Veteran Status Research Articles

Should I Stay or Should I Go: Veteran Status and Determinants of Turnover Intention

What are the individual employee-level determinants of turnover intention? What is the relationship between veteran status and these determinants of turnover intention? We answer these questions, b...

Veteran and clinician perceptions of recovery and stigma at a veterans affairs medical center.

This study assessed efforts to promote recovery-oriented and nonstigmatizing mental healthcare at 1 Veterans Affairs Medical Center. The study administered 2 questionnaires, the Recovery Self-Assessment and the Survey of Attitudes Toward Mental Illness, to 139 veterans receiving mental health services and 107 clinicians at a large Veterans Affairs Medical Center in an outpatient mental health clinic, inpatient and residential mental health programs, psychosocial rehabilitation (PSR) and recovery programs, and an outpatient substance abuse clinic. Analyses of covariance were used to evaluate differences across programs and between veteran consumers and clinicians. Significance was evaluated at p < .05. PSR program clinicians endorsed 3 of 5 recovery domains more strongly than clinicians from the other 3 settings although all were rated highly. However, veteran consumers from the 4 programs did not differ in levels of perceived recovery-oriented practice. Despite differing levels of endorsement of the recovery model, clinicians in the 4 locations did not differ in stigmatizing beliefs and had predominantly nonstigmatizing attitudes. Veteran consumers held more stigmatizing attitudes than staff, but there was no significant interaction between veteran status and program type. This study suggests that efforts to foster recovery attitudes and decrease stigma among professionals have been effective in specialized PSR programs, but also general mental health programs. While there were some differences between programs and across clinicians and veteran consumers, there were generally positive attitudes toward mental illness and strong endorsement of recovery. (PsycINFO Database Record

Longitudinal Cognitive Trajectories of Women Veterans from the Women's Health Initiative Memory Study.

A comparison of longitudinal global cognitive functioning in women Veteran and non-Veteran participants in the Women's Health Initiative (WHI). We studied 7,330 women aged 65-79 at baseline who participated in the WHI Hormone Therapy Trial and its ancillary Memory Study (WHIMS). Global cognitive functioning (Modified Mini-Mental State Examination [3MSE]) in Veterans (n = 279) and non-Veterans (n = 7,051) was compared at baseline and annually for 8 years using generalized linear modeling methods. Compared with non-Veterans, Veteran women were older, more likely to be Caucasian, unmarried, and had higher rates of educational and occupational attainment. Results of unadjusted baseline analyses suggest 3MSE scores were similar between groups. Longitudinal analyses, adjusted for age, education, ethnicity, and WHI trial assignment revealed differences in the rate of cognitive decline between groups over time, such that scores decreased more in Veterans relative to non-Veterans. This relative difference was more pronounced among Veterans who were older, had higher educational/occupational attainment and greater baseline prevalence of cardiovascular risk factors (e.g., smoking) and cardiovascular disease (e.g., angina, stroke). Veteran status was associated with higher prevalence of protective factors that may have helped initially preserve cognitive functioning. However, findings ultimately revealed more pronounced cognitive decline among Veteran relative to non-Veteran participants, likely suggesting the presence of risks that may impact neuropathology and the effects of which were initially masked by Veterans' greater cognitive reserve.

Impact of a Housing First intervention on homeless Veterans with mental illness: a Canadian multisite randomized controlled trial

Introduction: A large proportion of homeless Veterans live with severe mental health problems. We examine the impact of a Housing First program that included recovery-oriented initiatives (assertive community treatment or intensive case management) among those homeless Veterans who participated in a multisite demonstration project on homelessness and mental health. Methods: The data come from a Canadian multisite randomized trial (ISRCTN42520374), At Home/Chez Soi, with a volunteer sample of 2,285 homeless or precariously housed individuals living with mental health problems. Of this sample, 98 individuals reported being Veterans, of whom 57 were randomized to the intervention group and 41 to the control group. The data come from self-reported measures administered at baseline and after 6, 12, 18, and 24 months from Fall 2009 to Spring 2013. Data were analyzed by fitting a mixed model for each outcome variable, and special attention was given to the event × treatment × Veteran status interaction term. Results: The Housing First approach was effective in improving housing stability, social functioning, and quality of life in homeless Veterans with mental health problems. These results are consistent with the intervention’s effectiveness with other homeless Canadians with mental health problems. Discussion: These results are consistent with those of previous US studies and suggest that a Housing First approach that includes recovery-oriented support would effectively contribute to reducing homelessness in the Canadian Veteran population.

Previous anxiety and depression as risk factors for early labour force exit

BackgroundIndividuals with a history of mental illness have lower earnings than individuals without. A possible reason is that those with prior anxiety or depression may be more likely to exit...

Prospective Analysis of Health and Mortality Risk in Veteran and Non-Veteran Participants in the Women's Health Initiative

BackgroundThe health of postmenopausal women veterans is a neglected area of study. A stronger empirical evidence base is needed, and would inform the provision of health care for the nearly 1 million U.S. women veterans currently 50 years of age or older. To this end, the present work compares salient health outcomes and risk of all-cause mortality among veteran and non-veteran participants of the Women's Health Initiative (WHI). MethodsThis study features prospective analysis of long-term health outcomes and mortality risk (average follow-up, 8 years) among the 3,706 women veterans and 141,009 non-veterans who participated in the WHI Observational Study or Clinical Trials. Outcome measurements included confirmed incident cases of cardiovascular disease (CVD), cancer, diabetes, hip fractures, and all-cause mortality. ResultsWe identified 17,968 cases of CVD, 19,152 cases of cancer, 18,718 cases of diabetes, 2,817 cases of hip fracture, and 13,747 deaths. In Cox regression models adjusted for age, sociodemographic variables, and health risk factors, veteran status was associated with significantly increased risk of all-cause mortality (hazard ratio [HR], 1.13; 95% CI, 1.03–1.23), but not with risk of CVD (HR, 1.00; 95% CI, 0.90–1.11), cancer (HR, 1.04; 95% CI, 0.95–1.14), hip fracture (HR, 1.16; 95% CI, 0.94–1.43), or diabetes (HR, 1.00; 95% CI, 0.89–1.1). ConclusionsWomen veterans' postmenopausal health, particularly risk for all-cause mortality, warrants further consideration. In particular, efforts to identify and address modifiable risk factors associated with all-cause mortality are needed.

The association of military discharge variables with smoking status among homeless Veterans

ObjectiveThere is a dearth of research examining the health correlates of tobacco use within the homeless population, particularly with respect to homeless Veterans. An aim of the present study was to compare homeless Veteran and homeless non-Veteran smokers across a series of socio-demographic and health variables, and to determine whether any of these variables were independently associated with Veteran status. A subsequent aim was to compare the socio-demographic and health profiles of Veteran smokers and Veteran nonsmokers, and to determine whether any of these variables were independently associated with current smoking. MethodsData were obtained from the 2009 Homelessness in Minnesota survey conducted by the Wilder Research Foundation. The final sample included 4750 homeless individuals living throughout Minnesota. ResultsThe prevalence of smoking was greater among homeless Veterans (74%) than homeless non-Veterans (70%). The prevalence of physical and mental health problems was higher among homeless Veteran smokers than homeless non-Veteran smokers, although these variables were not independently associated with Veteran status after controlling for socio-demographics. Analyses of the homeless Veteran sample indicated that receipt of Veterans' benefits, type of discharge, and alcohol and/or chemical dependence were independently associated with current smoking. ConclusionHomeless Veteran smokers exhibit heightened rates of physical and mental health problems compared to homeless non-Veteran smokers. Military service and discharge characteristics may contribute to this high smoking prevalence. Future efforts should focus on increasing Veterans' access to and knowledge of Veterans' health resources, and on developing innovative strategies to boost cessation in this population.

The Long-Term Consequences of Vietnam-Era Conscription and Genotype on Smoking Behavior and Health.

Research is needed to understand the extent to which environmental factors moderate links between genetic risk and the development of smoking behaviors. The Vietnam-era draft lottery offers a unique opportunity to investigate whether genetic susceptibility to smoking is influenced by risky environments in young adulthood. Access to free or reduced-price cigarettes coupled with the stress of military life meant conscripts were exposed to a large, exogenous shock to smoking behavior at a young age. Using data from the Health and Retirement Study (HRS), we interact a genetic risk score for smoking initiation with instrumented veteran status in an instrumental variables (IV) framework to test for genetic moderation (i.e. heterogeneous treatment effects) of veteran status on smoking behavior and smoking-related morbidities. We find evidence that veterans with a high genetic predisposition for smoking were more likely to have been smokers, smoke heavily, and are at a higher risk of being diagnosed with cancer or hypertension at older ages. Smoking behavior was significantly attenuated for high-risk veterans who attended college after the war, indicating post-service schooling gains from veterans' use of the GI Bill may have reduced tobacco consumption in adulthood.

Commentaries on health services research

Commentaries on health services research

Contemporary nationwide patterns of self-reported prostate-specific antigen screening in US veterans

Introduction and objectivesThe quality of medical care to US veterans, as provided by the Veterans Health Administration, has recently been subjected to heightened scrutiny. We sought to report prostate-specific antigen screening (PSAS) in a contemporary cohort of veteran men (VM) vs. nonveteran men (NVM). We hypothesize that VM are less likely to receive age-appropriate PSAS compared with NVM. Materials and methodsWe identified VM and NVM aged 55 to 69 years without history of prostate cancer who underwent PSA testing in the year preceding that of the 2012 Behavioral Risk Factor and Surveillance System survey. The prevalence of PSAS among VM and NVM was determined in aggregate and on a state-by-state basis. Complex samples logistic regression models calculated the odds of PSAS based on veteran status, adjusted for patient/demographic characteristics. ResultsIn all, 56,962 responses were collected, yielding a weighted estimate of 23.7 million men, of which 30.5% were VM. Overall, 45.2% (CI: 43.9%–46.5%) of VM reported PSAS compared with only 37.5% (CI: 36.5%–38.5%) of NVM. VM were more likely to have health insurance (92.0%; CI: 91.3%–92.8% vs. 86.2%; CI: 85.4%–87.0%) and a regular health care provider (89.0%; CI: 88.2%–89.8% vs. 85.9%; CI: 85.1%–86.6%) compared with NVM. Unadjusted prevalence of PSAS varied widely across the United States for VM and NVM. In multivariable analyses, VM had higher odds for PSAS (odds ratio = 1.10, CI: 1.02%–1.18%). ConclusionsContrary to our initial hypothesis, our findings suggest a continued pattern of greater preventive health services use by veterans. VM were more likely to undergo PSAS than NVM. This is, in part, attributable to better access to primary care and health insurance. Nonetheless, heterogeneity in screening practices remained largely dependent on geography.

Women's Health Identities in the Transition From Military Member to Service Veteran

As servicewomen leave behind their military rank and status to become veterans, they must learn to effectively navigate a fragmented structure of care and communicate their health care needs. This study proposes a culture-centered approach to understanding how structural changes contribute to a reduction in positive health perception and behavior as active duty servicewomen transition to a veteran status. Results suggest during the process of disengagement from military cultural norms, women veterans’ health care prevention service utilization decreases, and their physical and mental health decreases through the transition. These findings highlight the need for widely available and culturally appropriate programs to meet the needs of this unique patient population.

The Impact of Veteran Status on Life-Space Mobility among Older Black and White Men in the Deep South.

To examine life-space mobility over 8.5 years among older Black and White male veterans and non-veterans in the Deep South. A prospective longitudinal study of community-dwelling Black and White male adults aged >65 years (N=501; mean age=74.9; 50% Black and 50% White) enrolled in the University of Alabama at Birmingham (UAB) Study of Aging. Data from baseline in-home assessments with follow-up telephone assessments of life-space mobility completed every 6 months were used in linear mixed-effects modeling analyses to examine life-space mobility trajectories. Life-space mobility. In comparison to veterans, non-veterans were more likely to be Black, single, and live in rural areas. They also reported lower income and education. Veterans had higher baseline life-space (73.7 vs 64.9 for non-veterans; P<.001). Race-veteran subgroup analyses revealed significant differences in demographics, comorbidity, cognition, and physical function. Relative to Black veterans, there were significantly greater declines in life-space trajectories for White non-veterans (P=.009), but not for White veterans (P=.807) nor Black non-veterans (P=.633). Mortality at 8.5 years was 43.5% for veterans and 49.5% for non-veterans (P=.190) with no significant differences by race-veteran status. Veterans had significantly higher baseline life-space mobility. There were significantly greater declines in life-space trajectories for White non-veterans in comparison to other race-veteran subgroups. Black veterans and non-veterans did not have significantly different trajectories.

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults.

These Practice Guidelines for the Psychiatric Evaluation of Adults mark a transition in the American Psychiatric Association’s Practice Guidelines. Since the publication of the 2011 Institute of Medicine report Clinical Practice Guidelines We Can Trust, there has been an increasing focus on using clearly defined, transparent processes for rating the quality of evidence and the strength of the overall body of evidence in systematic reviews of the scientific literature. These guidelines were developed using a process intended to be consistent with the recommendations of the Institute of Medicine (2011), the Principles for theDevelopment of Specialty Society Clinical Guidelines of the Council of Medical Specialty Societies (2012), and the requirements of the Agency for Healthcare Research andQuality (AHRQ) for inclusion of a guideline in the National Guideline Clearinghouse. Parameters used for the guidelines’ systematic review are included with the full text of the guidelines; the development process is fully described in a document available on the APA website: http:// www.psychiatry.org/File%20Library/Practice/APA-GuidelineDevelopment-Process–updated-2011-.pdf. To supplement the expertise of members of the guideline work group, we used a “snowball” survey methodology to identify experts on psychiatric evaluation and solicit their input on aspects of the psychiatric evaluation that they saw as likely to improve specific patient outcomes (Yager 2014). Results of this expert survey are included with the full text of the practice guideline.

Cardiovascular Disease Risk Factors Among Male Veterans, U.S., 2009-2012.

Cardiovascular disease remains an important cause of death in the U.S. where veterans of the U.S. Armed Forces represent a significant segment of the population. Limited national estimates of cardiovascular disease risk factors using physical measurements and reported veteran status in the U.S. civilian population have been reported. The purpose of this study was to compare the prevalence of cardiovascular disease risk factors among veteran and non-veteran men in the U.S. civilian population. Using data from the 2009-2012 National Health and Nutrition Examination Surveys, 1,107 veteran and 3,972 non-veteran men were identified for this study (analyzed in 2014-2015). Differences in hypertension, dsylipidemia, diabetes, obesity, and smoking between veterans and non-veterans were compared using chi-square and t-tests. Predicted prevalence from multivariable logistic regression models adjusted for age, race/Hispanic origin, and poverty level were used to assess whether previous military service was associated with having a cardiovascular disease risk factor. Veteran men were older than non-veteran men (59.9 years vs 43.4 years) and were more likely to be non-Hispanic white (79.9% vs 65.7%). Adjusted predicted prevalence estimates show that veterans were more likely than non-veterans to be obese (42.6% vs 33.7%, p<0.01). After adjustment for obesity, there was no difference in hypertension, dyslipidemia, diagnosed diabetes, or smoking between veteran and non-veteran men. This study identified a segment of the U.S. civilian population-veteran men-who have a higher prevalence for obesity, a risk factor associated with increased risk for other cardiovascular disease risk factors.

Vasomotor Symptoms and Quality of Life Among Veteran and Non-Veteran Postmenopausal Women.

Vasomotor symptoms (VMS), including hot flashes and night sweats, are common among postmenopausal women and are associated with reduced health related quality of life (HRQOL). To determine whether Veterans are more likely to report VMS than non-Veterans, and whether the association of VMS with HRQOL varies by Veteran status. We used data from the Women's Health Initiative Observational Study, including self-reported baseline VMS presence and severity, and HRQOL at follow-up Year 3 (RAND Short Form 36-Item Health Survey). Employing generalized linear models we estimated whether Veteran status was associated with any VMS. We estimated the association between any VMS and HRQOL using linear regression, stratified by Veteran status. Interaction terms were added separately to determine whether the association varied by baseline depression, obesity, or smoking status. The final analyses included 77,153 postmenopausal women (2,004 Veterans). After adjustment, Veterans were no more likely than non-Veterans to report any VMS at baseline (relative risk [RR] 0.97, 95% confidence interval [CI] 0.90-1.04) or moderate to severe VMS (RR 1.03, 95% CI 0.89-1.18). Any VMS was associated with decreased HRQOL at Year 3, particularly among Veterans (mean difference range: Veterans -2.7 to -4.6, p-values < .001; non-Veterans -2.2 to -2.6, 95% CI -0.13 to -0.09, p values < .001). Baseline depression and obesity, but not smoking, amplified the negative association between VMS and HRQOL. Multicondition care models for postmenopausal Veteran and non-Veteran women are needed that incorporate management strategies for VMS, weight, and depression.

Posttraumatic growth in individuals with amputations

BackgroundStudying positive outcomes post-amputation is an important area of research in order to help individuals recover with the optimal quality of life possible. ObjectiveTo examine posttraumatic growth (PTG) in the understudied population of individuals with amputations. Our main aim was to assess the effect of gender, veteran status, age, and time since amputation on PTG. Our secondary aim was to examine the role support group participation on PTG. MethodsSixty-six adults with amputations completed an online survey consisting of the Posttraumatic Growth Inventory (PTGI) and free response questions about experiences with support groups. T-tests and correlations were the main statistical analyses. ResultsThere were no gender differences in PTGI scores. Veterans had significantly lower PTGI scores than civilians, t(64) = 2.63, p < 0.05, Cohen's d = .41. Age was negatively correlated with PTGI score, r = −.27, p < 0.05. Participants who indicated consistent engagement in a support group had significantly higher PTGI scores than participants without support group engagement, t(64) = 3.49, p < 0.01, Cohen's d = .89. ConclusionsVeterans may be a specific population to target for PTG. Support groups appear to be a venue associated with higher levels of growth.

Smoking cessation in homeless veterans.

aRalph H. Johnson VA Medical Center, Charleston, South Carolina. *Corresponding author: Mark B. Hamner, MD, Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC 29401-5799 (mark.hamner@va.gov). J Clin Psychiatry 2015;76(7):e911–e912 dx.doi.org/10.4088/JCP.14com09726 © Copyright 2015 Physicians Postgraduate Press, Inc. S is likely much higher in the homeless than in the general population. It is likely higher still in the mentally ill homeless. The effect of veteran status on smoking in the homeless is unclear. However, there is no reason to think that smoking rates would be different as a function of veteran status in this population. For example, homeless veterans are much more likely to have nicotine dependence than veterans who are not homeless.1 Few studies have investigated the treatment of smoking in the homeless, despite the fact that the majority of smokers seem to want to quit. In this issue of the Journal, Carpenter and colleagues2 report an open trial of a multicomponent smoking cessation program for 20 homeless veterans. A novel feature of the study was the development of a smartphone application to facilitate mobile contingency management (mCM) therapy. The smoking cessation program utilized in the study included 4 weeks of using mCM, 4 counseling sessions, nicotine replacement therapy, and bupropion if medically appropriate. Participants could earn up to $815 ($480 for mCM, $100 for verified abstinence at 3 follow-up visits, and $35 for equipment return). This approach was a success in this pilot study. Abstinence as verified by carbon monoxide concentrations ≤ 6 ppm was 50% at the 4-week endpoint. Follow-up bioverified abstinence was 55% at 3 months and 45% at 6 months. Not surprisingly, there was a high rate of psychiatric comorbidity in this sample including posttraumatic stress disorder, major depressive disorder, and lifetime alcohol or substance dependence. This study further suggests that the intervention may be effective despite other psychiatric conditions that are thought to limit successful abstinence. The interpretation of this study, as the authors note appropriately, is limited by the small sample size and the lack of a control group. Nonetheless, the results are promising and should be further explored using a randomized controlled trial design.

The effect of adaptive sports on employment among people with disabilities

Purpose: The purpose of this study is to analyse the role of adaptive sport in predicting employment for individuals with physical disabilities. Method: This study is cross-sectional. We collected survey data on employment and other covariates including education, age, age at disability onset, veteran status and athletic classification from 140 mobility impaired athletes who play either wheelchair rugby or wheelchair basketball. Results: One hundred and thirty-one participants were studied. Our analysis shows that playing an additional year of adaptive sport is associated with an approximately 4% increase in likelihood of employment. Education and duration of disability are found to be positive predictors of employment, while veteran status and severity of injury are negative predictors of employment. Age of disability onset is not found to be a predictor of employment when other controls are included. Conclusions: This result indicates that a substantial economic benefit would result from increased participation in adaptive sport, and therefore may justify additional funding to expand adaptive sport programs.Implications for RehabilitationEmployment rates are very low among individuals with physical disabilities, despite research indicating extensive benefits from employment.Participation in adaptive sport is associated with a higher likelihood of employment.Efforts to increase participation in adaptive sport could have a large economic benefit.

The relationship of disability and employment for veterans from the 2010 Medical Expenditure Panel Survey (MEPS).

Veterans with disabilities, especially those with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) have difficulty obtaining and maintaining competitive employment. To determine if there are significant differences in employment between veterans with and without disability, between veterans with a disability and nonveterans with a disability, and to investigate the association of veteran status and disability with employment. Chi square analyses were conducted on data obtained from the 2010 Medical Expenditure Panel Survey to determine if significant differences in employment occurred between veterans with disabilities, veterans without disabilities and nonveterans with disabilities. Multivariate regression analyses were used to determine how veteran status and disability are associated with employment. Significant differences in employment were found between veterans with and without a disability; however, no significant differences existed in employment between veterans and nonveterans with a disability. Multivariate analysis showed that veteran status (aOR=1.80), having any disability (aOR=7.29), social disability (aOR=3.47) or a cognitive disability (aOR=3.16) were associated with not being employed. Veterans with disabilities are more likely not to be employed than veteran populations without disabilities. Veterans; however have unique disabilities, different than nonveterans with disabilities, that need to be addressed, such as social and cognitive disabilities resulting from TBI and PTSD. Future research should focus on evaluating the effectiveness of employment programs and policies designed to address the unique issues faced by veterans with disabilities.

Education of military veterans in physician assistant programs.

To assess the admission policies, experiences, and attitudes of physician assistant (PA) program directors regarding recruiting, admitting, and training military veterans after the announcement of the "Helping Veterans Become Physician Assistants" initiative. A descriptive survey of 22 questions was distributed to all 173 PA program directors in the United States in April 2013. The survey covered years 2011 to 2013, although it was completed in June of 2013. The results of the survey were compared with the results of a similar survey that covered years 2008 through 2010. One hundred and five (60.7%) program directors participated in this survey. Veterans were admitted into 88.1% of responding programs and accounted for an average of 4.0% of all students. One-third of programs (33%) accepted transfer credits for veterans' military training, and 20% accepted credits for off-duty education. One-third (33%) of programs participated in the Yellow Ribbon Program. Almost 60% of programs had military veteran faculty members. Active recruitment of military veteran students occurred in 31.2% of programs. Program directors described multiple benefits of, and barriers to, admitting and educating veterans. For the years 2011 through 2013, as compared to 2008 through 2010, there was an increase in the percentage of PA programs that actively recruited veterans, considered veteran status in the admission process, admitted veterans, and contributed to their financial support. There was also an increased percentage of students with military experience matriculating into PA programs. However, barriers still exist for veterans seeking admission into PA programs, the most significant of which is academic preparedness for a graduate-level PA program.