Veterans Research Articles

No Increased Risk of Major Adverse Cardiovascular Events following Nicotinamide Exposure.

Nicotinamide metabolites have recently been implicated in increased risk of major cardiovascular events (MACE). Supportive data about clinical risk of MACE for nicotinamide users is lacking. To determine whether nicotinamide use results in an increase of MACE. Retrospective cohort study of two patient cohorts, Vanderbilt University Medical Center (VUMC) and Military Veteran Program (MVP). The risk of MACE in patients exposed to nicotinamide was compared to the risk of MACE in unexposed patients. In the VUMC cohort, 1228 patients were exposed to nicotinamide based on keyword entry for "nicotinamide" or "niacinamide" and hand-review of charts, while 253 were unexposed but had documented recommendation for use. In the MVP cohort, there were 1594 with exposure to nicotinamide propensity score matched to 2694 without exposure. The primary exposure for the VUMC cohort was a confirmed exposure to nicotinamide in chart review. The primary exposure for the MVP cohort was medication entry for "nicotinamide" or "niacinamide". The primary outcome was development of MACE based on a validated phenotype. Between both cohorts, 6039 patients were included, of whom 5125 were male with a mean age of 63.2 years. Neither cohort had significant differences in mean age, sex, race and ethnicity between the nicotinamide exposed and unexposed groups. In the VUMC cohort, there was no significant association between nicotinamide exposure and the primary outcome of MACE (HR 0.76, 95% CI 0.46 - 1.25, p = 0.28). MACE prior to nicotinamide exposure was strongly associated with subsequent MACE (HR 9.01, 95% CI 5.90 - 13.70, p < 0.001). In the MVP cohort, we adjusted for MACE risk factors as potential confounding variables and saw no significant association between nicotinamide exposure and MACE (HR 1.00 95% CI 0.75 - 1.32), while history of prior MACE remained strongly associated with subsequent MACE (HR 9.50, 95% CI 6.38 - 14.1). In this retrospective cohort study of 6039 adults from two different patient populations, we found no increased risk of MACE in patients with nicotinamide exposure.

Nationalism, Internationalism, and Interventionism: How Overseas Military Service Influences Foreign Policy Attitudes

Abstracts How does military experience change individual foreign policy preferences? Prior research on military service focuses on the effects of combat experience on political participation and policy preferences, but combat is not the only military experience that influences attitudes. Living overseas is a common military experience with the potential to shape foreign policy preferences. Using observational data from a sample of military elites and original survey data from a sample of military veterans, I leverage semi-random and non-voluntary assignments to overseas military bases to investigate the relationship between overseas exposure and foreign policy preferences. The data provides evidence that overseas military service increases the likelihood of calling for international engagement, decreases nationalist attitudes, and increases the willingness of military members to assist individual allies. The ability to shape the preferences of military members has important implications for the development of foreign policy and the stability of international engagement.

The Epidemiology of Psychedelic Use Among United States Military Veterans

ABSTRACT We sought to identify patterns of psychedelic use among United States military veterans, compare demographic variables and perspectives of those who did and did not report use, and characterize benefits and adverse outcomes associated with use. Respondents (N = 426) were recruited to complete an online cross-sectional survey. Approximately one-half (51%) reported using psychedelics. Most did so for healing/treatment (70%) and/or spiritual purposes (48%), and most (85%) reported benefiting from use. Those who used psychedelics reported they would be more likely to use VA services (p < .001, d = 0.64) and to return to the VA for care (p < .001, d = 0.79) if psychedelic therapy was offered. Almost two-thirds (59%) reported adverse outcomes associated with use. Equivalent proportions rated their psychedelic experiences as beneficial among those who did (89%) and did not (81%) report adverse outcomes. Fewer adverse outcomes were associated with being older, using psilocybin, feeling prepared and confident in the reasons for use, being in a comfortable setting, and being able to “trust, let go, and be open” (Rc = 0.77; p < .001). Psychedelics may offer benefits but may also lead to adverse outcomes without proper preparation and support. Future research should examine the utility of psychedelic-based approaches for veteran mental health care.

Permethrin exposure primes neuroinflammatory stress response to drive depression-like behavior through microglial activation in a mouse model of Gulf War Illness

Gulf War Illness (GWI) is a chronic multisymptom disorder that affects approximately 25–32% of Gulf War veterans and is characterized by a number of symptoms such as cognitive impairment, psychiatric disturbances, chronic fatigue and gastrointestinal distress, among others. While the exact etiology of GWI is unknown, it is believed to have been caused by toxic exposures encountered during deployment in combination with other factors such as stress. In the present study we sought to evaluate the hypothesis that exposure to the toxin permethrin could prime neuroinflammatory stress response and elicit psychiatric symptoms associated with GWI. Specifically, we developed a mouse model of GWI, to evaluate the effects of chronic permethrin exposure followed by unpredictable stress. We found that subjecting mice to 14 days of chronic permethrin exposure followed by 7 days of unpredictable stress resulted in the development of depression-like behavior. This behavioral change coincided with distinct alterations in the microglia phenotype, indicating microglial activation in the hippocampus. We revealed that blocking microglial activation through Gi inhibitory DREADD receptors in microglia effectively prevented the behavioral change associated with permethrin and stress exposure. To elucidate the transcriptional networks impacted within distinct microglia populations linked to depression-like behavior in mice exposed to both permethrin and stress, we conducted a single-cell RNA sequencing analysis using 21,566 single nuclei collected from the hippocampus of mice. For bioinformatics, UniCell Deconvolve was a pre-trained, interpretable, deep learning model used to deconvolve cell type fractions and predict cell identity across spatial datasets. Our bioinformatics analysis identified significant alterations in permethrin exposure followed by stress-associated microglia population, notably pathways related to neuronal development, neuronal communication, and neuronal morphogenesis, all of which are associated with neural synaptic plasticity. Additionally, we observed permethrin exposure followed by stress-mediated changes in signal transduction, including modulation of chemical synaptic transmission, regulation of neurotransmitter receptors, and regulation of postsynaptic neurotransmitter receptor activity, a known contributor to the pathophysiology of depression in a subset of the hippocampal pyramidal neurons in CA3 subregions. Our findings tentatively suggest that permethrin may prime microglia towards a state of inflammatory activation that can be triggered by psychological stressors, resulting in depression-like behavior and alterations of neural plasticity. These findings underscore the significance of synergistic interactions between multi-causal factors associated with GWI.

A randomized controlled trial of targeted vs. General direct-to-consumer marketing to address psychotherapy attitudes and stigma in military service members and Veterans

ABSTRACT Many military service members and Veterans who experience a psychological need do not seek psychotherapy, which may be due to negative attitudes and stigma toward mental health services. In this study, we investigated the effectiveness of a general vs. military-specific direct-to-consumer psychotherapy marketing video to address psychotherapy attitudes in a nationwide sample of military service members and Veterans (N = 262). Participants were randomly assigned to watch a general commercial produced by the American Psychological Association (APA Video), a military-specific commercial produced by the Department of Veteran Affairs (VA Video), or a control video. After watching the video, they were asked to complete measures assessing public and self-stigma, attitudes, intentions, and preferences for psychotherapy. Consistent with our hypotheses, participants in the direct-to-consumer marketing conditions reported experiencing significantly less self-stigma and more positive attitudes and preferences for psychotherapy after watching their videos, compared to participants in the control condition. Participants who viewed the APA video also reported significantly less public stigma than those in the control condition. Contrary to our hypotheses, the targeted VA video did not outperform the general APA video on any of the dependent variables. These results support the use of direct-to-consumer psychotherapy marketing videos, general or targeted, with military service members and Veterans. Limitations and future directions are discussed.

B - 47 Assessing Subjective Cognitive Outcomes in Military Veterans: a Comparative Study of Million Veteran Program Participants with and without TBI History and PTSD

Abstract Objective We examined the distinct impacts of traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) on subjective cognitive symptoms in Iraq/Afghanistan-era military Veterans who enrolled in the Million Veteran Program (MVP) and completed the Veterans Affairs TBI Screening and Evaluation Program. Method Veterans initially screened for possible deployment-related TBI (Screen+/Screen-). If a Veteran screened positive, they completed the Comprehensive Traumatic Brain Injury Evaluation to establish TBI diagnosis (CTBIE+/CTBIE-). Self-reported PTSD status (PTSD+/PTSD-) was collected from the MVP baseline survey. Veterans also completed the Medical Outcomes Study Cognitive Functioning Scale (MOS-Cog-R), a self-report measure of cognitive symptoms (6 items with total score 6–36). Veterans (N = 7774; 77.4% male) were categorized into six exclusive diagnostic groups based on screening, TBI diagnosis, and PTSD status: (1) Screen-/CTBIE-/PTSD- (n = 7537); (2) Screen-/CTBIE-/PTSD+ (n = 747); (3) Screen+/CTBIE-/PTSD- (n = 380); (4) Screen+/CTBIE-/PTSD+ (n = 633); (5) Screen+/CTBIE+/PTSD- (n = 397); and (6) Screen+/CTBIE+/PTSD+ (n = 1080). ANCOVAs adjusted for sociodemographic characteristics evaluated the association between diagnostic group and MOS-Cog-R total score. Results Results showed a significant association of diagnostic group with MOS-Cog-R total score (p &amp;lt; 0.001, $\square{\!\!\!?}\, $p2 = 0.29). Post-hoc analyses showed that all groups endorsed significantly greater symptoms than the Screen-/CTBIE-/PTSD- group (p’s &amp;lt; 0.001, $\square{\!\!\!?}\, $p2 = 0.04–0.31). Additionally, each PTSD+ group endorsed significantly greater symptoms compared to their counterpart PTSD- groups (p’s &amp;lt; 0.001, $\square{\!\!\!?}\, $p2 = 0.08–0.11). Conclusions This is the first study to investigate distinct impacts of TBI and PTSD on subjective cognitive symptoms using TBI Screening and Evaluation Program data. Results reinforce prior work suggesting that PTSD greatly contributes to subjective cognitive distress, supporting that interventions should prioritize mental health treatment in this unique population.

Childhood Neighborhood Disadvantage and Cognitive Function among Veterans Recovering from Mild Traumatic Brain Injury

Abstract Objective Identifying risk factors and interventions for chronic symptoms following mild traumatic brain injury (TBI) is an important area of research for Veterans. Growing up in a disadvantaged neighborhood is associated with poorer health outcomes. We examined the relationship between childhood neighborhood disadvantage and cognitive outcomes among symptomatic Veterans with history of mild TBI. Method 58 Participants completed neuropsychological tests (CVLT-3, TMT A&amp;B, COWA, Category Test), NSI, and PCL-5. The Neighborhood Atlas was used to derive disadvantage scores using childhood addresses. Global deficit scores were calculated as described by Heaton (2004). Results Neighborhood disadvantage was significantly correlated with CVLT-3 Total Learning (r = −0.26, p = 0.046), but not the overall global deficit or deficit performance across CVLT-3 Delayed Recall, TMT-A, TMT-B, COWA, and Category Test. There was a significant difference in neighborhood disadvantage between participants scoring in the deficit and normal ranges on CVLT-3 Total Learning (p = 0.046). There were no other differences in neighborhood disadvantage across other neuropsychological tests. There was a significant difference in PTSD symptoms between participants scoring within the deficit and normal ranges on the COWA (p = 0.002). There were no other significant group differences in neuropsychiatric symptoms or PTSD symptom severity. Conclusions Among Veterans in this sample, neighborhood disadvantage was not associated with cognitive function or cognitive deficits. Although neighborhood disadvantage is an important psychosocial risk factor for poor outcomes in the civilian literature, these results suggest that it may not be an important contributing factor in recovery from mild TBI for military Veterans.

Global Suicide Mortality Rates (2000-2019): Clustering, Themes, and Causes Analyzed through Machine Learning and Bibliographic Data.

Suicide research is directed at understanding social, economic, and biological causes of suicide thoughts and behaviors. (1) Background: Worldwide, certain countries have high suicide mortality rates (SMRs) compared to others. Age-standardized suicide mortality rates (SMRs) published by the World Health Organization (WHO) plus numerous bibliographic records of the Web of Science (WoS) database provide resources to understand these disparities between countries and regions. (2) Methods: Hierarchical clustering was applied to age-standardized suicide mortality rates per 100,000 population from 2000-2019. Keywords of country-specific suicide-related publications collected from WoS were analyzed by network and association rule mining. Keyword embedding was carried out using a recurrent neural network. (3) Results: Countries with similar SMR trends formed naturally distinct groups of high, medium, and low suicide mortality rates. Major themes in suicide research worldwide are depression, mental disorders, youth suicide, euthanasia, hopelessness, loneliness, unemployment, and drugs. Prominent themes differentiating countries and regions include: alcohol in post-Soviet countries; HIV/AIDS in Sub-Saharan Africa, war veterans and PTSD in the Middle East, students in East Asia, and many others. (4) Conclusion: Countries naturally group into high, medium, and low SMR categories characterized by different keyword-informed themes. The compiled dataset and presented methodology enable enrichment of analytical results by bibliographic data where observed results are difficult to interpret.

Detecting suicide risk among U.S. servicemembers and veterans: a deep learning approach using social media data.

Military Servicemembers and Veterans are at elevated risk for suicide, but rarely self-identify to their leaders or clinicians regarding their experience of suicidal thoughts. We developed an algorithm to identify posts containing suicide-related content on a military-specific social media platform. Publicly-shared social media posts (n = 8449) from a military-specific social media platform were reviewed and labeled by our team for the presence/absence of suicidal thoughts and behaviors and used to train several machine learning models to identify such posts. The best performing model was a deep learning (RoBERTa) model that incorporated post text and metadata and detected the presence of suicidal posts with relatively high sensitivity (0.85), specificity (0.96), precision (0.64), F1 score (0.73), and an area under the precision-recall curve of 0.84. Compared to non-suicidal posts, suicidal posts were more likely to contain explicit mentions of suicide, descriptions of risk factors (e.g. depression, PTSD) and help-seeking, and first-person singular pronouns. Our results demonstrate the feasibility and potential promise of using social media posts to identify at-risk Servicemembers and Veterans. Future work will use this approach to deliver targeted interventions to social media users at risk for suicide.

The Thin Blue Line: Perspectives From Military Veteran Police Officers on Camaraderie and Cooperation

The Thin Blue Line: Perspectives From Military Veteran Police Officers on Camaraderie and Cooperation

Moral Injury as a Precondition for Reconciliation: An Anthropology of Veterans’ Lives and Peacemaking

In this article, I rely on religious existential philosophy to make sense of the moral restoration expressed by combat veterans who engage in reconciliation with former enemies after suffering from moral injury. Moral injury is the persistent feeling of having betrayed one’s deepest moral values. Anthropological research and analyses of combat veterans’ testimony suggest that moral injury may be associated with reconciliation, which is considered here as a manifestation of an inner transformation akin to existential philosophies of striving for moral authenticity. Specifically, it is argued that Thomas Merton’s defense of living a morally authentic life, which constitutes a process of moving from spiritual woundedness to social engagement with the other, parallels the transition of combat veterans involved in postconflict reconciliation efforts. Given this correspondence, existential moral transformation is considered alongside the anthropology of peace for explaining moral injury as a precondition for reconciliation, notably after armed conflict.

Developing a systems-focused tool for modeling lung cancer screening resource needs

BackgroundEarly detection through screening dramatically improves lung cancer survival rates, including among war Veterans, who are at heightened risk. The effectiveness of low dose computed tomography scans in lung cancer screening (LCS) prompted the Veteran’s Affairs Lung Precision Oncology Program (VA LPOP) to increase screening rates. We aimed to develop an adaptive population health tool to determine adequate resource allocation for the program, with a specific focus on primary care providers, nurse navigators, and radiologists.MethodsWe developed a tool using C + + that uses inputs that represents the process of the VA LCS program in Ann Arbor, Michigan to calculate FTEs of human resource needs to screen a given population. Further, we performed a sensitivity analysis to understand how resource needs are impacted by changes in population, screening eligibility, and time allocated for the nurse navigators’ tasks.ResultsUsing estimates from the VA LCS Program as demonstrative inputs, we determined that the greatest number of full-time equivalents required were for radiologists, followed by nurse navigators and then primary care providers, for a target population of 75,000. An increase in the population resulted in a linear increase of resource needs, with radiologists experiencing the greatest rate of increase, followed by nurse navigators and primary care providers. These resource requirements changed with primary care providers, nurse navigators and radiologists demonstrating the greatest increase when 1–20, 20–40 and > 40% of Veterans accepted to be screened respectively. Finally, when increasing the time allocated to check eligibility by the nurse navigator from zero to three minutes, there was a linear increase in the full-time equivalents required for the nurse navigator.ConclusionVariation of resource utilization demonstrated by our user facing tool emphasizes the importance of tailored strategies to accommodate specific population demographics and downstream work. We will continue to refine this tool by incorporating additional variability in system parameters, resource requirements following an abnormal test result, and resource distribution over time to reach steady state. While our tool is designed for a specific program in one center, it has wider applicability to other cancer screening programs.

Associations between concussion and more severe TBIs, mild cognitive impairment, and early-onset dementia among military retirees over 40 years.

As the population of U.S. service members (SMs) who have sustained concussions and more severe traumatic brain injuries (TBIs) during military service ages, understanding the long-term outcomes associated with such injuries will provide critical information that may promote long-term assessment, support, and rehabilitation following military service. The objective of this research was to examine whether concussion and more severe TBIs are associated with greater risk of precursors to dementia (i.e., mild cognitive impairment, memory loss), early-onset dementia, and any dementia. This study used a retrospective cohort design wherein archival medical and career records from 1980 to 2020 identified U.S. military personnel who retired from military service and their corresponding Tricare-reimbursable medical encounters in inpatient and/or outpatient settings in military treatment facilities and/or purchased care settings both before and after retirement. All military personnel who served on active duty between 1980 and 2020 and were at least 45 years of age by 2020 were eligible for inclusion (N = 6,092,432). Those who were discharged from military service with a retirement designation, and were thus eligible for Tricare for Life, were included in the analytic sample (N = 1,211,972). Diagnoses of concussion and more severe TBI during active duty service recorded in inpatient settings between 1980 and 2020 and in outpatient settings from 2001 to 2020 were identified. Focal outcomes of interest included memory loss, mild cognitive impairment, Alzheimer's, Lewy Body dementia, frontotemporal dementia, and vascular dementia. Dementia diagnoses before age 65 were labeled early-onset. Those with (vs. without) concussion diagnoses during military service were significantly more likely to be diagnosed with memory loss and mild cognitive impairment and any of the dementias examined. However, they were not at greater risk of being diagnosed with early-onset dementia. Military SMs diagnosed with concussion may be at elevated risk for long-term neurodegenerative outcomes including memory loss, mild cognitive impairment, and dementia. As the population of SMs who sustained TBI during the Global War on Terror continue to age, the prevalence of dementia will increase and may bring a unique burden to the VHA.

Editorial Comment on “Exposures and Bladder Cancer Risk Among Military Veterans: A Systematic Review and Meta-analysis”

Editorial Comment on “Exposures and Bladder Cancer Risk Among Military Veterans: A Systematic Review and Meta-analysis”

Regulating posttraumatic stress disorder symptoms with neurofeedback: Regaining control of the mind

Neurofeedback is emerging as a psychophysiological treatment where self-regulation is achieved through online feed-back of neural states. Novel personalized medicine approaches are particularly important for the treatment of posttrau-matic stress disorder (PTSD), as symptom presentation of the disorder, as well as responses to treatment, are highly het-erogeneous. Learning to achieve control of specific neural substrates through neurofeedback has been shown to display therapeutic evidence in patients with a wide variety of psychiatric disorders, including PTSD. This article outlines the neural mechanisms underlying neurofeedback and examines converging evidence for the efficacy of neurofeedback as an adjunctive treatment for PTSD via both electroencephalography (EEG) and real-time functional magnetic resonance imaging (fMRI) modalities. Further, implications for the treatment of PTSD via neurofeedback in the military mem-ber and Veteran population is examined.

Latent profiles of drinking motives among trauma-exposed combat veterans and civilians: A comparative investigation.

Latent profiles of drinking motives among trauma-exposed combat veterans and civilians: A comparative investigation.

The Family Climate Questionnaire: A general measure of autonomy support from family members.

The current study examines the psychometric characteristics of the Family Climate Questionnaire (FCQ), which was intended to measure the degree of autonomy-support among family members for a respondent with health concerns. The sample included military veterans (N = 350), a portion of whom had congestive heart failure (N = 86) or diabetes (N = 77), and a portion who were referred from primary care for behavioral health concerns (N = 187). Overall, 92.6% of the participants were male, and 56.7% were Black or African American and 40.6% were Caucasian. The findings highly supported the factor structure, internal consistency, and construct validity of the Autonomy Support subscale. In addition, there was high support for factorial invariance across subsamples of veterans with chronic medical problems compared to those referred from primary care. The findings for an additional subscale developed for this study, Coercion, were less supportive, with insufficient convergence in factor structure and relatively poorer internal consistency. The FCQ Autonomy Support measure appears to have potential as a useful measure of a family environment that supports autonomy for health among individuals with both medical and mental health conditions, and it is a flexible measure that can be used with a range of family member types. The FCQ Coercion measure received less consistent empirical support and will require additional development and testing. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Living alongside military PTSD: A qualitative study of female partners’ experiences with UK Veterans

Introduction: An increased risk of emotional burden in partners of military Veterans with mental health difficulties has been observed. This study aimed to explore the experiences and needs of female partners of Veterans seeking help. Methods: Our sample of eight female partners was drawn from a population of help-seeking Veterans who had received treatment for PTSD. Qualitative data were collected using a semi-structured interview schedule. Results: Super-ordinate themes of challenges faced, desired type of support, and barriers to support were each described by a set of sub-themes. Challenges faced were described with the themes of inequality in relationship, loss of congruence with own identity, volatile environment, and emotional distress and isolation. Desired type of support was described by the themes of practical focus on improving, sharing with fellow experts, and support tailored to the partner. Barriers to support were described by the themes feeling restricted by practical barriers and ambivalence about the involvement of others. Discussion: Interventions to support partners of Veterans with mental health difficulties need to address their individual needs, focus on practical techniques, and consider practical limitations.

Reflecting on JMVFH’s most popular article of 2022: ‘Sharing of military Veterans’ mental health data across Canada: A scoping review’

Reflecting on <i>JMVFH</i>’s most popular article of 2022: ‘Sharing of military Veterans’ mental health data across Canada: A scoping review’

Allison M. Johnson, editor. The Left-Armed Corps: Writings by Amputee Civil War Veterans.

Allison M. Johnson, editor. <i>The Left-Armed Corps: Writings by Amputee Civil War Veterans</i>.