processes and have estimated rates of tumor growth ( g) and regression ( d) in over 30,000 patients (pts) with diverse tumors. Results: In prostate cancer (PC) we have analyzed both clinical trial and real-world data from Veterans. Using clinical trial data from 6819 pts enrolled in 15 treatment arms we have established separately and by combining all the data that g correlates highly (p<0.0001) with overall survival (OS) – slower g associated with better OS. In PC, abiraterone (ABI) and docetaxel (DOC) are superior to placebo, prednisone and mitoxantrone. ABI (median g =0.0017) is superior to DOC ( g=0.0021) in first line (p=0.0013); and ABI in 2nd line ( g=0.0034) is inferior to ABI in 1st line ( g=0.0017; p<0.0001). Finally, using combined clinical trial data as a benchmark we could assess the efficacy of novel therapies in as few as 30-40 patients. Amongst 7457 Veterans, the median g on a taxane ( g=0.0022) was similar to that from clinical trials ( g=0.0012). Although only 258 Veterans received cabazitaxel (CAB), g values for CAB ( g=0.0018) and DOC ( g=0.0023) were indistinguishable (p=0.3) consistent with their identical mechanism of action. Finally, outcomes with DOC in African American (AA) ( g=0.00212) and Caucasian ( g=0.00205) Veterans were indistinguishable (p=0.9) and comparable across all VAMCs. Conclusions: The rate of tumor growth, g, is an excellent biomarker for OS both in clinical trials and in real-world settings. g allows comparisons between trials and for large trial data sets to be used as benchmarks of efficacy. Real-world outcomes in the VAMCs are similar to those in clinical trials. In the egalitarian VAMCs DOC efficacy in PC is comparable in AA and Caucasian Veterans -- indicating inferior outcomes reported in AAs are likely due to differential health care access, not differences in biology.

Evaluating the stability of DSM-5 PTSD symptom network structure in a national sample of U.S. military veterans

BackgroundPrevious studies have used network models to investigate how PTSD symptoms associate with each other. However, analyses examining the degree to which these networks are stable over time, which are critical to identifying symptoms that may contribute to the chronicity of this disorder, are scarce. In the current study, we evaluated the temporal stability of DSM-5 PTSD symptom networks over a three-year period in a nationally representative sample of trauma-exposed U.S. military veterans. MethodsData were analyzed from 611 trauma-exposed U.S. military veterans who participated in the National Health and Resilience in Veterans Study (NHRVS). We estimated regularized partial correlation networks of DSM-5 PTSD symptoms at baseline (Time 1) and at three-year follow-up (Time 2), and examined their temporal stability. ResultsEvaluation of the network structure of PTSD symptoms at Time 1 and Time 2 using a formal network comparison indicated that the Time 1 network did not differ significantly from the Time 2 network with regard to network structure (p = 0.12) or global strength (sum of all absolute associations, i.e. connectivity; p = 0.25). Centrality estimates of both networks (r = 0.86) and adjacency matrices (r = 0.69) were highly correlated. In both networks, avoidance, intrusive, and negative cognition and mood symptoms were among the more central nodes. LimitationsThis study is limited by the use of a self-report instrument to assess PTSD symptoms and recruitment of a relatively homogeneous sample of predominantly older, Caucasian veterans. ConclusionResults of this study demonstrate the three-year stability of DSM-5 PTSD symptom network structure in a nationally representative sample of trauma-exposed U.S. military veterans. They further suggest that trauma-related avoidance, intrusive, and dysphoric symptoms may contribute to the chronicity of PTSD symptoms in this population.

Factors impacting rural Pacific Island veterans' access to care: A qualitative examination.

Pacific Island veterans suffer from greater severity of posttraumatic stress disorder (PTSD) compared with Caucasian veterans but face substantial barriers to mental health care. However, the factors that may dissuade or facilitate veterans in the Pacific Islands from seeking mental health care are not known. The main aim of this study was to identify how internal and external factors interact to impact wounded warriors' access to and use of mental health services. Veterans residing in 5 rural Pacific Island locations were mailed recruitment materials. Other veterans were made aware of the project by key stakeholders in their communities. Thirty-seven male veterans (across 5 focus groups) and 1 female veteran (via individual interview) participated. The study utilized an analytic design in which taped focus group discussions were transcribed verbatim and coded for major themes. Results indicated that most veterans identified Veterans Affairs (VA) as a positive source for health care. However, common concerns acknowledged were as follows: (a) difficulty navigating the VA system, (b) time associated with receiving care, (c) family stigma, (d) community stigma, (e) cultural differences, and (f) a lack of knowledge about VA services and benefits. Facilitators of care included the following: (a) individual knowledge and self-efficacy, (b) networking with other veterans, (c) family support, and (d) rural community support. All factor levels interacted in subtle ways to ultimately impact access to care. Next steps are described, including projects designed to better meet the needs of rural Pacific Island veterans. (PsycINFO Database Record

C-89Influence of Reading Ability on Neuropsychological Test Performance in a Clinical Sample of African American and Caucasian Veterans

C-89Influence of Reading Ability on Neuropsychological Test Performance in a Clinical Sample of African American and Caucasian Veterans

Abstract #523: Lower Serum 25-Hydroxyvitamin D is an Independent Predictor for Obesity but not for Common Chronic Conditions: an Observational Study of African American and Caucasian Male Veterans

Abstract #523: Lower Serum 25-Hydroxyvitamin D is an Independent Predictor for Obesity but not for Common Chronic Conditions: an Observational Study of African American and Caucasian Male Veterans

Aggression, DRD1 polymorphism, and lesion location in penetrating traumatic brain injury

This study evaluated whether structural brain lesions modulate the relationship between pathological aggression and the dopaminergic system in traumatic brain injury (TBI). While converging evidence suggests that different areas of the prefrontal cortex modulate dopaminergic activity, to date no evidence exists of a modulation of endogenous dopaminergic tone by lesion localization in penetrating TBI (pTBI). This study included 141 male Caucasian veterans who suffered penetrating pTBI during their service in Vietnam and 29 healthy male Caucasian Vietnam veterans. Participants were genotyped for 3 functional single nucleotide polymorphisms (SNPs): dopamine receptor D1 (DRD1) rs686, dopamine receptor D2 (DRD2) rs4648317, and catechol-O-methyltransferase (COMT) Val158Met. Patients underwent brain CT scans and were divided into medial prefrontal cortex, lateral prefrontal cortex, and posterior cortex lesion groups. Long-term aggression levels were evaluated with the agitation/aggression subscale of the Neuropsychiatric Inventory. Our data showed that carriers of more transcriptionally active DRD1 alleles compared to noncarriers demonstrated greater aggression levels due to medial prefrontal cortex lesions but reduced aggression levels due to lateral prefrontal cortex lesions independently of DRD2 rs4648317 or COMT Val158Met genotypes. Our results suggest that the relationship between pTBI-related aggression and the dopaminergic system is modulated by lesion location. Potentially lesion location could represent an easy-to-use, widely available, para-clinical marker to help in the development of an individualized therapeutic approach to pTBI-related pathological aggression.

Race and Incarceration in an Aging Cohort of Vietnam Veterans in Treatment for Post-Traumatic Stress Disorder (PTSD)

Cross sectional studies have addressed the incarceration of Vietnam veterans with post-traumatic stress disorder (PTSD), but no studies have examined changes in incarceration as they age. This study examines patterns of incarceration among Vietnam veterans treated in specialized veterans affairs (VA) intensive PTSD programs over time. Data was drawn from admission data from the initial episode of treatment of Caucasian and African American Vietnam veterans entering VA specialized intensive PTSD programs between 1993 and 2011 (N = 31,707). Bivariate correlations and logistic regression were used to examine associations among race and incarceration over time and the potentially confounding influence of demographic and clinical covariates on this relationship. Rates of reported incarceration declined from 63 to 43%. Over time, African American veterans were 34% more likely than Caucasian veterans to have a lifetime history of incarceration while interaction analysis showed steeper declines for Caucasians than African Americans. Rates of incarceration among these Vietnam veterans declined as they aged. Furthermore, African American veterans were substantially more likely than Caucasian veterans to have been incarcerated and showed less decline as the cohort aged. While reduced, needs for clinical PTSD services remain among aging combat veterans.

Racial Differences in Veterans’ Satisfaction With Examination of Disability From Posttraumatic Stress Disorder

The examination that determines if a veteran has service-connected posttraumatic stress disorder (PTSD) affects veterans' lives for years. This study examined factors potentially associated with veterans' perception of their examination's quality. Veterans (N=384) being evaluated for an initial PTSD service-connection claim were randomly assigned to receive either a semistructured interview or the examiner's usual interview. Immediately after the interview, veterans completed confidential ratings of the examinations' quality and of their examiners' interpersonal qualities and competence. Extensive data characterizing the veterans, the 33 participating examiners, and the examinations themselves were collected. Forty-seven percent of Caucasian veterans and 34% of African-American veterans rated their examination quality as excellent. African Americans were less likely than Caucasians to assign a higher quality rating (odds ratio=.61, 95% confidence interval=.38-.99, p=.047). Compared with Caucasians, African Americans rated their examiners as having significantly worse interpersonal qualities but not lower competence. Ratings were not significantly related to the veterans' age, gender, marital status, eventual diagnosis of PTSD, Global Assessment of Functioning score, the examiner's perception of the prevalence of malingering, or the presence of a third party during the examination. Ratings of disability examinations were generally high, although ratings were less favorable among African-American veterans than among Caucasian veterans.

A High-Density Genome-Wide Association Screen of Sporadic ALS in US Veterans

Following reports of an increased incidence of amyotrophic lateral sclerosis (ALS) in U.S. veterans, we have conducted a high-density genome-wide association study (GWAS) of ALS outcome and survival time in a sample of U.S. veterans. We tested ∼1.3 million single nucleotide polymorphisms (SNPs) for association with ALS outcome in 442 incident Caucasian veteran cases diagnosed with definite or probable ALS and 348 Caucasian veteran controls. To increase power, we also included genotypes from 5909 publicly-available non-veteran controls in the analysis. In the survival analysis, we tested for association between SNPs and post-diagnosis survival time in 639 Caucasian veteran cases with definite or probable ALS. After this discovery phase, we performed follow-up genotyping of 299 SNPs in an independent replication sample of Caucasian veterans and non-veterans (ALS outcome: 183 cases and 961 controls; survival: 118 cases). Although no SNPs reached genome-wide significance in the discovery phase for either phenotype, three SNPs were statistically significant in the replication analysis of ALS outcome: rs6080539 (177 kb from PCSK2), rs7000234 (4 kb from ZNF704), and rs3113494 (13 kb from LOC100506746). Two SNPs located in genes that were implicated by previous GWA studies of ALS were marginally significant in the pooled analysis of discovery and replication samples: rs17174381 in DPP6 (p = 4.4×10−4) and rs6985069 near ELP3 (p = 4.8×10−4). Our results underscore the difficulty of identifying and convincingly replicating genetic associations with a rare and genetically heterogeneous disorder such as ALS, and suggest that common SNPs are unlikely to account for a substantial proportion of patients affected by this devastating disorder.

Cranial Electrotherapy Stimulation in the Treatment of Posttraumatic Stress Disorder: A Pilot Study of Two Military Veterans

This case study investigated the effects of cranial electrotherapy stimulation (CES) on the prevalence and intensity of posttraumatic stress disorder (PTSD) symptoms and self- perceived improvement of performance and satisfaction in daily activities in war veterans. Two male Caucasian veterans (ages 54 and 38) diagnosed with PTSD participated in these case studies with a pretest–posttest design. The Canadian Occupational Performance Measure (COPM) and the PTSD Symptom Scale–Interview (PSS-I) were administered before and after the 4-week CES treatment. The participants self-administered the 4-week CES treatment protocol using Alpha-Stim SCS CES device in their home for 20 to 60 min a day, 3 to 5 days a week with a comfortable, self-selected, current level between 100 and 500 microamperes. They were asked to document the settings and responses in a daily treatment log. Through visual trend analysis and change scores, the results revealed daily PTSD symptoms decreased in frequency and severity for both parti...

Differences in Treatment Attitudes Between Depressed African-American and Caucasian Veterans in Primary Care

Depressive disorders are common, and it is important to understand the factors that contribute to racial disparities in depression treatment. This primary care study of veterans with subsyndromal depression examined two hypotheses: that African Americans would be less likely than Caucasians to believe that medication is beneficial in depression treatment and would be more likely to believe that counseling or psychotherapy is beneficial. Primary care patients with subsyndromal depression were referred to the Philadelphia Department of Veterans Affairs Behavioral Health Laboratory and asked about past experiences and attitudes toward depression treatment. Among 111 African-American and 95 Caucasian participants, logistic regression analyses determined that African Americans were less likely to view medication as beneficial (odds ratio=.44). No racial differences were found in participants' attitude toward counseling or psychotherapy. The findings support the premise that clinicians treating patients with subsyndromal depressive syndromes should take into account racial differences in attitudes toward treatment.

Differences in Treatment Attitudes Between Depressed African-American and Caucasian Veterans in Primary Care

Objectives: Depressive disorders are common, and it is important to understand the factors that contribute to racial disparities in depression treatment. This primary care study of veterans with subsyndromal depression examined two hypotheses: that African Americans would be less likely than Caucasians to believe that medication is beneficial in depression treatment and would be more likely to believe that counseling or psychotherapy is beneficial. Methods: Primary care patients with subsyndromal depression were referred to the Philadelphia Department of Veterans Affairs Behavioral Health Laboratory and asked about past experiences and attitudes toward depression treatment. Results: Among 111 African-American and 95 Caucasian participants, logistic regression analyses determined that African Americans were less likely to view medication as beneficial (odds ratio=.44). No racial differences were found in participants' attitude toward counseling or psychotherapy. Conclusions: The findings support the premise that clinicians treating patients with subsyndromal depressive syndromes should take into account racial differences in attitudes toward treatment. (Psychiatric Services 62:426–429, 2011)

Risk of colorectal cancer among African-American and Caucasian veterans with ulcerative colitis

Risk of colorectal cancer among African-American and Caucasian veterans with ulcerative colitis

Longitudinal analyses of family functioning in veterans and their partners across treatment.

This study evaluated the relations between posttraumatic stress disorder (PTSD) symptoms and poor family functioning in veterans and their partners. Data were collected from Caucasian veterans with PTSD (N = 1,822) and their partners (N = 702); mean age = 53.9 years, SD = 7.36. Veterans completed the Posttraumatic Checklist Military Version (PCL-M) and, along with their partners, completed the McMaster Family Assessment Device (FAD-12). Assessments were conducted at intake into a treatment program at 3 months and 9 months posttreatment. Structural equation models (SEMs) were developed for veterans as well as for veterans and their partners. Poor family functioning for veterans at intake predicted intrusion (β = .08), hyperarousal (β = .07), and avoidance (β = .09) at 3 months posttreatment. At 3 months posttreatment, family functioning predicted hyperarousal (β = .09) and avoidance (β = .10) at 9 months. For veterans and their partners, family functioning at intake predicted avoidance (β = .07) at 3 months, and poor family functioning at 3 months predicted intrusion (β = .09) and hyperarousal (β = .14) at 9 months. The reverse pathways, with PTSD symptoms predicting poor family functioning, were only evident with avoidance (β = .06). Family functioning may play a role in treatment for veterans.

Body mass index in male Caucasian veterans with or without posttraumatic stress disorder

Obesity (defined as body mass index (BMI) higher than 30), is a serious and global public health problem, associated with increased morbidity and mortality and it represents a risk factor for developing various somatic and psychiatric disorders. Combat-related posttraumatic stress disorder (PTSD) is frequently associated with increased BMI which leads to overweight and obesity. We therefore evaluated BMI in the ethnically uniform Croatian male participants of the Caucasian origin, combat exposed veterans with or without PTSD, controlled for the effect of trauma, age, smoking, alcohol consumption, physical activity and comorbid psychiatric disorders, and in age matched healthy control subjects. BMI did not differ significantly between veterans with or without PTSD and healthy control subjects, or when participants were subdivided according to the age groups, BMI categories, or the presence of psychiatric disorders. Limitation of the study might be a small number of veterans with or without PTSD. Similar BMI was found in Croatian male veterans with or without PTSD, and age matched healthy control subjects. The data provided evidence of overweight and obesity in large number of veterans but also in healthy control subjects, and indicated that public health organizations should develop more effective strategies to prevent overweight and obesity.

Surgical Outcomes in American Indian Veterans: A Closer Look

American Indian/Alaska Native (AI/ANs) male veterans have considerably higher postoperative mortality rates than their Caucasian counterparts, but similar postoperative morbidity rates even after adjusting for major preoperative risk factors. This study seeks to explain the discrepancy in morbidity and mortality. We obtained data from the Veterans Affairs National Surgical Quality Improvement Program on major, noncardiac, surgical procedures performed from 1991 to 2002 for all AI/AN men (n = 2,155), and a random sample of Caucasian men (n = 2,264), matched by site. We compared the number and types of postoperative complications and mortality rates for those patients in whom complications developed. We also examined complication and mortality rates by whether they occurred after hospital discharge, or by specific type of surgical procedure. Preoperative risk factors were assessed in patients who died. Chi-square or Fisher's exact tests were used for all comparisons. AI/ANs and Caucasians did not differ by number of complications but Caucasian patients had considerably higher rates for three specific complications. There was no difference in deaths after discharge or in mortality rates after specific surgical procedures. The groups differed considerably in the types of procedures performed. Among patients who died, three preoperative risk factors, ie, hemiplegia, diabetes, and wound infection, occurred more frequently among AI/AN than Caucasian veterans. We cannot fully explain higher postoperative mortality rates experienced by AI/AN relative to Caucasian veterans after examining complications, types of procedures, and other relevant factors. AI/ANs with certain preoperative risk factors can be vulnerable to 30-day postoperative mortality and benefit from closer postoperative surveillance.

Racial Disparities In Trauma Exposure, Psychiatric Symptoms, and Service Use Among Female Patients In Veterans Affairs Primary Care Clinics

We sought to compare female African-American (n = 84) and Caucasian (n = 99) veterans from primary care clinics at 4 Veterans Affairs Medical Centers (VAMCs) on rates of trauma, posttraumatic stress disorder, other psychiatric diagnoses, functional status, and use of VA services and disability benefits. Analyses were based on a cross-sectional, epidemiologic design incorporating self-report measures, structured interviews, and chart reviews. With the exception of higher rates of child sexual abuse among Caucasian women and higher rates of physical assault among African-American women, there were no other statistically significant racial differences across analyses. However, some clinically meaningful trends emerged, and the implications of these findings are discussed within the context of our other results. Among female veterans seen in VA primary care clinics, African-Americans and Caucasians do not differ dramatically with regard to the manifestation or severity of psychopathology, or in their use of relevant VA health care services and disability benefits. These data are important because women represent the fastest growing segment of the VA population after aging veterans. Further research is needed to replicate and extend these findings to ensure that female veterans' needs are adequately identified and met by VAMC providers.

Racial Differences in Psychiatric Symptom Patterns and Service Use in VA Primary Care Clinics

The purpose of this study was to assess racial differences in psychopathology and service use in a sample of African-American and Caucasian veterans. African-American (N=253) and Caucasian (N=460) veterans from primary care clinics at four Department of Veterans Affairs (VA) medical centers were compared on rates of trauma, posttraumatic stress disorder (PTSD), other psychiatric diagnoses, functional status, and use of VA services and benefits. A cross-sectional, epidemiologic design incorporating self-report measures, structured interviews, and chart reviews was used. With the exception of substance abuse or dependence diagnoses and use of substance abuse treatment and urgent care services, few racial differences emerged. Overall, the findings suggest that African-American and Caucasian veterans, including those with PTSD, do not differ significantly in psychopathology or in their use of VA benefits and services.