Veteran Status Research Articles

Examining Changes in Sexual Functioning after Cognitive Processing Therapy in a Sample of Women Trauma Survivors.

Posttraumatic stress disorder (PTSD) and sexual dysfunction commonly co-occur. Although sexual dysfunction is more prevalent among women and the negative impact of sexual dysfunction on quality of life is stronger in women compared with men, few studies examine the impact of evidence-based PTSD treatments on sexual functioning outcomes in women with PTSD. The current study examined the relationship between PTSD and sexual functioning among women trauma survivors to examine if sexual functioning improves after cognitive processing therapy (CPT). A total of 126 civilian and veteran women were randomly assigned to receive CPT delivered via either office-based videoconferencing or traditional office-based care. PTSD outcomes were examined from before treatment to after treatment and sexual functioning outcomes were examined from before treatment to the 3-month follow-up. Multigroup structural equation modeling was used to compare changes in sexual functioning and PTSD scores over time. We also compared how sexual functioning changed after treatment among women who identified a sexual trauma as their index trauma compared with those with nonsexual index traumas. Greater baseline PTSD symptoms predicted poorer sexual satisfaction at baseline. Sexual satisfaction, arousal, and desire improved after CPT; veteran status and index trauma type (i.e., sexual vs. nonsexual) did not attenuate this relationship. Women who had greater decreases in PTSD symptoms experienced greater improvements in sexual satisfaction, arousal, and desire. The current study provides preliminary support that CPT treatment may improve sexual functioning in women trauma survivors. Clinicians should assess sexual functioning to promote disclosure and develop a treatment plan.

Offending behaviour, health and wellbeing of military veterans in the criminal justice system.

BackgroundA small but significant proportion of military veterans become involved in the criminal justice system (CJS) after leaving service. Liaison and Diversion (L&D) services aim to identify vulnerable offenders in order to provide them with the health/welfare support they need, and (where possible) divert them away from custody. An administrative database of L&D service-users was utilised to compare the needs of veterans with those of non-veteran L&D service-users.MethodNational data collected from 29 L&D services in 2015–2016 was utilised. Of the 62,397 cases, 1,067 (2%) reported previous service in the Armed Forces, and 48,578 had no previous service history. The associations between veteran status and socio-demographic characteristics, offending behaviour, health- and mental health-problems were explored. The associations between specific types of offending and mental health problems within the veterans in the sample were also investigated.ResultsVeterans tended to be older, and less likely to be unemployed than non-veterans, but just as likely to have unstable living arrangements (including homelessness). Veteran status was associated with increased levels of interpersonal violence, motoring offences, anxiety disorders and hazardous drinking patterns. Veteran status was associated with decreased levels of acquisitive offending, schizophrenia, ADHD, and substance misuse. Among veterans, the presence of an anxiety disorder (umbrella term which included GAD, Phobias, PTSD etc.) was associated with increased interpersonal violence, alcohol misuse was associated with increased motoring offences, and substance use was associated with increased acquisitive offending.ConclusionsOur study indicates that among offenders in the CJS who have been identified as needing health or welfare support, veterans differ from non-veterans in terms of their health and welfare needs and offending behaviour. These differences may be influenced by the impact of military service and the transition into civilian life. Our findings support the identification of military personnel within the CJS to provide appropriate interventions and support to improve outcomes and reduce offending.

The prevalence and trend of depression among veterans in the United States

BackgroundDepression is a common psychiatric illness that is associated with high rates of mortality and morbidity. However, studies reporting the trends of depression among U.S. veterans are limited. Therefore, the aim of this study was to evaluate the prevalence and trend of depression among U.S. veterans and evaluate potential exploratory variables that may contribute. MethodsData were from six cycles, 2005–2016, of the National Health and Nutrition Examination Survey (NHANES). Veteran status of depression was self-reported using the Patient Health Questionnaire. Rao–Scott χ2 test measured bivariate association of depression and exploratory variables (age, gender, race/ethnicity, poverty, and education). Cochran–Armitage trend test assessed depression prevalence time-trends from 2005 to 2016. ResultsOver a two-week period, 16.3% of veterans spent at least half of the days feeling tired or having little energy. Also, over 15.0% of veterans reported having trouble sleeping or sleeping too much on more than half of the days (6.5%) or nearly every day (9.1%). The overall prevalence of depression among veterans peaked in 2011–2012 at 12.3%. Among female veterans, there is a general increasing prevalence of depression, escalating from 9.0% in the 2007–2008 cycle to 14.8% in the 2015–2016 cycle. White veterans consistently had a higher prevalence of depression compared to Black and Hispanic veterans. LimitationsNHANES data were only able to assess noninstitutionalized individuals. ConclusionsResults indicate that disparities in prevalence of depression existed among U.S. veterans. Cost-effective strategies are needed to help prevent and treat depression among U.S. veterans.

The Battlefield Behind Bars: How Mental Disorder and Suicidal Behavior Impacts the Prison Experience for Veterans

Military veteran status has been associated with a variety of criminal justice outcomes as well as higher rates of mental illness and suicide when compared to the general population. Although research has generally focused on why veterans become involved with the justice system, less is known about their experiences while incarcerated. In particular, studies of veterans in the community context indicate that they are unwilling to seek out mental health treatment due to potential stigmas, suggesting that this reluctance may extend into the prison environment. Using a sample of 14,278 veteran and nonveteran inmates, we find that veterans do not necessarily fare worse in prison and are actually more likely to obtain treatment. However, this effect is largely mediated by the greater history of mental disorders and suicidal behaviors among veterans. Our findings lend credence to recent efforts designed to screen and manage justice-involved veterans as a distinct, at-risk group.

Mental Health Differences Between Older and Younger Lesbian, Gay, Bisexual, and Transgender Veterans: Evidence of Resilience

ABSTRACTObjective: To examine health and identity differences between older (50+) and younger (< 50) lesbian, gay, bisexual, and transgender (LGBT) veterans.Methods: Participants (N = 254) completed an internet survey assessing depression, anxiety, alcohol use, identity, minority stress, and outness. T tests and logistic regression were used to analyze results.Results: Older LGBT veterans reported less alcohol use (p < .01) than younger counterparts. No age differences in depression or anxiety were reported. Older participants reported LGBT identity as more central to their overall identity (p < .01) and having less minority stress (p < .05), than younger participants.Conclusions: Compared to younger LGBT veterans, older LGBT veterans appeared more resilient over stressors that can impact mental health. Overall older LGBT veterans experienced less alcohol use and reported less minority stress than younger veterans. LGBT identity was more central to older veterans’ overall identity than younger Veterans.Clinical Implications: LGBT veterans may experience stressors that can impact mental health, although older LGBT veterans show remarkable resilience. Clinicians should assess sexual orientation and gender identity, as well as veteran status, of patients in order to best evaluate their health risks and strengths.

Kilocalorie Expenditure and All-Cause Mortality in Older Male Veterans and Nonveterans.

The objective of this study was to determine the effect of self-reported leisure-time physical activity, converted to kilocalorie expenditure and expressed as average daily expenditure, on all-cause mortality among older males 65 years of age and older in the University of Alabama at Birmingham (UAB) Study of Aging (SOA). Mean age of participants was 75.4 years. Multivariable Cox proportional hazard models evaluated the predictors of overall survival. Kilocalorie expenditure (p = .01), Black race (p = .02), young age (p < .00), fewer depressive symptoms (p = .00), and absence of cognitive impairment (p < .00) were significant independent predictors of higher rates of survival. Low body mass index was a significant independent predictor of death (p = .03). Veteran status did not improve survival. Further study about kilocalorie expenditure and mortality could lead to reductions in premature mortality in community-dwelling older men in the Deep South.

Does military veteran status and deployment history impact officer involved shootings? A case-control study.

Despite veterans' preference hiring policies by law enforcement agencies, no studies have examined the nature or effects of military service or deployments on health outcomes. This study will examine the effect of military veteran status and deployment history on law enforcement officer (LEO)-involved shootings. Ten years of data were extracted from Dallas Police Department records. LEOs who were involved in a shooting in the past 10 years were frequency matched on sex to LEOs never involved in a shooting. Military discharge records were examined to quantify veteran status and deployment(s). Multivariable logistic regression was used to estimate the effect of veteran status and deployment history on officer-involved shooting involvement. Records were abstracted for 516 officers. In the adjusted models, veteran LEOs who were not deployed were significantly more likely to be involved in a shooting than non-veteran officers. Veterans with a deployment history were 2.9 times more likely to be in a shooting than non-veteran officers. Military veteran status, regardless of deployment history, is associated with increased odds of shootings among LEOs. Future studies should identify mechanisms that explain this relationship, and whether officers who experienced firsthand combat exposure experience greater odds of shooting involvement.

Caring for veterans in US civilian primary care: qualitative interviews with primary care providers.

Non-VA health care providers in the USA have been called upon to screen patients for veteran status as a means to better identify military-related health sequelae. Despite this recognized need, many service members are still not being asked about veteran status. The purpose of this research was to qualitatively assess, from non-VA primary care providers' point-of-view, barriers to providing care to veterans, the training providers perceive as most useful and the tools and translational processes they think would be most valuable in increasing military cultural competency. Semi-structured qualitative interviews, with non-VA primary care providers (N = 10) as part of a larger quantitative study of primary care providers' attitudes around veteran care. Interviews asked about providers' approach to addressing veteran status in their practice and their thoughts on how to address the needs of this population. Qualitative data were analyzed using a thematic content analysis approach. Three major themes were identified: (i) barriers to caring for patients who are identified as veterans, (ii) thoughts on tools that might help better identify and screen veteran patients and (iii) thoughts on translating and implementing new care processes for veteran patients into everyday practice. Our study identified barriers related to non-VA providers' ability to care for veterans among their patients and possible mechanisms for improving recognition of veterans in civilian health care settings. There is a need for further research to understand how assessment, screening and follow up care for veteran patients is best implemented into civilian primary care settings.

Racial and Ethnic Disparities in the Lifetime Prevalence of Homelessness in the United States.

Homelessness in the United States is often examined using cross-sectional, point-in-time samples. Any experience of homelessness is a risk factor for adverse outcomes, so it is also useful to understand the incidence of homelessness over longer periods. We estimate the lifetime prevalence of homelessness among members of the Baby Boom cohort (n = 6,545) using the 2012 and 2014 waves of the Health and Retirement Study (HRS), a nationally representative survey of older Americans. Our analysis indicates that 6.2% of respondents had a period of homelessness at some point in their lives. We also identify dramatic disparities in lifetime incidence of homelessness by racial and ethnic subgroups. Rates of homelessness were higher for non-Hispanic blacks (16.8%) or Hispanics of any race (8.1%) than for non-Hispanic whites (4.8%; all differences significant with p < .05). The black-white gap, but not the Hispanic-white gap, remained significant after adjustment for covariates such as education, veteran status, and geographic region.

Alcohol screening and brief intervention in a representative sample of veterans receiving primary care services

AimsUnhealthy alcohol use is common among adults, and in particular, Veterans. Routine alcohol screening followed by brief intervention is recommended and considered a prevention priority in primary care settings. While previous studies have found that Veterans enrolled in the Veteran's Health Administration (VA) receive high rates of screening and brief intervention, less than 50% of Veterans receive VA health care. No study has evaluated receipt of these services in a general sample of Veterans. Therefore, in a nationally-representative sample, we examine whether Veteran status was associated with receiving alcohol screening and brief intervention in primary care. MethodsUsing the Centers for Disease Control and Prevention's 2014 Behavioral Risk Factor Surveillance System data, we identified adults who endorsed visiting a doctor for routine checkup at least once in the past two years and responded to an optional module assessing alcohol-related care (N = 92,206; 14.1% Veterans). Multivariable logistic regression was used to assess the association between Veteran status and screening and brief intervention outcomes. We also evaluate differences in alcohol-related care across Veteran status stratified by gender. Models were adjusted for sociodemographic and clinical characteristics likely to confound the association. ResultsOverall, Veterans were more likely than non-Veterans to be screened for alcohol quantity and heavy episodic drinking (ps < 0.05), and more likely to endorse receiving brief intervention advice about alcohol's harmful effects (p < .001). Veteran status predicted an increased likelihood of being screened and receipt of advice about alcohol's harmful effects, but did not predict the likelihood of receiving advice to reduce or abstain from drinking (AOR = 1.00, 95% C.I. [0.80–1.26]). Analyses stratified by gender indicated a similar pattern of results for males as the overall sample. Results among females indicated Veteran status predicted the likelihood of being asked about heavy episodic drinking (AOR = 1.47, 95% C.I. [1.09–1.99]) and being offered advice about the harmful effects of alcohol (AOR = 1.62, 95% C.I. [1.06–2.48]). Female Veterans were not more likely than female non-Veterans to be advised to reduce and/or abstain from drinking. ConclusionsScreening about any alcohol use was common while report of screening for quantity and heavy episodic drinking occurrence and report of brief intervention were less common. Veterans were more likely than non-Veterans to report receiving recommended care, though rates of advice to reduce or abstain from drinking did not differ across groups. Persistent gaps in delivery of recommended alcohol-related care, especially for particularly vulnerable subpopulations such as women Veterans, suggest a need for quality improvement.

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.

Odds of talking to healthcare providers as the initial source of healthcare information: updated cross-sectional results from the Health Information National Trends Survey (HINTS)

BackgroundPeople use a variety of means to find health information, including searching the Internet, seeking print sources, and talking to healthcare providers, family members, and friends. Doctors are considered the most trusted source of health information, but people may be underutilizing them in favor of searching the Internet.MethodsA multinomial logistic regression of cross-sectional data from Cycle 4 of the Health Information National Trends Survey (HINTS) was conducted. Independent variables included gender, age, rurality, cancer history, general health, income, race, education level, insurance status, veteran status, Internet use, and data year; the dependent variable was the first chosen source of health information.ResultsThe most frequent initial source of health information was the Internet, and the second most frequent was healthcare providers. There were significant differences in odds of using healthcare providers as the first source of health information. Those likely to use doctors as their initial source of health information were older adults, black adults, adults with health insurance, those who do not use the Internet, and adults who do not have a college degree.ConclusionsPeople who use healthcare providers as the first source of health information may have better access to health care and be those less likely to use the Internet. Doctors may have to provide more information to those who do not use the internet and spend time verifying information for those who do use health information from the internet.

Non-fatal self-harm in Scottish military veterans: a retrospective cohort study of 57,000 veterans and 173,000 matched non-veterans

PurposeAlthough suicide risk in veterans has been widely studied, there is little information on the risk of non-fatal self-harm in this population. We used data from the Scottish Veterans Health Study to conduct an epidemiological analysis of self-harm in veterans, in comparison with people who have never served.MethodsWe conducted a retrospective, 30-year cohort study of 56,205 veterans born 1945–1985, and 172,741 people with no record of military service, and used Cox proportional hazard models to examine the association between veteran status and cumulative risk of non-fatal self-harm, overall and stratified by birth cohort, sex and length of service. We also examined mental and physical comorbidities, and association of suicide with prior self-harm.ResultsThere were 1620 (2.90%) first episodes of self-harm in veterans, compared with 4212 (2.45%) in non-veterans. The difference was statistically significant overall (unadjusted HR 1.27, 95% CI 1.21–1.35, p < 0.001). The risk was highest in the oldest veterans, and in the early service leavers who failed to complete initial training (unadjusted HR 1.69, 95% CI 1.50–1.91, p < 0.001). The risk reduced with longer service and in the intermediate birth cohorts but has increased again in the youngest cohort.ConclusionsThe highest risk of non-fatal self-harm was in veterans with the shortest service, especially those who did not complete training or minimum engagement, and in the oldest birth cohorts, whilst those who had served the longest were at reduced risk. The risk has increased again in the youngest veterans, and further study of this subgroup is indicated.

Veterans in Prison for Sexual Offenses: Characteristics and Reentry Service Needs.

Among prison-incarcerated men in the United States, more veterans (35%) have a sexual offense conviction than nonveterans (23%). Limited research has investigated factors explaining the link between military service and sexual offending. Nationally representative data from prison-incarcerated men (n = 14,080) were used to examine the association between veteran status and sexual offenses, adjusting for demographic, childhood, and clinical characteristics. Veterans had 1.35 higher odds (95% confidence interval = [1.12, 1.62], p < .01) of a sexual offense than nonveterans. Among veterans, those who were homeless or taking mental health medications at arrest had lower odds and veterans with a sexual trauma history had higher odds of a sexual offense compared with other offense types. Offering mental health services in correctional and health care settings to address trauma experiences and providing long-term housing options can help veterans with sexual offenses as they transition from prison to their communities.

Veteran Status, Income, and Intergenerational Mobility Across Three Cohorts of American Men

Existing research linking prior military employment with labor market outcomes has focused on comparing the relative income of veterans and nonveterans. However, people who join the armed forces are uniquely selected from the broader population, and the form and direction of selectivity has shifted over time, with differential enlistment rates by race, region, and socioeconomic status. Understanding changes in the demographic composition of enlistees and veterans has significant import for the study of social mobility, particularly given changes in the occupational structure since the mid-twentieth century and wage stagnation well into the new millennium. Furthermore, labor market polarization and increases in educational attainment since WWII raise additional concerns about the social origins of military personnel and their occupational trajectories after discharge. Using data from the National Longitudinal Surveys, we investigate how social background is linked to both income and occupational mobility among veterans from three cohorts of American men: World War II, Vietnam, and the All-Volunteer Force. We find few benefits for veterans, for either income or intergenerational occupational mobility, once social background is controlled, suggesting that selection into the armed forces largely governs outcomes in the civilian labor market. Our findings have significant importance for understanding civilian labor market outcomes and trajectories of social mobility during distinct phases of military staffing.

Impact of Veteran Status and Timing of PTSD Diagnosis on Criminal Justice Outcomes.

Previous research has demonstrated that jurors show a bias towards treatment for veterans with post-traumatic stress disorder (PTSD). The present research examines this bias when jurors are faced with cases of potential malingering, in which the defendant’s claim of PTSD is a perceived attempt to escape legal punishments. Trial vignettes, in which veteran status and PTSD diagnosis timing were manipulated, were used to explore this phenomenon. It was found that veterans who received their diagnosis after being arrested were found guilty more often, and were diverted to treatment less often, than those who were diagnosed before an arrest. This has critical implications for mental healthcare in that it is crucial to properly diagnose and treat people before they find themselves in court. Further, the negative outcomes in court demonstrate one of the severe social impacts of untreated or late-diagnosed PTSD.

Can Diversity Management Improve Job Satisfaction for Military Veterans in the Federal Government?

On November 9, 2009, Executive Order 13518 established the Veterans Employment Initiative and invigorated veteran hiring within the federal government. By fiscal year 2016, 635,266 veterans accounted for 31% of the federal workforce, an increase of over 5% in 7 years. To account for this growing employee demographic, the Federal Employee Viewpoint Survey began tracking veteran status in 2012 and analysis of these data show that veterans are more likely to express turnover intention than nonveterans. This raises a troubling question: Is the policy objective of the Veterans Hiring Initiative achieved if these veterans are more likely to turnover than nonveterans? This article explores whether diversity management mitigates lower job satisfaction levels among military veterans working for the federal government and whether veterans might be considered a stand-alone demographic in diversity scholarship. This study finds that perceptions of fair and effective diversity management are associated with higher job satisfaction among veteran employees, but slightly less so than among nonveterans. The results demonstrate that veterans are a unique employee demographic by showing statistically significant differences in job satisfaction between veterans and nonveterans while controlling for other demographics. Overall, this article contributes to public management research by highlighting military veteran employees and offering insight into an understudied employee population accounting for approximately 31% of the federal workforce.

Healthcare Experiences of Underrepresented Lesbian and Bisexual Women: A Focus Group Qualitative Study.

Purpose: To understand the complex healthcare experiences of women identifying as lesbian or bisexual. who are also women of color, veterans, and/or 65 years of age and older.Methods: Inclusion criteria were age 25 or older, Los Angeles County resident, self-identification as a lesbian or bisexual woman, and as an African American, Latina, Asian-Pacific Islander, and/or a veteran. For the age 65 years and older group, participants were eligible regardless of their veteran status or race/ethnicity. Five focus groups were conducted (n=35) and the same questions were asked addressing their comfort interacting with healthcare providers, the provider knowing their sexual orientation, characteristics of a perfect provider, and barriers to care. Structured qualitative analyses were performed.Results: Participants identified concerns that providers often hold to heterosexual cultural norms. Participants varied on preferences for providers of the same race/ethnicity as themselves. Lesbians who are 65 years and older identified legal barriers as major concerns. All groups identified incorrect provider assumptions about sexual orientation and sexual practices as frequently compromising their care. Participants supported the idea of certification for providers skilled in lesbian, gay, bisexual, transgender, and queer (LGBTQ) health, but expressed skepticism that such programs would necessarily result in better care.Conclusion: Healthcare provider trainings need to address the specific concerns and experiences of underrepresented lesbian and bisexual women. Healthcare environments must be transformed to effectively address their needs. More research is needed on the separate healthcare experiences of specific marginalized populations related to their sexual orientation and/or gender identity.

Understanding mental health among military veterans in the fire service

Firefighters who have previously served in the military may be at potentially higher risk for worsened mental health outcomes. This investigation examined the mental health of military veterans, as compared to non-veterans, in the fire service. We hypothesized that firefighters who endorsed military veteran status would have higher rates of mental health symptoms, in comparison to firefighters who did not endorse prior service in the military. Age, gender, and race/ethnicity were used as covariates. The sample was comprised of 910 career firefighters, 209 (23.0%) of whom endorsed military veteran status. One-way analyses of covariance were employed. The military veteran subsample reported significantly higher levels of sleep disturbance, depression, and posttraumatic stress symptom severity in comparison to the non-veteran subsample; however, effect sizes were small indicating that between group differences are actually negligible. Results highlight the need to improve our understanding of risk and resilience factors for firefighters who have served in the military, as this line of inquiry has potentially important mental health intervention implications for this exceptionally understudied population.

Combattenti e reduci della Prima guerra mondiale nel cinema italiano e francese 1915-1925

In this essay, I will clarify the relationship between propaganda and film censorship in Italy and French during and after the First World War through veterans' experience. I analyzed those themes between 1915 and 1925.I propose to consider the films of Italian fiction on veterans' experience not in a unified way: after two years of war thesituation got worst. No film in this period had a happy end. In French the situation was inverse: during the war brutality and death was revealed. After armistice of Compiegne, films about war became less violent and the veteran status improved.