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Rattray NA, Natividad D, Spontak K, Kukla M, Do ANL, Danson L, Frankel RM, True G. Learning from women veterans who navigate invisible injuries, caregiving, and reintegration challenges. BMC Womens Health 2023; 23:665. [PMID: 38082289 PMCID: PMC10714493 DOI: 10.1186/s12905-023-02815-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND As women comprise a greater proportion of military service members, there is growing recognition of how their experiences in the early phase of military to civilian transitions have an important influence on their health and reintegration outcomes. Qualitative accounts of women veterans can inform programs that support transitioning service members. OBJECTIVES We examined narratives of civilian reintegration among women veterans to understand their experiences of adjusting to community life while coping with mental health challenges. METHODS/PARTICIPANTS We interviewed 16 post-911 era women who were within 5 years of separating from military service and developed a case study based on three participants. MAIN APPROACH Interviews were audio-recorded and transcribed verbatim. Inductive thematic analysis was conducted to establish categories about reintegration. Immersion/crystallization techniques were used to identify exemplary cases that illustrated salient themes. KEY RESULTS Women veterans identified establishing a future career direction, drawing on social support, and navigating health care services as major factors influencing how they adjusted to civilian life. In addition, participants also highlighted the navigation of complex and intersecting identities (i.e., wife, mother, employee, friend, veteran, patient, etc.), further magnified by gender inequalities. These women performed emotional labor, which is often rendered invisible and oriented toward their family and loved ones, while simultaneously monitoring self-care activities. During the early period of reintegration, they described how they felt marginalized in terms of accessing healthcare compared to their military spouses and male veteran peers. CONCLUSIONS Our case study suggests that there are key gaps in addressing healthcare and readjustment needs for women servicemembers, a high priority VA group, as they transition into post-military life. It is important to consider innovative ways to address specific needs of women in veteran-focused policies and programs.
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Affiliation(s)
- Nicholas A Rattray
- VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, USA.
- Regenstrief Institute, Inc, Indianapolis, IN, USA.
- Indiana University School of Medicine, Indianapolis, USA.
| | - Diana Natividad
- VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, USA
| | - Katrina Spontak
- VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, USA
- University of Indianapolis, Indianapolis, USA
| | - Marina Kukla
- VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, USA
- Department of Psychology, Indiana-University-Purdue University, Indianapolis, USA
| | - Ai-Nghia L Do
- VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, USA
| | - Leah Danson
- VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, USA
- University of Indianapolis, Indianapolis, USA
| | - Richard M Frankel
- VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, USA
- Regenstrief Institute, Inc, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, USA
| | - Gala True
- South Central MIRECC, Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
- Section of Community and Population Medicine, Louisiana State University School of Medicine, New Orleans, LA, USA
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Brickell TA, Wright MM, Sullivan JK, Varbedian NV, Nose KA, Rather LM, Tien NK, French LM, Lange RT. Caregiver sleep impairment and service member and veteran adjustment following traumatic brain injury is related to caregiver health-related quality of life. J Clin Sleep Med 2022; 18:2577-2588. [PMID: 35912703 PMCID: PMC9622982 DOI: 10.5664/jcsm.10164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To examine the relationship between caregiver sleep impairment and/or service member/veteran (SMV) adjustment post-traumatic brain injury, with caregiver health-related quality of life (HRQOL). METHODS Caregivers (n = 283) completed 18 measures of HRQOL, sleep impairment, and SMV adjustment. Caregivers were classified into 4 sleep impairment/SMV adjustment groups: 1) Good Sleep/Good Adjustment (n = 43), 2) Good Sleep/Poor Adjustment (n = 39), 3) Poor Sleep/Good Adjustment (n = 55), and 4) Poor Sleep/Poor Adjustment (n = 146). RESULTS The Poor Sleep/Poor Adjustment group reported significantly worse scores on most HRQOL measures and a higher prevalence of clinically elevated T-scores (≥ 60T) on the majority of comparisons compared to the other 3 groups. The Good Sleep/Poor Adjustment and Poor Sleep/Good Adjustment groups reported worse scores on the majority of the HRQOL measures and a higher prevalence of clinically elevated scores on 7 comparisons compared to the Good Sleep/Good Adjustment group. Fewer differences were found between the Good Sleep/Poor Adjustment and Poor Sleep/Good Adjustment groups. The Poor Sleep/Poor Adjustment group reported a higher prevalence of severe ratings for SMV Irritability, Anger, and Aggression compared to the Good Sleep/Poor Adjustment group. CONCLUSIONS While the presence of either caregiver sleep impairment or poor SMV adjustment singularly was associated with worse caregiver HRQOL, the presence of both sleep impairment and poor SMV adjustment was associated with further impairment in HRQOL. Caregivers could benefit from sleep intervention. Treatment of SMVs neurobehavioral problems may improve the SMV's recovery and lessen sleep problems, distress, and burden among their caregivers. CITATION Brickell TA, Wright MM, Sullivan JK, et al. Caregiver sleep impairment and service member and veteran adjustment following traumatic brain injury is related to caregiver health-related quality of life. J Clin Sleep Med. 2022;18(11):2577-2588.
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Affiliation(s)
- Tracey A. Brickell
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland
| | - Megan M. Wright
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland
| | - Jamie K. Sullivan
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland
| | - Nicole V. Varbedian
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland
| | - Kathryn A. Nose
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland
| | - Lauren M. Rather
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland
| | - Nicole K. Tien
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland
| | - Louis M. French
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Rael T. Lange
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland
- University of British Columbia, Vancouver, British Columbia, Canada
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3
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LaVela SL, Pedersen J, Ehrlich-Jones L, Heinemann AW. Positive and negative ways that informal caregivers are affected by weight and weight management efforts for care recipients with spinal cord injury. Disabil Rehabil 2022; 44:7152-7160. [PMID: 34613825 DOI: 10.1080/09638288.2021.1985629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To understand how informal caregivers are affected by weight and weight management of care recipients with SCI. MATERIALS AND METHODS In-depth qualitative interviews were conducted with 24 informal caregivers of community-dwelling Veterans and civilians with SCI. Thematic analysis was conducted. RESULTS Three themes described how the care recipient's weight management efforts impacted the caregiver, including: (1) motivation and involvement in weight management efforts for themselves, (2) emotional well-being (positive and negative aspects), and (3) physical tasks (both ease and burden). Caregivers may experience emotional and/or physical burden by taking on extra caregiving tasks to help with care recipient's weight management. Caregivers also may experience positive impacts from the care recipient's weight management efforts, regardless of who drove the efforts, including improvement in their own motivation and involvement in weight management, enhanced emotional well-being (happiness for and with the care-recipient), and making physical caregiving tasks easier. CONCLUSIONS Rehabilitation providers can use these findings to educate dyads about potential impacts of weight management efforts for the care recipient, specifying areas that may cause burden but emphasizing the potential benefits for both recipient and caregiver. Integrating this education into rehabilitation practice may reduce overweight-related problems with function and declines in disability among dyads.Implications for RehabilitationInformal caregivers experience both positive and negative consequences with regard to weight management for individuals with SCI.Helping their loved one with weight management can facilitate informal caregivers' involvement in their own weight management activities.Findings may offer guidance to healthcare and rehabilitation providers as they incorporate weight management into education programs for informal caregivers of persons with SCI.Integrating this education into rehabilitation practice may reduce or delay overweight-related problems with function and declines in disability among dyads.
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Affiliation(s)
- Sherri L LaVela
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL, USA.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jessica Pedersen
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Midwest Regional SCI Care System (MRSCICS), Shirley Ryan AbilityLab (SRAlab), Chicago, IL, USA
| | - Linda Ehrlich-Jones
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Midwest Regional SCI Care System (MRSCICS), Shirley Ryan AbilityLab (SRAlab), Chicago, IL, USA
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Midwest Regional SCI Care System (MRSCICS), Shirley Ryan AbilityLab (SRAlab), Chicago, IL, USA
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Nicosia FM, Gibson CJ, Purcell N, Zamora K, Tighe J, Seal KH. Women Veterans' Experiences with Integrated, Biopsychosocial Pain Care: A Qualitative Study. PAIN MEDICINE 2021; 22:1954-1961. [PMID: 33547797 DOI: 10.1093/pm/pnaa481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Biopsychosocial, integrated pain care models are increasingly implemented in the Veterans Health Administration to improve chronic pain care and reduce opioid-related risks, but little is known about how well these models address women veterans' needs. DESIGN Qualitative, interview-based study. SETTING San Francisco VA Health Care System Integrated Pain Team (IPT), an interdisciplinary team that provides short-term, personalized chronic pain care emphasizing functional goals and active self-management. SUBJECTS Women with chronic pain who completed ≥3 IPT sessions. METHODS Semistructured phone interviews focused on overall experience with IPT, perceived effectiveness of IPT care, pain care preferences, and suggested changes for improving gender-sensitive pain care. We used a rapid approach to qualitative thematic analysis to analyze interviews. RESULTS Fourteen women veterans (mean age 51 years; range 33-67 years) completed interviews. Interviews revealed several factors impacting women veterans' experiences: 1) an overall preference for receiving both primary and IPT care in gender-specific settings, 2) varying levels of confidence that IPT could adequately address gender-specific pain issues, 3) barriers to participating in pain groups, and 4) barriers to IPT self-management recommendations due to caregiving responsibilities. CONCLUSIONS Women veterans reported varied experiences with IPT. Recommendations to improve gender-sensitive pain care include increased provider training; increased knowledge of and sensitivity to women's health concerns; and improved accommodations for prior trauma, family and work obligations, and geographic barriers. To better meet the needs of women veterans with chronic pain, integrated pain care models must be informed by an understanding of gender-specific needs, challenges, and preferences.
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Affiliation(s)
- Francesca M Nicosia
- San Francisco VA Health Care System, San Francisco, California.,Institute for Health and Aging, University of California San Francisco, San Francisco, California
| | - Carolyn J Gibson
- San Francisco VA Health Care System, San Francisco, California.,Department of Psychiatry, University of California San Francisco, San Francisco, California
| | - Natalie Purcell
- San Francisco VA Health Care System, San Francisco, California.,Institute for Health and Aging, University of California San Francisco, San Francisco, California.,Department of Social and Behavioral Sciences, University of California San Francisco, San Francisco, California
| | - Kara Zamora
- San Francisco VA Health Care System, San Francisco, California.,Department of Anthropology, History, and Social Medicine, University of California San Francisco, San Francisco, California
| | - Jennifer Tighe
- San Francisco VA Health Care System, San Francisco, California
| | - Karen H Seal
- San Francisco VA Health Care System, San Francisco, California.,Department of Psychiatry, University of California San Francisco, San Francisco, California.,Department of Anthropology, History, and Social Medicine, University of California San Francisco, San Francisco, California.,Department of Medicine, University of California San Francisco, San Francisco, California, USA
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5
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Song Y, Carlson GC, McGowan SK, Fung CH, Josephson KR, Mitchell MN, McCurry SM, Teng E, Irwin MR, Alessi C, Martin J. Sleep Disruption Due to Stress in Women Veterans: A Comparison between Caregivers and Noncaregivers. Behav Sleep Med 2021; 19:243-254. [PMID: 32116050 PMCID: PMC7483161 DOI: 10.1080/15402002.2020.1732981] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objective/Background: Sleep problems are common in women and caregiving for an adult is a common role among women. However, the effects of caregiving on sleep and related daytime impairment are poorly understood among women veterans. This study compared stress-related sleep disturbances, insomnia symptoms, and sleep-related daytime impairment between women veterans who were caregivers and those who did not have a caregiving role. Participants: Of 12,225 women veterans who received care in one Veterans Administration Healthcare System, 1,457 completed data on a postal survey (mean age = 51.7 ± 15.9 years). Two hundred forty three (17%) respondents (mean age 53.8 ± 12.7 years) were caregivers for an adult, predominantly for a parent, providing transportation. Methods: The survey included items that addressed insomnia symptoms, total sleep time, sleep-related daytime impairments, caregiving characteristics, self-rated health, pain, stress, body mass index, and demographic information. Results: In adjusted analyses, caregiver status did not directly predict sleep complaints alone. However, in multiple regression analyses, being a caregiver (odds ratio 1.7, p = .001) significantly predicted stress-related sleep disturbance, even after adjusting for age, pain, self-rated health, and other characteristics. Furthermore, being a caregiver (β = 3.9, p = .031) significantly predicted more symptoms of sleep-related daytime impairment after adjusting for age, pain, self-rated health, and other factors. Conclusions: Compared to noncaregivers, women veterans who were caregivers for an adult were more likely to report stress causing poor sleep, and more daytime impairment due to poor sleep. These findings suggest the need to target stress and other factors when addressing sleep disturbance among women veterans who are caregivers.
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Affiliation(s)
- Yeonsu Song
- School of Nursing, University of California, Los Angeles, Los Angeles, CA,Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Gwendolyn C. Carlson
- Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, North Hills, CA
| | - Sarah Kate McGowan
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA
| | - Constance H. Fung
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Karen R. Josephson
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA
| | - Michael N. Mitchell
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA
| | - Susan M. McCurry
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA
| | - Edmond Teng
- School of Medicine, Stanford University, Palo Alto, CA
| | - Michael R. Irwin
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA
| | - Cathy Alessi
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Jennifer Martin
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
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Manley NA, Hicken BL, Rupper RW. Veterans Caregiving for Others: Caregiving as a Factor in the Health of America's Military Veterans. Mil Med 2019; 184:e162-e168. [PMID: 29901741 DOI: 10.1093/milmed/usy131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/14/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Natalie A Manley
- Division of Geriatrics, University of Nebraska Medical Center, 986155 Nebraska Medical Center, Omaha, NE
| | - Bret L Hicken
- George E. Wahlen Department of Veteran Affairs Medical Center, VA Building #2, GRECC 182, 500 S. Foothill Dr., SLC, UT
| | - Randall W Rupper
- George E. Wahlen Department of Veteran Affairs Medical Center, VA Building #2, GRECC 182, 500 S. Foothill Dr., SLC, UT
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Saban KL, Griffin JM, Urban A, Janusek MA, Pape TLB, Collins E. Perceived health, caregiver burden, and quality of life in women partners providing care to Veterans with traumatic brain injury. ACTA ACUST UNITED AC 2018; 53:681-692. [PMID: 27997670 DOI: 10.1682/jrrd.2015.07.0143] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 12/17/2015] [Indexed: 11/05/2022]
Abstract
Families of Veterans with traumatic brain injury (TBI) are often faced with providing long-term informal care to their loved one. However, little is known about how their perceived health and caregiving burden contribute to their quality of life (QOL). The purpose of this descriptive study was to describe perceived health, somatic symptoms, caregiver burden, and perceived QOL and to identify the extent to which these variables are associated with QOL in female partners/spouses of Veterans with TBI. Participants completed a written questionnaire including the Patient Health Questionnaire-15, Caregiver Reaction Assessment, Quality of Life Index, and the general health subscale of the 12-Item Short Form Survey version 2. Caregivers reported moderate levels of QOL, and over a quarter of the sample reported high levels of somatic symptoms, particularly fatigue and sleep disturbance. Age, perceived general health, somatic symptoms, the five subscales of caregiver burden (self-esteem, disrupted schedule, effect on finances, lack of family support, and effect on health) predicted QOL and explained 64% of its variance (adjusted r2 = 0.64, F(8,31) = 9.59). However, only somatic symptoms and the caregiver burden subscales of self-esteem and effect on finances were significant predictors in the model. These findings have implications for development of family-centered interventions to enhance the QOL of informal caregivers of Veterans with TBI.
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Affiliation(s)
- Karen L Saban
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Department of Veterans Affairs (VA) Hospital, Hines, IL.,Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL
| | - Joan M Griffin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic College of Medicine, Rochester, MN.,Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN
| | | | | | - Theresa Louise-Bender Pape
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Department of Veterans Affairs (VA) Hospital, Hines, IL.,Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Eileen Collins
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Department of Veterans Affairs (VA) Hospital, Hines, IL.,Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL
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8
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Song Y, Washington DL, Yano EM, McCurry SM, Fung CH, Dzierzewski JM, Rodriguez JC, Jouldjian S, Mitchell MN, Alessi CA, Martin JL. Caregiving-Related Sleep Problems and Their Relationship to Mental Health and Daytime Function in Female Veterans. Behav Sleep Med 2018; 16:371-379. [PMID: 27690634 PMCID: PMC5378653 DOI: 10.1080/15402002.2016.1228640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE/BACKGROUND To identify caregiving-related sleep problems and their relationship to mental health and daytime function in female Veterans. PARTICIPANTS Female Veterans (N = 1,477) from cross-sectional, nationwide, postal survey data. METHODS The survey respondent characteristics included demographics, comorbidity, physical activity, health, use of sleep medications, and history of sleep apnea. They self-identified caregiving- related sleep problems (i.e., those who had trouble sleeping because of caring for a sick adult, an infant/child, or other respondents). Patient Health Questionnaire (PHQ-4) was used to assess mental health, and daytime function was measured using 11 items of International Classification of Sleep Disorders-2 (ICSD-2). RESULTS Female Veterans with self-identified sleep problems due to caring for a sick adult (n = 59) experienced significantly more symptoms of depression and anxiety (p < 0.001) and impairment in daytime function (e.g., fatigue, daytime sleepiness, loss of concentration, p < 0.001) than those with self-identified sleep problems due to caring for an infant or child (n = 95) or all other respondents (n = 1,323) after controlling for the respondent characteristics. CONCLUSIONS Healthcare providers should pay attention to assessing sleep characteristics of female Veterans with caregiving responsibilities, particularly those caregiving for a sick adult.
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Affiliation(s)
- Yeonsu Song
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California. David Geffen School of Medicine, University of California, Los Angeles, California
| | - Donna L. Washington
- David Geffen School of Medicine, University of California, Los Angeles, California. VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Elizabeth M. Yano
- VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California. Fielding School of Public Health, University of California, Los Angeles, California
| | - Susan M. McCurry
- Department of Psychosocial and Community Health, University of Washington, School of Nursing, Seattle, Washington
| | - Constance H. Fung
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California. David Geffen School of Medicine, University of California, Los Angeles, California
| | | | - Juan Carlos Rodriguez
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California. Department of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Stella Jouldjian
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Michael N. Mitchell
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Cathy A. Alessi
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California. David Geffen School of Medicine, University of California, Los Angeles, California
| | - Jennifer L. Martin
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California. David Geffen School of Medicine, University of California, Los Angeles, California
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9
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Danan ER, Krebs EE, Ensrud K, Koeller E, MacDonald R, Velasquez T, Greer N, Wilt TJ. An Evidence Map of the Women Veterans' Health Research Literature (2008-2015). J Gen Intern Med 2017; 32:1359-1376. [PMID: 28913683 PMCID: PMC5698220 DOI: 10.1007/s11606-017-4152-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 06/08/2017] [Accepted: 07/27/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Women comprise a growing proportion of Veterans seeking care at Veterans Affairs (VA) healthcare facilities. VA initiatives have accelerated changes in services for female Veterans, yet the corresponding literature has not been systematically reviewed since 2008. In 2015, VA Women's Health Services and the VA Women's Health Research Network requested an updated literature review to facilitate policy and research planning. METHODS The Minneapolis VA Evidence-based Synthesis Program performed a systematic search of research related to female Veterans' health published from 2008 through 2015. We extracted study characteristics including healthcare topic, design, sample size and proportion female, research setting, and funding source. We created an evidence map by organizing and presenting results within and across healthcare topics, and describing patterns, strengths, and gaps. RESULTS We identified 2276 abstracts and assessed each for relevance. We excluded 1092 abstracts and reviewed 1184 full-text articles; 750 were excluded. Of 440 included articles, 208 (47%) were related to mental health, particularly post-traumatic stress disorder (71 articles), military sexual trauma (37 articles), and substance abuse (20 articles). The number of articles addressing VA priority topic areas increased over time, including reproductive health, healthcare organization and delivery, access and utilization, and post-deployment health. Three or fewer articles addressed each of the common chronic diseases: diabetes, hypertension, depression, or anxiety. Nearly 400 articles (90%) used an observational design. Eight articles (2%) described randomized trials. CONCLUSIONS Our evidence map summarizes patterns, progress, and growth in the female Veterans' health and healthcare literature. Observational studies in mental health make up the majority of research. A focus on primary care delivery over clinical topics in primary care and a lack of sex-specific results for studies that include men and women have contributed to research gaps in addressing common chronic diseases. Interventional research using randomized trials is needed.
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Affiliation(s)
- Elisheva R Danan
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA. .,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Erin E Krebs
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kristine Ensrud
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Eva Koeller
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Roderick MacDonald
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Tina Velasquez
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Nancy Greer
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Timothy J Wilt
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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10
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Easom LR, Wang K, Moore RH, Wang H, Bauer L. Operation family caregiver: Problem-solving training for military caregivers in a community setting. J Clin Psychol 2017; 74:536-553. [DOI: 10.1002/jclp.22536] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 08/17/2017] [Accepted: 08/19/2017] [Indexed: 01/07/2023]
Affiliation(s)
| | - Ke Wang
- Georgia Southwestern State University
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