Veteran Men Research Articles

Gender differences in reported potentially morally injurious events among post-9/11 U.S. combat veterans, using two measures.

Military experiences that violate one's sense of right and wrong (i.e., potentially morally injurious events [PMIEs]) may result in moral injury, characterized by shame, guilt, demoralization, self-condemnation, and social withdrawal. The objective of this study was to examine gender-related differences in the rate of reporting PMIEs. Secondary analyses were conducted on a previously collected longitudinal cohort study of postdeployment functioning among U.S. post-9/11 combat veterans in Central Texas (N = 406). As part of the parent study, participants completed two measures of PMIEs-the Moral Injury Events Scale (MIES; Nash et al., 2013) and the Moral Injury Questionnaire-Military Version (MIQ-M; Currier et al., 2015). Gender differences at the item response level were analyzed in a series of Bayesian multilevel item response theory models. The most frequently endorsed responses on both the MIES and MIQ-M for both men and women were never or strongly disagree. On the MIQ-M, more veteran men endorsed experiencing PMIEs to some degree. On the MIES, more veteran women endorsed strongly agree to betrayal items. Veteran men and women reported any PMIE occurring at relatively high rates. Gender differences at the item response level were found for most items on both the MIES and MIQ-M, albeit of small magnitude. Awareness of gender differences in the likelihood of experiencing a given PMIE may help inform clinical assessments and case conceptualizations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Examining posttraumatic cognitions as a pathway linking trauma exposure and eating disorder symptoms in veteran men and women: A replication and extension study

ABSTRACT Trauma is a risk factor for eating disorders (EDs). Enhanced understanding of the pathways from trauma to EDs could identify important treatment targets. Guided by theory, the present study sought to replicate previous findings identifying posttraumatic stress disorder (PTSD) symptoms and shape/weight overvaluation as important pathways between trauma and ED symptoms and extend this work by investigating the role of posttraumatic cognitions in these associations. The sample included 825 female and 565 male post-9/11 veterans who completed cross-sectional survey measures of trauma, posttraumatic cognitions, PTSD symptoms, shape/weight overvaluation, and ED symptoms. Gender-stratified structural equation models were used to examine direct and indirect pathways from trauma exposure to EDs via PTSD symptoms and shape/weight overvaluation (replication) and posttraumatic cognitions (extension). Results suggested that trauma exposure was indirectly associated with ED symptoms via shape/weight overvaluation and posttraumatic cognitions. There was no indirect association between trauma exposure and ED symptoms via PTSD symptoms. Overall, findings from this study highlight the potential role of posttraumatic cognitions in understanding the association between trauma and ED symptoms. However, future longitudinal research is needed to verify the directionality of these associations and investigate cognitions as a potentially targetable risk mechanism in co-occurring trauma and EDs.

Associations between avoidant/restrictive food intake disorder profiles and trauma exposure in veteran men and women.

Trauma exposure, particularly interpersonal trauma, is prevalent among individuals with eating disorders (EDs), and trauma exposure and the subsequent development of posttraumatic stress disorder have been associated with poorer outcomes for ED treatment. To our knowledge, there are no published investigations of trauma exposure among individuals with avoidant/restrictive food intake disorder (ARFID), a new diagnosis introduced by the Diagnostic and Statistical Manual of Mental Disorders-5. We investigated associations between trauma exposure and ARFID profiles in a sample of U.S. military veteran men and women. Participants in this cross-sectional study included 1494 veterans randomly selected from the population of post-9/11 veterans who had separated from military service within the previous 18 months. They completed a survey assessing EDs, including the Nine Item ARFID Screen and trauma exposure. Results revealed that 9.8% of the sample exceeded cutoffs for any ARFID profile, with the picky eating profile being the most common. Trauma exposure was prevalent among participants who exceeded cutoffs for ARFID, particularly the picky eating profile. Findings highlight the importance of addressing EDs, including ARFID, in veterans. It will be important to examine the extent to which trauma and trauma-related disorders impact treatment outcomes for individuals with ARFID.

Health and Health Care Use of American Indian/Alaska Native Women Veterans: A Scoping Review

BackgroundAmerican Indian/Alaska Native (AI/AN) women serve in the U.S. military, use Veterans Health Administration (VA) health care, and reside in rural areas at the highest rates compared with other women veterans. However, little is known about their unique health care needs, access, and health care use. ObjectiveWe assessed the existing literature on the health and health care use of U.S. AI/AN women veterans. MethodsOnline databases were searched to identify studies. Study characteristics extracted included health care topic, study design, overall sample size and number of AI/AN women veterans, and funding source. We screened 1,508 publications for inclusion; 28 publications were ultimately retained. ResultsHealth care access and use were the most common health care research topics (39%), followed by mental health (36%) and physical health (25%). Few studies considered the impact of rurality. Most studies found significant differences between AI/AN women veterans and other women veterans or AI/AN men veterans. Publication dates ranged from 1998 to 2023, with 71% published after 2010. The majority of studies (75%) were secondary analyses of extant health care data. More than three-quarters of studies (82%) were funded federally (e.g., VA). Many studies were based on VA administrative data, resulting in a gap in knowledge regarding AI/AN women veterans who are not eligible for, or choose not to use, VA health care. ConclusionResearch to inform the health and health care of AI/AN women veterans is limited, especially in terms of known AI/AN and women veterans' prevalent health concerns (e.g., diabetes, hypertension), women's health and reproduction, and how AI/AN women veterans access, use, and confront barriers to health care. Moreover, there is scarce research specific to cultural, tribal, and regional factors that likely affect access and use of particular health care systems or that can affect perspectives on illness that impact long-term treatment adherence and patient outcomes.

Examining the Utility of Veterans Health Administration (VHA) Traumatic Brain Injury Screening among Women Veterans: Recommendations for Expansion to Include Interpersonal Violence.

Women veterans (WVs) are more likely than men veterans to experience traumatic brain injury (TBI) from causes unrelated to deployment. Yet, current Veterans Health Administration (VHA) TBI screening focuses on deployment. This study examines the utility of the VHA TBI screening tool for WVs. Using the Boston Assessment for TBI-Lifetime (BAT-L) as the gold standard, sensitivity and specificity of the VHA screen were identified for deployment and non-deployment injuries. Injuries missed by the screen were thematically described. Sensitivity and specificity were compared by context (research, clinical). Ninety WVs were included; fifty-three (60.9%) met TBI criteria per the BAT-L. For TBIs occurring during deployment, sensitivity was higher in research (89.1%) compared to clinics (61.7%); specificity was lower in research (60.7%) compared to clinics (93.0%). The BAT-L identified 27 non-deployment TBIs not captured by the VHA screen, most frequently from physical assault or sports. The VHA screen does not include non-deployment events; thus, non-deployment sensitivity and specificity could not be calculated. For lifetime TBIs (deployment + non-deployment etiologies), sensitivity was higher in research (73.5%) compared to clinics (48.9%). Specificity was lower in research (60.0%) compared to clinics (100.0%). Findings can inform improvements to TBI screening among WVs, including expansion for interpersonal violence.

What's Gender Got to Do With It: Accounting for Differences in Incident Guideline Discordant Prescribing for PTSD Among Women and Men Veterans.

What's Gender Got to Do With It: Accounting for Differences in Incident Guideline Discordant Prescribing for PTSD Among Women and Men Veterans.

Implications of Physical Activity in Reducing Alcohol Use for Women Veterans: A Narrative Review.

Women veterans (WV) are a fast-growing population in the United States with concerning health disparities. Reports of increased risks of cardiovascular disease (CVD) and poorer health are evident in WV compared with their civilian counterparts. The transition from active duty to veteran poses additional life stressors, causing changes in health behaviors such as unhealthy alcohol consumption and decreased physical activity, which may explain health disparities in WV. The changes in these two health risk behaviors may be influenced by each other, and emerging evidence suggests that physical activity aids in managing alcohol consumption during alcohol use treatment. In this general narrative review, we summarized findings from studies involving WV on (1) the associations between alcohol consumption and physical activity and (2) the effect of physical activity on reducing alcohol use. We also discussed the clinical consideration of adding physical activity to alcohol use interventions for WV. Most of the literature included in this review has been based on predominantly veteran men populations. This knowledge gap highlights the importance of continued efforts and research studies targeting WV to eliminate health disparities among them.

Examining associations between disordered eating and harmful substance use in a nationally representative sample of US veterans.

The association between eating disorders (EDs) and harmful substance use (substance use that causes psychosocial impairment) is well recognized in the literature, and military veterans may be at heightened risk for both issues due to deployment-related stressors. However, little is known about which ED-related symptoms are associated with harmful substance use in veterans, and whether gender plays a differential role in this relationship. Our aims were to: (1) examine gender differences in ED-related symptoms; and (2) examine whether ED-related symptoms differentially predict harmful substance use in US veteran men and women who had recently separated from service. This study was based on a nationally representative four-wave longitudinal sample of post-9/11 veterans (N = 835; 61.2% female). Longitudinal mixed modeling was used to test whether specific ED-related behaviors at baseline predicted harmful substance use at follow-ups. We replicated gendered patterns of ED-related symptoms observed in civilian populations, wherein men had higher weight-and-body-related concerns (including excessive exercise and muscle building) and negative attitude toward obesity, and women had higher bulimic and restricting symptoms. For women, alcohol, drug, and marijuana problems were predicted by higher bulimic symptoms, whereas for men, these problems were predicted by higher restricting symptoms. Gender played a differential role in the relationship between EDs and harmful substance use. Bulimic symptoms were the most robust predictor for harmful substance use among veteran women, whereas restricting was the most robust predictor for harmful substance use among veteran men. The current study found that veteran women had higher bulimic symptoms (characterized by binge eating and purging) and restricting than veteran men. In women, bulimic symptoms predicted future harmful use of alcohol, marijuana, and other drugs. In contrast, veteran men had higher weight-and-body-related concerns (characterized by excessive exercise and muscle building) than veteran women. In men, restricting symptoms predicted future harmful use of alcohol, marijuana, and other drugs.

Perceived social support moderates the relations between mental health symptoms and current suicidal ideation.

Despite efforts to identify risk factors associated with suicidal ideation (SI), less work has been conducted to highlight protective factors to promote prevention. Perceived social support has been shown to positively impact a wide range of psychological outcomes; however, prior efforts exploring whether perceived social support moderates the relationship between mental health (MH) symptoms and current SI among men and women have been hampered by limitations. To address knowledge gaps, data from the Comparative Health Assessment Interview Research Study was used to evaluate whether (a) perceived social support moderates the relationship between mental health symptoms (posttraumatic stress, anxiety, alcohol use, depressive) and current SI among veterans and nonveterans; (b) the strength of this moderating effect varies by gender and veteran status; and (c) the strength of this moderating effect varies by social support source (significant other, friend, family). Results suggest that perceived social support is more protective against SI for those with lower levels of mental health symptoms (≤ 25th percentile) than for those with higher symptom levels (≥ 75th percentile). Findings were largely consistent across study groups, support sources, and mental health symptoms examined; however, a significant moderating effect on the alcohol use-SI relationship was only observed for veteran men. Those with a lower mental health symptom severity may receive more benefit from strategies aimed at increasing perceived social support compared to those with higher symptom severity. Research is needed to match protective factors to individual phenotypes, with the goal of engaging those living with SI in more effective interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Military sexual trauma-related posttraumatic stress disorder service-connection: Characteristics of claimants and award denial across gender, race, and compared to combat trauma.

The current study characterizes a cohort of veteran claims filed with the Veterans Benefits Administration for posttraumatic stress disorder secondary to experiencing military sexual trauma, compares posttraumatic stress disorder service-connection award denial for military sexual trauma-related claims versus combat-related claims, and examines military sexual trauma -related award denial across gender and race. We conducted analyses on a retrospective national cohort of veteran claims submitted and rated between October 2017-May 2022, including 102,409 combat-related claims and 31,803 military sexual trauma-related claims. Descriptive statistics were calculated, logistic regressions assessed denial of service-connection across stressor type and demographics, and odds ratios were calculated as effect sizes. Military sexual trauma-related claims were submitted primarily by White women Army veterans, and had higher odds of being denied than combat claims (27.6% vs 18.2%). When controlling for age, race, and gender, men veterans had a 1.78 times higher odds of having military sexual trauma-related claims denied compared to women veterans (36.6% vs. 25.4%), and Black veterans had a 1.39 times higher odds of having military sexual trauma-related claims denied compared to White veterans (32.4% vs. 25.3%). Three-fourths of military sexual trauma-related claims were awarded in this cohort. However, there were disparities in awarding of claims for men and Black veterans, which suggest the possibility of systemic barriers for veterans from underserved backgrounds and/or veterans who may underreport military sexual trauma.

Metformin use and stroke risk in Hispanic and non‐Hispanic veteran men with type 2 diabetes

AbstractBackgroundStroke is a strong risk factor for dementia in the elderly. Traditional stroke risk factors such as hypertension and diabetes are also associated with the incidence and progression of dementia. There is a lack of data characterizing the effect of metformin use on stroke in racially/ethnically diverse cohorts. We sought to evaluate the impact of metformin as a preventative treatment in reducing the incidence of stroke risk in a cohort of older US veteran men with type 2 diabetes (T2D).MethodOur cohort included men with T2D, ≥65 years old, insulin/thiazolidinediones naïve, and without stroke history. Metformin use was defined as ≥180 days of prescription during 2002‐2003. Stroke incidence was identified by ICD9 codes 430‐438 (excluding TIA, 435) from inpatient/outpatient visits every year during 2004‐2012. Generalized estimating equations were used to estimate the odds ratios (OR) of stroke diagnosis over time associated with metformin use, where inverse propensity score weights (IPSW) for metformin use were incorporated to minimize confounding. Furthermore, the generalizability method was used to compare IPSW adjusted ORs between race/ethnicity groups after calibrating covariates between groups. Finally, inverse probability weights for survival were incorporated to project the adjusted ORs among the survivors.ResultAmong 19,705 men with T2D, 81.3% were non‐Hispanic White, 5.3% Hispanic White, and 13.4% were non‐Hispanic Black. Overall, 26.7% used metformin (35.2% of Hispanic Whites, 27% of non‐Hispanic Whites, and 21.4% of non‐Hispanic Blacks). Metformin use was associated with attenuating the temporal increase in stroke risk during 2009‐2012 (vs. 2004‐2008) among Hispanic White (log(aOR) = ‐0.05, p‐value = 0.02), This stroke risk attenuation effect by metformin use was marginally different between Hispanic White with non‐Hispanic Black (p = 0.056) and significantly different between Hispanic White and non‐Hispanic White (p = 0.02). The stroke risk attenuation effect of metformin was not significant conditioned on survival.ConclusionOur study suggests that metformin use is associated with a reduced distal stroke risk amongst men of Hispanic ethnicity compared to non‐Hispanics. Further studies are needed to elucidate the putative biological or pharmacological mechanism for this difference and to uncover the impact on dementia risk.

Perceived friendships protect against the development of anger following childhood adversities in UK military veteran men residing in Northern Ireland

ABSTRACT Background: Experience of childhood adversity is associated with greater anger as an adult, particularly in men. Soldiers and veterans report higher incidence of adverse childhood experiences, many of whom also experience elevated rates of PTSD and anger. However, little is known about factors which may protect against the development of anger after experiencing childhood adversity. Objective: This study aims to assess the potential protective aspects of perceived social support in military veterans. Methods: Data from the Northern Ireland Veterans’ Health and Wellbeing Study (N = 590, Mage = 56) was utilised in regression models to examine perceived social support (family, friend, partner; MSPSS) as a moderator of the association between adverse childhood experiences (ACEQ-10) and anger (DAR-7). This sample comprised men who were UK Armed Forces veterans residing in Northern Ireland. Results: Significant interaction effects, visualised using interaction plots, were found between perceived friend support and both child abuse and household challenge. When men perceived high friend support, there was no association between child abuse or household challenge and anger. For veteran men who perceived the maximum amount of partner support, there was no association between child abuse and anger. Family support did not change the positive association between child abuse, child neglect or household challenge and future anger. Conclusions: This study indicates that it is especially important to foster supportive and empathetic friendships for men that have experienced adversity as a child, perhaps through programmes such as Men’s Sheds, as these friendships may alleviate the negative influences of child abuse and household challenge on anger.

Examining the unique and interactive associations of gender and race on PTSD symptom severity among military sexual trauma survivors.

Despite a robust association between military sexual trauma (MST) and posttraumatic stress disorder (PTSD), few studies have examined factors that are associated with increased symptom severity. To this end, the current study was designed to examine the unique and interactive effects of gender and race on PTSD symptoms using a sample of MST survivors. The sample included 126 veterans (71% Women, 29% Men; 70% Black/African American and 30% White/Caucasian) presenting for psychological services to a MST specialty clinic at a large Southeastern Veterans Affairs (VA) hospital. As part of their intake evaluation, veterans completed a diagnostic interview and battery of self-report questionnaires. Results revealed a main effect of gender and race such that veteran men and Black/African American veterans were found to have increased PTSD symptom severity. However, there was not a significant gender by race interaction. Findings are discussed with regard to previous research and treatment implications. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Bring your spouse: Brief multifamily group outcome for posttraumatic stress disorder.

There has been little evidence supporting the efficacy of psychoeducation as a stand-alone approach to alleviate posttraumatic stress disorder (PTSD). This study examined the efficacy of a stand-alone psychoeducation PTSD intervention using a group format that incorporated the option of bringing an emotional support person to sessions. PTSD 102 is an eight-session, 1-hr, weekly intervention for veterans and their family members. Pre- and posttreatment symptom measurement data were analyzed from 101 veteran men and women seeking outpatient treatment in a PTSD Clinical Team clinic at a Veteran Health care outpatient facility. Paired-samples t tests were performed, which demonstrated a significant difference in the scores for pretreatment PTSD symptoms (M = 55.049, SD = 14.585) and posttreatment scores (M = 45.696, SD = 17.814); t(100) = 8.496, p < .001. The effect size was d = .843. Additionally, there was a significant difference in the scores for pretreatment depressive symptoms (M = 17.000, SD = 6.183) and posttreatment scores (M = 13.608, SD = 6.229); t(89) = 7.106, p < .001. The effect size was d = .749. Results from this study suggest that integrating emotional support individuals into a psychoeducational PTSD treatment group had a significant impact on mental health symptoms for veteran participants. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Differing time trends for alcohol misuse and alcohol use disorder among Veteran men: A comparison of population surveillance and clinical data

IntroductionData on time trends are important to track the health burden of alcohol use disorder (AUD) and plan for alcohol-related healthcare needs. Our aim was to estimate time trends in AUD for male VA patients and to assess whether trends in documented diagnosis rates were similar to trends in unhealthy alcohol use measured through clinical screening or trends in AUD prevalence among US veterans in the general population. Materials and methodsWe used VA electronic health record data (10/1/2009–9/30/2019) to measure AUD diagnosis rates and clinical alcohol screening data to measure unhealthy alcohol use. We used data from the National Survey on Drug Use and Health to measure AUD prevalence for 2010–2019. We estimated time trends using regression models with year entered as a linear term. ResultsFor male VA patients, AUD diagnosis rates increased overall and for most age groups, Alcohol screening rates increased, but the proportion with unhealthy alcohol use decreased, except among older patients. AUD prevalence for male US veterans decreased by −0.17 percentage points (pp) annually (p = 0.010), reflecting a strong decreasing trend for ages 18–34 years (−1.20 pp per year, p < 0.001). ConclusionsIncreasing trends in AUD diagnoses among VA patients are a contrast to the decreasing trends in unhealthy alcohol use and AUD population prevalence among male US veterans. However, differences in trends by age group highlights a need to better understand the process of clinical AUD identification, particularly for younger men.

Associations between DSM-5 posttraumatic stress disorder Criterion E2 endorsement and selected self-destructive behaviors in recent-era veterans: A focus on disordered eating.

Revisions to the posttraumatic stress disorder (PTSD) criteria in the DSM-5 included a new criterion in the alterations in arousal and reactivity cluster (i.e., engagement in reckless and self-destructive behaviors; Criterion E2). Despite its clinical significance, little is known about how this symptom corresponds to engagement in specific direct and indirect self-harm behaviors. We examined associations between E2 and self-reported recent engagement in direct and indirect self-harm behaviors, including disordered eating, which is not included in the prototypical E2 symptom scope, in a trauma-exposed sample of 1,010 recent-era veterans (61.5% self-identified women, 38.5% self-identified men). We also tested whether gender moderated these associations. We repeated analyses in a subsample of participants with clinically elevated PTSD symptoms. Participants self-reported past-month PTSD symptoms (PCL-5) as well as past-month nonsuicidal self-injury, suicidal ideation, suicide planning, fasting, purging, binge eating, compulsive exercise, and problematic alcohol and drug use. We found no evidence for moderation by gender for any of the behaviors examined in the main sample. However, after controlling for gender and demographic covariates, weighted logistic regressions showed small, significant associations between E2 score and direct self-harm behaviors, substance use, purging, and binge eating, aORs = 1.30-1.91. Criterion E2 was linked to behaviors included in the typical symptom scope (self-directed violence, substance use) and those that are not (disordered eating behaviors). Comprehensive screening for self-destructive behaviors, including disordered eating, among veteran men and women who endorse Criterion E2 is indicated.

The Impact ofResilience onEmployment Among Post-9/11 Veterans With andWithout Military Sexual Trauma Exposure.

Successful employment is a functional outcome of high importance for veterans after military discharge. There is a significant rising concern regarding exposure to military sexual trauma (MST) and related mental health outcomes that can impair functional outcomes, such as employment. Although resilience training is a key component of preparing for military service, to date the impact of resilience on employment outcomes for veterans with exposure to MST has yet to be examined. We sought to examine the relationship between resilience and employment in a national sample of post-9/11 veterans with and without MST exposure. A national survey was conducted between October 2021 and January 2022 to respond to the 2021 National Defense Authorization Act mandate to identify factors affecting post-9/11 women veteran's unemployment. Of veterans, 1,185 completed the survey. Of these, 565 (47.6%) were post-9/11 veterans. The survey collected data on demographics and employment; MST, adult sexual trauma (AST, outside of military), and childhood sexual trauma (CST) exposure; resilience (Response to Stressful Experiences Scale); Post Traumatic Stress Disorder (PTSD) Checklist (PCL-5); and depression (Patient Health Questionnaire-2). Multivariable logistic regression models identified gender-specific associations of resilience with employment among those exposed and not exposed to MST, adjusting for AST, CST, PTSD, and depression. Significance was set at P < .05. Of 322 women and 243 men post-9/11 veterans, 86.5% were employed. MST exposure (MST[+]) was reported by 31.4% (n = 101) of women and 16.9% (n = 41) of men. MST(+) women veterans were more likely to report CST (35.6% vs. 14.5%; P < .001), AST (68.3% vs. 17.2%; P < .001), and both CST and AST (19.8% vs. 7.2%; P < .001) than MST(-) women. MST(+) men were more likely to report AST (65.9% vs. 7.9%; P < .001), and both CST and AST (14.6% vs. 1.0%; P < .001) than MST(-) men. Levels of self-reported resilience were similar for MST(+) women and men and their MST(-) counterparts (women: 11.1 vs. 11.0; men: 11.5 vs. 12.0). For MST(+) women, each unit increase in resilience was associated with a 36% increase in odds of employment (OR: 1.36, 95% CI, 1.08-1.71); resilience was not associated with increased odds of employment among MST(-) women. Among MST(+) men veterans, each unit increase in resilience was associated with an 83% increase in odds of employment (aOR: 1.83, 95% CI, 1.13-2.98), and like women veterans, resilience was not associated with employment among MST(-) men. Among MST(+) women and men post-9/11 veterans, higher resilience was associated with increased odds of employment, whereas resilience was not associated with employment in MST(-) veterans. These findings suggest that resiliency during and after military service is a key component for potentially improving long-term outcomes. Improving resilience using evidence-based approaches among post-9/11 veterans exposed to MST may be an important avenue for increasing successful functional outcomes such as employment. Moreover, MST(+) women and men veterans may benefit from trauma-informed care as a substantial proportion of these individuals also report exposure to CST, AST, PTSD, and depression.

“A Hidden Community”: The Experiences of Help-Seeking and Receiving Mental Health Treatment in U.K. Women Veterans. A Qualitative Study

Women veterans are often underserved in both the research into and provision of mental health treatment. This study explored women veterans’ experiences of mental health difficulties, help-seeking, and treatment provision. Semistructured telephone interviews with 19 U.K. women veterans who met criteria for posttraumatic stress disorder were conducted and Reflexive Thematic Analysis was used in analysis. Three superordinate themes encompassing participants’ experiences were developed: (a) attitudes toward mental health and help-seeking; (b) the need to acknowledge the uniqueness of women veterans; and (c) the structural elements of care provision. The findings indicate that women veterans have additional gender-specific challenges and needs concerning tailored pathways into help and support, as well as the environment and modality of treatment delivery, as distinct from veteran men.

Treatment outcomes of Veteran men in a comprehensive dialectical behavior therapy program: Characterizing sex differences in symptom trajectories

Dialectical Behavior Therapy (DBT) is one of the primary psychosocial treatments for reducing suicidal behaviors and improving psychosocial outcomes among patients with borderline personality disorder (BPD) and has been shown to reduce BPD symptoms when delivered in a Veteran Affairs medical center setting. Despite evidence of similar rates of BPD in both men and women, the vast majority of treatment outcome research in BPD has focused on women. We sought to characterize sex differences in symptom trajectories among Veterans participating in a comprehensive DBT program. We found that Veteran men and women who entered the DBT program were diagnostically and demographically similar. Participants exhibited reductions in BPD symptoms and improvements in emotion regulation over the course of treatment. Moreover, Veteran men reported BPD symptom reductions that were not statistically inferior to those of Veteran women and exhibited a sharper reduction in these symptoms. This research provides support for the use of DBT as a psychosocial treatment for Veteran men with BPD symptoms.

Gender Differences in Barriers and Facilitators to Care among U.S. military Veterans at High Risk for Suicide: A Qualitative Study

Veteran engagement in care is imperative to suicide prevention. However, barriers to engaging veterans at risk for suicide in care remain a challenge, and women veterans may have unique experiences that promote or inhibit care-seeking behaviors. The goal of this study was to better understand barriers and facilitators to care among veterans at high risk for suicide and identify potential gender differences. We interviewed 25 women and 25 men veterans utilizing VHA health care across the United States (U.S.), who had a recent suicide attempt (6 months prior). Psychological safety was a dominant theme for veterans seeking and using VHA care. Women and men both needed to feel safe and comfortable in the VHA environment. Women described psychological safety as being able to let their guard down, while men desired to not feel judged for seeking care. Veterans felt a sense of comradery in the VHA environment; however, women did not always feel welcome as veterans. Findings suggest the need to attend to the psychological safety of women and men veterans at high risk of suicide in VHA. Strategies to attune VHA staff to trauma-informed care practices for women and expand trauma-informed care resources may facilitate care engagement.