Veterans Affairs Health Care Services Research Articles

Patterns of Psychiatric Medication Prescriptions for Veterans in Treatment Courts and Other Specialty Courts.

Psychiatric medications can serve as important tools for addressing behavioral health issues among criminal justice-involved (CJI) veterans. This study used national data on 12,790 CJI veterans in the U.S. Department of Veterans Affairs (VA) Veterans Justice Outreach program from 2019 to 2020 to compare patterns of psychiatric medication prescriptions among veterans who entered a veterans treatment court (n = 6975), another specialty court (SC; n = 414), or no-SC (n = 5401). Different classes of medications were examined, including antidepressants, stimulants, antipsychotics, benzodiazepines, and medications for substance use disorders. The results showed that 60.2% of the total sample was prescribed a psychiatric medication within 1 year of entering the Veterans Justice Outreach program. There was no significant difference in overall psychiatric prescribing among veterans treatment court, other SC, and no-SC groups, but there were a few differences in certain classes of psychiatric medications. Moreover, about 7.8% of veterans who were in the no-SC group and were prescribed psychiatric medications did not have a psychiatric diagnosis. Veterans who were younger, non-Hispanic white, married, with a VA service-connected disability rating, had a diagnosis of mental and/or substance use disorder, and used more VA health care services were more likely to have been prescribed psychiatric medication. Together, these findings illustrate the essential role of psychiatric medications in courts and programs that serve CJI veterans, as well as the important link between VA service engagement and psychiatric prescriptions.

Evaluating Veterans Response Teams and Police Interventions on Veterans' Health Care Utilization.

This study examined the effects of veteran-specific cooperative police interventions, including a Veterans Response Team (VRT) and broad collaboration between local police departments and a Veterans Affairs (VA) medical center police department (local-VA police [LVP]), on veterans' health care utilization. Data were analyzed on 241 veterans (51 received VRT and 190 received LVP intervention) in Wilmington, Delaware. Nearly all veterans in the sample were enrolled in VA health care at the time of police intervention. Veterans who received VRT or LVP interventions showed similar increases in use of outpatient and inpatient mental health and substance abuse treatment services, rehabilitation services, ancillary care services, homeless programs, and emergency department/urgent care services after 6 months. These findings suggest the importance of relationship building among local police departments, VA Police, and Veterans Justice Outreach to create pathways to care to ensure that veterans are connected to needed VA health care services.

Service use and barriers to care among homeless veterans: Results from the National Veteran Homeless and Other Poverty Experiences (NV-HOPE) study.

The objective of this study was to examine type of services U.S. veterans seek when they experience homelessness, characteristics associated with service use, and reasons for not using services. Data from a 2021 nationally representative survey of 1004 low-income U.S. veterans were analyzed with descriptive and multivariable analyses. One-quarter of low-income U.S. veterans with experiences of homelessness reported using homeless services while they were homeless and about 27% reported using U.S. Department of Veterans Affairs (VA) healthcare or benefits while homeless. Black and Hispanic veterans were more likely to use both homeless services and VA services while homeless than veterans of other race/ethnic groups. The most common barriers to services were: veterans felt they did not need help, they did not have information about services, there was stigma and shame, and transportation barriers were encountered. These findings suggest veterans use various VA and community-based homeless and healthcare services, but they do experience barriers that may be improved with better public information and care coordination to improve service uptake among homeless veterans.

Predictors of COVID-19 Vaccination among Veterans Experiencing Homelessness.

Sufficient uptake of the COVID-19 vaccine is key to slowing the spread of the coronavirus among the most vulnerable in society, including individuals experiencing homelessness. However, COVID-19 vaccination rates among the Veteran homeless population are currently unknown. This study examines the COVID-19 vaccination rate among homeless Veterans who receive care at the U.S. Department of Veterans Affairs (VA), and the factors that are associated with vaccine uptake. Using VA administrative and clinical data, bivariate and multivariate analyses were conducted to identify the sociodemographic, health-related, and healthcare and housing services utilization factors that influenced COVID-19 vaccine uptake during the first eight months of the vaccine rollout (December 2020–August 2021). Of the 83,528 Veterans experiencing homelessness included in the study, 45.8% were vaccinated for COVID-19. Non-white, older Veterans (65+), females, those who received the seasonal flu vaccine, and Veterans with multiple comorbidities and mental health conditions were more likely to be vaccinated. There was a strong association between COVID-19 vaccination and Veterans who utilized VA healthcare and housing services. VA healthcare and homeless service providers are particularly well-positioned to provide trusted information and overcome access barriers for homeless Veterans to receive the COVID-19 vaccine.

The Impact of Human Trafficking on Veterans: Increasing Awareness among Veterans and Employees through Education

Background Health care systems serve an essential role in identifying and treating individuals impacted by human trafficking. The Department of Veterans Affairs (VA) Veterans Health Administration recognizes that human trafficking is a public safety concern and has intentionally increased awareness of human trafficking and how it relates to Veteran care. In 2020, the VA National Social Work Program Office, Care Management and Social Work launched a national Human Trafficking Tiger Team to understand the impact of human trafficking within the Veteran community. Methods Initial Human Trafficking Tiger Team efforts focused on qualitative reviews of existing VA health care services data to identify trends and themes. A series of three trainings for VA staff including Social Workers, Licensed Marriage and Family Therapists (LMFT), Licensed Professional Counselors (LPC), Psychologists (PsyD/PhD), Registered Nurses (RN), and Certified Rehabilitation Counselors (CRC) were completed. A pre and post-test was administered to assess VA staff’s knowledge about human trafficking and the impact on the Veteran community. Results Upon examination of qualitative review of evidence, formal study is needed to develop programming to address human trafficking in the Veteran community. Discussion Further study is needed to understand the prevalence of human trafficking among the Veteran population. While the VA’s human trafficking initiatives are integral initial steps, additional research remains necessary to identify treatment needs and services gaps. Conclusion Human Trafficking Tiger Team Knowledge Needs Assessment trainings revealed that VA staff had contact with survivors of human trafficking, suspected victims, as well as traffickers. 38% of staff acknowledged missed opportunities to assess and intervene with potential trafficking victims. This revealed a clear need for standardized screening, protocols, and implementing routine training to Veterans impacted by human trafficking.

Antipsychotic Medication Prescriptions for Homeless and Unstably Housed Veterans in the Veterans Affairs Health Care System.

Many homeless and unstably housed (HUH) adults have severe mental illnesses that are managed with antipsychotic medications. The US Department of Veterans Affairs (VA) is the largest provider of homeless services, but there has been little study of psychotropic medication prescriptions for HUH veterans. Using national VA administrative data in 2017, rates and characteristics associated with prescriptions for antipsychotic medications for veterans using VA health care services (N = 2,882,993), including HUH veterans (n = 266,855), were analyzed. Among HUH veterans, 17.6% had an antipsychotic prescription within 1 year of indication of HUH and 4.3% had prescriptions for 3 or more antipsychotic medications, which was higher than the 2.2% of non-HUH veterans with 3 or more antipsychotic prescriptions. Controlling for sociodemographic and clinical characteristics, HUH veterans were more than 3 times as likely to have an antipsychotic prescription as other veterans. However, among HUH veterans with an ICD-10-documented psychotic or bipolar disorder, HUH veterans were less likely to have prescriptions for first-generation and second-generation antipsychotics compared to their non-HUH counterparts (odds ratios for any antipsychotic < 0.5). Less than 2% of both HUH and non-HUH veterans had received long-acting injectable second-generation antipsychotic medications, and less than 0.2% were on clozapine treatment. These findings provide a snapshot of antipsychotic prescription practices for HUH veterans in the VA health care system. The higher rates of antipsychotic prescriptions for HUH veterans overall, but potential underprescribing of antipsychotics for HUH veterans with severe mental illness, suggest there are opportunities for improving antipsychotic prescription practices in this population, including increasing use of long-acting injectable medications.

Veteran Perspectives on Care Coordination Between Veterans Affairs and Community Providers: A Qualitative Analysis.

To investigate veteran perspectives on challenges in care coordination between US Department of Veterans Affairs (VA) clinics and community providers in rural areas. We completed qualitative interviews with a geographically diverse sample of 51 veterans who had used both VA and community health care services. Interviews were audio-recorded and transcribed verbatim. We used directed content analysis (informed by previous work with VA and community staff) to elucidate findings, while remaining attentive to emergent themes. We report results in 5 key domains related to interorganizational care coordination: organizational mechanisms, organizational culture, relational practices, contextual factors, and the role of the Third-Party Administrators responsible for scheduling and payment for community services. Veterans described successes and challenges in interorganizational coordination across these domains, while also reporting a variety of workarounds and mitigation strategies. Veterans living in rural areas face myriad challenges when using health care services both within and outside of VA. In the absence of strong mechanisms for ensuring coordination and communication between health care providers at different institutions, veterans themselves may carry the primary burden for coordinating their care. Our results suggest the utility of both structural and relational approaches to enhancing interorganizational care coordination in these settings.

Barriers to the use of Veterans Affairs health care services among female veterans who served in Iraq and Afghanistan.

The study investigated barriers to the utilization of Veterans Affairs (VA) health care services among female veterans who served in served in Iraq and Afghanistan, including reasons for not choosing VA health care, reasons for not seeking mental health treatment, and types of desired VA services. Female respondents to a survey assessing Operation Enduring Freedom/Operation Iraqi Freedom veterans' needs and health (N = 186) completed measures of military history, posttraumatic stress disorder, depression, barriers to VA health care, and preferences for services. Barriers to use of VA health care endorsed by female veterans included receiving care elsewhere and logistical issues. Barriers to utilization of mental health services among female veterans who screened positive for depression or posttraumatic stress disorder included negative treatment biases and concerns about stigma, privacy, and cost. Female veterans endorsed preferences for services related to eligibility education, nonprimary care physical health services, vocational assistance, and a few behavioral/mental health services. Findings highlight the need for ongoing outreach and education regarding eligibility and types of resources for physical and mental health problems experienced by female veterans who served in Iraq and Afghanistan, as well as inform types of VA programming and services desired by female veterans. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

US Veterans Who Do and Do Not Utilize Veterans Affairs Health Care Services: Demographic, Military, Medical, and Psychosocial Characteristics.

To examine sociodemographic and military characteristics of US veterans who do and do not utilize Veterans Affairs (VA) health care services as their primary source of health care and examine the relationship between VA utilization and medical and psychosocial characteristics. Participants were a nationally representative sample of 3,152 military veterans (89.8% male, 83.5% white, 6.0% black, mean age = 62.0 [SD = 13.1] years) who completed a survey in 2011 assessing health care utilization, sociodemographic, military service, medical, and psychosocial characteristics. Receiver operator characteristic analyses and logistic and linear regressions were conducted to provide a comprehensive and multivariate examination of factors associated with VA utilization. Veterans who used VA services were more likely to be black, younger, female, unmarried, and less educated and to have lower household incomes. They were also more likely to have served longer in the military and in combat. VA users were more likely to screen positive for lifetime psychopathology, endorse current suicidality, and report enduring more traumas. VA users were also more likely to report more medical conditions, endorse a disability, and score lower on measures of functioning. The primary factor differentiating VA users from those that did not use VA services was presence of lifetime psychopathology. Results provide a comprehensive profile of veterans who do and do not utilize VA services and suggest that veterans who use VA services have a substantially elevated health burden compared to other veterans. Results may help inform outreach and engagement initiatives targeting the unique health care needs of veterans who do and do not utilize VA services.

Engaging African American Veterans with Health Care Access Challenges in a Community Partnered Care Coordination Initiative: A Qualitative Needs Assessment.

Little has been written about engaging potentially eligible members of a health care system who are not accessing the care to which they are entitled. Knowing more about the experiences of African American Veterans who regularly experience health care access challenges may be an important step toward equitable, coordinated Veterans Health Administration (VHA) care. This article explores the experiences of African American Veterans who are at risk of experiencing poor care coordination. We partnered with a community organization to recruit and engage Veterans in three exploratory engagement workshops between October 2015 and February 2016. Veterans living in South Los Angeles, California. Veterans were asked to describe their experiences with community care and the VHA, a division of the US Department of Veterans Affairs (VA). Field notes taken during the workshops were analyzed by community and academic partners using grounded theory methodology to identify emergent themes. 12 Veterans and 3 family members of Veterans participated in one or more engagement workshops. Their trust in the VA was generally low. Positive themes included: Veterans have knowledge to share and want to help other Veterans; and connecting to VA services can result in positive experiences. Negative themes included: functional barriers to accessing VA health care services; insensitive VA health care environment; lack of trust in the VA health care system; and Veteran status as disadvantageous for accessing non-VA community services. Veterans living in underserved areas who have had difficulty accessing VA care have unique perspectives on VA services. Partnering with trusted local community organizations to engage Veterans in their home communities is a promising strategy to inform efforts to improve care access and coordination for vulnerable Veterans.

Cancer Among Women Treated in the Veterans Affairs Healthcare System.

The Veterans Affairs (VA) healthcare system is a high-volume provider of cancer care. Women are the fastest growing patient population using VA healthcare services. Quantifying the types of cancers diagnosed among women in the VA is a critical step toward identifying needed healthcare resources for women Veterans with cancer. We obtained data from the VA Central Cancer Registry for cancers newly diagnosed in calendar year 2010. Our analysis was limited to women diagnosed with invasive cancers (e.g., stages I-IV) between January 1, 2010, and December 31, 2010, in the VA healthcare system. We evaluated frequency distributions of incident cancer diagnoses by primary anatomical site, race, and geographic region. For commonly occurring cancers, we reported distribution by stage. We identified 1,330 women diagnosed with invasive cancer in the VA healthcare system in 2010. The most commonly diagnosed cancer among women Veterans was breast (30%), followed by cancers of the respiratory (16%), gastrointestinal (12%), and gynecological systems (12%). The most commonly diagnosed cancers were similar for white and minority women, except white women were significantly more likely to be diagnosed with respiratory cancers (p < 0.01) and minority women were significantly more likely to be diagnosed with gastrointestinal cancers (p = 0.03). Understanding cancer incidence among women Veterans is important for healthcare resource planning. While cancer incidence among women using the VA healthcare system is similar to U.S civilian women, the geographic dispersion and small incidence relative to male cancers raise challenges for high quality, well-coordinated cancer care within the VA.

Disaster-related communication preferences of homeless and nonhomeless VA patients.

To identify the communication preferences of homeless (H) and nonhomeless (NH) Veterans Affairs (VA) patients for receiving information about the impact of natural disasters on VA healthcare services. Probability-based sampling design stratified on age categories, urban/rural, coastal/noncoastal, and homelessness. Northeast United States. Eligible NH and H participants included those who lived in and had at least one healthcare visit to a VA medical center/clinic in the region in the previous 24 months. Homeless participants included those receiving VA homeless services or having ICD9-CM V60.0 (Lack of Housing). 2,264/6,088 NH and 383/2,000 H completed the survey. Cross-sectional, mixed-mode survey administered August-November 2015. Helpfulness of ten communication modes for receiving information about the impact of natural disasters on VA healthcare services. Despite sociodemographic and health status differences, the top five communication modes rated extremely/very helpful were the same for both groups: telephone (76 percent H; 81 percent NH), TV (63 percent H; 60 percent NH), text (62 percent H; 50 percent NH), e-mail (56 percent H; 58 percent NH), radio (54 percent H; 47 percent NH). Newspaper and online modes (VA/other Web sites, Twitter, Facebook, MyHealtheVet) were rated substantially lower. H and NH patients prefer similar communication modes for receiving updates about the impact of natural disasters on VA healthcare services. Findings suggest that a multimodal communication strategy that incorporates phone, TV, text, e-mail, and radio will help Veterans Affairs (VA) reach its diverse patient population during natural disasters. Dissemination of messages via online modes, while rated less helpful, may augment the number of patients reached.

Characteristics and Health Needs of Veterans with Other-than-Honorable Discharges: Expanding Eligibility in the Veterans Health Administration.

There has been nearly no research on the health of veterans with Other-than-Honorable (OTH) discharges because they have traditionally not been eligible for health care through the Department of Veterans Affairs (VA). However, the Secretary of the VA has recently expanded eligibility provisions to provide access to some VA health care services to veterans with OTH discharges to help address any urgent mental health care needs. It is unknown if veterans with OTH discharges have worse mental health and potentially greater mental health care needs than other veterans. Using data from the 2001 National Survey of Veterans, this study examined the characteristics and health status of veterans with OTH discharges compared with veterans with honorable or general discharges. Physical and mental health was assessed with the 12-item Short Form health survey. Bivariate comparisons revealed that veterans with OTH discharges were younger, reported lower income, were more likely to lack health insurance, and reported more mental health problems than other veterans. After controlling for other factors, veterans with OTH discharges were still younger and reported more mental health problems than other veterans. Post hoc analyses revealed veterans with OTH discharges were significantly more likely to report having accomplished less because of emotional problems, performed activities less carefully because of emotional problems, felt less calm and peaceful, and felt more downhearted and blue in the previous 4 wk than other veterans. These findings suggest that veterans with OTH discharges have substantial mental health care needs and may benefit from the VA's recent provision granting them increased access to VA care but some may need more comprehensive mental health care services.

Characteristics and Health Needs of Veterans in Jails and Prisons: What We Know and Do Not Know about Incarcerated Women Veterans

PurposeThe majority of U.S. veterans in prisons and local jails are men, but incarcerated women veterans remain an important and understudied group. MethodsThis study reported differences in sociodemographic, health, and criminal justice characteristics using Veterans Affairs (VA) administrative data on a national sample of 30,964 incarcerated veterans (30,440 men and 524 women) who received outreach from the VA Health Care for Reentry Veterans program between 2007 and 2011. Descriptive statistics and multivariable logistic regressions determined gender and racial differences in this population. ResultsCompared with incarcerated veterans who were men, incarcerated women veterans were younger (d = 0.68), had significantly lower lifetime arrests (AOR, 0.65; p < .001; 99% CI, 0.49–0.87), and were less likely to have been incarcerated for a violent offense (AOR, 0.47; p < .001; 99% CI, 0.35–0.63). Notably, 58% of women were of reproductive age. Women were more likely to have reported eye problems, hypertension, chronic obstructive pulmonary disease, and seizure disorder, and were more likely to receive a preliminary diagnosis of mood disorder than men. Women were more likely to have received VA benefits, used VA health care before, and be willing to use VA services after release. A few important differences emerged when stratified by race. ConclusionsThese findings suggest that incarcerated women veterans are interested in VA health care services, but there is lack of information about women's health needs through the Health Care for Reentry Veterans program. The inclusion of Health Care for Reentry Veterans screening questions about women's health issues may support the VA's interests to better engage women veterans in care.

U.S. Veteran Health Care Utilization Increases after Caregivers' Use of National Caregiver Telephone Support Line.

The U.S. Department of Veterans Affairs (VA) established the national Caregiver Support Line (CSL) in February 2011. The CSL is operated by licensed master's degree social workers who provide caregivers of veterans with information about caregiver benefits and services, counseling, and referrals to a caregiver support coordinator at the nearest VA medical center. The authors compared differences in veteran health care utilization patterns in the six months before and after a caregiver call to the CSL, hypothesizing that veterans with caregivers using the CSL had improved access to health care services and improved access increased utilization of health care. A pre- and posttest design was used. CSL calls that resulted in referrals to VA health care services or to local VA caregiver support coordinators were included in the sample. Data were extracted from the CSL database and matched to veteran care utilization data using veteran medical record data. Veteran inpatient stays for general medicine, hospice, respite, and long-term care significantly increased after the CSL call, but other inpatient stays (surgery, neurology) did not. Outpatient services for home health, respite, and mental health all significantly increased. Caregivers' use of the national CSL may help facilitate access for veterans to needed care services.

Assessment of the healthcare needs and barriers to VA use experienced by women veterans: findings from the national survey of women Veterans.

Prior regional studies of women Veterans identified barriers to Veterans Affairs (VA) healthcare use. However, these studies do not reflect the demographic profile of women Veterans nationally, recent advances in VA women's healthcare, and the national context of expanded healthcare alternatives. To characterize health, VA perceptions, barriers, healthcare delivery preferences, and reasons for VA or non-VA healthcare use in a national women Veteran sample. Cross-sectional, population-based 2008-2009 National Survey of Women Veterans (n=3611). VA users had worse physical and mental health than non-VA-only users and healthcare nonusers. Older women Veterans had worse physical health, whereas younger groups had worse mental health. Healthcare use was highest for dual users, followed by VA-only users, but did not differ by age group. Healthcare nonusers were most likely to lack a regular source for healthcare. Perceptions of VA care quality and sex-appropriateness were highest for VA-only, followed by dual, then non-VA-only users. VA perceptions were guided by personal experience for 90% of VA users, versus media or other secondhand sources for 70% of other groups. Non-VA-only users and healthcare nonusers had more knowledge gaps about VA and misperceptions about VA eligibility and services; non-VA-only users more likely encountered VA enrollment barriers. Many nonusers had healthcare needs that were not met. Positive VA perceptions by women with first-hand VA experience, contrasted with VA knowledge gaps by those without such exposure, suggests the need for more education about available VA healthcare services. VA planning should account for mental health needs and healthcare use by younger women Veterans.

Tribal Veterans Representative (TVR) Training Program: The Effect of Community Outreach Workers on American Indian and Alaska Native Veterans Access to and Utilization of the Veterans Health Administration

American Indians and Alaska Natives serve at the highest rate of any US race or ethnic group, yet are the most underserved population of Veterans and do not take advantage of the Department of Veterans Affairs (VA) benefits and services. Barriers to seeking care include stigma, especially for mental health issues; distance to care; and lack of awareness of benefits and services they are entitled to receive. In response to this underutilization of the VA, an innovative program--the Tribal Veterans Representative (TVR) program--was developed within the VA to work with American Indians and Alaska Natives in rural and remote areas. The TVR goes through extensive training every year; is a volunteer, a Veteran and tribal community member who seeks out unenrolled Native Veterans, provides them with information on VA health care services and benefits, and assists them with enrollment paperwork. Being from the community they serve, these outreach workers are able to develop relationships and build rapport and trust with fellow Veterans. In place for over a decade in Montana, this program has enrolled a countless number of Veterans, benefiting not only the individual, but their family and the community as well. Also resulting from this program, are the implementation of Telemental Health Clinics treating Veterans with PTSD, a transportation program helping Veterans get to and from distant VA facilities, a Veteran Resource Center, and a Veteran Tribal Clinic. This program has successfully trained over 800 TVRs, expanded to other parts of the country and into remote areas of Alaska.

Access to the US Department of Veterans Affairs health system: self-reported barriers to care among returnees of Operations Enduring Freedom and Iraqi Freedom

BackgroundThe U.S. Department of Veterans Affairs (VA) implemented the Polytrauma System of Care to meet the health care needs of military and veterans with multiple injuries returning from combat operations in Afghanistan and Iraq. Studies are needed to systematically assess barriers to use of comprehensive and exclusive VA healthcare services from the perspective of veterans with polytrauma and with other complex health outcomes following their service in Afghanistan and Iraq. These perspectives can inform policy with regard to the optimal delivery of care to returning veterans.MethodsWe studied combat veterans (n = 359) from two polytrauma rehabilitation centers using structured clinical interviews and qualitative open-ended questions, augmented with data collected from electronic health records. Our outcomes included several measures of exclusive utilization of VA care with our primary exposure as reported access barriers to care.ResultsNearly two thirds of the veterans reported one or more barriers to their exclusive use of VA healthcare services. These barriers predicted differences in exclusive use of VA healthcare services. Experiencing any barriers doubled the returnees’ odds of not using VA exclusively, the geographic distance to VA barrier resulted in a 7 fold increase in the returnees odds of not using VA, and reporting a wait time barrier doubled the returnee’s odds of not using VA. There were no striking differences in access barriers for veterans with polytrauma compared to other returning veterans, suggesting the barriers may be uniform barriers that predict differences in using the VA exclusively for health care.ConclusionsThis study provides an initial description of utilization of VA polytrauma rehabilitation and other medical care for veteran returnees from all military services who were involved in combat operations in Afghanistan or Iraq. Our findings indicate that these veterans reported important stigmatization and barriers to receiving services exclusively from the VA, including mutable health delivery system factors.

Risk of Incarceration and Other Characteristics of Iraq and Afghanistan Era Veterans in State and Federal Prisons

The Health Care for Reentry Veterans (HCRV) program provides Veterans Health Administration outreach services to veterans incarcerated in state and federal prisons. This study used HCRV data to compare risk of incarceration of veterans of Operations Enduring Freedom (OEF), Iraqi Freedom (OIF), and New Dawn (OND) and other veterans and to identify sociodemographic and clinical characteristics of incarcerated veterans of OEF/OIF/OND. Administrative national data were analyzed for 30,968 incarcerated veterans, including 1,201 OEF/OIF/OND veterans, contacted from October 2007 to April 2011. Odds ratios were calculated comparing the risk of incarceration among OEF/OIF/OND and other veterans in the HCRV sample and in a weighted sample of nonincarcerated veterans from the 2010 National Survey of Veterans. Stepwise logistic regressions of HCRV data examined characteristics of incarcerated veterans independently associated with OEF/OIF/OND service. Regardless of ethnicity or age, OEF/OIF/OND veterans were less than half as likely as other veterans to be incarcerated and constituted only 3.9% of the incarcerated veterans. Compared with other incarcerated veterans, OEF/OIF/OND veterans were younger, were more likely to be married, were more likely to report combat exposure, expected a shorter incarceration, were 26% less likely to have a diagnosis of drug abuse or dependence, and were three times more likely to have combat-related posttraumatic stress disorder (PTSD). OEF/OIF/OND veterans appeared to be at lower risk of incarceration than veterans of other service eras, but those who were incarcerated had higher rates of PTSD. Efforts to link these veterans to mental health services upon their release are warranted.

Community-Based Wounded Warrior Sustainability Initiative (CBWSI): An integrative medicine strategy for mitigating the effects of PTSD

How people behave is dramatically influenced by how we organize institutions. Elliott Jaques INTRODUCTION The U.S. Department of Veterans Affairs (VA) healthcare system is preparing for an increase in the number of veteran patients caused by the drawdown of troops from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), many of whom suffer from posttraumatic stress disorder (PTSD). As such, it is imperative that local communities also prepare for their return. This editorial discusses the unique circumstance of the U.S. veteran with PTSD, examines groundbreaking measures made by the VA to help identify and treat veterans experiencing the invisible wounds of war, and introduces an innovative, community-based, primary care level strategy to mitigate the untoward effects of PTSD on veterans and their families, the VA healthcare system, and local communities. THE VETERAN According to the VA, in June 2010, there were 171,423 OIF/OEF veterans diagnosed with PTSD, out of a total of 593,634 patients treated by the VA [1]. The good and bad news about blast injuries from improvised explosive devices is that while many more individuals survive the initial event because of improved military medicine, many also sustain additional injuries that make rehabilitation and full recovery very challenging (i.e., limb loss, traumatic brain injury [TBI], PTSD). Thus far, 84,005 veteran patients have been granted VA disability compensation; of these, about half were for PTSD [2]. The full effect of OIF/OEF on the mental health of soldiers will not be known for years. One study looked at members of four U.S. combat infantry units (three Army and one Marine Corps) who had served in Iraq and Afghanistan. The majority of soldiers were exposed to a variety of traumatic, combat-related situations, such as being attacked or ambushed (92%), seeking dead bodies (94.5%), being shot at (95%), and/or knowing someone who was seriously injured or killed (86.5%). After deployment, approximately 12.5 percent had PTSD, a rate greater than that found among these soldiers before deployment [3]. There is an alarming rise in PTSD-related suicides, which increased from 11 per day in 2009 to 18 per day in 2011 [4]. Acts of violence by veterans and their associated effects on society are commonly seen in the media [5]. According to VA healthcare services, access to care appears to be a key factor, noting once a veteran is inside the VA care program . . . special efforts are made to track those considered to be at high risk ... [4]. Suicide attempts by Iraq and Afghanistan veterans are of special concern because their rates are so much higher. Combined physical and psychological traumas, such as feelings of hopelessness compounded by a cognitive inability to adjust or cope with stress, may result in a further sense of despair. In fiscal year 2009, there were 1,621 suicide attempts by men and 247 by women, with 94 men and 4 women dying [4]. Early studies were of interest to the military [6-7] because of the large numbers of soldiers returning from Iraq and Afghanistan with TBI and PTSD as a result of having survived blast injuries. PTSD has been identified as one of the signature disorders of OIF/OEF [8]. A 2008 RAND Corporation study estimated that 13.8 percent of U.S. servicemembers experience PTSD [9], while other studies report military prevalence rates ranging from 2 to 22 percent [10-11]. The VA and Department of Defense have recently embarked on additional research in the military population at VA facilities using acupuncture for the treatment of PTSD and related symptoms. The scientific rationale for acupuncture is better understood today, including interactions with muscle fascia and peripheral and central neurologic pathways [12-13]. VA AND NATIONAL CENTER FOR PTSD Recognizing the need for research and education on the prevention, understanding, and treatment of PTSD, the VA designed and implemented a Center of Excellence called the National Center for PTSD. …